An Opinion on "Staging" of Infant Formula: A Developmental Perspective on Infant Feeding.

Breast milk is a dynamic fluid with compositional changes occurring throughout the period of lactation. Some of these changes in nutrient concentrations reflect the successively slowing growth rate and developmental changes in metabolic requirements that infants undergo during the first year of life. Infant formula, in contrast, has a static composition, intended to meet the nutritional requirements of infants from birth to 6 or 12 months of age. To better fit the metabolic needs of infants and to avoid nutrient limitations or excesses, we suggest that infant formulas should change in composition with the age of the infant, that is, different formulas are created/used for different ages during the first year of life. We propose that specific formulas for 0 to 3 months (stage 1), 3 to 6 months (stage 2), and 6 to 12 months (stage 3) of age may be nutritionally and physiologically advantageous to infants. Although this initially may impose some difficult practical/conceptual issues, we believe that this staging concept would improve nutrition of formula-fed infants and, ultimately, improve outcomes and make their performance more similar to that of breast-fed infants.

Effectiveness of Enteral Versus Oral Nutrition With a Medium-Chain Triglyceride Formula to Prevent Malnutrition and Growth Impairment in Infants With Biliary Atresia.

OBJECTIVES: The aim of this study was to compare the effectiveness of oral (PO) versus enteral nutrition (EN) medium-chain triglyceride (MCT) containing-formula to prevent malnutrition and growth impairment in infants with biliary atresia (BA) waiting for a liver transplant. METHODS: A total of 15 infants, 3 to 9 months old with BA were included. They were randomly assigned to either PO or EN. For 12 weeks, both groups received an MCT formula fortified with glucose polymers and corn oil to reach a caloric density between 0.8 and 1 kcal/mL. The formula given to the PO group was administered ad libitum and that given via EN was infused through a nasogastric tube to reach 140% of the energy intake recommended by the Dietary Recommended Intake guidelines. Protein intake was adjusted to 4 to 5 g/kg present weight. Outcome variables were growth and nutritional status evaluated periodically by anthropometric indicators. Biochemical and hematological variables were evaluated through the study. RESULTS: Baseline clinical, nutritional, biochemical, and hematological variables showed no differences between the study groups. Baseline length/age was <-2 SD in 10 of the 15 patients; in the PO group, it fell <-3 SD, whereas in the EN group, it remained stable. Head circumference z score dropped 0.6 SD in the PO group, whereas in the EN group it remained stable. Triceps skinfold values improved in the infants taking EN, P < 0.001. The frequency of adverse effects--respiratory infection and diarrhea--was higher in the EN group. No biochemical or hematological differences were observed between the study groups throughout the study. CONCLUSIONS: A 12-week EN trial with an MCT-fortified formula prevented malnutrition and growth impairment in infants with BA waiting for a liver transplant.

Nutritional status of breast-fed and non-exclusively breast-fed infants from birth to age 5 months in 8 Chinese cities.

This study aimed to assess the nutritional status of infants aged 0 to 5 months by different feeding approaches. A cross-sectional study on infant nutrition was performed in eight cities in China. A total of 622 infants from birth to 2 months of age and 456 infants from 3 months to 5 months of age were included in this study. Mix-fed infants received breast milk and complementary foods from birth to 2 months of age. Approximately 38.2% of mix-fed infants received excessive vitamin A, and 15.6% of infants exceeded the tolerable upper intake levels (ULs) of zinc. For artificially fed infants who received only complementary foods, approximately 20% and 12.5% infants received inadequate dietary vitamin A and zinc intakes, respectively. The vitamin A and zinc intakes of half of the infants exceeded the ULs. Results showed that the usual intake distribution of the infants from 3 months to 5 months of age were similar to that of the infants from birth to 2 months of age. The common vitamin A and zinc intakes were also severely imbalanced. In addition, higher disease prevalence and lower Z scores of length-forage, weight-for-age, and weight-for-length were found in artificially fed infants and mix-fed infants compared with those in breast-fed infants. In conclusion, the usual nutrient intakes were adequate for the majority of Chinese infants, except for an important number of infants at risk for imbalance of vitamin A and zinc intakes.

[Progress and significance of early nutrition in preterm infants].

Early nutrition of preterm infants is crucial for their early and long term health. There are many unclears and challenges in their early nutrition. Great variations exist in clinical practice. This review focuses on the new concepts and advantages on early nutrition of preterm infants. Mineral enteral feeding, early onset enteral feeding, human milk feeding and its related issues, and the new strategy in parentral nutrition are discussed and emphasized.

Desarrollo de producto sobre la base de harinas de cereales y leguminosa para niños celíacos entre 6 y 24 meses; I: Formulación y aceptabilidad / Product development on the basis of cereal and leguminous flours to coeliac disease in children between 6-24 months; I: Formulation and acceptability

La revalorización de los cultivos andinos, quinua (Chenopodiumquinua Willd) y lupino (Lupinus albus L), para ser utilizados en mezclas alimenticias, con cereales tradicionales como maíz (Zea mays L.) y arroz (Oryza sativa L.), originan mezclas sin gluten que constituyen una buena alternativa para la alimentación de niños menores de 24 meses que sufren la enfermedad celíaca, ya que mejoran la calidad de la proteína, por compensación de los aminoácidos es enciales,e incide en la diversificación de productos. En el presente trabajo se determinó la composición de los porcentajes de cada harina en la mezcla mediante Programación Lineal empleando la planilla Solver de la hoja de cálculo Excel. Se determinaron las prolaminas en las harinas de quinua y lupino por el método ELISA y se empleó la técnica delHPLC en los dos productos obtenidos, denominados “mezcladulce” y “mezcla postre”, para definir la cantidad de aminoácidos con la finalidad de suplementar alrededor del 15% de las proteínas requeridas en el día. Las mezclas deharina seleccionadas como óptimas, mezcla dulce, apropiada para la preparación de queques, así como para la mezcla postre, que por adición de agua o leche, da origen a un postre, se evaluaron después de tres meses de almacenamiento,siendo aceptables sus requisitos microbiológicos,bromatológicos y sensoriales, corroborándose los resultados,con la buena aceptación de los productos preparados a partir de las mezclas formuladas, por parte de los menores de 2 Jardines Infantiles de la Ciudad de Antofagasta-Chile (AU)

The revaluation of the Andean cultivations, quinua(Chenopodium quinua Willd) and lupin (Lupinus albusL.), to be used in nutritional mixtures, with traditional cereals like corn (Zea mays L.) and rice (Oryza sativa L.),originate mixtures without gluten which constitute a good alternative for the nutrition of children under 24 monthsthat suffer from celiac disease, since they improve the quality of the protein, by essential amino acids compensation,and also impacts in the product’s diversification strategy. In the present work, the percentage composition of each flour in the mixture was determined by means of Linear Programming by means of the Solver form from the Excel spreadsheet. Prolamines were determined in the quinua and lupin flours by the ELISA test and theHPLC technique was used in both products obtainedcalled “sweet mix” and “dessert mix”, to define the quantity of amino acids with the purpose of providing aroundthe 15% of the proteins required in the day. The flourmixtures selected as optimum, sweet mix, suitable for thepreparation of sweet pancakes, as well as for the dessertmix, that by addition of water or milk produce a semisolid dessert, were evaluated after three months of storage,being acceptable their microbiological, bromatological and sensorial requirements, corroborating the results with the good acceptance of the products, prepared from the formulated mixtures, by the children of two Day Carecenters of the City of Antofagasta-Chile (AU)

Strategies for feeding the preterm infant.

According to many experts in neonatal nutrition, the goal for nutrition of the preterm infant should be to achieve a postnatal growth rate approximating that of the normal fetus of the same gestational age. Unfortunately, most preterm infants, especially those born very preterm with extremely low birth weight, are not fed sufficient amounts of nutrients to produce normal fetal rates of growth and, as a result, end up growth-restricted during their hospital period after birth. Growth restriction is a significant problem, as numerous studies have shown definitively that undernutrition, especially of protein, at critical stages of development produces long-term short stature, organ growth failure, and both neuronal deficits of number and dendritic connections as well as later behavioral and cognitive outcomes. Furthermore, clinical follow-up studies have shown that among infants fed formulas, the nutrient content of the formula is directly and positively related to mental and motor outcomes later in life. Nutritional requirements do not stop at birth. Thus, delaying nutrition after birth 'until the infant is stable' ignores the fundamental point that without nutrition starting immediately after birth, the infant enters a catabolic condition, and catabolism does not contribute to normal development and growth. Oxygen is necessary for all metabolic processes. Recent trends to limit oxygen supply to prevent oxygen toxicity have the potential, particularly when the blood hemoglobin concentration falls to less than 8 g/dl, to develop growth failure. Glucose should be provided at 6-8 mg/min/kg as soon after birth as possible and adjusted according to frequent measurements of plasma glucose to achieve and maintain concentrations >45 mg/dl but <120 mg/dl to avoid the frequent problems of hyperglycemia and hypoglycemia. Similarly, lipid is required to provide at least 0.5 g/kg/day to prevent essential fatty acid deficiency. However, the high rate of carbohydrate and lipid supply that preterm infants often get, based on the incomplete assumption that this is necessary to promote protein growth, tends to produce increased fat in organs like the liver and heart as well as adipose tissue. More and better essential fatty acid nutrition is valuable, but more organ and adipose fat has no known benefit and many problems. Amino acids and protein are essential not only for body growth but for metabolic signaling, protein synthesis, and protein accretion. 3.5-4.0 g/kg/day are necessary to produce normal protein balance and growth in very preterm infants. Attempts to promote protein growth with insulin has many problems - it is ineffective while contributing to even further organ and adipose tissue fat deposition. Enteral feeding always is indicated and to date nearly all studies have shown that minimal enteral feeding approaches (e.g., 'trophic feeds') promote the capacity to feed enterally. Milk has distinct advantages over formulas in avoiding necrotizing enterocolitis (NEC), and while feeding is associated with NEC, minimal enteral feeding regimens produce less NEC than those geared towards more aggressive introduction of enteral feeding. Finally, overfeeding has the definite potential to produce adipose tissue, or obesity, which then leads to insulin resistance, glucose intolerance, and diabetes. This scenario occurs more commonly as infants are fed more and gain weight more rapidly after birth, regardless of their birth weight. Infants with IUGR and postnatal growth failure may be uniquely 'set up' for this outcome, while infants with in utero obesity, such as infants of diabetic mothers, already are well along this adverse outcome pathway.

Revisión sistemática: tratamiento nutricional del cólico del lactante (I) / Systematic review: dietary treatment of infant colic (I)

Introducción: El cólico del lactante es un problema prevalente en el que se han ensayado a lo largo de la historia diversos tratamientos, ninguno de ellos definitivo. En los últimos años se han realizado nuevas propuestas terapéuticas, y han aparecido en el mercado las llamadas fórmulas anticólico o confort (FAC). En el presente trabajo se realiza una revisión estructurada sobre el tratamiento nutricional del cólico del lactante, con el objetivo de integrar la información actual sobre este aspecto y establecer las pruebas existentes sobre la utilidad de distintas modalidades de tratamiento nutricional. Metodología: Revisión sistemática mediante búsqueda bibliográfica electrónica de los ensayos clínicos con diseño aleatorizado y controlado acerca del tratamiento nutricional del cólico del lactante. Análisis de las modificaciones en la composición de las FAC en relación con la fórmula adaptada convencional según los datos proporcionados por los fabricantes del producto. Resultados: Los 23 ensayos clínicos incluidos estudiaron 6modalidades de tratamiento nutricional: disminución de lactosa en la fórmula artificial, dieta hipoalergénica, adición de fibra, administración de soluciones azucaradas, probióticos y preparados fitoterápicos. Una proporción significativa de los trabajos analizados presenta problemas metodológicos, como escaso número de pacientes, alta tasa de pérdidas y sesgos de selección, que dificultan la extrapolación de sus resultados a la práctica clínica. De las distintas intervenciones nutricionales, la exclusión de proteínas de leche de vaca en lactantes con fórmula artificial, la administración de preparados fitoterápicos y la dieta hipoalergénica extensa en la madre del lactante han demostrado tener algún grado de eficacia. Se necesitan estudios adicionales para verificar la eficacia de otras modalidades de tratamiento nutricional(AU)

Introduction: Infant colic is a common problem. Although several treatments have been tested over the years, none have proved to be definitive. A number of novel therapeutic strategies have been proposed in recent years, and anticolic or comfort formulas have appeared in the market. The present report is a systematic review of the dietary treatment of infant colic to provide an update of the available information and to establish the utility of different forms of dietary treatment. Methods: We conducted a systematic review based on electronic databases that entailed searching exclusively for studies classified as randomized, controlled trials involving dietary treatment of infant colic. We analyzed the modifications in the composition of the anticolic formulas, as compared to a standard formula, according to the data provided by the manufacturers of the product. Results: Of the twenty-three clinical trials selected, six modalities of dietary treatment were studied: reduction of lactose, low-allergen diet, fiber-enriched formula, sweetened solutions, probiotics and phytotherapeutic agents. Methodological problems, such as small sample size, high dropout rate and selection bias, were found in a substantial number of the trials analyzed.The elimination of cow’s milk from the diet of bottle-fed infants, administration of phytotherapeutic agents and a low allergen diet in the mother of the breast-fed infant have been found to demonstrate a certain degree of efficacy. Additional studies are needed to verify the utility of other modalities of dietary treatment(AU)