Randomised controlled trial demonstrates that fermented infant formula with short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides reduces the incidence of infantile colic.

AIM: We examined the effects on gastrointestinal (GI) tolerance of a novel infant formula that combined specific fermented formula (FERM) with short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides (scGOS/lcFOS), with a 9:1 ratio and concentration of 0.8 g/100 mL. METHODS: This prospective, double-blind, randomised, controlled trial comprised 432 healthy, term infants aged 0-28 days whose parents decided to not start, or discontinued, breastfeeding. Infant formula with scGOS/lcFOS+50%FERM, scGOS/lcFOS+15%FERM, 50%FERM and scGOS/lcFOS were tested. Parents completed standardised seven-day diaries on GI symptoms, crying, sleeping and stool characteristics each month until the infants were 17 weeks. RESULTS: All the formulas were well tolerated. At four weeks, the overall incidence of infantile colic was significantly lower (8%) with scGOS/lcFOS+50%FERM than scGOS/lcFOS (20%, p = 0.034) or 50%FERM (20%, p = 0.036). Longitudinal modelling showed that scGOS/lcFOS+50%FERM-fed infants also displayed a persistently lower daily crying duration and showed a consistent stool-softening effect than infants who received formula without scGOS/lcFOS. CONCLUSION: The combination of fermented formula with scGOS/lcFOS was well tolerated and showed a lower overall crying time, a lower incidence of infantile colic and a stool-softening effect in healthy term infants. These findings suggest for the first time that a specific infant formula has a preventive effect on infantile colic in formula-fed infants.

Fermented Infant Formula Increases Ileal Protein Digestibility and Reduces Ileal Proteolytic Activity Compared with Standard and Hydrolyzed Infant Formulas in Piglets.

BACKGROUND: An infant formula that contained milk fermented by the bacteria Bifidobacterium breve and Streptococcus thermophilus (Lactofidus) was reported to alleviate functional digestive symptoms in infants. It was hypothesized that improved protein digestibility of the fermented infant formula could contribute to this effect. OBJECTIVE: The aim of this study was to evaluate the protein digestibility of a specific fermented (FF), a standard (SF), and an extensively hydrolyzed protein (HF) formula. METHODS: Four-week-old piglets (n = 7) were fitted with a T-cannula at the terminal ileum and received each formula in a Latin square design. FF, SF, and HF contained 11.7%, 9.3%, and 11.9% (w/w) crude protein; 1.5%, 5.4%, and 5.6% (w/w) fiber; and had a casein/whey ratio of 60:40, 50:50, and 0:100 per kilogram of powder, respectively. Ileal digesta were collected and analyzed for amino acids and proteolytic activity. RESULTS: FF had a significantly higher apparent ileal crude protein digestibility (92.1% ± 1.0%) than SF and HF (84.4% ± 1.0% and 83.9% ± 0.9%, respectively). FF also had a significantly higher dry matter digestibility than SF and HF. The ileal crude protein flow of FF was significantly lower than that of SF and HF. The ileal flow of FF total proteolytic activity was significantly lower than that of SF but not significantly different from that of HF (412 ± 163 kU/8 h vs. 1530 ± 163 and 703 ± 156 kU/8 h, respectively). CONCLUSIONS: The FF in piglets had a significantly higher apparent ileal crude protein digestibility than the SF and HF and displayed lower ileal proteolytic activity than the SF. Both effects may contribute to the alleviation of functional gastrointestinal symptoms reported in infants fed fermented infant milk formula.

Gastrointestinal Tolerance, Growth and Safety of a Partly Fermented Formula with Specific Prebiotics in Healthy Infants: A Double-Blind, Randomized, Controlled Trial.

This study evaluated the effect of a partly fermented infant formula (using the bacterial strains Bifidobacterium breve C50 and Streptococcus thermophilus 065) with a specific prebiotic mixture (short-chain galacto-oligosaccharides (scGOS) and long-chain fructo-oligosaccharides (lcFOS; 9:1)) on the incidence of gastrointestinal symptoms, stool characteristics, sleeping and crying behaviour, growth adequacy and safety. Two-hundred infants ≤28 days of age were assigned either to experimental infant formula containing 30% fermented formula and 0.8 g/100 mL scGOS/lcFOS or to non-fermented control infant formula without scGOS/lcFOS. A group of breastfed infants served as a reference. No relevant differences in parent-reported gastrointestinal symptoms were observed. Stool consistency was softer in the experimental versus control group with values closer to the breastfed reference group. Daily weight gain was equivalent for both formula groups (0.5 SD margins) with growth outcomes close to breastfed infants. No clinically relevant differences in adverse events were observed, apart from a lower investigator-reported prevalence of infantile colic in the experimental versus control group (1.1% vs. 8.7%; p < 0.02). Both study formulae are well-tolerated, support an adequate infant growth and are safe for use in healthy term infants. Compared to the control formula, the partly fermented formula with prebiotics induces stool consistencies closer to breastfed infants.

A specific blend of intact protein rich in aspartate has strong postprandial glucose attenuating properties in rats.

Three studies were carried out to help define an optimal protein blend for use in a nutritional product for diabetic patients. To this end, we tested the effects of coinfusions of combinations of different types of carbohydrates and proteins on the postprandial glycemic plasma response in healthy rats. Expt. 1 compared the effects of administering different forms of soy protein (intact protein, its hydrolysate, or an equivalent amount of the same amino acids), all in combination with a fixed amount of glucose (Glu), on postprandial Glu and insulin plasma concentrations. Intact soy protein (SI) had stronger insulinogenic properties compared with its hydrolysate but was equally potent in reducing the postprandial Glu response. In Expt. 2, we compared the effect of replacing 50% of the SI with the whey-derived protein alpha-lactalbumin when coingested with maltodextrin as the carbohydrate source. Only the specific aspartate-rich blend of SI and alpha-lactalbumin significantly improved the postprandial Glu response. In Expt. 3, we studied the effect of using the blend of SI and alpha-lactalbumin combined with a slowly digestible carbohydrate. The protein blend was still capable of significantly decreasing the postprandial Glu response even when a slow-release carbohydrate source was included. Combining this aspartate-rich protein blend with a slow-release carbohydrate might therefore lead to a low-glycemic nutritional product beneficial for dietary management in diabetic patients.

Carbohydrate supplementation before operation retains intestinal barrier function and lowers bacterial translocation in a rat model of major abdominal surgery.

BACKGROUND: Overnight fasting of rats augments the susceptibility of the small intestine to ischemia-reperfusion damage. Feeding before surgery may improve injuries to distant organs that were induced by ischemia-reperfusion. The present study tested the hypothesis that one of the food constituents, namely carbohydrates, may be responsible for the protective effect of preoperative feeding on postoperative organ dysfunction. METHODS: Male Wistar rats were fed ad libitum for 5 d and had either free access to water or free access to a carbohydrate drink and water. Then they were fasted for 16 h and access remained to either water or a carbohydrate drink and water. Following this, the arteria mesenterica superior was clamped for 60 min followed by 180 min of reperfusion. Subsequently, the intestinal permeability of stripped ileum was determined by measuring the mucosal to serosal flux in Ussing chambers. For assessment of bacterial content, organs were aseptically removed and assessed for bacterial content by culture under anaerobic conditions. RESULTS: Preoperative supplementation with carbohydrates resulted in a better maintenance of intestinal barrier function when compared with water supplemented animals. Moreover, carbohydrate supplementation resulted in a reduction in the ischemiareperfusion-induced increase in bacterial content of the liver, kidney, and mesenteric lymph nodes. CONCLUSIONS: Preoperative intake of carbohydrates by rats retains both the intestinal barrier function and prevents translocation of bacteria to distant organs.

Preoperative feeding preserves heart function and decreases oxidative injury in rats.

OBJECTIVE: The nutritional status of a patient has been implicated as an important factor in the development of postoperative complications. Fasting before an operation may have detrimental effects on the metabolic state. We hypothesized that there was a positive correlation between preoperative nutritional status and postoperative organ function. METHODS: Preoperative feeding was compared with fasting with respect to effects on organ function and biochemical parameters in an animal model of extensive large abdominal surgery. Male Wistar rats were fed ad libitum or fasted for 16 h, after which the arteria mesenterica superior was clamped for 60 min followed by 180 min of reperfusion. RESULTS: After the ischemic period, heart function was significantly better in animals that were fed ad libitum than in fasted animals. Moreover, after intestinal ischemia and reperfusion, fed rats showed significantly higher levels of intestinal adenosine triphosphate and a significantly higher malondialdehyde concentration in the intestine and lung than did fasted rats. The ratio of adenosine triphosphate to adenosine diphosphate in the liver, an indicator of energy status, in fed rats was similar to that in a sham group, whereas fasted animals showed a significantly lower value. CONCLUSIONS: Preoperative nutrition in contrast to fasting may attenuate ischemia/reperfusion-induced injury and preserve organ function in the rat.

GI symptoms in infants are a potential target for fermented infant milk formulae: a review.

Besides pre- and pro-biotic-containing infant formulae, fermented infant formulae are commonly used to relieve or prevent symptoms of gastrointestinal (GI) discomfort in young infants. During the fermentation process in cow's milk-based formulae, the beneficial bacteria modulate the product by forming several beneficial compounds, which contribute to the alleviation of the symptoms observed. This review summarizes the clinical evidence on the impact of fermented infant formulae on common pediatric GI-symptoms. The potential mechanisms involved are discussed: i.e., the lactose and protein (in-) digestibility, effects on gastric emptying and gut transit and modulation of the colonic microbiota. Although initial evidence indicates a beneficial effect of fermented formulae on GI discomfort in newborns, validation and confirmation of the clinical proof obtained so far is warranted, as well as further research to (more fully) understand the mode of action.

Preservation of the gut by preoperative carbohydrate loading improves postoperative food intake.

BACKGROUND & AIMS: A carbohydrate (CHO) drink given preoperatively changes the fasted state into a fed state. The ESPEN guidelines for perioperative care include preoperative CHO loading and re-establishment of oral feeding as early as possible after surgery. An intestinal ischaemia reperfusion (IR) animal model was used to investigate whether preoperative CHO loading increases spontaneous postoperative food intake, intestinal barrier function and the catabolic response. METHODS: Male Wistar rats (n = 65) were subjected to 16 h fasting with ad libitum water and: A) sham laparotomy (Sham fasted, n = 24); B) intestinal ischaemia (IR fasted, n = 27); and C) intestinal ischaemia with preoperatively access to a CHO drink (IR CHO, n = 14). Spontaneous food intake, intestinal barrier function, insulin sensitivity, intestinal motility and plasma amino acids were measured after surgery. RESULTS: The IR CHO animals started eating significantly earlier and also ate significantly more than the IR fasted animals. Furthermore, preoperative CHO loading improved the intestinal barrier function, functional enterocyte metabolic mass measured by citrulline and reduced muscle protein catabolism, as indicated by normalization of the biomarker 3-methylhistidine. CONCLUSIONS: Preoperative CHO loading improves food intake, preserves the GI function and reduces the catabolic response in an IR animal model. These findings suggest that preoperative CHO loading preserves the intestinal function in order to accelerate recovery and food intake. If this effect is caused by overcoming the fasted state or CHO loading remains unclear.

Sterilization in a liquid of a specific starch makes it slowly digestible in vitro and low glycemic in rats.

Diabetics are recommended to eat a balanced diet containing normal amounts of carbohydrates, preferably those with a low glycemic index. For solid foods, this can be achieved by choosing whole-grain, fiber-rich products. For (sterilized) liquid products, such as meal replacers, the choices for carbohydrate sources are restricted due to technological limitations. Starches usually have a high glycemic index after sterilization in liquids, whereas low glycemic sugars and sugar replacers can only be used in limited amounts. Using an in vitro digestion assay, we identified a resistant starch (RS) source [modified high amylose starch (mHAS)] that might enable the production of a sterilized liquid product with a low glycemic index. Heating mHAS for 4-5 min in liquid increased the slowly digestible starch (SDS) fraction at the expense of the RS portion. The effect was temperature dependent and reached its maximum above 120 degrees C. Heating at 130 degrees C significantly reduced the RS fraction from 49 to 22%. The product remained stable for at least several months when stored at 4 degrees C. To investigate whether a higher SDS fraction would result in a lower postprandial glycemic response, the sterilized mHAS solution was compared with rapidly digestible maltodextrin. Male Wistar rats received an i.g. bolus of 2.0 g available carbohydrate/kg body weight. Ingestion of heat-treated mHAS resulted in a significant attenuation of the postprandial plasma glucose and insulin responses compared with maltodextrin. mHAS appears to be a starch source which, after sterilization in a liquid product, acquires slow-release properties. The long-term stability of mHAS solutions indicates that this may provide a suitable carbohydrate source for low glycemic index liquid products for inclusion in a diabetes-specific diet.