NEmecum: herramienta digital de ayuda a la prescripción y dispensación de fórmulas de nutrición enteral y preparados infantiles / NEmecum: digital tool for assisting in the prescription and dispensing of enteral nutrition formulas and infant preparations

Introducción: existe una amplia variedad de fórmulas o preparados de nutrición enteral y fórmulas o preparados infantiles. La consulta de información relacionada debe hacerse en las herramientas propias de cada laboratorio, lo que dificulta la visión crítica y la comparativa entre las mismas. Objetivo: describir el desarrollo de NEmecum como la primera web que permite realizar una búsqueda dirigida e independiente de fórmulas de nutrición o preparados infantiles, analizar el abanico nutricional actual en España y evaluar los datos de uso de la herramienta. Métodos: se desarrolló la estructura de una base de datos que unifica los parámetros de todas las fórmulas y se analizó el abanico nutricional español. Posteriormente, se seleccionaron los principales algoritmos de búsqueda dirigida y se codificó la herramienta digital. Se llevó a cabo una intensa difusión y se evaluó el impacto obtenido. Se analizaron el perfil de usuarios y centros registrados y los datos de uso de la herramienta y se evaluó su usabilidad mediante el cuestionario System Usability Scale (SUS). Resultados: se obtuvo una web responsive de acceso gratuito (http://nemecum.com) que permite realizar búsquedas dirigidas en base a unos filtros de búsqueda preestablecidos. La herramienta permitió analizar detalladamente el abanico nutricional en España, observándose la gran variedad de fórmulas disponibles de similares características. La campaña de difusión consiguió incrementar su uso de forma exponencial y cuenta actualmente con 1.370 usuarios y 79 centros registrados. La usabilidad fue valorada como excelente. Conclusión: el desarrollo de NEmecum supone una herramienta valiosa en la búsqueda y consulta de datos de fórmulas o preparados de nutrición enteral y fórmulas o preparados infantiles. (AU)

Introduction: there is a wide variety of enteral nutrition and infant formulas preparations. When there is a need to find infomation on a product,only the infomation from industy is available. Comparison amomg products becomes then ardous.Objective: to describe the development of NEmecum as the first website that allows a directed and independent search for enteral nutritionproducts and infant formulas, currently available in Spain, and to evaluate the initial use of NEmecum.Methods: the structure of a database that unifies the parameters of all formulas was developed, and the nutritional composition of all formulaswas analyzed. Subsequently, the main search algorithms were selected and the digital tool was codified. Intensive dissemination was performedand the impact was evaluated. The profile of users and registered centers and the use of the tool were analyzed, and its usability was evaluatedusing the System Usability Scale (SUS) questionnaire.Results: a free-access responsive website (http://nemecum.com) that allows searches based on pre-established search filters was obtained. Thistool allows for a detailed analysis available formulas in Spain by observing a wide variety of formulas with similar characteristics. The disseminationcampaign managed to increase its use exponentially, currently reaching 1,370 users and 79 registered centers. Usability was rated as excellent.Conclusion: the development of the NEmecum represents a valuable tool in the search and consultation of the characteristics of enteral nutritionformulas and infant preparations. (AU)

Conduct and reporting of formula milk trials: systematic review.

OBJECTIVE: To systematically review the conduct and reporting of formula trials. DESIGN: Systematic review. DATA SOURCES: Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 1 January 2006 to 31 December 2020. REVIEW METHODS: Intervention trials comparing at least two formula products in children less than three years of age were included, but not trials of human breast milk or fortifiers of breast milk. Data were extracted in duplicate and primary outcome data were synthesised for meta-analysis with a random effects model weighted by the inverse variance method. Risk of bias was evaluated with Cochrane risk of bias version 2.0, and risk of undermining breastfeeding was evaluated according to published consensus guidance. Primary outcomes of the trials included in the systematic review were identified from clinical trial registries, protocols, or trial publications. RESULTS: 22 201 titles were screened and 307 trials were identified that were published between 2006 and 2020, of which 73 (24%) trials in 13 197 children were prospectively registered. Another 111 unpublished but registered trials in 17 411 children were identified. Detailed analysis was undertaken for 125 trials (23 757 children) published since 2015. Seventeen (14%) of these recently published trials were conducted independently of formula companies, 26 (21%) were prospectively registered with a clear aim and primary outcome, and authors or sponsors shared prospective protocols for 11 (9%) trials. Risk of bias was low in five (4%) and high in 100 (80%) recently published trials, mainly because of inappropriate exclusions from analysis and selective reporting. For 68 recently published superiority trials, a pooled standardised mean difference of 0.51 (range -0.43 to 3.29) was calculated with an asymmetrical funnel plot (Egger's test P<0.001), which reduced to 0.19 after correction for asymmetry. Primary outcomes were reported by authors as favourable in 86 (69%) trials, and 115 (92%) abstract conclusions were favourable. One of 38 (3%) trials in partially breastfed infants reported adequate support for breastfeeding and 14 of 87 (16%) trials in non-breastfed infants confirmed the decision not to breastfeed was firmly established before enrolment in the trial. CONCLUSIONS: The results show that formula trials lack independence or transparency, and published outcomes are biased by selective reporting. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2018 CRD42018091928.

Randomized Controlled Trial of Iron-Fortified versus Low-Iron Infant Formula: Developmental Outcomes at 16 Years.

OBJECTIVES: To test differences in cognitive outcomes among adolescents randomly assigned previously as infants to iron-fortified formula or low-iron formula as part of an iron deficiency anemia prevention trial. STUDY DESIGN: Infants were recruited from community clinics in low- to middle-income neighborhoods in Santiago, Chile. Entrance criteria included term, singleton infants; birth weight of ≥3.0 kg; and no major congenital anomalies, perinatal complications, phototherapy, hospitalization >5 days, chronic illness, or iron deficiency anemia at 6 months. Six-month-old infants were randomized to iron-fortified (12 mg/L) or low-iron (2.3 mg/L) formula for 6 months. At 16 years of age, cognitive ability, visual perceptual ability, visual memory, and achievement in math, vocabulary, and comprehension were assessed, using standardized measures. We compared differences in developmental test scores according to randomization group. RESULTS: At the follow-up assessment, the 405 participants averaged 16.2 years of age and 46% were male. Those randomized to iron-fortified formula had lower scores than those randomized to low-iron formula for visual memory, arithmetic achievement, and reading comprehension achievement. For visual motor integration, there was an interaction with baseline infancy hemoglobin, such that the iron-fortified group outperformed the low-iron group when 6-month hemoglobin was low and underperformed when 6-month hemoglobin was high. CONCLUSIONS: Adolescents who received iron-fortified formula as infants from 6 to 12 months of age at levels recommended in the US had poorer cognitive outcomes compared with those who received a low-iron formula. The prevention of iron deficiency anemia in infancy is important for brain development. However, the optimal level of iron supplementation in infancy is unclear. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01166451.

[Evaluation of Efficacy and Safety of Longterm Feeding with Amino Acid-Based Formula in Infants with Cow's Milk Protein Allergy: Results of the Open-Label Prospective Controlled Post-Registration Trial].

Background: The cow's milk allergy (CMA) prevalence is 2−3% in children under one year. Approximately in 5% of cases transferring to extensively hydrolysed formula (eHF) doesn't lead to disappearance of CMA symptoms. Aims: Evaluation of efficacy and safety of amino-acid formula (AAF) longterm feeding in children under one year and development of predictors of successful transfer from AAF to eHF. Materials and Methods: In open-label prospective post-registration trial duration of 365 days were included 43 children aged from 3 to 12 months with CMA. CMA was based on Russian and international guidelines. When a patient was included in the trial, child received eHF for 4 weeks with the evaluation of the effect of elimination diet (ED): in case of absence of effect, for diagnostic purposes child feed with AAF for 2 weeks and upon receiving the effect, child continued to receive it for at least 6 months. Diet was considered effective if there were observed disappearance of clinical manifestations of CMA during of formula using. Results: Children fed with AAF gain weight and increased height statistically higher during the first 6 months, compared with children receiving eHF, but without subsequent difference in a year. After 4 weeks' of AAF feeding, there was a significant decrease in SCORAD index from 46.84 (SD 4.164) to 2.52 (SD 2.204) (p=0.005); disappearance of gastrointestinal manifestations of CMA from 3 to 14 day. After 4 weeks, the 100% normalization of previously elevated faecal calprotectin (p<0.05) was observed; and after 6months. ED, in 60% of children normalization of the index of activation of basophils with milk was observed. 38.7% of children were transferred to eHF in 6 months, 12.9% and 25.8% in 9 and 12 months respectively. Conclusions: Use of AAF for children with CMA is an effective and safe treatment without lengthening the period of elimination, which is necessary for the formation of tolerance to cow's milk protein and has a positive impact on weight and height. Normalization of specific activation of basophils with milk could be considered as a predictor of successful transfer from AAF to eHF in children with CMA.

Formula frustrations.

The mother of a pediatric patient was recently diagnosed with a rheumatologic illness, requiring her to take medications that would be dangerous to her nursing baby. She realized that she would need to feed her baby formula. She asked me, "What is the difference between the formulas at the grocery store? Which is the best kind for my baby?" The answer to this question is different for every baby. This article is a short guide for primary care pediatricians to help them understand the differences between common formulas.

Dietary arachidonic acid and docosahexaenoic acid regulate liver fatty acid desaturase (FADS) alternative transcript expression in suckling piglets.

Molecular regulation of fatty acid desaturase (Fads) gene expression by dietary arachidonic acid (ARA) and docosahexaenoic acid (DHA) during early post-natal period, when the demand for long chain polyunsaturated fatty acids (LC-PUFA) is very high, has not been well defined. The objective of the current study was to determine regulation of liver Fads1, Fads2 and Fads3 classical (CS) and alternative transcripts (AT) expression by dietary ARA and DHA, within the physiological range present in human breast milk, in suckling piglets. Piglets were fed one of six milk replacer formula diets (formula-reared groups, FR) with varying ARA and DHA content from days 3-28 of age. The ARA/DHA levels of the six formula diets were as follows (% total fatty acid, FA/FA): (A1) 0.1/1.0; (A2) 0.53/1.0; (A3-D3) 0.69/1.0; (A4) 1.1/1.0; (D2) 0.67/0.62; and (D1) 0.66/0.33. The control maternal-reared (MR) group remained with the dam. Fads1 expression was not significantly different between FR and MR groups. Fads2 expression was down-regulated significantly in diets with 1:1 ratio of ARA:DHA, compared to MR. Fads2 AT1 expression was highly correlated to Fads2 expression. Fads3 AT7 was the only Fads3 transcript sensitive to dietary LC-PUFA intake and was up-regulated in the formula diets with lowest ARA and DHA contents compared to MR. Thus, the present study provides evidence that the proportion of dietary ARA:DHA is a significant determinant of Fads2 expression and LC-PUFA metabolism during the early postnatal period. Further, the data suggest that Fads3 AT7 may have functional significance when dietary supply of ARA and DHA are low during early development.

Diet, sensitive periods in flavour learning, and growth.

Diet in early infancy has an impact on early growth and the formation of flavour preferences, as well as on later life health outcomes. Although breast milk is the preferred source of nutrition during infancy, more than half of American infants receive infant formula by the age of 4 months. As a group, formula-fed infants weigh more by the age of one year and have a greater risk for later obesity than breastfed infants. However, a recent randomized study found that, when compared to breastfed infants, infants fed an extensively hydrolysed protein formula (ePHF) had more normative weight gain velocity than infants fed cow's milk formula (CMF). Therefore, grouping all formula-fed infants together with respect to certain health outcomes such as obesity may not be appropriate. Scientific evidence also suggests that there are sensitive periods for flavour learning. Infants become familiar with and learn to accept the flavours they experience through their mother's amniotic fluid and breast milk as well as formula. These early experiences influence flavour preferences of children that may affect food choices and therefore later life health. Further research on the influence of early diet on growth, flavour preferences, and food choices is imperative.

Fórmulas infantiles / Infant formulas

Las fórmulas para la alimentación de los lactantes tratan de ser parecidas lo más posible a la leche materna (LM). En el siglo XIX se describió una de las primeras fórmulas y en esta misma época Von Bunge publicó el primer análisis de la composición tanto de la LM como la LV. En 1977 el Comité de la ESPGHAN, publica recomendaciones para la composición de una fórmula adaptada. Las 3 indicaciones principales para el uso de las fórmulas para lactantes son: sustituto de la LM en aquellos lactantes en quienes la LM se contraindica por alguna razón médica; complemento en aquellos lactantes alimentados al seno materno que no incrementan de peso adecuadamente, y sustituto o complemento de la LM en lactantes cuyas madres eligen no amamantar o no hacerlo de forma exclusiva.

The formulas for feeding infants try to be similar as posible to breast milk (BM). In the nineteenth century, describe done of the first formulas and this time Von Bunge pusblished the first analysis of the composition of both the BM and cow's milk (CM). In 1977 the ESPGHAN Committee publishes recommendations for the composition of an adapted formula. The 3 main indications for the use of infant formulas are: BM substitute in infants in whom the BM is contraindicated for medical reasons, complementary in those breastfed infants do not increase weight appropriately, and substitute or BM complement infants whose mothers choose not to breastfeed or not do so exclusively.

Nutrición enteral: primera parte / Enteral nutrition: first part

La nutrición enteral comprende todas las formas de soporte nutricional que implican el empleo de alimentación para propósitos médicos especiales, independientemente de la vía de alimentación, por vía oral o por sonda de alimentación. Debe ser considerada en pacientes con tracto gastrointestinal funcional que requieren apoyo nutricio. Las contraindicaciones son isquemia gastrointestinal, enterocolitis necrosante, íleo paralítico, megacolon tóxico, vómito o diarrea intratable, íleo paralítico, peritonitis difusa, sangrado de tubo digestivo grave y obstrucción intestinal. Las ventajas incluyen, aún cuando sea estimulación, la preservación de la función gastrointestinal, riesgo disminuido de infección y anormalidades metabólicas, atenuación de la respuesta catabólica, aumento de los sistemas antioxidantes, imita la nutrición humana estándar, reducción del tiempo de estancia hospitalaria, limitada traslocación bacteriana, disminuye la frecuencia de sepsis y falla orgánica múltiple, menor costo, fácil manejo y seguridad. Entre las fórmulas de alimentación se encuentran estándar, poliméricas o con proteínas intactas, hidrolizadas o basadas en péptidos, con aminoácidos libres o elementales, poliméricas artesanales, específicas para enfermedades, y modulares.

Enteral nutrition encompasses all forms of nutritional support involving the use of food for special medical purposes, regardless of route of feeding, orally or by feeding tube. It should be considered in patients with functional gastrointestinal tract who require nutritional support. The benefits include stimulation even when the preservation of gastrointestinal function, decreased risk of infection and metabolic abnormalities, catabolic response attenuation, increased antioxidant systems, mimics the standard human nutrition, reduced hospital stay, limited bacterial translocation, decreases the frequency of sepsis and multiple organ failure, lower cost, easy handling and safety. Among the feeding formulas are standard, polymeric or intact proteins, hydrolyzed or based on peptides, free amino acid or elemental, polymeric craft specific diseases, and modular.

Conocimientos sobre alimentación durante el primer año de vida en médicos generales de Cali, Colombia / Knowledge of food during the first year of life in general practitioners from Cali, Colombia

Materiales y métodos: Estudio observacional descriptivo de corte transversal. N = 78 MD que laboraban en Instituciones de Salud de Cali, Colombia. La encuesta incluyó datos de identificación, preguntas sobre conocimientos en alimentación normal y recomendaciones alimentarias. Base de datos enSPSS. Descripción con frecuencias, promedios, desviación estándar y proporciones y análisis bivariado utilizando Chi2 y t de student. Resultados: 82.1% recomienda LM exclusiva; 85.9% suspende LM por infecciones maternas; 38.5% sabe que la LM previene enfermedades crónicas; 12.8% sugiere dieta de eliminación en madre alérgica; 33.3% recomienda fórmula infantil; 98.7% no recomienda leche de vaca (LV) antes del año de edad. 83.3% inicia complementaria en > 6 meses: 57.7% indica frutas, 35.9% cereales, 2.6% carnes y huevo; 73.1% prefiere 1 alimento por vez; el 56.7% ensaya cada 3 a 5 días alimentos nuevos; 73.1% cambia consistencia del alimento en > 6 meses; en > 6 meses 73.1% inicia carne, 15.4% pescado, 69.2% leguminosas y 73.1% tubérculos; 78.3% retira alimentos alergénicos en niños alérgicos. 70.5% no recomienda vitaminas ni el 67.9% suplementos nutricionales. 65.4% adquieren sus conocimientos de sus profesores. No diferencias significativas en cuanto a conocimientos previos, ejercicio profesional, género; pero sí en MD solteros, sin hijos, con antecedentes de alergenicidad, MD femeninas y LM y MD con 30 y 35 años de edad. Conclusión: El 61.5% de los MD poseen conocimientos insuficientes sobre alimentación normal durante el primer año de vida, entre lo que se destaca positivamente que la LVdebe indicarse en > 1 año de edad y negativamente sobre dieta de eliminación en la madre alérgica.

Materials and methods: Cross sectional observational study. N = 78 GP who worked in health institutions in Cali, Colombia. The survey included identification data, questions about knowledge in nutrition and normal dietary recommendations. SPSS Database. Description frequencies, averages, standard deviations and proportions and bivariate analysis using student t and Chi2. Results: 82.1% recommended exclusive BF, 85.9% suspending BF by maternal infections, 38.5% know that the BF prevent chronic diseases, 12.8%suggests elimination diet in a mother allergic, 33.3% recommended infant formula, 98.7% do not recommend cow's milk (CM) before one year of age. 83.3% starts complementary foods in > 6 months: 57.7% fruits, 35.9% cereals, 2.6% meat and eggs, 73.1% prefer one food at a time, 56.7% tested every 3 to 5 days new foods, 73.1% changes the food consistency in > 6 months and 73.1% starts meat in > 6 months, 15.4% fish, 69.2% legumes and 73.1% tubers; 78.3% removes allergens in allergic children. 70.5% not recommended vitamins and 67.9% nutritional supplements. 65.4% acquire their knowledge from their teachers. No significant differences in terms of background, occupation, gender, but yes in GP unmarried, childless, with a history of allergenicity, and female GP and BF and GP with 30 and 35 years of age. Conclusion: 61.5% GP have enough knowledge about normal feeding during the first year of life, between what stands out positively that the BF should be indicated by > 1 year old and negatively elimination diet in the mother allergic.

Aflatoxin M1 in Spanish infant formulae: occurrence and dietary intake regarding type, protein-base and physical state.

The incidence of aflatoxin M1 (AFM1) in 69 different infant formulae marketed in Spain between 2007 and 2008 was studied and dietary intake estimated. Samples were analysed using an HPLC method coupled with fluorescence detection after immunoaffinity column clean-up. The toxin was detected in 26 formulae (37.7%) at levels below the permissible limit set by EC legislation, giving a range of 0.6-11.6 ng kg(-1) with a mean value of 3.1 ng kg(-1). Increasing occurrence was found in those formulae produced by the less complex manufacturing processes affecting casein/whey protein ratio: pre-term, 14.3%; starter, 35.3%; follow-up, 42.1%; toddler 87.6%; while hypoallergenic and lactose-free were totally exempt. Additionally, the influence of main protein source and physical state (powdered and ready-to-use formula) on AFM1 occurrence was evaluated leading to similar conclusions. Dietary AFM1 weekly intake was observed to be stable around 1 ng kg(-1) bw for standard formula and 0.1 ng kg(-1) bw for pre-term feeding.

Modified proteins in allergy prevention.

Around 2.5% of neonates experience hypersensitivity reactions to cow's milk protein during the first year of life, which is highly associated with early exposure to cow's milk. To prevent early allergy development, cow's milk proteins in infant formulas were modified by hydrolyzation processes for use in children at high atopic risk who need milk supplementation in the first months of life. Dependent on the degree of modification, hydrolyzed cow's milk formulas are differentiated into extensively and partially hydrolyzed whey or casein hydrolysates (pHF, eHF). However, their allergy-preventive potential seems not only to dependent on the degree but also on the process of hydrolysis. pHF and eHF can be used for primary prevention of allergy in infants at high atopic risk, while only eHFs are indicated for secondary prevention in patients with manifest cow's milk allergy. In clinical trials a consistent trend to a reduction in atopy, mainly atopic eczema and food allergy, by certain pHFs and eHFs could be demonstrated in children with a familial risk of atopy until the age of 6 years. Because more than 50% of allergic children do not have a family history of atopy, it would be worthwhile to consider primary allergy prevention with hydrolysates for all children who need supplementation to breastfeeding.

Short-wave near-infrared spectroscopy of milk powder for brand identification and component analysis.

The aim of the present paper was to provide new insight into the short-wave near-infrared (NIR) spectroscopic analysis of milk powder. Near-infrared spectra in the 800- to 1,025-nm region of 350 samples were analyzed to determine the brands and quality of milk powders. Brand identification was done by a least squares support vector machine (LS-SVM) model coupled with fast fixed-point independent component analysis (ICA). The correct answer rate of the ICA-LS-SVM model reached as high as 98%, which was better than that of the LS-SVM (95%). Contents of fat, protein, and carbohydrate were determined by the LS-SVM and ICA-LS-SVM models. Both processes offered good determination performance for analyzing the main components in milk powder based on short-wave NIR spectra. The coefficients of determination for prediction and root mean square error of prediction of ICA-LS-SVM were 0.983, 0.231, and 0.982, and 0.161, 0.980, and 0.410, respectively, for the 3 components. However, there were less than 10 input variables in the ICA-LS-SVM model compared with 225 in the LS-SVM model. Thus, the processing time was much shorter and the model was simpler. The results presented in this paper demonstrate that the short-wave NIR region is promising for fast and reliable determination of the brand and main components in milk powder.

[Our experience based on Omneo 1 /Nutrilon Comfort 1/ formula-fed of high-risk newborn babies].

OBJECTIVE: To investigate the acceptability and effect of Omneo 1/Nutrilon Comfort/milk formula of high-risk newborn babies. METHODS: Omneo 1 was given as food to 30 high-risk newborn babies. All of them were prematurely born of an average birth gestation age-33 gestation weeks and of average weight--1757,16 gr. None of the infants was ever fed mother's milk. The intake of Omneo 1 was applied to infants of stabilized health condition and post conceptual age no less than 38 gestation weeks /the average gestation weeks were 38,96/. The following parameters were closely observed: Body weight was measured once a week with the accuracy of +/- 5 gr.; The fecal pH was measured an 20 babies by means of multicolor indication paper Merck Eurolaba GmbH, Darmstadt, Germany; Stool characteristics-consistency and frequency, regurgitation and vomiting were recorded on the basis of mother's and personals interview. Methods used--clinical analysis, inquiry method, laboratory and anthropometric measuring. The survey is prospective. RESULTS: Weight gain was of 800 gr up to 1200 gr per month. Per day was achieved at an average weight gain - 37,60 gr. Decrease fecal pH was observed--at the beginning 7.1 (+/- 0.65) at the end of the study--5.1(+/-). The acidity of the excrements decreased which suppressed the development of pathogenic microorganisms. As regards the public inquiry, parents did not report cases an gastro-intestinal discomfort (regurgitation, constipation, colic). In two of the babies, blood in the excrements was macroscopically traced and "Allergy to cow's milk protein" was diagnosed. One of the infants was hospitalized with a generalized infection. The feeding with Omneo 1 was suspended in the case of these newborn, and they were excluded from the survey. CONCLUSION: Parents are positive about feeding Omneo 1 despite the higher price of the product. Omneo 1 milk contributes to adequate weight growth of high-risk newborn babies and its intake results in lower fecal pH as an indicator of positive bifidus effect.

Feeding with premature or infant formula in premature infants after discharge: comparison of growth and nutrition status.

We designed this prospective randomized controlled study to evaluate the effects of premature and standard term formula on growth, nutrient intake and biochemical response in premature infants from hospital discharge to 6 months of corrected age. Premature infants with a gestational age of < or =35 weeks and a birth weight < or =1850 gm were assigned to receive premature infant formula (n = 19) or a standard term infant formula (n = 15). No differences were found between the two groups in weight, length, or head circumference at baseline or on follow-up. Infants fed premature formula had higher blood urea nitrogen and phosphorus at 3 months of corrected age. Those on the premature formula also had higher energy intake at 1 month of corrected age. We suggest that premature infants, especially very low birth weight infants, fed preterm infant formula after discharge until 6 months of corrected age tolerate the formula well and may benefit over those standard term formula.