Energy requirements of breast-fed infants

Current recommendations for energy intake are reviewed in light of emerging data on energy intakes of breast-fed infants and on total daily energy expenditure of infants. For determination of energy requirements, the historical approach based on observed intakes of healthy infants is compared with a newly proposed approach based on energy expenditure and deposition. A data set of exclusively breast-fed infants is used to illustrate the circuity of either approach. Energy intake, expenditure, and stores must be evaluated in an assessment of dietary adequacy. Ultimately, energy requirements of infants should reflect growth rate, body composition, and level of physical activity conducive to optimal health and neurobehavioral development.     

Physical growth of breast-fed and formula-fed infants from birth to age two years

Weight and length data were collected from birth to age two years on the growth of 159 infants breast-fed for 2–15 months and 150 formula-fed infants. Breast-fed male infants were significantly lighter than formula-fed infants at 6 and 12 months of age (p=0.03 and p=0.009 respectively), but at 24 months the differences were not significant. Breast-fed white females weighed less at 24 mo than their formula-fed counterparts. Using two weight to length indices, statistically significantly fewer infants who were breast-fed for longer periods were categorized as overweight. Incremental weight, weight gain per unit time, was statistically significant only for white males at 6 and 12 months of age. The data suggest that longer breast feeding affects weight and not length.     

Protein-degradation products and bacterial enzyme activities in faeces of breast-fed and formula-fed infants

The aim of the present study was to determine the effects of age and diet (breast milk, formula milk and weaning diet) on metabolic activities in faecal samples from infants aged 1 week to 1 year, and to compare these findings with activities found in samples from adults. Such activities can provide valuable information on functional changes in the microbiota that may have significance for the health of the host. Fresh faecal samples were collected from forty-four breast-fed infants (twenty-four males, twenty females) and thirteen formula-fed infants (three males, ten females) throughout the first year of life. The samples were analysed for protein-breakdown products, including the faecal concentrations of NH3, phenol and p-cresol, and faecal bacterial enzyme activities. There was wide individual variation in all variables measured; however, the values in infants were substantially lower then those found in adults. In pre-weaned infants, faecal NH3 concentration and beta-glucuronidase activity were the only endpoints that were significantly different in breast-fed and formula-fed infants (P<0.001 and P<0.05 respectively). This was not apparent after weaning. There was a significant difference between the breast-fed and formula-fed weaned groups and their pre-weaned counterparts only for NH3 (P<0.05). beta-Glucuronidase activity and phenol concentration were significantly (P<0.01) greater in weaned breast-fed infants compared with pre-weaned breast-fed infants. No differences were observed between pre-weaned and weaned formula-fed infants for any of the variables except for NH3 concentration. It can be concluded from the present study that there are significant differences in two faecal characteristics between breast- and formula-fed infants and that changes occur as the infants grow older and are weaned onto solid foods.     

Comparison of the gut microbiota profile in breast-fed and formula-fed Korean infants using pyrosequencing

BACKGROUND/OBJECTIVES

Feeding in infancy is the most significant determinant of the intestinal microbiota in early life. The aim of this study was to determine the gut microbiota of Korean infants and compare the microbiota obtained between breast-fed and formula-fed Korean infants.

SUBJECTS/METHODS

We analyzed the microbial communities in fecal samples collected from twenty 4-week old Korean (ten samples in each breast-fed or formula-fed) infants using pyrosequencing.

RESULTS

The fecal microbiota of the 4-week-old Korean infants consisted of the three phyla Actinobacteria, Firmicutes, and Proteobacteria. In addition, five species, including Bifidocbacterium longum, Streptococcus salivarius, Strepotococcus lactarius, Streptococcus pseudopneumoniae, and Lactobacillus gasseri were common commensal intestinal microbiota in all infants. The predominant intestinal microbiota in the breast-fed infants (BFI) included the phylum Actinobacteria (average 70.55%), family Bifidobacteriacea (70.12%), genus Bifidobacterium (70.03%) and species Bifidobacterium longum (69.96%). In the microbiota from the formula-fed infants (FFI), the proportion of the phylum Actinobacteria (40.68%) was less, whereas the proportions of Firmicutes (45.38%) and Proteobacteria (13.85%) as well as the diversity of each taxonomic level were greater, compared to those of the BFI. The probiotic species found in the 4-week-old Korean infants were Bifidobacterium longum, Streptococcus salivarius, and Lactobacillus gasseri. These probiotic species accounted for 93.81% of the microbiota from the BFI, while only 63.80% of the microbiota from the FFI. In particular, B. longum was more abundant in BFI (69.96%) than in FFI (34.17%).

CONCLUSIONS

Breast milk supports the growth of B. longum and inhibits others. To the best of our knowledge, this study was the first attempt to analyze the gut microbiota of healthy Korean infants according to the feeding type using pyrosequencing. Our data can be used as a basis for further studies to investigate the development of intestinal microbiota with aging and disease status.     

Evaluation of test-weighing for the assessment of milk volume intake of formula-fed infants and its application to breast-fed infants

Test-weighing (TW) was evaluated in formula-fed (FF) infants by comparison with direct measurement (DM) of formula intake during a 24 h period at 1, 2, 4 and 6 mo of age. Formula intakes estimated by TW ranged from 87 to 93% of those determined by DM over the 6-mo period. During the study period the number of feedings per day decreased but were not significantly different for FF and BF infants. Volume of intake per feeding by FF infants increased significantly during the 6-mo period whereas milk intakes of BF infants were not different at the four ages studied. These data indicated that when the number of daily feedings decreased with age, FF infants increased their volume of intake per feeding whereas BF infants did not adjust their intakes. Mean volume of milk intake at 4 and 6 mo, estimated by TW, was significantly greater in FF infants compared to breast-fed (BF) infants matched for age and size. Data from this study indicated clearly that when milk intakes of BF infants are compared to those of FF infants, both groups of infants should be test-weighed.     

Earlier appearance of the ossification center of the femoral head in breast-fed versus formula-fed infants

ObjectiveThe aim of this study was to evaluate possible differences in the rate of appearance of the femoral head ossification center (FHOC) in infants according to the type of feeding (exclusive breast-feeding, formula, mixed feeding).MethodsA retrospective study was conducted in a population of 285 healthy infants who consecutively underwent echographic evaluation of the hip as a screening for hip dysplasia from April 1 through October 31, 2008. For each infant, type of feeding, sex, gestational age, weight at birth, and age at the time of echographic examination were recorded. Data analysis was performed in the entire sample population and in a subpopulation of 143 infants after exclusion of preterm or low-birth-weight infants and those who underwent echographic examination outside the scheduled age range. Data were analyzed by chi-square test, Kruskal–Wallis test, and multiple logistic regression analysis.ResultsAn FHOC was present in 48.3% of breast-fed infants, 25.7% of formula-fed infants, and 28% of the mixed feeding group (P = 0.001). In multiple logistic regression analysis, the best regression model included the following variables: age at test (P = 2.23 × 10^?7), gestational age (P = 0.0017), and exclusive breast-feeding (P = 0.0003). Similar results were obtained in the selected subpopulation of 143 infants (FHOC in 54.2% of breast-fed group, 28.2% of formula-fed group, and 33.3% of mixed-feeding group, P = 0.01).ConclusionExclusive breast-feeding may be associated to an earlier appearance of FHOC in a population of normal infants compared with formula feeding.     

Beta-glucuronidase and hyperbilirubinemia in breast-fed versus formula-fed babies.

Breast milk and formula milk and the corresponding serum samples from 20 breast-fed babies, 20 formula-fed babies, and their mothers were examined at 3 days of age for beta-glucuronidase enzyme. Serum indirect bilirubin levels were also examined for all the infants. Serum indirect bilirubin concentrations were significantly higher (p < 0.001) in breast-fed (4.87 +/- 2.4 mg/dl) than in formula-fed infants (1.04 +/- 0.5 mg/dl). beta-glucuronidase activity in formula milk was negligible, while that in human milk was considerable (468.26 +/- 220.8 Sigma units/ml) and was correlated (p < 0.05) with that in the serum of the breast-fed (66.13 +/- 18.1 Sigma units/ml) than in formula fed infants (52.08 +/- 11.9 Sigma units/ml) and a significant (p < 0.05) correlation was found between its serum level and serum indirect bilirubin in both breast and formula fed infants. Also in breast-fed infants serum bilirubin concentrations were related to beta-glucuronidase activity in breast milk (p < 0.05): Breast milk beta-glucuronidase--by facilitating intestinal reabsorption of bilirubin--seems to be an important factor in the neonatal hyperbilirubinemia of breast-fed babies.     

Serum T4 level in term newborns: Comparison between breast-fed and formula-fed infants

Serum thyroxine measurement ([¹²⁵I] T₄-RIA) was performed on the third day of life in 1759 normal, full-term infants. The T₄ concentrations were similar in the 680 formula-fed infants (16.32±0.09 μg/dl) and in the 1079 breast-fed infants (16.46±0.08 μg/dl). A male breast-fed infant was discovered to have hypo-TBG-emia. Our findings show that breast feeding from birth will not interfere with neonatal screening for hypothyroxinemia on the third day of life. Additionally, the mean T₄ value in the formulafed males was significantly lower than the breast-fed males, (15.88±0.13 μg/dl vs 16.32±0.11 μg/dl, p<0.01). Also, the formula-fed males has a significantly lower (p<0.01) T₄ concentration when compared with the formula-fed females.     

Nutritional effect of including egg yolk in the weaning diet of breast-fed and formula-fed infants: a randomized controlled trial

BACKGROUND: Egg yolks can be a source of docosahexaenoic acid (DHA) and iron but are often associated with adverse consequences on plasma cholesterol. OBJECTIVE: Our goal was to investigate the effect of consumption of 4 egg yolks/wk on infant DHA status and hemoglobin, ferritin, and plasma cholesterol concentrations. Secondary outcomes included plasma iron, transferrin, and transferrin saturation. DESIGN: This was a randomized controlled trial comparing no dietary intervention, consumption of 4 regular egg yolks/wk, and consumption of 4 n-3 fatty acid-enriched egg yolks/wk in breast-fed and formula-fed infants from 6 to 12 mo of age. Erythrocyte DHA concentrations, cholesterol, and iron status were assessed at 6 and 12 mo of age. RESULTS: Of the 82 breast-fed infants recruited, 23 of 28 (no intervention), 23 of 27 (regular eggs), and 24 of 27 (n-3 eggs) completed the trial. Of the 79 formula-fed infants enrolled, 23 of 27 (no intervention), 24 of 26 (regular eggs), and 20 of 26 (n-3 eggs) completed the trial. Erythrocyte DHA concentrations were 30-40% higher after the n-3 egg intervention than after treatment with regular eggs or no eggs in both breast-fed and formula-fed infants. Egg treatment had no significant effect on plasma cholesterol, hemoglobin, ferritin, and transferrin but did result in improvements in plasma iron and transferrin saturation compared with no egg treatment. CONCLUSIONS: n-3 Fatty acid-enriched eggs may provide a means of increasing dietary DHA during the second 6 mo of life. Egg yolks may also be a useful source of iron during the weaning period and can be safely included in the weaning diet with no perturbations in plasma cholesterol.     

Immunostimulatory effect of faecal Bifidobacterium species of breast-fed and formula-fed infants in a peripheral blood mononuclear cell/Caco-2 co-culture system

Bifidobacterium spp. typical of the human intestinal microbiota are believed to influence the balance of immune responses in the intestinal mucosa. The aim of the present study was to investigate the effect of different bifidobacterial species and their mixtures in in vitro experiments with peripheral blood mononuclear cells (PBMC) and Caco-2 cells. Bifidobacterium adolescentis, B. angulatum, B. breve, B. catenulatum, B. infantis, B. longum and two combinations of these bifidobacteria simulating the species composition found in faecal samples from breast-fed (BF) and formula-fed (FF) infants were used. The levels of several cytokines were measured by direct stimulation of PBMC and by stimulation of a Caco-2/PBMC co-culture with bifidobacteria. B. catenulatum and B. breve were the strongest enhancers of interferon-γ (IFN-γ) production by direct stimulation of PBMC. B. longum was the highest inducer of IL-10 and the lowest TNF-α stimulus. In the Caco-2/PBMC system, B. breve was the highest inducer of IL-8 production by Caco-2 cells, significantly different from B. infantis, B. adolescentis and the FF mixture (P?相似文献   

Nutritional rickets in breast-fed infants

A ten-year literature review was prompted by the fortuitous discovery of nutritional rickets in a "well child." Sixty-three cases were identified, suggesting that this disease is not so rare as thought. Rickets should be considered in the differential diagnosis of nonspecific musculoskeletal complaints and poor growth. Vitamin D supplementation in breast-fed children should be prescribed more often.     

Zinc requirements and zinc intakes of breast-fed infants

Longitudinal changes in dietary zinc requirements for infants at different levels of net absorption were estimated using a factorial approach. Apart from variations in net absorption, the zinc needed for new lean body mass is the major determinant of requirements. As growth velocity declines progressively, estimated zinc requirements for growth and for replacement of urine and sweat losses decrease from a high for male infants of 780 micrograms/day at 1 mo to 480 micrograms/day in the 5th mo and then remain quite constant through the 1st yr. Calculated percentage absorption of zinc from human milk necessary to meet estimated requirements increases with duration of lactation. For infants of mothers whose zinc intake approximated 25 mg/day the calculated percentage absorption remained within plausible limits. It is suggested that the progressive decrease in milk zinc concentrations provides a mechanism for conserving maternal zinc while meeting infant needs.     

Macro- and trace-mineral intakes of exclusively breast-fed infants

Intakes of calcium, phosphorus, magnesium, zinc, sodium, potassium, iron, and copper of 45 exclusively breast-fed infants were determined during the first 4 mo of life. Direct 24-h measurements of milk intake and mineral contents of human milk were used to estimate mineral intakes. Daily intakes of Ca, P, Zn, K, Na, Fe, and Cu decreased significantly over the study period while the intake of Mg increased. With the exception of Mg, mineral intakes on a weight basis displayed significant quadratic trends over the 4 mo. In spite of seemingly low-mineral intakes, growth progressed satisfactorily.     

Flavor variety enhances food acceptance in formula-fed infants

BACKGROUND: Research in humans and animal models suggests that acceptance of solid foods by infants during weaning is enhanced by early experiences with flavor variety. OBJECTIVE: We tested the hypotheses that the acceptance of novel foods by formula-fed infants could be facilitated by providing the infants with a variety of flavors at the time when beikost is first introduced and that, contrary to medical lore, infants who had previously consumed fruit would be less likely to reject vegetables when first introduced than would infants without such an experience. DESIGN: The infants' acceptance of a novel vegetable (puréed carrot) and a novel meat (puréed chicken) was evaluated after a 9-d exposure period in 3 groups of infants, some of whom had previously consumed fruit. During the home-exposure period, one group was fed only carrots, the target vegetable; a second group was fed only potatoes, a vegetable that differed in flavor from carrots; and a third group was fed a variety of vegetables that did not include carrots. RESULTS: Infants fed either carrots or a variety of vegetables, but not those fed potatoes, ate significantly more of the carrots after the exposure period. Exposure to a variety of vegetables also facilitated the acceptance of the novel food, puréed chicken, and daily experience with fruit enhanced the infants' initial acceptance of carrots. CONCLUSION: These findings are the first experimental evidence to indicate that exposure to a variety of flavors enhances acceptance of novel foods in human infants.     

Phenylalanine kinetics differ between formula-fed and human milk-fed preterm infants

Infants fed casein-dominant formulas have higher plasma phenylalanine and tyrosine concentrations than those fed mother's milk. Conversely, elevated plasma threonine concentrations are observed in infants fed whey-dominant formulas. We recently showed that formula-fed preterm infants have a lower capacity to degrade threonine than do preterm infants fed mother's milk. We hypothesized that these same infants (n = 18) would differ in their catabolism of phenylalanine in response to phenylalanine loads provided by formulas with increasing casein content of formulas (whey:casein 60:40, 40:60, and 20:80) compared with preterm infants fed mother's milk. Plasma phenylalanine concentrations significantly rose (49, 46, 79 micromol . L(-1) for whey:casein 60:40, 40:60, and 20:80, respectively, pooled SD 8, P < 0.05); and plasma phenylalanine concentrations in infants fed mother's milk were low (40 +/- 4 micromol . L(-1)). Using [1-(13)C]phenylalanine tracer and (13)CO(2) production in breath we found that although there was a significant positive relation between phenylalanine oxidation and phenylalanine intake in formula-fed infants (r(2) = 0.43, P = 0.03), these infants were not able to increase their oxidation of phenylalanine enough to prevent a significant rise in plasma phenylalanine when fed the 20:80 formula. Compared to infants fed mother's milk, formula-fed infants had significantly lower phenylalanine oxidation (39.1 vs. 30.7% of phenylalanine intake, respectively, P < 0.05). We conclude that one of the mechanisms for the differences in plasma amino acid concentration between formula-fed and mother's milk-fed preterm infants may be in vivo down-regulated catabolism of 2 important essential amino acids (phenylalanine in addition to threonine) in formula-fed preterm infants.     

Fat-soluble vitamins in breast-fed preterm and term infants

OBJECTIVE: To examine the supply and status of fat-soluble vitamins in very low birth weight (VLBW) infants compared to a reference group of normal birth weight (NBW) infants. DESIGN: A longitudinal study of VLBW infants in the early neonatal period. Blood samples were drawn at 1 week of age and at discharge from hospital. Plasma was analyzed for the fat-soluble vitamins: retinol, 25-OH-vitamin D, alpha-tocopherol and phylloquinone (vitamin K(1)) using high-performance liquid chromatography. SUBJECTS: A total of 40 VLBW infants were included in the study. A reference group of 33 NBW infants was randomly selected from one of our previous studies. RESULTS: The VLBW infants received fortified human milk, and daily oral vitamin supplement (Multibionta). In VLBW infants, plasma retinol concentrations decreased and plasma 25-OH-vitamin D increased during the study period. VLBW infants had significantly lower plasma retinol (0.3 vs 0.7 mu M) and higher plasma 25-OH-vitamin D (166 vs 25 nM) at discharge compared to NBW infants. Plasma phylloquinone concentration in VLBW infants was very high (53 ng/ml) at one week of age, especially in the youngest infants (192 ng/ml), but decreased rapidly during the study period resulting in low/normal plasma concentrations (0.9 ng/ml) at discharge. CONCLUSIONS: We observed alterations in plasma concentration of retinol and 25-OH-vitamin D in VLBW infants in the early neonatal period, resulting in marked differences between VLBW at discharge and NBW. Further trials are needed to evaluate whether changes in vitamin supplementation may improve clinical outcome in VLBW infants.     

Latent vitamin K deficiency in breast-fed infants

Quick test, coagulation activity of vitamin K-dependent clotting factors, factor II activity by ecarin, levels of factor II immunoreactive antigen and acarboxyprothrombin were examined in two groups of infants, breast-fed and bottle-fed at the ages of one month and 3 months. None of them received vitamin K at birth and later. Acarboxyprothrombin could be demonstrated in about 14% at the both age of life of breast-fed children, but not in the groups of bottle-fed infants. The activity of coagulation factors was significantly lower in the acarboxyprothrombin-positive group compared to the acarboxyprothrombin-negative group. In none of the infants manifest bleeding was observed. No difference in the activities of factors could be detected in the acarboxyprothrombin-negative groups of breast- and bottle-fed children. These data suggest a frequent latent deficiency of vitamin K in breast-fed infants.