Role of prolonged breast feeding in infant growth

The growth of 238 healthy full-term infants was followed under a carefully monitored nutritional protocol during the first year of life. The infants were weaned at different ages either to a proprietary infant milk formula or to a home-prepared cow's milk formula. Solid foods were introduced at 3.5 months of age. The 56 infants who were breast-fed for a period of at least 6 months were compared to infants weaned prior to one month of age to one of the two milk regimens. In the breast-fed infants, the weight, weight-for-height-age, and skinfold thickness were similar to values in the proprietary formula-fed infants but were lower than the corresponding values in the cow's milk-fed infants at 6 months of age and subsequently. By using weight-for-height-age as a criterion, no obesity was found among any of the 238 infants, and only 1.7% were considered to be overweight. The results indicate that present recommendations for infant feeding in Finland--including prolonged breast feeding, the use of proprietary milk formulas after weaning, and later introduction of solid foods--prevent overnutrition.     

Iron gain in low-birthweight infants: role of milk feeding

The availability of iron is critical in low-birthweight infants. We followed a group of small preterm infants without iron supplementation who were either exclusively breast-fed or weaned early to industrial infant milk formula or home-prepared cow's milk formula. The gain of iron was compared within the milk groups on the basis of hemoglobin and serum ferritin concentrations at the ages of 3 and 4 mth when only trace amounts of solid foods had been given. Contrary to the reports on term infants we found unsupplemented proprietary infant milk formula and breast milk similar as a source of iron. It is possible that there is no major inhibition of iron absorption from any milk during the time of simultaneously occurring accelerated erythropoiesis and exhaustion of iron stores in preterm infants. The apparent inferiority of cow's milk could be due to increased intestinal loss of blood.     

Folate nutrition is optimal in exclusively breast-fed infants but inadequate in some of their mothers and in formula-fed infants

Plasma concentrations of folate were studied in a group of exclusively breast-fed infants and their mothers (their numbers gradually decreased from 200 at birth to 7 at 12 months) and in infants completely weaned to a cow's milk formula (containing 35 micrograms of folate/L) and solid foods. The exclusively breast-fed infants were in no danger of folate deficiency; their plasma levels were elevated after the age of 2 months and, on average, were 2.0-3.3-fold higher than maternal levels throughout the study. None of these infants had an inadequate plasma concentration, whereas up to 5% of the mothers had values less than or equal to 3 micrograms/L, despite supplementation during lactation with 0.1 mg folate/day. In the formula-fed infants, 69-94% of the plasma folate concentrations lay below the lowest concentration for the breast-fed infants. Although no infant had signs of anemia or macrocytosis in red cell indices, the infants weaned earliest had the lowest hemoglobin concentrations (p = 0.09) and the highest mean corpuscular volume (MCV) values (p = 0.06) at 9 months of age. Thus, an infant fed a formula containing the recommended amount of folate runs a risk of folate deficiency.     

Plasma Antibodies to Cow's Milk Are Increased by Early Weaning and Consumption of Unmodified Milk, but Production of Plasma IgA and IgM Cow's Milk Antibodies Is Stimulated Even during Exclusive Breast-Feeding

ABSTRACT. We measured levels of cow's milk-specific (CM) antibodies of immunoglobulin classes G, A and M by enzyme-linked immunosorbent assay in plasma of 198 healthy infants; a variable number of samples taken at birth and at ages of 2, 4, 6, 9, 12 and 28 months were available (altogether 765 samples). The rise in the level of IgG CM antibodies was highest and most rapid in infants exposed to CM formula before the age of 1 month. The level fell by 9 months, but rose again by 12 months. This second rise was attributed to the introduction of dairy milk. Partially breast-fed and fully weaned infants had similar levels of IgG CM antibodies. The levels of IgG CM antibodies were unaffected by the infants' own atopy, their heredity for atopy, and the umbilical serum level of IgG CM antibodies. IgA and IgM CM antibodies were absent at birth. Their levels increased similarly in exclusively breast-fed infants and infants fed CM formula. We conclude that plasma IgG antibodies to cow's milk are increased by early weaning and by consumption of unmodified cow's milk. Production of plasma IgA and IgM antibodies to cow's milk is stimulated even during exclusive breast-feeding.     

Progress in the Prevention of Iron Deficiency in Infants

ABSTRACT. Our present success in preventing iron deficiency in infants is based on a gradual growth in our understanding of iron nutrition. It became recognized that full term infants only become vulnerable to iron deficiency after about 5 months of age, and to a lesser degree if they are breast-fed. The specific foods in which iron is provided during infancy were found to be more important in determining iron absorption than the actual amount of iron in the diet. Experience has also shown that fortification of infant foods is more reliable and cost effective than providing iron medication. Our current approaches to preventing iron deficiency in infants include: 1) maintaining breast feeding for at least 6 months, if possible; 2) using an iron-fortified infant formula if a formula is used and using formula in preference to cow's milk; 3) using iron-fortified infant cereal as one of the first solid foods; and 4) providing supplemental iron for low birth weight infants.     

Bioavailability of iron in soy-based formula and its effect on iron nutriture in infancy

Soy products have been reported to inhibit absorption of nonheme food iron and fortification iron. Iron bioavailability from a soy formula (Prosobee-PP 710) (iron added as ferrous sulfate: 12 mg/L; ascorbic acid: 54 mg/L) was examined in 16 adult women using the extrinsic radioactive tag method. The geometric mean absorption from the soy formula was only 1.7%. The effect of this formula on iron nutrition in infants was studied in 47 healthy term infants weaned spontaneously before 2 months of age and who received the formula ad libitum until 9 months of age. For control, 45 infants received a cow's milk formula fortified with ferrous sulfate (iron: 15 mg/L; ascorbic acid: 100 mg/L), which has been shown to be effective in preventing iron deficiency, and 49 additional breast-fed infants were also followed. All babies received solid foods (vegetables and meat) starting at 4 months of age. Iron nutritional status was determined at 9 months. Infants fed soy formula and iron-fortified cow's milk had similar mean values of hemoglobin, mean corpuscular volume, transferrin saturation, free erythrocyte protoporphyrin, and serum ferritin; both formula groups differed significantly (P less than .05) from the breast-fed group in all measurements except free erythrocyte protoporphyrin. Anemia (hemoglobin less than 11 g/dL) was present in only 4.3% and 2.2% of infants receiving the soy and the fortified formulas, respectively, v 27.3% in the breast-fed group. These results indicate that soy formula, in spite of the lower iron bioavailability when measured in adults, is essentially as effective as iron-fortified cow's milk in preventing iron deficiency in infants.     

Serum total and free tryptophan levels in term infants fed cow's milk formula or human milk

We found no significant differences in mean total and free tryptophan concentrations in sera of healthy, full-term infants fed cow's milk formula and healthy, full-term infants who were breast-fed. Serum tryptophan concentrations were measured 1 h after feeding when the infants were 2 and 6 days of age. In this study cow's milk formula compared favourably with human milk as primary nutrition for full-term infants, despite a two-to-three fold higher level of free tryptophan in human colostrum.     

Incidence and symptoms of cow's milk protein intolerance following acute gastroenteritis in young infants. Effect of a hypoallergenic diet

In a prospective randomized study we investigated in 28 mainly bottle-fed infants younger than 60 days whether in acute gastroenteritis a hypoallergenic formula could prevent the development of cow's milk protein intolerance. Group 1 (14 infants) was fed with a formula adapted to human milk, Group 2 (14 infants) got a semi-elementary formula (Alfaré). After 3 months group II was exposed to cow's milk protein with a standardized challenge and the incidence of CMPI in both groups was calculated. All cases with the acute form of CMPI occurred in group II (5/12) whereas in group I only one infant suffered from the protracted mild form of the disease. Inspite of the relatively small number of probands we conclude from our results that in infants who are not totally breast-fed in the post-enteritic period feeding with a formula adapted to human milk is preferable to hypoallergenic semi-elementary preparations. An allergen free period of 3 months seems to induce symptoms of cow's milk intolerance, probably as a booster-effect to early sensibilisation.     

Food Intake and Growth of Infants between Six and Twenty-six Weeks of Age on Breast Milk, Cow's Milk Formula, or Soy Formula

ABSTRACT. In 59 normal infants attending well-baby clinics, food consumption was registered until 26 and growth until 52 weeks of age. They were either breast-fed or formula-fed with a cow's milk product or a soy protein product. The average consumption of breastmilk was 746, 796, 722 and 689 g/day at 6, 14, 22 and 26 weeks respectively. Bottle-fed infants received larger volumes, and at 6 and 14 weeks were the calculated total energy intakes significantly higher than in breast-fed infants. No differences were seen between the feeding groups with respect to length and the sum of four skin folds. The soy formula-fed children, who happened to be 200 g heavier at birth, had lower weight gains during the first 6 weeks than the other two groups. Thereafter, the average weights of the soy formula group did not differ from the other groups. At 3 months, the soy formula-fed children displayed a slower mineralisation and maturation of bone, but the difference was no longer significant when re-examined at 6 months. Formulas based on soy protein isolates seem to be acceptable as substitutes for cow's milk formulas in feeding normal infants.     

Prolonged exclusive breast-feeding results in low serum concentrations of immunoglobulin G, A and M

Serum levels of IgG, IgA and IgM were measured in 198 infants at ages 2, 4, 6, 9 and 12 months. By age 9 months 30 infants were still exclusively breast-fed; their IgG and IgM levels were significantly lower than those of infants weaned early to formula (before age 3.5 months). By 12 months 6 infants were still exclusively breast-fed; their IgA levels were by then also similarly lower. There was no significant difference in the number of infections experienced by these groups of infants. After 2 months on formula feeding, the IgG and IgM levels of the infants who were exclusively breast-fed for 9 months had caught up with the levels of the infants weaned early to formula. Only at 12 months of age prealbumin levels of the exclusively breast-fed infants showed a positive correlation to IgG and IgA levels; no correlation was found between immunoglobulin levels and levels of serum iron and zinc.     

Prolonged Exclusive Breast-Feeding Results in Low Serum Concentrations of Immunoglobulin G, A and M

ABSTRACT. Serum levels of IgG, IgA and IgM were measured in 198 infants at ages 2, 4, 6, 9 and 12 months. By age 9 months 30 infants were still exclusively breast-fed; their IgG and IgM levels were significantly lower than those of infants weaned early to formula (before age 3.5 months). By 12 months 6 infants were still exclusively breast-fed; their IgA levels were by then also similarly lower. There was no significant difference in the number of infections experienced by these groups of infants. After 2 months on formula feeding, the IgG and IgM levels of the infants who were exclusively breast-fed for 9 months had caught up with the levels of the infants weaned early to formula. Only at 12 months of age prealbumin levels of the exclusively breast-fed infants showed a positive correlation to IgG and IgA levels; no correlation was found between immunoglobulin levels and levels of serum iron and zinc.     

Serum zinc concentration in exclusively breast-fed infants and in infants fed an adapted formula

Serum zinc concentrations have been determined in 28 healthy full-term Italian infants of both sexes at birth, as well as at 3 and at 5 months of age. Fourteen exclusively breast-fed infants who served as a control group were compared with 14 infants fed a cow's milk based adapted infant formula. No significant differences in serum zinc concentration between the breast-fed and the bottle-fed group became apparent during the study. The results of this study suggest a similar zinc nutriture in both groups. The availability of zinc from the adapted infant formula was not significatly different from that of human milk. These findings may be explained by the composition of the adapted formula tested, e.g. by a protein composition fairly close to that of human milk, by the presence of zinc derived from the natural ingredients only, by the low Fe/Zn ratio and by the elevated citrate content.     

PROPHYLAXIS OF ATOPIC DISEASE BY SIX MONTHS' TOTAL SOLID FOOD ELIMINATION

ABSTRACT. One hundred and thirty-five infants of atopic parents were exclusively breast-fed for 6 months without any cow's milk based supplements. Of these infants 70 received no nourishment except breast milk during the 6 months, and 65 were started on solid foods at the age of 3 months. The diet of all the infants was similar during 6 to 12 months of age. The children were examined at the age of one year. In the exclusive breast milk group atopic eczema and food allergy were less frequent than in the solid food group. The results suggest that total solid food elimination for the first 6 months of life, in addition to exclusive breast milk feeding, is prophylactic for atopic disease in children who are at hereditary risk.     

Type of milk feeding in infants and young children up to 19 months of age in three Socio-economic groups in Madrid

The feeding practices of 344 children in Madrid between 3 and 19 months were investigated by controlled interview or their mothers of care-takers. Four different types of milk were given to the children: human milk, infant formula, follow-on formula and cow's milk. Three periods could be defined when infants were most likely to change from one milk type to another. The majority of babies changed from human milk to infant formula some time in the first three months of life. At between four and six months, about half the sample changed to a follow-on formula and, finally, around the baby's first year formula was substituted for cow's milk. Differences in feeding behaviour could be observed among Socio-economic groups, but were not statistically significant. Feeding patterns closely followed international recommendations for infant feeding.     

Type of Milk Feeding and Nutrient Intake during Infancy The Leiden Pre-School Children Study

ABSTRACT. During infancy different types of milk feeding can be used, i.e. breast milk, formula or cow's milk. In the Leiden Pre-School Children Study food intake and anthropometric data of four-, six- and nine-month-old infants were collected to study the influence of the type of milk feeding on the energy and nutrient intake on one hand and on height and weight on the other hand. All three different types of milk feeding were studied in the four-month-old infants. In the six- and nine-month-old infants food intake data of those breast-fed were not collected. No differences in energy intake and in height and weight were found between formula-fed infants and infants fed on cow's milk at the three age-levels. The influence on nutrient intake, on the contrary, was substantial. Compared to formula feeding, cow's milk feeding resulted in a significantly higher intake of protein, sodium, potassium, calcium and phosphorus and a significantly lower intake of linoleic acid, iron and ascorbic acid. Cow's milk feeding at four months was more prevalent among less educated mothers than among mothers with higher education. Breast feeding was strongly positively related to educational level of the mother at all three ages. It can be concluded that more information should be given about the advantages and disadvantages of different types of milk feeding especially to less educated mothers.     

Infant feeding in urban south Indian families

A longitudinal study of feeding practices of South Indian infants 6-22 weeks of age revealed no differences between poor and middle class families. Even among the poor, artificial feeding was initiated in early infancy. The proportion of exclusively breastfed infants dropped from 82% at 6 weeks of age to 58% at 14 weeks and to 36% at 22 weeks. At 22 weeks of age, 16% of the 271 infants studied had been completely weaned from the breast. 58% of the bottle-fed infants were initially given diluted cow's milk while 28% received diluted commercial milk substitute. By the age of 22 weeks, 70% of the bottle-fed infants were receiving either full-strength cow's milk or formula. Commercial weaning foods were preferred up to the 18th week; after that point, rice and rice products were provided. At each age interval analyzed, the mean caloric intake from artificial food was less than half the daily caloric requirement. There was no significant difference between poor and middle class families in terms of the duration of breastfeeding or mean caloric intake from artificial feeds. At 22 weeks, 50% of poor infants and 71% of middle-class infants were receiving food supplements. 72% of infants who had been completely weaned by 22 weeks were from middle class families and 28% were from poor families. These findings confirm earlier observations that the urban poor in India are abandoning long-term breastfeeding and using up to 10% of family income on commercial infant food. Educational campaigns to promote prolonged breastfeeding and restricted use of artificial substitutes should be an important part of child health efforts in India.     

Protein hydrolysate formula maintains homeostasis of plasma amino acids in preterm infants.

BACKGROUND: Plasma amino acid concentrations were measured in preterm infants who were fed either a new hydrolyzed cow's milk protein formula or a standard preterm infant formula. It was hypothesized that feeding with the hydrolysate results in preprandial amino acid concentrations that are significantly different from the concentrations found when feeding with the standard formula. METHODS: Fifteen preterm infants, median gestational age, 29 weeks (range, 24-32 weeks); birth weight, 1241 g (range, 660-1900 g); and postnatal age, 18 days (range, 7-54 days) receiving full enteral feedings (>150 ml/kg x day), were enrolled. The intervention was randomized allocation to the formula with hydrolyzed or natural cow's milk protein (the whey/casein ratio was 60:40 in both formulas). In a crossover design, each formula was fed for 5 days, and plasma amino acids were analyzed on day 4 or 5 of each 5-day period. RESULTS: In spite of the 12% higher amino acid intake with hydrolysate formula, the median individual plasma amino acid concentrations were virtually identical with both formulas, and they were within the 10th and the 90th percentile of the reference of levels in the umbilical cord artery after elective cesarean delivery or of breast-fed newborn infants. The median concentrations of lysine and aspartic acid were higher with hydrolyzed formula feeding (p<0.05; two-tailed Mann-Whitney test). With both formulas, single amino acid concentrations were out of the reference values. CONCLUSION: Virtually identical plasma amino acid concentration patterns were measured with the new hydrolyzed preterm infant formula and the standard preterm infant formula, but longitudinal studies are required before the studied protein hydrolysate can be recommended for preterm feeding in general.     

Need for iron supplementation in infants on prolonged breast feeding

Iron status, as measured by blood counts and indices, serum iron, transferrin saturation, and serum ferritin values, was studied longitudinally in 56 infants on prolonged breast feeding, and compared to that of 29 infants receiving cow milk formula prepared at home and of 47 infants receiving a proprietary infant formula. The first two groups received no iron supplementation, whereas the proprietary formula was supplemented with iron. Although breast feeding was found to be sufficient to meet iron needs during the first 6 months of life, supplemental iron would be necessary during the second half of infancy in order to guarantee the optimal iron status.     

Selenium in German infants fed breast milk or different formulas

At birth and at 4 months of age, selenium (Se) values of 129 term infants on three different diets were determined: 50 infants were breast fed (HM), 44 received formula based on cow's milk (F) and 35 were fed "hypoallergenic formula" (PHF) (partially hydrolysed whey protein). The Se status of a group of twins (n = 12) fed "hypoallergenic formula" was compared with the respective group of singletons. All infants had low plasma Se values during early infancy. The plasma Se of breast-fed infants remained stable (plasma Se 438 ng/ml at birth and at 4 months), whereas plasma glutathione peroxidase (GSH-Px) decreased (birth: 10729 U/l; 4 months: 6211 U/l). The formula-fed infants showed a reduction in plasma Se levels from birth to 4 months (3810 ng/ml and 299 ng/ml, respectively). The decrease was even more pronounced in infants fed the "hypoallergenic formula". This group presented the lowest Se values (plasma Se 399 ng/ml at birth; 206 ng/ml at 4 months). Renal excretion of Se was found to be lower in the formula-fed infants (F and PHF) compared with the HM group. There was a significant correlation between plasma and urinary Se (r = 0.62, p = 0.0001). Urinary Se ($uMg Se/g creatinine) appeared to be a good indicator of Se intake. Measurements of urine Se might be used as a screening method for the estimation of the Se supply. Weight and length increases in all infants were within the normal range. There were no differences between the different feeding groups. Glutathione peroxidase activity, human milk, infant formula, infant nutrition, screening method, selenium, selenium excretion, trace elements, twins
F Jochum, Department of Paediatrics, Heinrich-Heine-University, D-40225 Dusseldorf, Moorenstrafie 5a, Geb 23.12.02, Germany     

Iron status in low birth weight infants on breast and formula feeding

Iron status in 15 low birth weight infants, 1000–2499 g, on breast feeding was studied longitudinally for the first 6 months of age, and the findings compared to those of 30 low birth weight infants receiving a proprietary iron-fortified formula. The two groups received no iron supplement until they developed iron deficiency. The incidence of iron deficiency at 6 months was significantly greater in the breast-fed group than in the formula-fed group (86% v 33%). The breast-fed group had significantly lower serum ferritin and hemoglobin values after 4 months of age. The findings indicate that breast-fed low birth weight infants have a higher risk of developing iron deficiency and should receive iron supplementation from 2 months of age.Abbreviations TIBC total iron-binding capacity - MCV mean corpuscular volume