Micronutrient-fortified infant cereal improves Hb status and reduces iron-deficiency anaemia in Indian infants: an effectiveness study.

Anaemia affects approximately 69 % of Indian children aged 6-12 months, with Fe deficiency (ID) being a common cause. The effectiveness of micronutrient-fortified infant cereal in improving Fe status and neurodevelopment was evaluated in non-anaemic and mildly anaemic Indian infants. An intervention group (IC) enrolled at age 6 months consumed 50 g/d of rice-based cereal providing 3·75 mg Fe/d as ferrous fumarate for 6 months (n 80) and was compared with a matched static cross-sectional control group (CG) without intervention enrolled at age 12 months (n 80). Mean Hb was higher in IC (118·1 (sd 10·2) g/l) v. CG (109·5 (sd 16·4) g/l) at age 12 months (adjusted mean difference: 9·7 g/l; 95 % CI 5·1, 14·3; P < 0·001), while geometric mean serum ferritin tended to be higher (27·0 (-1 sd 13·4, +1 sd 54·4) v. 20·3 (-1 sd 7·5, +1 sd 55·0) ng/ml); P = 0·085) and soluble transferrin receptor was lower (1·70 (-1 sd 1·19, +1 sd 2·43) v. 2·07 (-1 sd 1·29, +1 sd 3·33) mg/l; P = 0·014). Anaemia (23 v. 45 %; P = 0·007) and ID (17 v. 40 %; P = 0·003) were lower in IC v. CG. Bayley Scales of Infant and Toddler Development Third Edition scores for language (P = 0·003), motor development (P = 0·018), social-emotional (P = 0·004) and adaptive behaviour (P < 0·001), but not cognitive development (P = 0·980), were higher in IC v. CG. No significant difference in anthropometric Z-scores was observed between the groups. Consuming a micronutrient-fortified infant cereal daily for 6 months during complementary feeding promoted better Fe status while reducing the risk for anaemia and ID and was associated with superior neurodevelopmental scores.

Efficacy and tolerance of a diabetes specific formula in patients with type 2 diabetes mellitus: An open label, randomized, crossover study.

AIM: This study evaluated the effect of a diabetes specific formula on acute glucose, insulin, and triglyceride responses in patients with type 2 diabetes mellitus (T2DM). METHODS: This open-label, randomized, crossover, pilot single center study had two phases (pre-treatment and treatment). After screening, the patients entered run-in period and were counseled on diet and exercise regime. They were then randomly allocated to receive either diabetes specific formula (Nutren Diabetes, Nestlé Health Science, Switzerland; Group A) or isocaloric meal (Cornflakes and milk; Group B). Blood samples were collected to estimate blood glucose, insulin and triglyceride levels (Baseline at 0 min and post-meal at 30, 60, 120, and 180 min). RESULTS: Area under curve for blood glucose post-meal at 30 min, 60 min, 120 min, and 180 min was significantly lower for Group A as compared with Group B (p=0.003, 0.0001, 0.0001, 0.0001, respectively). Increase in serum insulin levels from baseline was also lower for Group A post-meal at 120 and 180 min, respectively, as compared to Group B (p=0.0001 and 0.0002, respectively). CONCLUSION: The Diabetes specific formula tested in this study showed lower post-meal blood glucose and insulin levels as compared with isocaloric meal. Thus, diabetes specific formula may be an option for diabetic and hyperglycemic patients in need of nutritional support.

Bovine milk usage and feeding practices for infants in India.

BACKGROUND: Milk and dairy products from animal sources (cow's milk or buffalo's milk) are an important part of Indian diet and its consumption starts at an early age. OBJECTIVE: The purpose of this study is to understand the processing, storage and modifications carried out before bovine milk is fed to the infants and compare it with recommendations by Health Care Professionals (HCPs). MATERIALS AND METHODS: The study involved assessments involving HCPs and mothers of children below 1 year of age through both qualitative and quantitative methods. Feeding recommendations by HCPs were assessed through a quantitative method. RESULTS: The children are commonly initiated on bovine milk post 3 months of age. The milk is not covered while boiling in 70% cases and boiled at suboptimal temperature (moderate: 62% or low: 31%). Half of the families store milk outside refrigerators openly in the kitchen or rooms. The milk is modified in the majority of cases (81%) before being fed. Modification of the milk was often done with sugar (85%), followed by water (49%), biscuits, fennel seeds, cardamom or infant cereals before feeding the baby. Addition of water was more prevalent among mothers of infants between 3 and 6 months. HCPs do not advise consumption of bovine milk by infants unless there is no other option available. CONCLUSION: A clear gap exists between recommended and actual practices for infant feeding in India. There is a huge opportunity to educate mothers on importance of breast feeding and benefits of implementing appropriate processing, storage, and consumption practices of bovine milk.

Impact of household practices on the nutritional profile of milk.

BACKGROUND: It is a common practice to process milk before consumption. Processing generally involves boiling, addition of sugar and/or condiments, dilution with water, etc. The boiled milk is stored for subsequent use either at room temperature or under refrigerated conditions. OBJECTIVE: The purpose of this study was to see the effect of household practices on the nutritional profile of milk. MATERIALS AND METHODS: Different types of pasteurized milk samples: standardized, double toned, full cream, and unpasteurized milk were analyzed. The effect of household practices on the nutritional profile of all these milk samples was studied using National/International methods. RESULTS: Boiling of milk increased the concentration of most of the components and minerals except for vitamins A, B 3 , B 5 , and B 12 where the decrease observed was 21%, 13%, 3%, and 21%, respectively. Addition of water decreased the concentration of minerals and vitamins. Addition of sugar increased the energy and condiments increased total solids, carbohydrate and minerals content but led to a decrease in the vitamin content. Storage of milk led to a decrease in total solids by 19% and vitamins A, B 3 , B 5 , and B 12 by 26%, 17-19%, 23%, and 18-26%, respectively. The pH was not influenced by any of the household practices. CONCLUSION: Every step during household practices in the handling of milk reduces its nutritional profile and significantly affects the quality. Vitamins play a very important role in health and loss during household processing becomes an interesting attribute that requires further research in detail.

Contaminants in milk and impact of heating: an assessment study.

BACKGROUND: The major contaminants usually encountered in milk and milk products include pesticide residues, heavy metals, and aflatoxin M1 (AFM1). Primarily, milk get contaminated before milching, from the cattle feed, from sources/materials used during the processing of milk as well as improper handling of the milk during the pre- and postprocessing period. OBJECTIVE: The purpose of this study was to evaluate the effect of household practices on milk contaminants. MATERIALS AND METHODS: Samples of pasteurized as well as unpasteurized milk (Vendor's milk) were analyzed for AFM1, pesticide residues, and heavy metals. Simulating the household practices, the impact of boiling on these contaminants was assessed. RESULTS: The contaminant Aflatoxin M1 (AFM1) was detected at a concentration ranging from 0.071-0.075 ppb in unpasteurized as well as pasteurized milk samples analyzed during the course of study. Moreover, boiling had no impact on the quantity of AFM1 present in the milk. Pesticides and heavy metal contents were found to be within acceptable limits in all the milk samples tested. CONCLUSION: Mycotoxins especially aflatoxins in cattle feed and their consequential presence in milk and milk products is a serious concern world over as they are reported carcinogens. These fungal toxins are resistant to high temperatures and may lead to various health hazards. Preventive steps must be taken at each stage to ensure good quality of milk and milk products free from these contaminants. Awareness programs and education for the dairy farmers and milk processors may be helpful in this regard.

Microbiological profile of milk: impact of household practices.

BACKGROUND: Milk is susceptible to contamination by many microorganisms including microbial pathogens responsible for causing diseases. Various processes including pasteurization, boiling or storage under refrigerated conditions are undertaken to minimize the microbial contamination of milk. OBJECTIVE: This study was undertaken with an objective to evaluate the effect of household practices on the microbiological profile of milk. MATERIALS AND METHODS: Milk samples of pasteurized, ultra heat treated (UHT) as well as unpasteurized milk (Vendor's milk) were collected. The effect of different storage practices and treatments on the microbiological profile (standard plate count (SPC), coliform, E. coli, Salmonella, Shigella, Staphylococcus aureus, yeast and moulds, anaerobic spore count, and Listeria monocytogenes) of milk was studied using National/ International Standard Test Methods. RESULTS: Average SPC in vendor's milk was found very high as compared to pasteurized milk. Coliform, yeast and moulds, E. coli, and Staphylococcus aureus were detected in the samples of vendor's as well as pasteurized milk. Boiling the milk reduces SPC and kills the other microorganisms. Storage of boiled milk under room temperature or refrigerated condition resulted in a similar increase in SPC at the end of 24 h, but storage of un-boiled milk even under refrigerated conditions increased SPC manifold after 24 h. CONCLUSION: The pasteurization process and hygienic conditions at the milk processing units along with cold chain of milk from suppliers to end users needs improvement. Currently, even pasteurized milk does not match the microbiological standards. It is recommended that milk should be boiled before consumption and refrigerated for storage to improve its shelf life/keeping quality.

Safety, tolerability, and single- and multiple-dose pharmacokinetics of piperaquine phosphate in healthy subjects.

Piperaquine phosphate is an orally active bisquinolone antimalarial drug that has been used for the past 3 decades. The authors report the safety, tolerability, and pharmacokinetics of piperaquine from a classical controlled phase I study. It was a double-blind, randomized, parallel-group, placebo-controlled, and single- and multiple-dose study. During the rising single-dose study, single ascending oral doses of 500, 750, 1000, 1250, and 1500 mg of piperaquine phosphate were administered, whereas in rising multiple-dose study, once-daily ascending oral doses of 500, 750, 1000, and 1500 mg were administered for 3 consecutive days. Pharmacokinetic analysis for both the rising single- and multiple-dose studies was done using the noncompartmental approach. The mean apparent terminal half-life ranged from 11 to 23 days. Increase in exposure was less than dose proportional and linear. Piperaquine concentrations were measurable up to 60 days postdose. Multiple peaks were observed in the plasma piperaquine concentration-time profiles and exhibited 3- to 7-fold accumulation following multiple dosing. Piperaquine was well tolerated following single and multiple doses.