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.     

ROLE OF PROLONGED BREAST FEEDING IN INFANT GROWTH

Abstract. 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 over-nutrition.     

Serum and Saliva Ig-levels in Infants of Non-Atopic Mothers Fed Breast Milk or Cow's Milk-based Formulas

ABSTRACT. Of twenty-five healthy, full term infants without a family history of atopic diseases, 13 were exclusively breast-fed from birth for a minimum of 3½ months (median 4½ months), whereas the remaining 12 infants were fed with cow's milk-based formulas from birth for a minimum of 4 months. In the latter group of children a significant increase in serum IgE as well as in salivary IgA was found. In infants exclusively breast-fed, no increase in serum IgE was seen until 6 months of age; at nine months of age, salivary IgA was still significantly lower than in the infants fed cow's milk-based formulas. No children developed obvious allergic diseases during the first three years of life. Thus, cow's milk proteins given to newborn children of non-atopic mothers did not seem to increase the risk of IgE-mediated diseases, maybe due to the development of "blocking" IgA-antibodies in the alimentary tract.     

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.     

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.     

Immune status of infants fed soy-based formulas with or without added nucleotides for 1 year: part 1: vaccine responses, and morbidity

BACKGROUND: Immunologic development of soy-fed infants has not been extensively studied. Early studies of soy flour-based formulas showed decreased immunoglobulin production when soy protein intake was limited. However, there were no significant differences in rotavirus vaccine responses between breast-fed and soy protein isolate-based formula-fed infants. Nucleotides added to milk-based formula benefit infant immune status, but reports of the immunologic effects of adding nucleotides to soy-based formula are not available. This study evaluated immune status and morbidity of infants fed soy protein isolate formulas with and without added nucleotides for 1 year. METHODS: Newborn, term infants enrolled in a masked 12-month feeding trial were assigned randomly to groups fed soy formula with or without added nucleotides (n = 94, n = 92). A nonrandomized human milk/formula cohort (n = 81) was concurrently enrolled. Recommended immunizations were administered at 2, 4, and 6 months. Immune status was determined from antibody responses to Haemophilus influenzae type b, tetanus, diphtheria, and poliovirus vaccines at 6, 7, and 12 months. Parents and physicians reported morbidity data. RESULTS: All vaccine responses were within normal ranges. No response differences were observed between infants fed soy formula and those fed nucleotide-supplemented soy. However, antibody to H. influenzae type b at 7 and 12 months was higher in infants fed nucleotide-supplemented soy than in infants fed human milk/formula ( P = 0.007, P = 0.008, respectively). Human milk/formula-fed infants had higher poliovirus neutralizing antibody at 12 months than did soy-fed infants ( P = 0.016). Morbidity analyses showed that only physician-reported diarrhea was different among groups (groups fed human milk/formula had less diarrhea than did soy groups, P = 0.011). CONCLUSIONS: Term infants fed soy protein isolate-based formulas have normal immune development as measured by antibody responses to childhood immunizations.     

Effects of Formula Protein Level and Ratio on Infant Growth, Plasma Amino Acids and Serum Trace Elements I. Cow's Milk Formula

Abstract. The optimum level and ratios of protein to be used in cow's milk formula has recently been under discussion. Healthy term infants were fed from birth exclusively human milk or a formula that varied in protein level or whey:casein ratio: (A) 1.4 g/dl; 55:45, (B) 1.5 g/dl; 55:45, (C) 1.3 g/dl; 55:45, (D) 1.4 g/dl; 60:40, (E) 1.4 g/dl; 20:80. Infants were followed for 12 weeks and blood samples were taken at 2, 4, 8 and 12 weeks. Anthropometric indices did not show any significant differences among groups. Plasma amino acid and BUN levels of the C group were closest to the breast-fed group, while the formula with the highest protein level (B) resulted in high values for some amino acids. When comparing the formulas with 1.4 g protein/dl, the high casein group had the lowest plasma tryptophan levels. Taurine was added to all formulas at a level similar to that of breast milk; plasma taurine levels were similar for all groups. All formulas contained 0.7 mg iron and 0.7 mg zinc/dl; no differences were found among the groups in hematological indices or serum trace elements. These data show that feeding a formula with 1.3 g protein/dl and 55:45 whey: casein ratio from birth will result in growth and metabolic indices similar to those of breast-fed infants, although some plasma amino acid levels are not identical, 1990.     

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.     

Dietary modifications versus dicyclomine hydrochloride in the treatment of severe infantile colics

This study examined 120 infants, aged 3–12 weeks, with severe colics and compared the results of a specific hypoallergenic diet (group A) with those of pharmacological treatment (group B). Non-breastfed group A infants received soy milk and if unresponsive, hydrolyzed milk formulas; mothers of breast-fed infants received a diet without cow's milk, eggs or fish. Breast-fed and non-breast-fed group B infants received dicyclomine hydrochloride 3 mg/kg/day. Results, based on quantitative measurements of crying. indicated that in breast-fed infants there was no significant improvement between group A (62.5%) and group B (66.6%) infants. Among formula-fed infants, comparison of positive results using soy milk (65.9%) with positive results using dicyclomine (53.3%) was not significant; positive results using soy milk and hydrolyzed milk formulas in non-responders to soy milk, provided an improvement in 95.4% of cases. Pharmacological treatment provided an improvement in 53.3%) of cases. The diffcrence was significant ( p <0.01).     

Prospective studies of the effect of breast feeding on incidence of infection and allergy.

The effect of exclusive breast feeding in the first few weeks after birth on infant morbidity due to infectious and allergic disorders was investigated in three separate prospective studies. In a rural community in India, breast-fed infants had a significantly lower incidence of respiratory infection, otitis, diarrhoea, dehydration and pneumonia. In an urban population in Canada, breast feeding was associated with a marked decrease in the occurrence of otitis and respiratory disease and to a lesser extent of diarrhoea and dehydration. In newborn siblings of children with atopic disease exclusively breast-fed for a minimum of six weeks, the incidence of eczema, recurrent wheezing, elevated serum IgE-antibodies to cow's milk, complement activation in vivo after milk challenge and hemagglutinating antibodies to beta-lactoglobulin was significantly lower compared with formula-fed matched group. These observations provide clinical data attesting the immunologic advantages of human milk.     

Amino Acid Levels in the Critically ill Preterm Infant Given Mother's Milk Fortified with Protein from Human or Cow's Milk

ABSTRACT. Twenty preterm infants undergoing neonatal intensive care were randomly allocated to one of two feeding regimens: human milk enriched with either human milk protein (HMP) or adapted cow's milk protein (CMP). The birthweights (1076 ± 301 g; 1031 ± 309 g) and the gestational ages (28.4 ± 1.6 weeks; 27.7 ± 2.1 weeks) were comparable. The amount of protein added to the milk was set at 0.7 g/100 ml in order to provide a total supply of 3.0-3.5 g/kg/24 h. All infants received additional amounts of carbohydrate, calcium, phosphorous, and sodium chloride. Capillary whole blood amino acids were measured with high pressure liquid chromatography (HPLC). The amino acid levels did not differ significantly when the feeding groups were compared week by week, but the glycine/valine ratio was higher (p<0.05) in the HMP group after three weeks of fortification. Longitudinal changes after protein enrichment could be demonstrated in both groups. Alanine and threonine increased after one week (p<0.01) in both groups. Glycine in the HMP group peaked after two weeks (p<0.02), and valine in the CMP group increased (p<0.02) after one week on the feeding regimen. However, the amino acids never reached levels above those seen after a meal in normal term newborns. Other variables related to protein intake, such as protein and urea in serum, did not vary between the groups. Growth, expressed as gains in weight, length, and head circumference was poor but comparable. The quality of the protein, whether a human milk protein isolate or a cow's milk whey protein product, used for the fortification of human milk up to a protein load of 3.0-3.5 g/kg/24 h, did not cause any alterations of significance in the amino acid profiles of peripheral blood.     

Milk Protein Intake in the Term Infant

ABSTRACT. Thirty healthy term infants were studied during the three first months of life. The infants were divided into three feeding groups consisting of 10 infants in each. The feeding regimens were: human milk by breast feeding, a formula (F-I) containing 1.2 g/100 ml of protein and a control formula (F-II) containing 1.6 g protein/100 ml. Both formulas were whey predominant and isocaloric. Protein intake was significantly higher with formula F-II when compared to the human milk group and to formula F-I. No significant differences with respect to weight, length and head circumference were found among the groups, but the rate of growth between 2 to 12 weeks was higher in the control formula (F-II) group. Serum albumin concentrations were normal and similar in all feeding groups. Blood urea nitrogen and urine total nitrogen concentration was significantly lower in the low protein formula I group when compared to the control formula II. After the fourth week of life the low protein formula infants had similar blood urea nitrogen and urine nitrogen concentrations as those of the breast-fed infants. The results indicate that current formulas in use provide excessive protein intakes after the first months of life.     

Immune status of infants fed soy-based formulas with or without added nucleotides for 1 year: part 2: immune cell populations

BACKGROUND: Infants fed a soy protein isolate-based formula have immunization responses similar to breast-fed infants. However, cellular aspects of the immunologic development of soy-fed infants have not been studied extensively. Nucleotides added to milk-based formula benefit infant immune status, but reports of the immunologic effects of adding nucleotides to soy-based formula are not available. This study examines immune cell populations of infants fed soy protein isolate formulas with and without added nucleotides for 1 year. METHODS: Newborn, term infants studied in a masked 12-month feeding trial were assigned randomly to soy formula groups with and without added nucleotides (n = 94, n = 92). A nonrandomized human milk/formula-fed cohort (n = 81), was concurrently enrolled. Blood samples were collected at 6, 7, and 12 months. Thirty-two immune cell populations were characterized using three-color flow cytometry. Cellular markers were chosen to assess general pediatric immune status, emphasizing maturation and activation of B, T, and NK lymphocytes. RESULTS: All cell populations, number and percentages, were within age-related normal ranges. The only significant difference found between soy formula and human milk/formula-fed infants was the percentage of CD57 + NK T cells at 12 months (human milk/formula > soy formula, P = 0.034). There were significant differences at some time points between human milk/formula-fed and nucleotide-supplemented soy formula-fed infants in populations of lymphocytes, eosinophils, total T, helper T, naive helper, memory/effector helper, CD57 - T, and CD11b + CD8 + NK cells. None of the cell populations differed between infants fed soy formula versus soy plus nucleotides. CONCLUSIONS: Infants fed this commercial soy formula demonstrated immune cell status similar to human milk/formula-fed infants, consistent with normal immune system development. The addition of nucleotides to soy formula did not significantly change specific individual immune cell populations but tended to increase numbers and percentages of T cells and decreased numbers and percentages of NK cells.     

Growth and Plasma Amino Acid Concentrations in Very Low Birthweight Infants Fed Either Human Milk Protein Fortified Human Milk or a Whey-Predominant Formula

ABSTRACT. In a prospective, study involving 20 VLBW-infants (AGA), divided into two study groups of 10 infants, we have evaluated the effects on growth and metabolism of human milk fortified with ultrafiltrated human milk protein and a whey-predominant (whey/ casein = 60/40) formula containing 2 g/dl of protein. The study was initiated at a mean age of 30 days when an oral intake of 180 ml/kg/d was tolerated and continued until a weight of 2 kg was reached. The protein intake in both groups was about 3.7 g/kg/d. All infants in both groups reached intrauterine rates of growth for the age, weight gain 18.0 g/kg/d, and length 1.2 cm/week. BUN, acid-base status, total protein and albumin were normal and similar in the two groups. Plasma levels of threonine, glycine, citrulline and methionine were significantly greater in the formula-fed infants. Taurine and proline had higher concentrations in the protein fortified human milk group. There was good tolerance of protein from both sources but the differences in plasma amino acid profiles suggest that the dietary protein quality in formulas for preterm infants must be further modified, if the goal of formula feeding is to achieve metabolic indices of protein metabolism similar to those found when human milk protein is used.     

Trace elements (copper, zinc, manganese, and selenium) in plasma and erythrocytes in relation to dietary intake during infancy

All determinations of copper, zinc, manganese, and selenium were performed with a flameless atomic absorption spectrophotometer. Seventy-three full-term infants aged 1 to 52 weeks were divided into three age groups. Each age group contained two subgroups, breast-fed and formula-fed. No statistically significant differences between formula-fed and breast-fed subgroups were found in regard to the levels of copper and zinc in plasma and erythrocytes. At 1 to 5 weeks of age, the manganese concentration of erythrocytes was higher in formula-fed than in breast-fed infants (p less than 0.001). This might be due to the high dietary intake of this element in the formula-fed subgroup. On the other hand, plasma selenium concentrations were significantly higher in breast-fed than in formula-fed infants of all ages (p less than 0.01 at 1 to 5 weeks and p less than 0.05 at 6 to 52 weeks). This suggests that selenium compounds are biologically more available for infant nutrition in breast milk than in formula.     

Acute C-Peptide, Insulin and Branched Chain Amino Acid Response to Feeding in Formula and Breast Fed Infants

ABSTRACT. The response of C-peptide in serum and urine and of glucose and branched chain amino acids in blood to formula and breast feeding was assessed in six breast-fed and six formula-fed infants 3–6 months of age. We analysed serum C-peptide, branched chain amino acids (BCAA) in blood, and blood glucose in the fasting state at 90' and 180' after regular meal. The excretion of urinary C-peptide and creatinine was also determined. The formula-fed infants received formula in current use, containing 15–16 g protein/l and with casein/whey ratio of 40/60. In the fasting state, no significant inter-group difference was found in the level of serum C-peptide or the valine/glycine ratio. Postprandially, the formula-fed infants had significantly higher serum C-peptide values and valine/glycine ratio than the breast-fed infants, p ≤0.05. No significant inter-group difference was found for blood glucose. The urinary C-pep-tide/creatinine ratio was significantly lower in the breast-fed group, p =0.02, and significantly correlated both to the valine/glycine ratio at 90', r_s =0.75, p =0.02 and to the serum C-peptide value at 90', r_s =0.66, p =0.03. These results confirm that in formula-fed infants the insulin response to meal is enhanced compared to that in breast-fed infants. The finding of similar blood glucose values in the two groups may also indicate an insulin resistance in the formula-fed infants following meal.     

ANTIBODY PRODUCTION BY THE MAMMARY GLAND IN MOTHERS AFTER ARTIFICIAL ORAL COLONISATION OF THEIR INFANTS WITH A NON-PATHOGENIC STRAIN E. COLI 083

Abstract. Twenty five breast-fed and 25 formula-fed infants were colonised by oral administration of a living suspension of E. coli 083. Twenty breast-fed and 13 formula-fed infants were followed as controls. Specific antibody titres in serum, stool filtrates and milk, and secretory IgA levels in stool filtrates and milk were determined in samples taken fortnightly from birth until 20 weeks of age. The haemagglutinating antibody in serum and milk increased in the colonised groups, but in stool filtrates an inhibitory effect of breast-milk was demonstrated. Secretory IgA levels in stool filtrates were significantly higher in colonised infants and breast-fed controls than in bottle-fed infants during the period of breast feeding. Then levels in the colonised groups remained high, but in breast-fed controls they decreased to values found in bottle-fed controls. Artificial colonisation evoked local antibody and secretory IgA responses in the intestine, as well as an antibody response in the mother's mammary gland. The possible protective effect of those responses is discussed.     

Antibody production by the mammary gland in mothers after artificial oral colonisation of their infants with a non-pathogenic strain E. coli 083.

Twenty five breast-fed and 25 formula-fed infants were colonised by oral administration of a living suspension of E. coli 083. Twenty breast-fed and 13 formula-fed infants were followed as controls. Specific antibody titres in serum, stool filtrates and milk, and secretory IgA levels in stool filtrates and milk were determined in samples taken fortnightly from birth until 20 weeks of age. The haemagglutinating antibody in serum and milk increased in the colonised groups, but in stool filtrates an inhibitory effect of breast-milk was demonstrated. Secretory IgA levels in stool filtrates were significantly higher in colonised infants and breast-fed controls than in bottle-fed infants during the period of breast feeding. Then levels in the colonised groups remained high, but in breast-fed controls they decreased to values found in bottle-fed controls. Artificial colonisation evoked local antibody and secretory IgA responses in the intestine, as well as an antibody response in the mother's mammary gland. The possible protective effect of those responses is discussed.     

Milk and soy allergy

Cow's milk allergy (CMA) affects 2% to 3% of young children and presents with a wide range of IgE and non-IgE-mediated clinical syndromes, which have a significant economic and lifestyle effect. It is logical that a review of CMA would be linked to a review of soy allergy because soy formula is often an alternative source of nutrition for infants who do not tolerate cow's milk. This review examines the epidemiology, pathogenesis, clinical features, natural history, and diagnosis of cow's milk and soy allergy. Cross-reactivity and management of milk allergy are also discussed.     

Serial serum 25-hydroxyvitamin D and mineral homeostasis in very premature infants fed preterm human milk

Fourteen very low birthweight infants (mean +/- SD 1,070 +/- 180 g and 29.3 +/- 1.9 weeks gestation) fed their own mother's milk were clinically followed until 3-4 months of age with frequent measurements of serum calcium, phosphorus, magnesium, 25-hydroxyvitamin D (25-OHD), parathyroid hormone, alkaline phosphatase, and albumin, and urine calcium, phosphorus, and magnesium. These infants were matched for birthweight and gestation with 14 infants (1,075 +/- 152 g and 29.0 +/- 1.7 weeks) who had been similarly followed during concomitant studies of infants fed standard formula (Similac 20 cal/oz). Urine phosphorus was markedly lower in the breast milk-fed group from initiation of feedings, and serum phosphorus became significantly lower at and after 6 weeks of age. The fall in serum phosphorus was accompanied by a marked calciuria. Parathyroid hormone was suppressed in the breast milk-fed group, although serum calcium was not elevated and did not differ from formula-fed infants. A high incidence of moderate-severe hypomineralization on radiographs was seen in both breast milk- and formula-fed groups. Six of 14 breast-fed infants required phosphorus supplementation at 8-10 weeks of age because of significant hypophosphatemia, hypercalciuria, and hypomineralization. These infants differed from those not requiring phosphorus supplements by being smaller at birth but not of lower gestation, and having persistently low serum 25-OHD at and after 6 weeks of age.