Development of the immune system in the human embryo.

The fetal immune system is highly specialized which is to generate both tolerogenic and protective immune responses to tolerate both self- and maternal-antigens. Fetal T cells with pro-inflammatory potential are born in a tolerogenic environment and are tightly controlled by both cell-intrinsic and -extrinsic mechanisms. Fetal B-1 and B-2 B cells involved in innate and adaptive immune responses, respectively, arise in staggered waves of development from distinct progenitors. Innate immune responses are the key to the protection against infection and adaptive immunity creates memory after an initial response to a specific pathogen. This review aims to discuss the recent advances in understanding the development of immune system in fetus. IMPACT: During gestation, essential developmental changes occur to survive the neonates. At early stage, developmental signals and changes may be influenced due to immune deficiencies.

Gene Expression Profiles Suggest Iron Transport Pathway in the Lactating Human Epithelial Cell.

OBJECTIVES: The molecular background of iron excretion into breast milk has not been determined in humans. We determined the expression of known iron transporters in mRNA extracted from human milk fat globules to deduce which known transporters are responsible for iron excretion into human milk. METHODS: The expression of iron transporters in mRNA from human milk fat globules and mouse mammary epithelial cell lines was determined by quantitative real-time polymerase chain reaction. RESULTS: The expression of the transferrin receptor 1 (TFRC), divalent metal transporter 1 (SLC11A2), transferrin (TF), and lactoferrin (LTF) was confirmed in RNA isolated from the human milk fat globule. Similar expression was observed in the mouse mammary epithelial cell line HC11 in resting and lactating phenotypes. No iron export protein could be determined in the RNA isolated from fat globules in human breast milk and a human mammary epithelial cell line. CONCLUSIONS: The lack of iron exporters in the human mammary epithelia, in conjunction with the presence of lactoferrin suggests that transmembrane transport is not a major route of iron excretion into human milk.

Fatty Acid Composition in Feeds and Plasma of Canadian Premature Infants.

OBJECTIVES: The objective of the present exploratory study was to investigate how the fatty acid (FA) composition of different food sources for preterm infants including breast milk (BM), formula (F), human milk fortifiers (HMFs), and total parenteral nutrition (TPN) impacted preterm infant's plasma FA. The associations between FA content of plasma with antioxidant enzyme activity and cognition were also evaluated. METHODS: Thirty-two premature infants were included in the present study. Five different feeds (BM, F, BM + F, BM + HMF, and TPN) were provided. Foods and preterm infant plasma samples were collected at the same time on the same day biweekly where possible. Separation and identification of the plasma and food FA methyl esters were performed by gas-liquid chromatography. Antioxidant enzymes were measured. The Bayley Scale of Infant Development version III was used to evaluate cognition. RESULTS: In food sources, BM contained significantly lower stearic acid (C18:0) (P < 0.05), oleic acid (C18:1n9) (P < 0.01), linoleic acid (C18:2n6) (P < 0.01), α-linoleic acid (C18:3n3) (P < 0.01), and arachidonic acid (C20:4n6) (P < 0.05) compared with the F. Palmitic acid (C16:0) was significantly higher (P < 0.05) in the BM + HMF compared with the BM. Stearic acid (C18:0) was significantly higher (P < 0.05) in the BM + F and BM + HMF compared with the BM. In the plasma lauric acid (C12:0) (P < 0.05) and myristic acid (C14:0) (P < 0.001) were higher in the BM-fed babies compared with the F-fed or TPN-recipient groups. Antioxidant enzymes, activities and cognition scores did not differ by feeding groups, however the study may not have been powered to detect these differences. CONCLUSIONS: The type, and therefore quality, of fatty acids is an important consideration when selecting what is fed to premature infants because differences in feed fatty acids were seen in some plasma fatty acids in the study.

Human Milk Fortification Increases Bnip3 Expression Associated With Intestinal Cell Death In Vitro.

OBJECTIVES: The aim of the present study was to determine the in vitro effect(s) of a bovine-based human breast milk fortifier (HMF) on human intestinal cells. HMF increases the expression of BCL2/adenovirus E1B 19 kDa protein-interacting protein (Bnip3) and cell death; the prostaglandin analogue misoprostol will rescue this effect. METHODS: Cultured intestinal cells were exposed to in vitro-digested human breast milk (BM) ±â€ŠHMF. Intracellular oxidation, cell damage/cell death, and BNIP3 expression were measured after exposure. RESULTS: In vitro-digested BM + HMF significantly increased intracellular oxidation, cell damage, and cell death in enterocyte cell cultures compared with either saline or BM controls, an effect that was rescued by the prostaglandin analogue, misoprostol. Bnip3 transcript and Bnip3 protein levels were significantly increased in vitro after treatment with BM + HMF. We also provide evidence that transfection of enterocytes with Bnip3 increases cell death, an effect that is rescued by a nonfunctional Bnip3 splice variant. CONCLUSIONS: Our data support the hypothesis that HMF increases intestinal Bnip3 in vitro, and that the gene product triggers cell death. We suggest that misoprostol is a promising therapy, which may reduce intestinal cell death.

Hexapeptides from human milk prevent the induction of oxidative stress from parenteral nutrition in the newborn guinea pig.

INTRODUCTION: In preterm neonates, peroxides contaminating total parenteral nutrition (TPN) contribute to oxidative stress, which is suspected to be a strong inducer of hepatic complications related to prematurity. Recently, others reported that hexapeptides derived from human milk (HM) exerted free radical-scavenging activities in vitro. Therefore, the aim of this study was to assess the capacity of these hexapeptides to limit the generation of peroxides in TPN and to prevent TPN-induced hepatic oxidative stress. METHODS: At 3 d of life, guinea pigs were infused, through a catheter in jugular vein, with TPN containing or not peptide-A (YGYTGA) or peptide-B (ISELGW). Peroxide concentrations were measured in TPN solutions, whereas glutathione, glutathionyl-1,4-dihydroxynonenal (GS-HNE) and mRNA levels of interleukin-1 (IL-1) and tumor necrosis factor-α (TNFα) were determined in liver after 4 d of infusion. RESULTS: The addition of peptide-A to TPN allowed a reduction in peroxide contamination by half. In vivo, peptide-A or peptide-B corrected the hepatic oxidative status induced by TPN. Indeed, both peptides lowered the hepatic redox potential of glutathione and the level of GS-HNE, a marker of lipid peroxidation. As compared with animals infused with TPN without peptide, the hepatic mRNA levels of IL-1 and TNFα were lower in animals infused with TPN containing peptide-A or peptide-B. DISCUSSION: These results suggest that the addition of YGYTGA or ISELGW to TPN will reduce oxidative stress in newborns. The reduction in mRNA of two proinflammatory cytokines could be important for the incidence of hepatic complications related to TPN.

Response of urinary biomarkers of systemic oxidation to oral iron supplementation in healthy men.

BACKGROUND: Urinary biomarkers are used in assessment of severe, clinical oxidative stress. Little is known, however, about their diagnostic value within the normative range. OBJECTIVE: To evaluate the response of urinary thiobarbituric acid reactive substances (TBARS) and 8-hydroxy-2-deoxyguanosine (8-OHdG) as indicators of systemic oxidation in response to short-term oral iron and antioxidant supplementation. METHODS: Five healthy adult men participated in the pilot study phase and 12 in the definitive intervention trial. For 7 days each, separated by 12-day washouts, the subjects received different treatment regimens, consisting of 120 mg of iron, 120 mg of iron in refined palm oil, and 120 mg of iron in palm oil combined with one of the two doses of Carotino Tocotrienol Carotene Mixed Concentrate (CTCMC). Creatinine-normalized urinary TBARS and 8-OHdG concentrations were quantified in samples taken from subjects with and without active supplementation. Temporal and correlative associations between TBARS and 8-OHdG were explored. RESULTS: Daily intake of supplemental iron failed to produce any increment in urinary excretion of TBARS or 8-OHdG. However, a significant within-individual correlation between the urinary biomarkers was observed (Spearman r = 0.697, p < .0001, n = 466). Both doses of CTCMC significantly lowered urinary excretion of both oxidation indicators. CONCLUSIONS: Despite the lack of effect of oral iron on the biomarkers of systemic oxidation, they show a strong and significant mutual association within the nonpathological range of oxidative stress in healthy male adults.

Tryptophan from human milk induces oxidative stress and upregulates the Nrf-2-mediated stress response in human intestinal cell lines.

Chemical screening of digested human milk protein using the oxygen radical absorbance capacity (ORAC(FL)) antioxidant assay confirmed the presence of a peptide fraction (PF23) with high antioxidant activity [5.53 mmol Trolox equivalents (TE)/g] that contained tryptophan as a main component. We evaluated the effects of both PF23 and tryptophan alone on the modulation of oxidative stress in cultured intestinal cells using a dichlorofluorescein diacetate probe. Despite the high ORAC(FL) value, PF23 enhanced (P < 0.05) 2, 2'-azobis (2-amidinopropane) dihydrochloride (peroxyl radical generator)-induced intracellular oxidation in the Caco-2 human adenocarcinoma cell line, suggesting prooxidant activity. Compared to selected peptide fractions with relatively lower ORAC(FL) values, PF23 induced oxidative stress more than all other peptide fractions tested (P < 0.05) and contained more tryptophan than the others (P < 0.05). Similar prooxidant activity was observed for tryptophan when it was added to culture medium for both the Caco-2 cells and FHs 74 Int primary fetal enterocytes, while also exhibiting a high ORAC(FL) value (9.69 mmol TE/g). The effect of tryptophan that involves activation of the Nrf-2 pathway and transcription of antioxidant enzymes was therefore investigated in FHs 74 Int cells. Exposure of infant intestinal cells to tryptophan resulted in Nrf-2 activation and an increase in the gene transcript level of glutathione peroxidase 2. We conclude that tryptophan-induced oxidative stress associated with tryptophan-containing milk peptides induces an adaptive response that involves the activation of the antioxidant responsive signaling pathway in intestinal cells.

Evidence of oxidative stress in relation to feeding type during early life in premature infants.

Morbidity in the premature (PT) infant may reflect difficult adaptation to oxygen. We hypothesized that feeding including formula feeding (F) and feeding mother's milk (HM) with added fortifier would affect redox status. Therefore, 65 PT infants (birth weight: 1146 ± 261 g; GA: 29 ± 2.5 wk; mean ± SD) were followed biweekly, once oral feeds were introduced. Feeding groups: F (>75% total feeds) and HM (>75% total feeds) were further subdivided according to human milk fortifier (HMF) content of 0-19, 20-49, and ≥ 50%. Oxidative stress was quantified by F2-isoprostanes (F2-IsoPs) in urine, protein carbonyls, and oxygen radical absorbance capacity (ORAC) in plasma. F2-IsoPs (ng/mg creatinine): 0-2 wk, 125 ± 63; 3-4 wk, 191 ± 171; 5-6 wk, 172 ± 83; 7-8 wk, 211 ± 149; 9-10 wk, 222 ± 121; and >10 wk, 183 ± 67. Protein carbonyls from highest [2.41 ± 0.75 (n = 9)] and lowest [2.25 ± 0.89 (n = 12) pmol/µg protein] isoprostane groups did not differ. ORAC: baseline, 6778 ± 1093; discharge, 6639 ± 735 [full term 4 and 12 M, 9010 ± 600 mg (n = 12) TE]. Highest isoprostane values occurred in infants with >50% of their mother's milk fortified. Further research on HMF is warranted.

Effects of Total Enteral Nutrition on Early Growth, Immunity, and Neuronal Development of Preterm Infants.

The feeding of colostrum and mother's transitional milk improves immune protection and neurodevelopmental outcomes. It also helps with gut maturation and decreases the risks of infection. The supply of nutrients from human milk (HM) is not adequate for preterm infants, even though preterm mother's milk contains higher concentrations of protein, sodium, zinc, and calcium than mature HM. The human milk fortifiers, particularly those with protein, calcium, and phosphate, should be used to supplement HM to meet the necessities of preterm infants. The management of fluid and electrolytes is a challenging aspect of neonatal care of preterm infants. Trace minerals such as iron, zinc, copper, iodine, manganese, molybdenum, selenium, chromium, and fluoride are considered essential for preterm infants. Vitamins such as A, D, E, and K play an important role in the prevention of morbidities, such as bronchopulmonary dysplasia, retinopathy of prematurity, and intraventricular hemorrhage. Therefore, supplementation of HM with required nutrients is recommended for all preterm infants.

Antioxidant-rich oral supplements attenuate the effects of oral iron on in situ oxidation susceptibility of human feces.

Prophylactic doses of 120 mg of iron (Fe) are commonly used to prevent Fe-deficiency anemia in vulnerable populations, especially in developing countries. Evidence shows that residual Fe in the large bowel may alter the normal antioxidant capacity of the fecal stream. Our objective was to evaluate the effect of dietary antioxidants from the Carotino Tocotrienol-Carotene Mixed Concentrate (CTCMC) on the depletion of fecal antioxidant capacity by oral Fe supplementation. In total, 17 healthy male adults participated in the 2 phases of the study, 5 in the pilot study and 12 in the definitive intervention trial. Participants received different treatments, separated by washout periods. These included: 120 mg Fe; 120 mg Fe and refined palm oil (FeOil); and 120 mg Fe in refined palm oil combined with 1 of 2 dosages (0.4 g and 0.8 g) of CTCMC/5 mL of refined palm oil (CTCB and CTCA treatments, respectively). Fecal samples were collected and analyzed to quantify the products of hydroxyl radical attack on salicylic acid (2,5 dihydroxybenzoic acid, 2,3-dihydrobenzoic acid, and catechol) at baseline and after active supplementation. Fe supplementation in either form (Fe or FeOil treatments) increased the concentrations of hydroxylated compounds in fecal samples. The production of hydroxylated compounds was significantly lower in treatments CTCB and CTCA than in the FeOil reference. Baseline antioxidant capacity state was virtually restored with dietary carotenoids and tocotrienols from the CTCMC. In conclusion, dietary antioxidants can reverse the depletion of fecal antioxidant capacity induced by oral Fe supplements.

Antioxidant properties of breast milk in a novel in vitro digestion/enterocyte model.

OBJECTIVES: There is good evidence to suggest that human breast milk has antioxidant properties. Our primary goal was to investigate the antioxidant properties of human milk in a combined in vitro digestion/cell culture model that more closely replicates conditions in the gastrointestinal system of the preterm infant. MATERIALS AND METHODS: An in vitro digestion model was developed that incorporates both gastric and intestinal phases, based on reported luminal pH, digestive enzyme levels, and transit times observed in preterm infants. To mimic the human intestinal mucosa, 2 cell lines--Caco-2BBE and HT29-MTX--were cocultured on Matrigel, an artificial basement membrane substrate. Intracellular oxidative stress was measured with 2 broadly selective oxidant-sensitive dyes, and oxidative DNA damage was assessed by means of single-cell gel electrophoresis. RESULTS: Enterocyte differentiation and mucin secretion were observed by 14 seeding of cultures. Direct exposure to digested milk resulted in a loss of transepithelial electrical resistance; however, exogenous mucin mitigated this loss. Data suggested that both milk and digested milk alleviated oxidative stress in the coculture, and both reduced hydrogen peroxide-induced oxidative DNA damage, as demonstrated by the comet assay. CONCLUSIONS: Our results support the hypothesis that breast milk reduces oxidative stress in a cell culture model representative of the intestinal mucosa, and also confirmed the suitability of this combined in vitro digestion/cell culture system for investigating the physiologic effects of enteral nutrients such as breast milk, under conditions similar to those existing in the gastrointestinal system of the preterm infant.

Canadian infants' nutrient intakes from complementary foods during the first year of life.

BACKGROUND: Complementary feeding is currently recommended after six months of age, when the nutrients in breast milk alone are no longer adequate to support growth. Few studies have examined macro- and micro-nutrient intakes from complementary foods (CF) only. Our purpose was to assess the sources and nutritional contribution of CF over the first year of life. METHODS: In July 2003, a cross-sectional survey was conducted on a nationally representative sample of mothers with infants aged three to 12 months. The survey was administered evenly across all regions of the country and included a four-day dietary record to assess infants' CF intakes in household (tablespoon) measures (breast milk and formula intakes excluded). Records from 2,663 infants were analyzed for nutrient and CF food intake according to 12 categories. Mean daily intakes for infants at each month of age from CF were pooled and compared to the Dietary Reference Intakes for the respective age range. RESULTS: At three months of age, 83% of infants were already consuming infant cereals. Fruits and vegetables were among the most common foods consumed by infants at all ages, while meats were least common at all ages except 12 months. Macro- and micro-nutrient intakes from CF generally increased with age. All mean nutrient intakes, except vitamin D and iron, met CF recommendations at seven to 12 months. CONCLUSIONS: Complementary foods were introduced earlier than recommended. Although mean nutrient intakes from CF at six to 12 months appear to be adequate among Canadian infants, further attention to iron and vitamin D intakes and sources may be warranted.

The effect of the artificial sweeteners on glucose metabolism in healthy adults: a randomized, double-blinded, crossover clinical trial.

This study aimed to determine the effect of pure forms of sucralose and aspartame, in doses reflective of common consumption, on glucose metabolism. Healthy participants consumed pure forms of a non-nutritive sweetener (NNS) that were mixed with water and standardized to doses of 14% (0.425 g) of the acceptable daily intake (ADI) for aspartame and 20% (0.136 g) of the ADI for sucralose every day for 2 weeks. Blood samples were collected and analyzed for glucose, insulin, active glucagon-like peptide-1 (GLP-1), and leptin. Seventeen participants (10 females and 7 males; age, 24 ± 6.8 years; body mass index, 22.9 ± 2.5 kg/m2) participated in the study. The total area under the curve values of glucose, insulin, active GLP-1 and leptin were similar for the aspartame and sucralose treatment groups compared with the baseline values in healthy participants. There was no change in insulin sensitivity after NNS treatment compared with the baseline values. These findings suggest that daily repeated consumption of pure sucralose or aspartame for 2 weeks had no effect on glucose metabolism among normoglycaemic adults. However, these results need to be tested in studies with longer durations. Novelty Daily consumption of pure aspartame or sucralose for 2 weeks had no effect on glucose metabolism. Daily consumption of pure aspartame or sucralose for 2 weeks had no effect on insulin sensitivity among healthy adults.

Effect of sucralose and aspartame on glucose metabolism and gut hormones.

Non-nutritive sweeteners are thought to be useful replacements for caloric sweeteners in sweet food and beverages, since the reduction in energy and carbohydrate intake may lead to health benefits stemming from weight management and glycemic control. However, the potential effects of non-nutritive sweeteners on glucose metabolism and gut hormones have not been determined definitively. Here, the available evidence of the effects of aspartame and sucralose consumption on glucose metabolism and gut hormones is reviewed. A majority of studies have found that consumption of aspartame or sucralose has no effect on concentrations of blood glucose, insulin, or gut hormones; however, 2 trials have shown that aspartame consumption affects glucose, insulin, and glucagon-like peptide 1 concentrations, while only a few trials have shown that sucralose consumption affects glucose, insulin, and glucagon-like peptide 1 concentrations. One study found higher glucose concentrations after sucralose consumption, while 3 studies found lower concentrations and 33 studies found no change in glucose concentrations. Moreover, only 4 studies reported increased concentrations of glucagon-like peptide 1. Three studies reported decreased insulin sensitivity following sucralose consumption, while 1 trial reported an increase in insulin sensitivity. In summary, the evidence from the clinical trials conducted to date is contradictory because of the different protocols used.

Tryptophan released from mother's milk has antioxidant properties.

Bioactive factors in human milk (HM) are crucial to the health of newborns, especially preterm infants. These compounds assist in reducing the oxidative stress that may occur as a result of combined exposure to supplemental oxygen and immature physiologic defenses. To identify the components in HM that contribute to its greater resistance to oxidative stress compared with infant formulae, enzymatic hydrolysates of HM were prepared, ultrafiltered, separated, and analyzed for antioxidant potential. The antioxidant activity [microM Trolox equivalent (TE/g)] of nondigested milk, whole digested milk, and derived ultrafiltrates were 80.4 +/- 13.3, 159.0 +/- 5.6, and 127.4 +/- 3.1, respectively. An HPLC fraction denoted as fraction 23 (5274 +/- 630 microM TE/g) was obtained and its constituents identified as tryptophan (Trp), peptides HNPI, and PLAPQA. Scavenging activity was not observed for PLAPQA, whereas moderate activity was associated with HNPI (144 +/- 10.7 microM TE/g) and very high activity to Trp (7986 +/- 468 microM TE/g). Trp addition to HM and two infant formulas significantly increased formulae antioxidant properties. Trp appeared to be a powerful free radical scavenger naturally present in HM. Its antioxidant effects and potential application in the diets of infants, particularly preterm, must be examined further.

Evaluation of antioxidant capacity and aroma quality of breast milk.

OBJECTIVE: It is important to understand the difference and similarity in antioxidant capacity and aroma quality between formula and breast milk for purposes of modifying infant formulas. We evaluated the antioxidant properties and aroma quality of infant formula and breast milk. METHODS: Six breast milk samples and four infant formulas were used. Antioxidant properties were measured using the following methods: 2,2-diphenyl-1-picryhydrazyl free radical scavenging capacity, oxygen radical absorbance capacity, total phenolic content, and phenolic composition. Aroma quality was determined using the electronic nose. RESULTS: The 2,2-diphenyl-1-picryhydrazyl free radical scavenging activity for formula and breast milk ranged from 45.3% to 61.8% and from 52.8% to 61.2%, respectively. Oxygen radical absorbance capacity ranged from 28.8 to 31.9 g/kg for formula and from 25.5 to 39.2 g/kg for breast milk. Total phenolic content ranged from 422 to 751 mg/kg and from 329to 797 mg/kg for formula and milk, respectively. p-Hydroxybenzoic acid, p-coumaric acid, and ferulic acid were detected with values ranging from 614 to 635, 1391 to 1444, and 1425 to 1490 microg/kg in breast milk and from 783 to 3594, 1449 to 1510, and 1447 to 1561 microg/kg in formulas. Electronic nose results indicated that the aroma quality of formula controls 2, 3, and 4 was similar to that of breast milk. CONCLUSION: Differences and similarities in antioxidant properties and aroma quality were found among some of the formulas and breast milk. The contribution of phenolic acids to total antioxidant capacity was limited.

Impact of iron and vitamin C-containing supplements on preterm human milk: in vitro.

Stress due to reactive oxygen species (ROS) may lead to neonatal diseases, such as necrotizing enterocolitis and respiratory distress. Enteral supplements for premature infants (PREM) added to human milk (HM) to increase nutrient content may induce lipid oxidation due to free radical formation via Fenton chemistry. We hypothesized that ferrous iron and vitamin C-containing supplements added to HM in vitro cause oxidation of milk fats, affect intracellular redox balance, and induce DNA damage. Lipid peroxidation in HM was measured by FOX-2 and TBARS assays; fatty acid composition of supplemented HM was measured by gas chromatography. Two cell culture bioassays were used for assessing either intracellular oxidative stress or DNA damage: the former involved Caco-2BBe cells, a secondary differentiated cell line, and the latter utilized FHS-74 Int cells, a primary fetal small intestinal culture. Lipid oxidation products of HM increased after the addition of iron alone, iron and vitamin C, or iron and a vitamin C-containing supplement (Trivisol, TVS). A reduced content of mono and polyunsaturated fatty acids in HM was also observed. Iron, not iron+vitamin C, but iron+TVS induced significant intracellular oxidative stress in FHS-74 Int cells. In contrast, iron, either alone or in combination with TVS or vitamin C, increased DNA damage in Caco-2BBE cells. Iron supplementation may increase oxidative stress in PREM infants and should be given separately from vitamin C-containing supplements.

Improvements in the status of folate and cobalamin in pregnant Newfoundland women are consistent with observed reductions in the incidence of neural tube defects.

BACKGROUND: Historically, the province of Newfoundland and Labrador had one of the highest rates of neural tube defects (NTDs) in North America (1976-1991: 3.2/1000 births), which could be partially explained by the sub-optimal status of folate and cobalamin in this population. In order to gain evidence of the impact of folate fortification programs, as well as prenatal education programs, a cross-sectional study was conducted to obtain data on the folate and cobalamin status of pregnant Newfoundland women in the post-folate fortification era. Additionally, the rates of NTDs were determined. METHODS: Blood samples were collected during the first prenatal clinic (at approximately 16 weeks gestation) from 365 pregnant women in Newfoundland in 2002. Samples were analyzed for serum folate, cobalamin and homocysteine. In addition, rates of neural tube defects were calculated from data collected from the Provincial Medical Genetics Program, Newfoundland. Data were compared to historical data from a similar population of pregnant women in Newfoundland. RESULTS: The status of both folate and cobalamin has significantly improved (p<0.0001) in the post-fortification era, concurrent with a significant reduction in the number of neural tube defects (NTDs), from 4.67 (years 1992-1996) to 1.01 (years 1998-2002) per 1000 total births. INTERPRETATION: These data provide evidence that both folate and cobalamin status of pregnant Newfoundland women have improved since 1997. The data for cobalamin provide evidence that strategies in addition to folate fortification programs are contributing to the improvements of poor water-soluble vitamin status in this population, thus providing a partial explanation for the dramatic reductions in NTD rates observed since 1995.

Iron absorption and oxidant stress during erythropoietin therapy in very low birth weight premature infants: a cohort study.

BACKGROUND: Iron supplementation may be associated with oxidative stress particularly in premature infants. Our purpose was to examine 1) early supplemental iron during treatment with erythropoietin (EPO) and oxidative stress; 2) enhanced iron absorption during EPO in those infants receiving human milk. Therefore, we determined the effect of erythropoietin plus supplemental iron intakes (4 mg/kg/d) on antioxidant status and iron incorporation. METHODS: Ten very-low-birth-weight infants who were enterally fed and receiving either human milk or formula were followed for 4 weeks during erythropoietin therapy; blood and urine were collected at 3 times; baseline, 2 and 4 weeks later. Once oral feeds commenced the study protocol was initiated. After baseline blood collection, a dose of Fe57 was administered. Two weeks later, a dose of Fe58 was administered as ferrous chloride to determine the effect of human-milk or formula on iron incorporation into RBCs. RESULTS: Infants started the study at 35 +/- 13 days. Incorporation of isotope into RBCs did not differ between formula fed for Fe57 (mean incorporation 8 +/- 2.9 n = 3) compared to human-milk fed infants (8.7 +/- 5 n = 7) nor for Fe58 (6 +/- 2.7 n = 3 vs. 8.6 +/- 5 n = 7). Tissue damage measured by malondialdehyde in plasma and F-2--isoprostanes in urine, did not differ by feed or over time. Neither ability to resist oxidative stress/nor RBC superoxide dismutase differed according to feed or over time. CONCLUSION: Data suggest that during erythropoietin therapy antioxidant defence in VLBW infants are capable of dealing with early supplemental iron during treatment with EPO.