Nutrient intakes of American infants and children fed cow's milk or infant formula

Between April 1984 and August 1984, a national survey, the Ross Laboratories Infant Nutrition Survey, was undertaken to assess patterns of food consumption of American infants ranging in age from 6.5 months to 13.4 months. Nutrient intakes of 865 infants were evaluated according to different foods (milk and milk products, non-iron-fortified formula, iron-fortified formula, infant cereal, commercial baby foods, and home-prepared table foods). Results indicated that most American infants consumed nutrients in appropriate amounts. However, a large proportion of infants who were fed a diet that included cow's milk received amounts of sodium, potassium, and chloride that exceeded the recommended safe and adequate ranges. The median intake of iron of infants fed either cow's milk or a non-iron-fortified formula was below the recommended dietary allowance; a low percentage of these infants received medicinal iron supplementation. The results also indicated that the median estimated renal solute load of the diet of infants fed cow's milk was approximately twice the amount of that of infants fed formula. These data may be useful in the development of nutritional programs for older infants.     

Plasma vitamin E concentrations of older infants fed cow's milk or infant formula.

Nutrition of older infants, though important for optimal brain development, is inadequately studied. The beverage choice markedly influences nutrient intake, but little is known regarding nutrition status of older infants, particularly for vitamin E. This study assessed vitamin E intakes and plasma tocopherol concentrations in two groups of healthy infants, 8 to 13 months of age, who had consumed either cow's milk (n = 45) or milk-based formula (n = 55) for a minimum of the 3 preceding months. Mean (+/- SEM) vitamin E intake was significantly lower (p < or = 0.001) by the infants who had consumed cow's milk (CMF) than by infants who had consumed formula (FF); 4.1 +/- 0.25 mg/day and 10.9 +/- 0.57 mg/day, respectively. Mean (+/- SEM) intake of linoleic plus linolenic acids was significantly lower (p < or = 0.005) by CMF infants (3.4 +/- 0.2 g) than by FF infants (9.9 +/- 1.0 g), although mean (+/- SEM) dietary vitamin E to polyunsaturated fat ratio (E/PUFA ratio) was the same in both FF and CMF infants (1.3 +/- 0.1). Plasma alpha-tocopherol concentration (mean +/- SD) was significantly lower (p < or = 0.005) in CMF than in FF infants (0.86 +/- 0.28 mg/dl vs. 1.14 +/- 0.42 mg/dl, respectively). Dietary vitamin E intakes were positively correlated (p < or = 0.05) with plasma alpha-tocopherol concentrations. No correlations were found between plasma alpha-tocopherol concentrations and total fat intake, dietary E/PUFA ratios, erythrocyte polyunsaturated fatty acids > or = C18:2, or number of hours postprandial that blood was drawn.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

Type of milk feeding and nutrient intake during infancy. The Leiden Pre-School Children Study

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.     

Formulas providing adequate pantothenic acid,vitamin D,manganese, iron and vitamin A for infants fed with mother's milk (aged 6–11 months) according to the Japanese Dietary Reference Intakes prepared by the Ministry of Health,Labour and Welfare (2005 edition)

Weaning formulas served in hospitals and care facilities in Japan should conform to dietary reference intakes (DRIs). We examined whether the DRI for breastfed infants aged 6–11 months can be satisfied in dietary practice, with a particular focus on the fulfilment rates for vitamins, minerals, trace elements and electrolytes in weaning formulas containing energy and protein at levels either greater than or equal to the DRIs, as well as on the dietary profiles of weaning formulas to achieve the DRI for every nutrient. The results showed that no weaning formulas examined in this study fulfilled the DRI for pantothenic acid (5 mg), vitamin D (4 µg), manganese (1.2 mg) or iron (5.5 mg). Furthermore, their vitamin A content exceeded the DRI (350 µg RE). The discrepancy between the guidelines and actual dietary practice is probably because of the fact that the estimated reference values poorly reflect the actual dietary intake in the target population; for example, the pantothenic acid and manganese DRIs for breastfed infants aged 6–11 months were set based on the breast milk intake of younger infants (0–5 months) in combination with the breast milk contents. Our results suggest that dietary guidance for infants should include information to promote proper intakes of vitamins A and D, and iron by reducing the amount of vitamin A‐rich foods and utilizing dietary vitamin D and iron supplements including government‐approved specified health foods.     

Breast-feeding among teenage mothers: milk composition, infant growth, and maternal dietary intake

Information on breast-feeding was obtained from 25 mothers recruited from four high school programs for teenaged parents. Subjects were visited monthly 1-9 times (mean 3.7 visits) during the first 10 months of lactation to measure infant growth and maternal dietary intake and to collect a breast milk sample. Of 24 mothers visited more than once, 21 (88%) breast-fed for more than 3 months, and at least nine continued beyond 6 months. Compared to the nutrient content of milk samples from adult women, milk of teenage mothers was significantly lower in lactose, magnesium, calcium, potassium, and sodium. However, the differences in magnesium, calcium, and potassium may have been due to differences in the timing of sample collection. On the basis of infant growth, milk volume was judged to be adequate for 88% of the infants. Mean maternal energy and protein intakes were 2,897 kcal and 115 g, respectively; mean intakes of calcium, potassium, vitamin A, riboflavin, niacin, and vitamin C exceeded the National Research Council's Recommended Dietary Allowances (RDA) for lactation, while iron and thiamine intakes averaged 84% and 94% of the RDA, respectively. It is concluded that with active counseling teenage mothers are capable of successful lactation.     

Nitrogen and mineral balance in preterm infants fed human milks or formula

Growth as well as nitrogen, calcium, sodium, and potassium balances were evaluated in 16 preterm infants weighing less than 1,600 g at birth, who were fed either their mother's milk, donated mature human milk, or standard commercial formula. Birthweight, gestational age, age of balance, and energy and fluid intakes were similar between groups. There were no differences between groups in the rate of growth. The infants fed their mother's milk (obtained 11-30 days into lactation) demonstrated nutrient balance similar to infants fed mature human milk. Infants fed standard commercial formula demonstrated significantly greater intake and retention of calcium compared to either human milk group. Infants fed either their mother's milk or mature human milk demonstrated net nitrogen and calcium retention below estimates of fetal nitrogen and calcium accretion. Infants fed standard formula demonstrated retentions that more closely approach the fetal estimates. This study did not demonstrate an advantage to feeding premature infants their mother's milk when compared to the feeding of mature donor milk.     

Milk consumption in 10-month-old infants. Effects on iron intake

A study was conducted in 278 10-month-old infants, examined in 2 health care centres in Paris. The dietary history method was used to evaluate their food consumption: 54.5% were receiving usual cow's milk (semi-skimmed or whole milk), 44% adapted infant formulas, and 1.5% cow milk products only. There was no relationship between the quality of milk consumption of these infants and the socio-economic level or the nationality of their parents. Infants receiving usual cow milk had an iron intake lower than the recommended daily amounts while those who were fed with the adapted infant formulas had an adequate daily iron intake.     

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.     

Nutrient intake by breast-fed infants during the first five days after birth

The intakes of milk and specific nutrients during the first 120 hours after birth were measured in 11 full-term, breast-fed infants. Infants were test weighed at all feeds using an electronic balance, and milk samples were obtained from both breasts one to three times daily. Milk was analyzed for levels of fat, protein, lactose, calcium, sodium, and potassium; energy content was calculated using the Atwater factors. The average (+/- SD) intake of milk in the first 24 hours after birth was 13 +/- 16 g/kg (range, 3 to 32 g/kg), increasing to 98 +/- 47 g/kg (50 to 163 g/kg) and 155 +/- 29 g/kg (110 to 196 g/kg) on days 3 and 5, respectively. Mean daily intakes of energy, lactose, calcium, and potassium were less than 12% of the mean day 5 intake on day 1 and less than 25% of the day 5 intake on day 2. In the first few days after birth, the nutrient intake of the solely breast-fed infant is highly variable and is frequently low.     

Zinc and iron adequacy and relative importance of zinc/iron storage and intakes among breastfed infants

Neonatal nutrient storage and supplies from breast milk contribute to nutrient status and growth of infants during their early life. This study investigated the adequacy of zinc and iron intakes among breastfed infants during the first 4 months and determined the relative importance of zinc/iron storage versus nutrient intakes with infant's biochemical status and growth. A longitudinal study followed lactating women and their breastfed infants from birth to 4 months postpartum. Cord zinc and ferritin concentrations, as indicators of nutrient storages, were determined. Zinc and iron intakes from breast milk were determined by measurement of breast milk volume together with milk zinc and iron concentrations at 2 and 4 months postpartum. Inadequacy of nutrient intakes was determined using average requirement (AR) which were 1.6 and 0.24 mg/day for zinc and iron respectively. Infant's serum zinc and ferritin were determined at 4 months of age. The data were collected from 64 and 56 participants at 2 months and 4 months postpartum. Inadequate zinc intake was found in 14.5 and 40% of infants at 2 and 4 months old, respectively. The prevalence of biochemical zinc and iron deficiency in infants were 76 and 11%, respectively. Iron endowment was significantly associated with serum ferritin at 4 months. The cumulative zinc intake was positively associated with weight gain and weight-for-length Z-score, but not length. This study provides quantitative data on zinc and iron intakes, and demonstrates the relative importance of nutrient storage versus intakes on biochemical status and growth of breastfed infants.     

Optimal protein and energy intakes in preterm infants

There is compelling evidence that current nutritional practice fails to provide sufficient dietary protein for preterm infants, especially extremely and very low birth weight infants. Nutrient requirements can be estimated by a variety of techniques, but most suggest that these infants will require a protein intake of 3.5-4.0 g/kg/d. Even when these infants are able to tolerate full enteral feeds, most currently available artificial milk formula or breast milk fortifiers will not ensure these protein requirements are met except when fed at high volumes. Energy requirements on the other hand may be currently met, and evidence from controlled studies suggests that intakes higher than 110-135 kcal/kg/d might not be beneficial. The data from studies on neonatal adiposity outcomes, and from studies examining relationship between early growth and later cardiovascular outcome, also suggest that excess nutrient intake might be harmful. In the light of this data, optimal intakes and protein-energy ratios require re-appraisal.     

4～12个月中国婴儿能量摄入研究

目的以体重增长值（△WAZ）在±0．67之间为依据研究4～12个月婴儿能量摄入、乳类摄入产能与其他食物产能比,分析其相关因素。方法以2004年11月-2005年3月重庆医科大学儿童医院儿童保健门诊就诊的4个月龄132名婴儿为研究对象,定期随访至12月龄。分A组（4～5月龄组）、B组（6～8月龄组）、C组（9～12月龄组）。两名专业人员负责体格测量。若△WAZ〈-0．67则终止随访。食物称重与食物记录法计算每日食物摄入情况。结果各组婴儿体格发育良好,△WAZ在-0．67～0．67时婴儿平均食物摄入量为119～128g／（kg·d）;A、B、C组平均蛋白质摄入量分别为1．82、2．76、3．52g／（kg·d）;乳类摄入分别是总能量的93％、64％、56％;平均乳类摄入量为750～900g/d;平均能量摄入分别为83．9、81．6、85．8kcal／（kg·d）,接近世界卫生组织2003标准,低于中国营养学会推荐值;能量密度为0．6～0．8kcal／g。多元线性回归分析结果显示食物摄入量、能量密度是影响能量摄入的主要因素。结论（1）本组4～12月龄婴儿能量摄入为82～86kcal／（kg·d）时婴儿体格发育正常;（2）4～12月龄婴儿期乳类摄入量达750～900g／d可满足婴儿大部分能量、蛋白质需要;（3）食物摄入量和能量密度是影响婴儿能量摄入的两个最重要因素;婴儿食物能量密度以0.6～0．8kcal／g为宜。     

Longitudinal study of the body composition of weight gain in exclusively breast-fed and intake-measured whey-based formula-fed infants to age 3 months

Body composition and the composition of weight gain in 82 healthy infants during the first 3 months of life were measured in relation to the type of feeding and nutrient intakes by serial measurements of total body potassium (TBK), anthropometry, and formula intake. Infants were exclusively fed either breast milk (n = 34, B fed) or whey-based formula (n = 48, F fed). Formula intakes were substantially lower than WHO-FAO recommendations (although serial weights paralleled standards), and were significantly greater in male infants, who had greater gains in weight and lean tissue than females. In both sexes, tissues low in K (fat and extracellular water) were added faster to the body weight than lean tissue. Overall, compared with B fed infants, F fed infants gained less weight between birth and 10 days and more weight between 10 and 90 days, although mean actual weights at 90 days were similar; formula feeding caused greater fat deposition in males and greater daily gains in lean mass in females. Differences in both quantity and quality of ingested nutrients account for these differences although the biological importance of these findings is speculative. These studies further elucidate the nature of growth in relation to modern feeding practices and the question of optimal versus maximal nutrient intake and growth in early life.     

Food consumption of infants and young children in France in 1997]

BACKGROUND: In 1981 and 1989, two French nationwide food consumption surveys reported the dietary intakes of infants and toddlers. In 1997, another survey was conducted. POPULATION AND METHODS: Six-hundred and sixty, 1 to 30-month-old infants and children were recruited. Food records were completed by their parents during a 3-day period. Energy, proteins, carbohydrates, total lipids, minerals, vitamins, linoleic acid contents were calculated. Energy contribution of various food groups and the pattern of the distribution of the different meals were indicated. RESULTS: Between 1989 and 1997, the contribution of milk-based infant formulas increased at 4, 5, 7 and 8-9 months. From the age of 5 months, approximately 75% of the children had a protein intake twice as high as the official recommendations. Mean iron intakes were higher than those calculated in 1989 at the age of 7, 8-9 and 10-12 months. The average daily intake of linoleic acid was lower than the recommended daily allowance from the age of 6 months. CONCLUSION: Trends in dietary intakes between 1989 and 1997 indicated that the nutritional needs of French infants and toddlers are better covered as recommended by scientific committees. More effective efforts are needed for improvement of their nutritional status particularly for iron and essential fatty acids. For example, weaning foods should be introduced later and toddler's formulas should be used more systematically and longer.     

Protein utilization by premature infants with a birth weight less than 1,500 g during nutrition with MANASAN or breast milk protein

Protein utilization in very low birth weight infants fed the formula MANASAN or human milk protein. The influence of protein utilization was studied in 19 very low birth weight infants appropriate for gestational age between the 5th and 6th week of postnatal life. 8 of the infants were fed with the formula MANASAN (protein: cow's milk casein) and 11 were fed with similar quantities of human milk (HM) protein (HM fortified with 6g freeze-dried HM/100 ml). On two following days the protein intake and the nitrogen excretion in urine and stools were measured and the nitrogen balance was calculated. In the urine the excretions of alpha-amino-nitrogen, urea, ammonium and sulfuric acid were also estimated. On one of both study days the concentrations of alpha-amino-nitrogen and urea were measured in the preprandially obtained serum. The weight gain was calculated as mean of two weeks ending with the last day of study. Despite the similar protein intakes and the sufficient energy intakes in both study groups the serum concentration of alpha-amino-nitrogen and the renal excretions of alpha-amino-nitrogen, ammonium and sulfuric acid were significantly higher in the groups fed MANASAN than in the groups fed HM protein. The excretion of ammonium in the urine was significantly correlated to the excretion of sulfuric acid. The weight gain and the nitrogen balance were significantly lower in the infants fed MANASAN in comparison to the infants fed HM protein.(ABSTRACT TRUNCATED AT 250 WORDS)     

Low iron stores in infants and children with treated phenylketonuria: A population at risk for iron-deficiency anaemia and associated cognitive deficits

A retrospective study of 53 patients with phenylketonuria (PKU), whose disease was managed with a low-phenylalanine diet, revealed a high incidence of iron depletion (as reflected by subnormal serum ferritin concentrations). Serum ferritin concentrations under 10 g/l were found in one out of six infants aged 5–12 months. Concentrations under 16 g/l were found in 16 of 22 children aged 1–3 years and in 11 of 25 children aged 4–12 years. Dietary iron, estimated from prescribed intakes of medical foods, exceeded the Canadian recommended nutrient intake, suggesting that low stores of iron may be secondary to reduced bioavailability and absorption of iron. These findings suggest that the current dietary management of PKU is associated with an increased risk for low iron stores. Investigators have reported an association in young children between iron-deficiency anaemia and both cognitive and motor disturbances. Children with PKU, already at risk of neurological damage because of phenylalanine neurotoxicity, may be at increased risk as a result of iron depletion. Serum ferritin as well as haemoglobin concentration should be monitored, along with plasma phenylalanine and tyrosine, to ensure optimum treatment of affected children.     

Reappraisal of linoleic acid requirement of the young infant,with particular regard to use of modified cows' milk formulae.

Most infants in the UK are bottle fed with cows'' milk formulae that are alleged to provide less than the minimum requirement for linoleic acid, i.e. 1% of the total dietary energy. 20 term infants fed solely on a modified cows'' milk formula that provided 0.55% of the energy from linoleic acid were therefore examined for evidence of deficiency. Rates of growth in length and weight, measured during the first 3 months of life, were identical with those of 20 wholly breast-fed infants. Voluntary food intakes (kcal/kg per day) followed the normal pattern. The fatty acid composition of the plasma lipids showed changes characteristic of a low intake of linoleic acid, but triene:tetraene ratios did not indicate a deficiency state, and clinical signs of deficiency were not observed. These findings suggest that the requirement for linoleic acid is substantially less than was formerly believed. The small amount of alpha-linolenic acid present in cows'' milk may however exert a sparing effect on linoleic acid.     

Bone mineralization in preterm infants fed human milk with and without mineral supplementation

The bone mineral status of healthy preterm infants fed maternal milk was compared with that of similar infants fed maternal milk with mineral supplementation. Fifty infants with birth weight less than 1600 g were fed human milk for 1 week until reaching an intake of 120 kcal/kg/d. Thereafter, infants were assigned randomly to one of three diets: (1) continued unsupplemented human milk, providing an intake of 40 to 50 mg/kg/d calcium and 23 to 30 mg/kg/d phosphorus; (2) human milk mixed with a high mineral containing formula, providing total intakes of 130 mg/kg/d calcium and 68 mg/kg/d phosphorus; or (3) human milk alone for 1 additional week, followed by human milk mixed with a powdered fortifier, providing total intakes of 160 mg/kg/d calcium and 90 mg/kg/d phosphorus. Infants fed human milk with formula supplementation, but not those fed human milk with fortifier, had significantly higher serum phosphorus concentrations and significantly lower serum alkaline phosphatase concentrations than did those fed unsupplemented human milk (P less than 0.01). Bone mineral content of the humerus, determined by photon absorptiometry, however, was similar in all three groups; values averaged 0.104 g/cm at the beginning of the study, and remained unchanged irrespective of mineral supplementation. Shortly before hospital discharge, study diets were discontinued and infants were fed standard proprietary formula or were nursed by their mothers. At 44 weeks postconceptional age (7 to 10 weeks after change in diet), infants were reexamined. Serum phosphorus concentrations increased, serum alkaline phosphatase concentrations decreased, and bone mineral content more than doubled to values comparable with those in term infants. Results at follow-up were comparable for all three initial diet groups and for infants who were formula-fed or breast-fed after hospital discharge. The lack of any significant effect of early maternal milk supplementation on bone mineralization by 44 weeks postconceptional age suggests that these methods of supplementation of maternal milk may not be warranted for healthy preterm infants.     

Indices of protein metabolism in term infants fed human milk, whey-predominant formula, or cow's milk formula

Relationships between intakes of amino acids and total nitrogen, and blood indices of protein utilization were studied in 37 term infants fed either human milk, whey-predominant formula, or cow's milk formula as the sole nutritional source for 8 weeks. Biochemical analyses of two-hour fasting blood samples, and intakes calculated using three-day dietary records and direct analyses of milk samples were used to evaluate these relationships. Intakes of total nitrogen were positively correlated with plasma valine, leucine, isoleucine, phenylalanine, and serum urea nitrogen concentrations (r = .46 to .62, P less than .01 to .001). Intakes of the four amino acids whose plasma concentrations were positively correlated with total nitrogen intakes plus four additional amino acids (threonine, tyrosine, histidine, and methionine) were correlated with their respective plasma concentrations (r = .41 to .74, P less than .01 to .001). These relationships have not been previously described in term infants. Compared with values in infants fed human milk, plasma concentrations of valine, phenylalanine, methionine, and serum urea nitrogen were elevated with whey-predominant formula and cow's milk formula feeding. Values for four additional amino acids (threonine, lysine, leucine, and isoleucine) were elevated with whey-predominant formula feeding. Data indicate that altering the whey-to-casein ratio and, thus, the amino acid pattern of formulas will not achieve the desired blood indices characteristic of human milk feeding without a reduction in the total nitrogen content of formulas.