Hidrolizada con alto contenido de trigliceridos de cadena media en pacientes pediátricos con linfangiectasia intestinal primaria y alergia a la leche de vaca / Hydrolyzed with high content of medium chain triglycerides in pediatric patients with primary intestinal lymphangiectasia and allergy to cow's milk

ANTECEDENTES En el marco de la metodología ad hoc para evaluar solicitudes de tecnologías sanitarias, aprobada mediante Resolución de Institución de Evaluación de Tecnologías en Salud e Investigación N° 111-IETSI-ESSALUD-2021, se ha elaborado el presente dictamen, el que expone la evaluación de la eficacia y seguridad de la fórmula extensamente hidrolizada con alto contenido de triglicéridos de cadena media en pacientes pediátricos con linfangiectasia intestinal primaria y alergia a la leche de vaca. Así, el Dr. Marco Antonio Morales Acosta, médico especialista en Pediatría del Servicio de Pediatría Especializada del Hospital Nacional Edgardo Rebagliati Martins de la Red Prestacional Rebagliati, siguiendo la Directiva N° 003-IETSI-ESSALUD-2016, envía al Instituto de Evaluación de Tecnologías en Salud e Investigación ­ IETSI la solicitud de uso fuera del petitorio del producto fórmula extensamente hidrolizada alta en triglicéridos de cadena media. ASPECTOS GENERALES La linfangiectasia intestinal primaria (LIP) es una enfermedad poco frecuente caracterizada por una dilatación de los vasos linfáticos de la mucosa o submucosa del intestino delgado. Debido a la estasis y, finalmente, a la rotura de los vasos linfáticos, el líquido linfático, rico en albúmina y otras proteínas, se filtra hacia el tracto gastrointestinal (Brownell and Piccoli 2021). La LIP afecta principalmente a niños y adultos jóvenes, y generalmente se diagnostica antes de los 3 años de edad. El síntoma principal es el edema predominantemente bilateral de miembros inferiores relacionado con la gastroenteropatía perdedora de proteínas. También puede haber fatiga, dolor abdominal, pérdida de peso, incapacidad para aumentar de peso, retraso del crecimiento en los niños, diarrea moderada, deficiencias de vitaminas liposolubles debido a malabsorción, o deficiencia de hierro con anemia moderada (Brownell and Piccoli 2021; Orphanet 2021). La etiología y la prevalencia de la LIP es desconocida. En todo el mundo, se han notificado menos de 500 casos (Orphanet 2021). Su diagnóstico se confirma por la observación endoscópica de los vasos linfáticos intestinales dilatados con la correspondiente histología de las muestras de biopsia intestinal (Orphanet 2021). Y los objetivos del tratamiento incluyen maximizar el estado nutricional y la calidad de vida de los pacientes, mediante la reducción de los síntomas y de las secuelas. El pilar de la terapia dietética es una dieta baja en grasas, alta en proteínas y alta en triglicéridos de cadena media (TCM) (Brownell and Piccoli 2021). METODOLOGÍA: Se realizó una búsqueda sistemática utilizando las bases de datos PubMed, Cochrane Library y LILACS. Además, se realizó una búsqueda dentro de bases de datos pertenecientes a grupos que realizan evaluaciones de tecnologías sanitarias (ETS) y guías de práctica clínica (GPC), incluyendo el Scottish Medicines Consortium (SMC), el National Institute for Health and Care Excellence (NICE), la Canadian Agency for Drugs and Technologies in Health (CADTH), la Haute Autorité de Santé (HAS), el Institute for Quality and Efficiency in Health Care (IQWiG), el Instituto de Evaluación Tecnológica en Salud de Colombia (IETS), la Comissáo Nacional de Incorporacáo de Tecnologias no Sistema Único de Saúde (CONITEC), entre otros. Asimismo, se revisó la Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas (BRISA) y páginas web de sociedades especializadas en nutrición en pediatría como la North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN), la European Society for Clinical Nutrition and Metabolism (ESPEN), y la American Society for Parenteral and Enteral Nutrition (ASPEN). De manera adicional, se hizo una búsqueda en la página web del registro de ensayos clínicos administrado por la Biblioteca Nacional de Medicina de los Estados Unidos (https://clinicaltrials.qov/) e International Clinical Trial Registry Platform (ICTRP) (https://apps.who.int/trialsearch/) para poder identificar ensayos clínicos en curso o cuyos resultados no hayan sido publicados. Las estrategias de búsqueda para identificar la evidencia de ensayos clínicos aleatorizados (ECA) se encuentran en las Tabla 1, 2 y 3 del Material Suplementario. ANÁLISIS DE LA EVIDENCIA: En la presente evaluación no se identificaron guías, consensos de expertos o estudios que ayudaran a responder la pregunta PICO establecida en este dictamen. En ese sentido la evaluación se centró en la evidencia descrita previamente por el IETSI para el uso de la FEH en niños con APLV y la fórmula con alto contenido de TCM en niños con LIP, la plausibilidad biológica de la eficacia de la intervención de interés, y la opinión de los expertos de EsSalud. CONCLUSIONES: Por todo lo expuesto, el IETSI recomienda el uso de la fórmula extensamente hidrolizada con alto contenido de TCM en pacientes pediátricos con LIP y alergia la leche de vaca. Dado que actualmente el producto farmacéutico fórmula extensamente hidrolizada con alto contenido de triglicéridos de cadena media no cuenta con registro sanitario en el mercado peruano; de requerirse la autorización de este producto farmacéutico se recomienda seguir el procedimiento TUPA 118 "Autorización excepcional para la importación y uso de productos farmacéuticos, dispositivos médicos o productos sanitarios para la prevención y tratamiento individual" en el marco de lo establecido en el artículo 16 de la Ley N° 29459 "Ley de Productos Farmacéuticos, Dispositivos Médicos y Productos Sanitarios".

Microbiome analysis reveals gut microbiota alteration of early-weaned Yimeng black goats with the effect of milk replacer and age.

BACKGROUND: Colonization of intestinal microbiota in ruminant during the early life is important to host health, metabolism and immunity. Accumulating evidence revealed the ameliorative effect of milk replacer administration in the gut microbial development of early-weaned ruminants. Yimeng black goats (YBGs) inhabiting Shandong, China show a complex intestinal microbial ecosystem, but studies of their gut microbiota are still insufficient to report. Here, this study was performed to investigate how the gut microbiota develops in weaned YBGs with the effect of age and milk replacer. RESULTS: Results indicated that both age and milk replacer were important factors to change the gut microbiota of YBGs. Although the alpha diversity of gut microbiota did not change with the age of YBGs, the taxonomic compositions significantly changed. The relative abundance of some beneficial bacteria such as Lachnospiraceae, Ruminococcaceae, Ruminiclostridium, Eubacterium and Barnesiella significantly decreased and subsequently increase with age, which contributes to maintain the stability of intestinal environment and realize the diversity of intestinal functions. The relative abundance of Porphyromonas, Brevundimonas, Flavobacterium, Stenotrophomonas, Propionibacterium, Acinetobacter, Enterococcus and Clostridium belong to pathogenic bacteria in milk replacer-treated YBGs was significantly decreased. Additionally, some beneficial bacteria such as Ruminococcus, Ruminococcaceae, Christensenellaceae and Ruminiclostridium also display a trend of decreasing first followed by gradually increasing. CONCLUSIONS: This study first revealed the gut bacterial community alterations in YBGs with the effect of age and milk replacer. This study also characterized the gut microbial distribution in YBGs with different ages and provided better insight into microbial population structure and diversity of YBGs. Moreover, milk replacer may serve as a good applicant for improving gut microbial development in early-weaned YBGs.

Pre-weaning adaptation responses in piglets fed milk replacer with gradually increasing amounts of wheat.

Hyperprolific sows rear more piglets than they have teats, and to accommodate this, milk replacers are often offered as a supplement. Milk replacers are based on bovine milk, yet components of vegetable origin are often added. This may reduce growth, but could also accelerate maturational changes. Therefore, we investigated the effect of feeding piglets a milk replacer with gradually increasing levels of wheat flour on growth, gut enzyme activity and immune function compared with a diet based entirely on bovine milk. The hypothesis tested was that adding a starch component (wheat flour) induces maturation of the mucosa as measured by higher digestive activity and improved integrity and immunity of the small intestines (SI). To test this hypothesis, piglets were removed from the sow at day 3 and fed either a pure milk replacer diet (MILK) or from day 11 a milk replacer diet with increasing levels of wheat (WHEAT). The WHEAT piglets had an increased enzyme activity of maltase and sucrase in the proximal part of the SI compared with the MILK group. There were no differences in gut morphology, histopathology and gene expression between the groups. In conclusion, the pigs given a milk replacer with added wheat displayed immunological and gut mucosal enzyme maturational changes, indicatory of adaptation towards a vegetable-based diet. This was not associated with any clinical complications, and future studies are needed to show whether this could improve responses in the subsequent weaning process.

Feeding an amino acid-formulated milk replacer for Holstein calves during 2 time periods.

The milk-fed calf has a requirement for essential amino acids (EAA) instead of crude protein (CP). However, most milk replacers (MR) are still formulated to a CP concentration, and although limited amounts of Lys or Met may be added, these MR are not formulated solely on an AA basis. Previous work has demonstrated that feeding a modified MR balanced for specific EAA concentrations of a 24% CP MR, but reducing CP to 22%, resulted in improved growth performance in calves compared with a 24% CP MR. The 56-d objective was to determine if the hypothesis that an EAA MR formulated to the specific EAA concentrations of a 24% CP MR, but reducing CP to 22 (22AA) compared with a standard 22% CP MR would result in similar or enhanced growth performance, while reducing feed costs. Two 56-d studies using forty 3- to 5-d-old Holstein bull calves per study received in 1 lot starting on May 8, 2018 (late-spring cooler) and June 22, 2018 (summer with heat stress) were blocked by body weight (BW) and randomly assigned to 1 of 2 MR treatments. Milk replacer treatments consisted of a standard 22:20 (CP:fat; 22CP) and a 22:20 MR with greater EAA concentrations of a 24% CP MR (22AA). All MR, containing decoquinate and diflubenzuron, were fed at 0.57 kg/d per calf split into 2 feedings at 0630 h and 1800 h for 0 to 14 d via bucket, increased to 0.85 kg/d through 35 d split in 2 feedings, and fed once per day at 0.41 kg/d in the morning with weaning after 42 d. Calves were housed in straw-bedded hutches with ad libitum access to water and 25% CP pelleted calf starter (CS). All data were analyzed as a randomized complete block design with block within study considered random and week as a repeated measurement. Initial BW was similar across all treatments (39.9 ± 2.32 kg). Average daily temperature (i.e., heat stress intensity) tended to be greater for calves in study 2 compared with study 1 (20.5 and 22.9°C for study 1 and 2, respectively). The interaction of study and MR effects were nonsignificant. Calf BW, BW gain, average daily gain, CS intake, total dry matter intake (MR plus CS), feed conversions, and EAA intake (MR plus CS) were similar for calves fed both MR. Study 2 (summer heat stress) resulted in more scours incidences compared with study 1, and 22AA MR formulation tended to increase scours possibly due to synthetic AA addition or greater carbohydrate (lactose) inclusion when AA replaced protein sources. Feed costs as MR and total feed costs were lower for calves fed 22AA MR compared with calves fed 22CP MR. The increased Leu, Lys, Met, Thr, and Val concentrations in the 22AA MR compared with the 22CP MR resulted in similar calf growth performance, but the feed cost was lower for calves fed the 22AA MR, which achieved similar growth performance at a lesser cost under current study conditions, but not enhanced as hypothesized.

Postweaning response on growth and nutrient digestion to using different weaning strategies when feeding moderate and high amounts of milk replacer to Holstein calves.

Many changes occur in the rumen as calves transition from consuming a liquid diet to a completely solid diet. These changes can influence growth and calf health, being greatly affected by preweaning diet as well as the transitional steps used to wean calves. A 2 × 2 factorial design of moderate [MOD; 0.66 kg of dry matter (DM)] or high (HI; up to 1.1 kg of DM) feeding rates of milk replacer (MR) and abrupt (AB; 7-d step-down) or gradual weaning (GR; 21-d step-down) was used to study how preweaning program affects calf performance from 2 to 4 mo of age. Calves (n = 50) were randomly assigned to 1 of the 4 preweaning treatments. For the following 56-d grower portion of the experiment, calves were grouped into 12 pens based on MR program, with 4 to 5 calves per pen. Data were analyzed as a completely randomized design, with repeated measures when applicable, by PROC MIXED in SAS (version 9.4; SAS Institute Inc., Cary, NC). All calves received ad libitum access to water and a textured starter [42% starch and 20% crude protein (CP)] blended with 5% chopped grass hay. Overall, apparent digestibility coefficients (dC) of DM, neutral detergent fiber, and acid detergent fiber were greater for MOD compared with HI, and apparent dC of DM and ADF were greater for GR than for AB. No significant differences were detected between organic matter, CP, fat, starch, or sugar dC based on treatment, and no interactions were observed. However, by d 56 only starch dC differed by treatment. Weaning body weight (BW), hip width (HW), and hip height (HH) were greater for HI compared with MOD calves. Weaning HH was greater for AB than for GR calves. However, final BW, HW, HH, and body condition score, as well as average daily gain, did not differ among treatments. An interaction occurred where feed efficiency (gain/feed) was reduced with GR weaning in MOD, whereas the opposite occurred in the HI group. When feeding calves a moderate level of MR, a several-step gradual weaning is not necessary to ensure growth and development; however, calves should be gradually weaned when offered a high level of MR.

Health and growth of veal calves provided a fatty acid supplement and a dry teat.

Veal calves are at a high risk of disease early in life, which can lead to poor growth. Research is needed to determine interventions that can reduce disease and promote the growth of veal calves. The aim of this study was to determine the effects of fatty acid supplementation and the provision of a dry teat on the incidence of bovine respiratory disease (BRD), navel inflammation, and diarrhea, as well as calf growth. Upon arrival to a commercial veal facility (d 0), 240 Holstein bull calves from 2 cohorts were randomly assigned to 4 treatments using a 2 × 2 factorial arrangement (n = 60/treatment): (1) milk replacer (MR) without fatty acid supplementation and without access to a dry teat (control), (2) MR with fatty acid supplementation (NeoTec5g, Provimi, Brookville, OH) and without access to a dry teat (FAS), (3) MR without fatty acid supplementation and with access to a dry teat (TT), or (4) MR with fatty acid supplementation and with access to a dry teat (FAS+TT). Calves were housed in individual pens from 0 to 9 wk and then paired by treatment at wk 9. Milk replacer was fed twice daily using a step-up program. Fatty acid supplement was added to milk replacer at a feeding rate of 0.5 g/kg of body weight per head per day for the FAS and FAS+TT groups. Health exams were conducted twice weekly for 6 wk to diagnose BRD, navel inflammation, and diarrhea. Body weight, body condition score (BCS), and structural measurements were recorded at wk 0, 5, and 10. Average daily gain (ADG) was calculated for wk 1 to 5, wk 5 to 10, and wk 1 to 10. Health data were analyzed using logistic regression and are reported as relative risk. Body weight, BCS, and structural measurements were analyzed using repeated-measures ANOVA, and ADG was analyzed using a generalized linear model. There was no effect of FAS, TT, or their interaction on body weight or BCS. There was no effect of FAS on ADG wk 1 to 5, wk 5 to 10, or wk 1 to 10. There was a tendency for TT to decrease ADG from wk 1 to 5 but not from wk 5 to 10 or wk 1 to 10. There was a tendency for the interaction of FAS and TT to decrease ADG for wk 1 to 5 but not for wk 5 to 10 and wk 1 to 10. There was no effect of FAS, TT, or their interaction on the risk of BRD, diarrhea, or navel inflammation. We saw no effect of our interventions on calf health or growth. More research is needed to determine whether other factors, such as failure of passive transfer, poor ventilation, barren housing, and low milk allowance in the first few weeks after arrival, may have affected the efficacy of our interventions.

Effect of amount of milk replacer fed and the processing of corn in starter on growth performance, nutrient digestibility, and rumen and fecal fibrolytic bacteria of dairy calves.

The aim of this study was to evaluate effects of milk replacer (MR) feeding rate and processing of corn in calf starter (CS) on growth performance, nutrient digestibility, and rumen and fecal fibrolytic bacteria in dairy calves. Holstein male calves (n = 48, 2-3 d of age) were randomly assigned to 1 of 4 treatments with a 2 × 2 factorial arrangement of MR level of 0.749 kg of MR/d (LO) or up to 1.498 kg of MR/d (HI); and whole corn or flaked corn in textured CS. Calves were weaned by reducing MR offered by 50% during wk 6. Intakes of MR and CS were recorded daily, whereas body weight (BW) was measured weekly. Rumen fluid and fecal matter were collected at wk 5 and 8 to quantify fibrolytic bacteria and nutrient digestibility. Data were analyzed as a completely randomized design using mixed model ANOVA. Repeated measures were used as appropriate. Calves fed HI had greater average daily gain than calves fed LO at wk 2, 3, 4, and 5, yet at wk 7 calves fed HI had lower average daily gain compared with calves fed LO. Starter intake was greater for calves fed LO compared with HI at wk 4, 5, 6, and 7. During wk 5 and 8, calves fed LO had increased ADF and NDF digestibility compared with calves fed HI. During wk 5, dry matter and organic matter digestibility were lower for LO-fed calves compared with HI-fed calves, but during wk 8 the opposite was observed, with HI-fed calves having lower dry matter and organic matter digestibility than LO-fed calves. At wk 5, Clostridium cluster IV and Butyrivibrio fibrisolvens proportions in rumen fluid tended to be higher and Clostridium cluster IV, Fecalibacterium sp., and Prevotella sp. proportions in fecal matter were higher in calves fed LO compared with HI. From wk 8 to 16, dry matter intake was unaffected by treatment; however, energy efficiency was greater in calves fed LO, causing LO calves to have higher BW gain during this period. Greater starter digestibility was observed for calves fed LO versus HI in concert with increased fibrolytic bacteria proportions (wk 5) in fecal and rumen samples, which resulted in greater postweaning BW gain and similar BW and frame measurements by 16 wk of age. Overall the results show that rate of MR feeding has a larger effect than the processing of corn in CS on performance, fiber digestibility, and rumen and fecal fibrolytic bacterial communities.

Effects of milk replacer feeding rates on growth performance of Holstein dairy calves to 4 months of age, evaluated via a meta-analytical approach.

Our objective was to evaluate effects of feeding milk replacer (MR) at 2 feeding rates on digestion, intake, and growth of young dairy calves, via a meta-analytical approach using individual data. A database was developed from 10 published studies from the Nurture Research Center (Provimi; Brookville, OH), in which 26 dietary treatments and 491 calves from 0 to 8 wk of age in 13 nursery trials, and 22 dietary treatments and 485 calves from 8 to 16 wk of age in 13 grower trials occurred. Male Holstein calves (n = 491; initial body weight 42.8 ± 4.9 kg) were randomly assigned to 1 of 2 treatments: (1) moderate (MOD), 0.64 to 0.66 kg of dry matter (DM)/d for the first 35 to 39 d, followed by half the allotment per d for 3 to 7 d, fed at the a.m. feeding only; (2) high (HI), 0.92 to 1.07 kg of DM/d for the first 35 to 44 d, followed by half the allotment per d for 5 to 7 d, fed at the a.m. feeding only. Calves were weaned at 6 to 7 wk of age. Milk replacer ranged from 24.8 to 28.6% crude protein (CP) and 17.6 to 20.2% fat; starter ranged from 17.3 to 22.2% CP and 3.0 to 4.3% fat on a DM basis. On d 56 calves (n = 485) moved into pens (4 calves/pen) by treatments and were fed starter (19.4 to 22.3% CP and 3.4 to 4.6% fat, DM basis) blended with 5% hay until d 112. In all nursery trials (d 0 to 56), calves fed MOD had lower average daily gain (ADG; 0.634 vs. 0.545 kg/d), gain/DMI (0.488 vs. 0.466 kg/kg), and hip width change (0.069 vs. 0.064 cm/d), but greater starter intake (0.473 vs. 0.696 kg/d) compared with calves fed HI. Apparent total-tract digestibility of DM (73.3 vs. 78.4%), organic matter (OM; 74.1 vs. 79.0%), CP (74.8 vs. 78.9%), and neutral detergent fiber (NDF; 40.8 vs. 53.9%) were greater for calves fed MOD vs. HI when estimated during wk 8. In all grower trials (d 56 to 112), ADG (1.015 vs. 0.976 kg/d), gain/DMI (0.375 vs. 0.349 kg/kg), and hip width change (0.089 vs. 0.081 cm/d) were greater, but dry feed intake per kg of BW0.75 did not differ (87.8 vs. 88.2 g/d) for calves previously fed MOD vs. HI. Apparent digestibility of DM (78.7 vs. 76.0%), OM (79.8 vs. 77.0%), CP (80.5 vs. 78.4%), and NDF (54.8 vs. 45.8%) were greater for calves fed MOD vs. HI when estimated between wk 11 to 13. Over the entire 112-d period, calves fed MOD had lower ADG (0.805 vs. 0.784 kg/d) but tended to have greater hip width change (8.415 vs. 8.589 cm) compared with calves fed HI. Under the conditions of this study, feeding higher MR rates caused calves to partially lose growth advantage during the weaning transition and further decreased BW gain and structural growth in the grower period (d 56 to 112), which could be due to reductions in nutrient digestibility as a result of feeding more MR.

Short communication: Performance, intestinal permeability, and metabolic profile of calves fed a milk replacer supplemented with glutamic acid.

The objective of this study was to evaluate the potential benefits of supplementing glutamic acid in milk replacers (MR) with respect to calf performance, intestinal permeability, and metabolism. Sixty Holstein male calves (3 ± 1.3 d old and 45 ± 5.9 kg body weight) were individually housed and fed a control MR without AA supplementation (24.8% crude protein and 19.1% fat, dry matter basis), or MR supplemented with 0.3% glutamic acid (25.1% crude protein and 20.3% fat, dry matter basis). Animals followed the same MR feeding program and were weaned at 56 d of the study. The amount of starter concentrate offered was restricted to limit the effect of concentrate intake on calf metabolism. Individual daily consumption and weekly body weight were measured, and 4 h after the morning feeding, blood samples were obtained at 14 and 35 d to determine general biochemical parameters and plasma AA concentrations. On d 10 of the study, we conducted an intestinal permeability test by including 21 g of lactulose and 4.2 g of d-mannitol as markers in the MR. We found no differences in calf performance or in intestinal permeability (measured as lactulose:mannitol ratio). Serum glucose concentration was greater in unsupplemented calves than in Glu-supplemented calves. At 14 d, the proportion of plasma Leu was greater in Glu-supplemented calves; the proportion of Ile tended to be greater in Glu-supplemented calves; and the proportion of Met tended to be greater in unsupplemented calves. We observed no other differences. Small changes occurred in AA metabolism when supplementing calf MR with 0.3% glutamic acid, without leading to improvements in calf performance or changes in intestinal permeability.

Effects of milk replacer feeding levels on performance and metabolism of preweaned dairy calves during summer.

The objective of this study was to evaluate the effect of milk replacer (MR) feeding programs on performance and metabolism during summer. At 3 d of age (DOA), calves were randomly assigned to 1 of 4 dietary treatments: control [CON; 0.55 kg dry matter (DM) of a 20% crude protein (CP) and 20% fat MR per day], intermediate (IL; 0.66 kg DM of a 26% CP and 17% fat MR per day), high (HL; 0.77 kg DM of a 26% CP and 17% fat MR per day), or aggressive (AL; 0.87 kg DM of a 26% CP and 17% fat MR per day). Calves were managed similarly and housed in individual polyethylene hutches using sand as a bedding material. Because 3 calves fed the AL diet developed abomasum bloating during the first 30 DOA, the AL treatment was terminated. Milk replacer (12.5% solids) was offered twice daily until 42 DOA, when MR was fed once daily to reduce its intake by 50%. Calves were weaned at 49 DOA and remained in hutches until 56 DOA. Calf starter and water were offered ad libitum. Ambient temperature and relative humidity in and outside the hutches were assessed hourly. Starter and MR intakes were recorded daily. Respiration rate and rectal temperature were determined 3 times each week. Body weight was measured at 3, 14, 28, 42, and 56 DOA. Plasma was collected at 5, 10, 14, 28, 42, 43, 45, 47, 49, 51, and 56 DOA for analysis of glucose, ß-hydroxybutyrate, triglycerides, nonesterified fatty acids, urea nitrogen, and insulin concentrations. There were no treatment effects on starter intake, rectal temperature, or respiration rate. By 7 DOA, calves fed the IL and HL diets consumed the same amount of MR and a higher amount of MR than the CON calves. At wk 2, calves from all treatments had similar MR consumption before returning to the projected intake by design at wk 4. Calves fed the IL and HL treatments had similar body weight but were heavier than those fed the CON diet at wk 6, 7, and 8. Calves fed the IL and HL diets had similar average daily gain, which was higher than that of calves fed the CON diet. There was no difference in plasma metabolites among treatments, but insulin concentration increased as milk allowance increased. In summary, feeding an intermediate level of MR during summer improved calf growth compared with the CON diet, but a higher MR allowance did not support further improvements in calf performance.

Pre-weaning plane of nutrition and Mannheimia haemolytica dose influence inflammatory responses to a bovine herpesvirus-1 and Mannheimia haemolytica challenge in post-weaning Holstein calves.

The objectives of this study were to determine whether plane of nutrition (PON) of milk replacer previously provided to calves, and dosage level of Mannheimia haemolytica (MH), influenced inflammatory responses to a combined viral-bacterial respiratory challenge. Holstein calves (1 d of age; n = 30) were assigned to treatments in a 2 × 3 factorial with pre-weaning PON and MH dose as main effects (n = 5 per treatment). Calves were fed either a low (LPN; n = 15) or a high PON (HPN; n = 15) from birth through weaning. Calves fed LPN were fed 436 g of dry matter (DM) per day of milk replacer until weaning, and HPN calves were fed 797 g of DM per day of milk replacer from d 1 to 10 and 1,080 g of DM per day from d 11 until weaning. Calf starter and water were offered ad libitum. Calves were step-down weaned beginning at d 54 and moved into an enclosed barn at d 70. Indwelling rectal temperature (RT) recording devices and jugular catheters were inserted at d 80. Calves were challenged with 1.5 × 108 plaque-forming units (pfu) per mL of bovine herpesvirus-1 (BHV-1) in each nostril at d 81 and with either 106, 107, or 108 cfu of MH at d 84. Blood samples were collected at varying intervals relative to BHV-1 and MH challenges. Four LPN calves either died or were euthanized soon after the 144-h observation period, whereas all HPN calves survived the entire observation period. As dosage of MH administered increased, acute and systemic inflammatory responses increased. Higher doses of MH resulted in increased leukocyte, neutrophil, and haptoglobin concentrations in infected calves. Data from the current study suggest that the highest dose, 108 cfu, triggered weaned calves' acute disease response, whereas the lower doses, 106 and 107 cfu, caused more moderate inflammation and disease. The effects of PON on inflammation responses to the disease challenge indicated that calves previously fed the LPN diet had more severe pathophysiological responses. Calves fed LPN showed higher peripheral neutrophil and leukocyte counts and serum haptoglobin concentrations following the BHV-1 challenge. Additionally, following the MH challenge, LPN calves had higher peripheral neutrophil counts, neutrophil-to-lymphocyte ratios, and serum tumor necrosis factor-α concentrations. These data demonstrate that higher doses of MH increase the acute inflammatory response and prolong inflammation, and that calves previously fed LPN responded more severely to the combined viral-bacterial respiratory challenge.

Effects of ad libitum milk replacer feeding and butyrate supplementation on the epithelial growth and development of the gastrointestinal tract in Holstein calves.

Intensive milk feeding and butyrate supplementation in calves stimulate body growth and affect gastrointestinal development. The aim of the present study was to investigate the synergistic effects of ad libitum milk replacer (MR) feeding and butyrate supplementation of MR on rumen and small intestinal growth and on gene expression in the small intestine related to growth and energy metabolism at weaning. Male Holstein calves (n = 32) received colostrum from birth to d 3 of age and MR either ad libitum (Adl) or restrictively (Res; 6 L of MR/d; 12.5% solids) with (AdlB+, ResB+) or without (AdlB-, ResB-) 0.24% butyrate from d 4 until wk 8 of age. From wk 9 to 10, all calves were weaned and were fed 2 L/d until the end of the trial. Concentrate, hay, and water were freely available. At d 80, calves were slaughtered, volatile fatty acids were measured in rumen fluid, and rumen and small intestine samples were taken for histomorphometric measurements. The expression of mRNA associated with the local insulin-like growth factor (IGF) system and glucose metabolism as well as lactase and maltase activities were measured in the intestinal mucosa. The small intestine was 3 m longer in Adl than in Res. In the atrium ruminis, papilla width was greater in Res than in Adl. Villus circumference, cut surface, and height in the duodenum, proximal jejunum, and ileum were greater in Adl than in Res and in the proximal, mid, and distal jejunum and ileum were greater in calves treated with butyrate. Crypt depth in the duodenum and proximal jejunum was greater in Adl than in Res and in the ileum was smaller in calves treated with butyrate. The villus height:crypt depth ratio was greatest in AdlB+ calves. In the proximal and mid jejunum, IGF1 mRNA abundance was lower in calves treated with butyrate. In the proximal jejunum, INSR mRNA abundance was greater in Res than in Adl. The abundance of PCK2 mRNA was greater in Res than in Adl in the duodenum and was greatest in ResB- in the mid jejunum. Lactase activity tended to be greater in Res than in Adl and after butyrate treatment in the proximal jejunum. The results indicated an elevated growth of the small intestinal mucosa at weaning due to intensive milk feeding and butyrate supplementation, and the local IGF system was involved in intestinal growth regulation. Rumen development was not affected by butyrate supplementation of MR and was slightly delayed due to ad libitum MR feeding.

Short communication: Effects of porcine plasma or combined sodium butyrate and Bacillus subtilis on growth and health of grain-fed veal calves.

The objective of this study was to evaluate the effects of incorporating 2 commonly used additives or spray-dried porcine plasma in calf milk replacer (CMR) on calf performance and health. Male Holstein calves (n = 158) transported from auction barns and local dairy farms were randomly assigned to receive 1 of 3 decoquinate-containing CMR for the first 49 d of the experiment: all milk protein and no additives (CONT); 15% of crude protein (CP) replaced with spray-dried porcine plasma, no additives (PLM); or all milk protein and an added combination of sodium butyrate (rate 1.4 kg of butyric acid/Mt) and Bacillus subtilis (1.28 million cfu/g of feed; BB). All milk replacers were formulated to contain 26% CP and 17% fat, 2.4% Lys, and 0.8% Met, and were bucket-fed at daily feeding rates of 520 g during wk 1 and 2, 650 g during wk 3, and 900 g during wk 4 and 5, in a total of 4, 5, and 6 L of solution, respectively. Calves were offered texturized calf starter (18% CP) upon arrival until wk 3 and transitioned to a corn and pellet ration with 2% straw (18.1% CP). No prophylactic administration of antibiotics occurred. All calves were gradually weaned over a 2-wk period. Calves were individually housed until weaned and then housed in groups of 5 in a mechanically ventilated facility in southwestern Ontario, Canada. Fecal scores, treatments administered (antibiotic or supportive therapy), and mortalities were recorded daily. Body weight was measured using a digital scale at arrival and at 14, 49, 56, and 78 d after arrival. No differences were found among the groups with respect to growth, feed efficiency, or incidence of diarrhea or respiratory infection treatment. Calves supplemented with BB had a greater hazard of mortality over the growing period compared with CONT. An interaction was found between the BB group and the level of total serum protein, with the BB group having a lower proportion of days with a fecal score of 3 when the calves had a higher total serum protein level. Calves fed PLM had a lower proportion of d with a fecal score of 3 relative to CONT but no difference in the proportion of d with a fecal score of 2 or higher. This study found that the addition of spray-dried plasma in CMR reduced diarrhea severity; however, supplementing BB was associated with a higher hazard of calf mortality and had a varying response on fecal score.

[Milk and dairy products as vehicle for calcium and vitamin D: role of calcium enriched milks]. / Leche y productos lácteos como vehículos de calcio y vitamina D: papel de las leches enriquecidas.

INTRODUCTION: Milk and dairy products are key foods during all stages of life within a balanced Western diet. In recent decades, their consumption has decreased significantly. In parallel, an increase in some pathological alterations caused by the deficit of some micronutrients present in dairy products, mainly calcium and vitamin D, has been detected, resulting in a serious public health problem in certain groups of population. In order to avoid these deficiencies, foods enriched in these components have been launched into the market. Within them, enriched milks and dairy products stand out since they allow better bioavailability of calcium and are natural sources of vitamin D. Several studies have been carried out to demonstrate the benefit of supplementation with calcium and vitamin D enriched milks in vulnerable groups such as older adults and postmenopausal women. Those studies have reported a substantial improvement of bone turnover and an increase of bone density and strength. The aim of the present work is to revise the importance of milk-derived calcium intake on health, and the usefulness of calcium-enriched milks for allowing adequate calcium consumption without dietary modifications in certain groups of population. Likewise, it is intended to clarify the errors and myths that have recently arisen in relation to certain foods that seek to replace milk and dairy product, based on their differences in composition, bioavailability and health effects.

INTRODUCCIÓN: La leche y sus derivados son alimentos fundamentales durante todas las etapas de la vida dentro de una dieta occidental equilibrada. En las últimas décadas, su consumo ha disminuido notablemente y de forma paralela se ha detectado un aumento de algunas alteraciones provocadas por la carencia de micronutrientes presentes en los productos lácteos, principalmente calcio y vitamina D, lo que está derivando en un grave problema de salud pública en determinados grupos de población. Para intentar solucionar estos problemas, se han incorporado al mercado alimentos enriquecidos en estos componentes, dentro de los que destacan los productos lácteos porque proporcionan mejor biodisponibilidad del calcio y son fuentes de vitamina D, por lo que son los más recomendables. Se han realizado diversas investigaciones que demuestran el beneficio que supone la suplementación con leche enriquecida en calcio y vitamina D en grupos vulnerables como los adultos mayores y las mujeres posmenopáusicas, en los que mejora sustancialmente el recambio óseo y aumenta la densidad y la fuerza de los huesos. El objetivo de este trabajo es revisar la importancia que tiene el consumo del calcio de la leche, así como las recomendaciones actuales de ingesta, y analizar la utilidad de las leches enriquecidas en calcio para determinados grupos de población como alternativa para aumentar las ingestas de este mineral y también de vitamina D. Asimismo, se pretende clarificar los errores y mitos que han surgido recientemente en relación a determinados alimentos que pretenden sustituir a la leche y sus derivados, basándonos en sus diferencias de composición, biodisponibilidad y efectos sobre la salud.

Predictors of breast milk substitute feeding among newborns in delivery facilities in urban Cambodia and Nepal.

Introducing breast milk substitutes (BMS) in the first days after birth can increase infant morbidity and reduce duration and exclusivity of breastfeeding. This study assessed determinants of BMS feeding among newborns in delivery facilities in Phnom Penh, Cambodia, and Kathmandu Valley, Nepal. Cross-sectional surveys were conducted among mothers upon discharge from health facilities after delivery: 304 mothers in Kathmandu Valley and 306 mothers in Phnom Penh participated. On the basis of a conceptual framework for prelacteal feeding, multivariable logistic regression was used to identify factors associated with BMS feeding prior to facility discharge. In both Phnom Penh and Kathmandu Valley, feeds of BMS were reported by over half of mothers (56.9% and 55.9%, respectively). Receiving a health professional's recommendation to use BMS increased the odds of BMS feeding in both Kathmandu Valley and Phnom Penh (odds ratio: 24.87; confidence interval [6.05, 102.29]; odds ratio: 2.42; CI [1.20, 4.91], respectively). In Kathmandu Valley, recommendations from friends/family and caesarean delivery were also associated with BMS use among mothers. Early initiation of breastfeeding and higher parity were protective against the use of BMS in Kathmandu Valley. Breastfeeding support from a health professional lowered the odds of BMS feeding among newborns. Exposure to BMS promotions outside the health system was prevalent in Phnom Penh (84.6%) and Kathmandu Valley (27.0%) but was not associated with BMS feeds among newborns. Establishment of successful breastfeeding should be prioritized before discharging mothers from delivery facilities, and health professionals should be equipped to support and encourage breastfeeding among all new mothers.

Evaluación del contenido nutricional de productos lácteos en programa de alimentación venezolano / Evaluation of the nutritional content of dairy products in the Venezuelan food program

En Venezuela se distribuyen productos lácteos en polvo a través de los Comité Locales de Abastecimiento y Producción (CLAP). Con el objetivo de evaluar la composición nutricional de catorce marcas de productos lácteos provenientes de industrias mexicanas y distribuidos en Venezuela, se realizó un estudio descriptivo y transversal, con muestreo a conveniencia de 14 marcas de lácteos obtenidas en hogares beneficiados del área metropolitana de Caracas-Venezuela. Se cotejó la información presentada en el rotulado del producto y se efectuó un análisis químico de la composición nutricional. Los valores obtenidos se compararon utilizando como referencia a la norma COVENIN. En el etiquetado se encontró que sólo 2 marcas se denominan producto lácteo y el 43% de las marcas expresan el mismo contenido nutricional en el rótulo. En la analítica química se encontró inexactitud con la información presentada en el etiquetado nutricional. El análisis de componentes principales seguido de un conglomerado jerárquico permitió diferenciar 4 clúster o grupos: 2 reales y 2 ideales. La mayoría de los productos analizados son significativamente más altos en carbohidratos y sodio (p<0,05), además de bajos en proteínas y calcio (p<0,05). En conclusión, todas las muestras evaluadas incumplen la normativa correspondiente, al presentar irregularidades en la denominación del producto e informar valores que no se corresponden con el contenido nutricional resultante de los análisis químicos(AU)

In Venezuela, powdered milk products are distributed through the Local Supply and Production Committee (CLAP). The objective was to evaluate the nutritional composition of fourteen brands of dairy products from Mexican industries distributed in Venezuela, a descriptive and cross-sectional study was conducted, with convenience sampling of 14 brands of dairy products obtained in households benefiting from the Caracas Metropolitan area - Venezuela. The information presented in the product labeling was checked and a chemical analysis of the nutritional composition was performed. The values obtained were compared using the COVENIN standard as a reference. In the labeling, it was found that only 2 brands are called dairy products and 43% of the brands express the same nutritional content on the label. The chemical analysis showed inaccuracy with the information presented in the nutritional labeling. The analysis of principal components followed by a hierarchical conglomerate allowed us to differentiate 4 clusters or groups: 2 real and 2 ideal. Most of the products analyzed are significantly higher in carbohydrates and sodium (p <0.05), as well as low in protein and calcium (p <0.05). In conclusion, all the samples evaluated fail to comply with the corresponding regulations, presenting irregularities in the product name and reporting values that do not correspond to the nutritional content resulting from chemical analyzes(AU)

Effect of energy source in calf milk replacer on performance, digestibility, and gut permeability in rearing calves.

Current calf milk replacer (CMR) compositions significantly differ from whole milk in their levels of energy, protein, and minerals. Energy source is one of the major differences, as CMR contains high levels of lactose, whereas whole milk contains higher levels of fat. The aim of this study was to determine the effect of partially exchanging lactose for fat on performance, digestibility, and gut permeability in calves fed twice daily on a high feeding plane. Lactose and fat were exchanged in the CMR formulation on a weight-weight basis. The CMR were isonitrogenous but not isoenergetic. A total of 60 male Holstein-Friesian calves were assigned to 1 of 30 blocks based on serum IgG, body weight, and date of collection after birth. Within each block, calves were randomly assigned to 1 of 2 treatments: high fat and high lactose. The CMR was provided twice daily until 49 d of age, followed by a gradual weaning period of 14 d. Starter, straw, and water were available ad libitum throughout the complete study. Exchanging lactose for fat did not affect growth; intakes of starter, straw, water, crude protein, or total energy; or apparent total-tract digestibility of nutrients. Gastrointestinal permeability was assessed by measuring the recovery of lactulose and Cr in 24-h urine and the Cr concentration and lactulose:d-mannitol ratio in serum following an oral pulse dose. Urinary recoveries of Cr and lactulose were generally low in both treatments but were higher in calves fed the high-fat CMR. Accordingly, the serum lactulose:d-mannitol ratio and serum Cr concentrations were higher in calves fed the high-fat CMR. In wk 1 and during the weaning transition, calves fed the high-fat CMR had significantly fewer abnormal fecal scores. In conclusion, exchanging lactose for fat in the CMR did not affect growth performance, total feed intake, or nutrient digestibility. The high-fat CMR was associated with an increase in permeability markers but positively influenced fecal scores in calves.

Performance of ad libitum fed dairy calves weaned using fixed and individual methods.

The increasing availability of automated milk dispensers on dairy farms facilitates ad libitum milk supply but weaning calves from high milk allowances is challenging. This study evaluated effects of gradual weaning methods on starter intake, growth, selected blood parameters and weaning distress in ad libitum fed dairy calves during weaning and early post-weaning periods. Thirty-six male Holstein (n = 30) or crossbred (n = 6) calves were individually housed from days 2 to 14 of age and had ad libitum access to milk replacer (MR) from teat buckets. From days 15 to 84 of age, calves were grouped and had ad libitum access to MR, starter, straw and water from automated feeders. At day 35, calves were blocked (age and breed), and randomly assigned to a weaning method: (1) linear fixed (LIN), MR supply was stepped down to 6 l/day on day 36, and linearly reduced between days 36 to 63 from 6 to 2 l/day. (2) Step-down (STEP), MR supply was stepped down to 6 l/day from days 36 to 48, 4 l/day from days 49 to 56 and 2 l/day from days 57 to 63. (3) Dynamic (DYN), at day 36, MR supply was reduced for each individual calf to 75% of the average voluntary consumption between day 29 and 35, then maintained for 9 days, reduced to 50% for 10 days, and to 25% for 9 days. The DYN calves received more MR during weaning than LIN calves, whereas STEP calves had intermediate MR intake. Starter intake was not affected by weaning method. The DYN calves (1.33±0.08 kg/day) grew faster and were heavier than STEP calves (1.10±0.08 kg/day) during post-weaning period, whereas no difference was observed between LIN calves (1.23±0.08 kg/day) and others. At days 70 and 84, concentrations of ß-hydroxybutyric acid were higher in LIN calves compared to STEP and DYN calves. Hair cortisol concentrations were not affected by weaning method. During the gradual weaning process CP intake seemed to recovered earlier than metabolizable energy (ME) intake in all treatments, suggesting that ME rather than CP could be the first limiting factor for growth during weaning. These results highlight the post-weaning benefits of DYN and LIN weaning methods when compared with more abrupt step-down strategies.

Effects of gradual and later weaning ages when feeding high milk replacer rates on growth, textured starter digestibility, and behavior in Holstein calves from 0 to 4 months of age.

The objectives of this study were to evaluate calf performance, diet digestibility, and behaviors when feeding 4 milk replacer (MR) programs with different MR rates, weaning ages, and MR reduction steps. Male Holstein calves (n = 96; 40 ± 1 kg of body weight; 1 to 2 d of age) were housed in individual pens for 56 d. Feeding programs for MR were 0.66 kg for 35 d; then 0.33 kg for 7 d fed only in the a.m. (0.6 kg); 0.66 kg for 7 d, 0.82 kg for 35 d, 0.33 kg for 4 d in a.m. only, and 0.22 kg for 3 d in a.m. only (0.8 kg); 0.66 kg for 7 d, 0.82 kg for 7 d, 1.1 kg for 21 d, 0.82 kg for 7 d, 0.33 kg for 4 d in a.m. only, and 0.22 kg for 3 d in a.m. only (1.1 kg); and ad libitum allowance for 35 d, 0.82 kg for 7 d, 0.44 kg for 4 d in a.m. only, and 0.22 kg for 3 d in a.m. only (ad lib). Calves were fed a common MR [25% crude protein, 17% fat, dry matter (DM) basis]. A textured calf starter with whole corn and oats (20% crude protein and 39% starch, DM basis) and water were fed for ad libitum intake during the nursery trial. Daily behavior duration (rumination, eating, and activity) was continuously recorded from d 1 to 55 for 4 calves/treatment using ear tag accelerometers (CowManager SensOor; Agis, Harmelen, the Netherlands). All calves were moved into groups by MR program (4 calves/pen) at 56 d and fed the same starter blended with 5% grass hay. Fecal samples were collected from individual calves between d 52 to 56 and from pen floors on d 66 to 70 to estimate total-tract digestibility. Data were analyzed as a randomized complete block design with repeated measures when appropriate. Intake of MR averaged 25.3, 35.3, 40.9, and 46.5 kg of DM per calf for 0.6 kg, 0.8 kg, 1.1 kg, and ad lib treatments, respectively. Starter intake was greatest for 0.6 kg compared with others and average daily gain (ADG) differed among all 4 programs with 0.6 kg < 0.8 kg < 1.1 kg < ad lib during d 0 to 56. Intake of MR for ad lib was highly variable and was reflected in ADG. Daily rumination, eating, and activity durations did not differ among treatments from d 1 to 55 of the nursery trial. Digestibility of DM, organic matter, acid and neutral detergent fiber, and sugar at d 52 to 56 were greater for 0.6 kg versus ad lib. Digestibility of DM at d 66 to 70 differed for all treatments with 0.6 kg > 0.8 kg > 1.1 kg > ad lib and was mostly influenced by fiber digestibility. During the grower trial (d 56 to 112), ADG was greater for 0.6 kg versus 1.1 kg and ad lib. Hip width change was greater for 0.6 kg versus other treatments. Feeding more than 0.6 kg/d of MR increased ADG preweaning, but reduced diet digestibility postweaning resulted in similar calf BW and frame size by 4 mo of age among MR feeding programs.

Survey of biochemical and oxidative profile in donkey foals suckled with one natural and one semi-artificial technique.

Dairy donkey milking procedures require separating foals from their dams for a few hours a day. Artificial suckling in this species is a good technique for improving milk production and foal welfare. The aim of the work is to compare the effect of two different diets on donkey foals when separated from jennies for milking procedures with and without a milk replacer. Forty newborn Martina Franca donkey foals were subdivided into two experimental groups. Both groups were separated from their respective dams from 8.00to 20.00to allow the jennies to be milked. During the separation, all the foals had access ad libitum to water, hay and feed. During the separation period, one group had the availability of a mechanical milk replacer dispenser, so foals were partially artificially suckled (AS), while the other group had no milk replacer available, and so were totally naturally suckled (NS). The AS group had milk replacer availability until 120±7d of life. Both groups were naturally weaned at 168±7d. Blood samples were collected weekly starting from birth until two wks after weaning (i.e. at 182d), from all the foals included in the trial. Almost all the analytes were influenced by suckling technique and age of foals. Alanine-aminotransferase, aspartate-aminotransferase, alkaline phosphatase, NEFA, lipid hydroperoxides, serum proteins showed the greatest differences between the two experimental groups. Separating foals from their dams for 12hdaily for 24 weeks does not lead to pathological subclinical and metabolic conditions, thus confirming the high rusticity and resistance of the donkey.