Intestinal blood loss during cow milk feeding in older infants: quantitative measurements

Evaluation and Comparison of the Nutritional and Mineral Content of Milk Formula in the Saudi Arabia Market

Background/Aim

As recommended by WHO, breastfeeding is the best choice and safe for infants. The formula for infants plays an imperative role in the infant's diet and remains an excellent alternative for breast milk. The milk formula for most infants has been increasingly changed with various compositions to create a similar breast milk production. This study aims to analyze and determine the chemical composition of a few milk formulas available in the Saudi Arabian market.

Materials and Methods

Thirty-five milk formula samples for infants of different age categories were collected from Riyadh City and analyzed for protein, fat, carbohydrates, lactose, total solids, total non-fat solids, calcium, iron, and zinc. Among batches collected, there were 15 branded products suitable for those of age 0-6 months, five for those of age 0-12 months, four for those of age 1-3 years, and 11 for those of age 6-12 months.

Results

For infants, the milk formula sample parameters investigated varied significantly (p ≤ 0.05). A significantly high protein value was 22.72% for a brand for infants with an age of 0-6 months, and the lowest was 11.31% for a brand for those of age 0-12 months. Fat content was high in a brand (26.92%) for infants of age 0-6 months and low in a brand (17.31%) for those aged 6-12 months. The high value of carbohydrates was found in a brand (60.64%) for those of age 0-6 months and a low one (44.97%) in a brand for those of age 0-12 months. The total energy, lactose, total solids, total non-fat solids, and minerals (calcium, iron, zinc) were significantly (p ≤ 0.05) varied between milk formulas at the same age.

Conclusion

There were significant variations between milk formulas of the same ages. According to age groups, some nutrients were not identical to the reference values for children's food.

Association between Consumption of Cow's Milk and Iron Deficiency Anemia in Children: Are There Roles for Hepcidin-25/Ferroportin? A Case-Control Study

Systemic iron homeostasis is regulated by the interaction of the peptide hormone, hepcidin and the iron exporter, ferroportin. The objective was to investigate the relationship between the consumption of cow's milk and iron deficiency anemia in children 2-10 years old and its association with the hepcidin-25 and ferroportin concentrations. The study population consisted of 187 prepubescent children of similar ideal body weight (IBW:90-120%); 82 children with iron deficiency anemia (37girls and 45boys; 4.27 ± 0.28 years) and 105 (47girls and 58boys; 4.25 ± 0.34 years) healthy age-sex-matched controls. Serum fasting hepcidin-25/ferroportin concentrations were measured by enzyme immunoassay in all subjects. Mean cow's milk consumption in the anemic group (373 ± 248 mL/d) tended to be higher than that in the control group (320 ± 226 mL/d), but the result was not statistically significant (p = 0.063).The mean hepcidin-25 level was significantly higher in the anemic group (19.5 ± 18.4 ng/mL) than in the healthy controls (11.0 ± 10.7, p < 0.001). The mean ferroportin level was lower in the anemic group (21.04 ± 5.74 ng/mL) than in the healthy controls (22.68 ± 4.77 ng/ml, p = 0.037). Consuming cow's milk was not associated with IDA in prepubertal children, provided that it was adequately supplemented with iron-enriched foods. We observed a significant increase in hepcidin-25 levels and a decrease in ferroportin levels in children with iron deficiency anemia compared with healthy controls. Children who consumed more cow's milk had higher levels of hepcidin-25. Iron deficiency anemia is not a concern when cow's milk is given to children if the complementary foods are rich in iron.

A preliminary study of fonio-moringa seed meal-based complementary food in Wistar rats

Effect of fonio-moringa seed meal (FMSM)-based complementary food in Wistar rats was assessed in a 28 days balanced study. Seventy, 21-day-old Wistar rats were allotted to seven groups in a completely randomized design. Infant weaning foods (IWFs) 1, 2, 3, 4, and 5 had 0%, 5%, 10%, 15%, and 20% FMSM inclusion levels, respectively, while two commercial IWFs purchased were coded CFT and CFC. The water absorption capacity, swelling power, and the pasting properties, except peak time varied (p < .05) among the IWFs. Rats fed on IWFs 3 and 4 had comparable weight gain with those fed on the commercial foods. The heart and kidney relative weights were influenced (p < .05), while villus length (duodenum) of the rats were significant (p < .05). The blood indices were not significant, but the alanine aminotransferase and cholesterol levels ranged 15.65-32.25 µ/dl and 75.75-94.55 mg/100 ml, respectively. Incorporation of 10% FMSM is recommended in IWFs. PRACTICAL APPLICATIONS: The need to reduce hunger and starvation among the less-privileged people in society is becoming increasingly important. Specifically, many infants, preschool and school children are often not having access to nutritive foods that will enhance their mental alertness. The commercial IWFs on sale in Nigeria are in most cases high in prices and consequently out of the reach of the populace. Fonio is a starchy grain with an important potential not only as a survival food but as a compliment for standard diets. Also, moringa seed is known to be of nutritional value. Most infant formulae are based on maize and soybean and it is hoped that the incorporation of FMSM in the infant weaning formula will help to increase the nutritive value and stem the cost of IWFs.

Impact of a strategy to prevent the introduction of non-breast milk and complementary foods during the first 6 months of life: a randomized clinical trial with adolescent mothers and grandmothers

INTRODUCTION

Although the disadvantages of introducing non-breast milk and the early introduction of complementary foods are known, such practices are common worldwide.

OBJECTIVE

To evaluate the efficacy of counseling about breastfeeding and complementary feeding in preventing the introduction of non-breast milk and complementary foods in the first 6 months.

METHODS

This randomized clinical trial enrolled 323 adolescent mothers and their newborns and 169 maternal grandmothers; 163 mothers and 88 grandmothers received five counseling sessions on breastfeeding while in the hospital and at 7, 15, 30, and 60 days, and one session on complementary feeding at 120 days. Data about infant feeding were collected monthly. The impact was evaluated by comparing the Kaplan-Meier survival curves for the time of introduction of non-breast milk and complementary foods of the control and intervention groups. Median time of introduction of milk was calculated in the two groups.

RESULTS

The survival curves showed that the intervention postponed the introduction of non-breast milk and complementary foods. At 4 months, 41% (95% CI, 32.8-49.2) of the infants in the control group received complementary foods in comparison to 22.8% (95% CI, 15.9-29.7) of the intervention group. Counseling postponed the introduction of non-breast milk, which occurred at 95 days (95% CI, 8.7-111.3) in the control group and at 153 days (95% CI, 114.6-191.4) in the intervention group.

CONCLUSIONS

Counseling sessions on infant's first 4 months were an efficacious strategy to prevent the introduction of non-breast milk and complementary foods in the 6 months of life.

Consumption of cow's milk as a cause of iron deficiency in infants and toddlers

Consumption of cow's milk (CM) by infants and toddlers has adverse effects on their iron stores, a finding that has been well documented in many localities. Several mechanisms have been identified that may contribute to iron deficiency in this young population group. The most important of these is probably the low iron content of CM, which makes it difficult for infants to obtain the amounts of iron needed for growth. A second mechanism is the occult intestinal blood loss associated with CM consumption during infancy, a condition that affects about 40% of otherwise healthy infants. Loss of iron in the form of blood diminishes with age and ceases after the age of 1 year. A third mechanism is the inhibition of non-heme iron absorption by calcium and casein, both of which are present in high amounts in CM. Fortification of CM with iron, as practiced in some countries, can protect infants and toddlers against CM's negative effects on iron status. Consumption of CM produces a high renal solute load, which leads to a higher urine solute concentration than consumption of breast milk or formula, thereby narrowing the margin of safety during dehydrating events, such as diarrhea. The high protein intake from CM may also place infants at increased risk of obesity in later childhood. It is thus recommended that unmodified, unfortified CM not be fed to infants and that it be fed to toddlers in modest amounts only.

The Importance of Milk and other Animal-Source Foods for Children in Low-Income Countries

Background

Milk and other animal-source foods are concentrated dietary sources of macro- and micronutrients. Despite a global increase in milk production and consumption over the past decades, milk and other animal-source foods are often lacking in the diets of children in developing countries.

Objective

To evaluate the importance of milk and other animal-source food intake in promoting the growth, development, and health of children in low-income countries.

Methods

Original research articles describing observational and intervention studies with unfortified milk, fortified milk, and other animal-source foods in children were identified by searching the PubMed database.

Results

Consumption of milk and other animal-source foods by undernourished children improves anthropometric indices and cognitive function and reduces the prevalence of biochemical and functional nutritional deficiencies, reducing morbidity and mortality. Unfortified and fortified milk used in supplementation trials has been well tolerated and widely accepted by parents and children.

Conclusions

To improve the dietary quality of children in low-income countries and further the effort to eradicate extreme poverty and hunger in accordance with the United Nations Millennium Development Goals, additional research is necessary to identify and implement programs and policy supporting increased intake of milk and other animal-source foods.

Excessive Cow's Milk Consumption and Iron Deficiency in Toddlers

Elimination of iron deficiency and iron deficiency anemia in children is a crucial public health concern because these conditions have been linked to cognitive and behavioral deficits. In the infant age group, great strides have been made to reduce iron deficiency and iron deficiency anemia significantly. However, similar progress has not yet been made with toddlers. Cow's milk consumption has long been associated with iron deficiency and iron deficiency anemia in children. Because cow's milk is a staple in the diet of most toddlers, they are at particular risk for these conditions. Two unusual presentations of anemia in toddlers caused by excessive cow's milk consumption are described: one in a child with congestive heart failure, the other in a child with profound eosinophilia. The role of cow's milk in iron deficiency and iron deficiency anemia is also examined.

Setting the stage for child health and development: prevention of iron deficiency in early infancy

Iron deficiency is estimated to be the most common nutritional deficiency worldwide and is particularly persistent among infants and children. The high prevalence of anemia in 6- to 9-mo-old children raises the concern that birth iron stores in some infants are inadequate to sustain growth and development through the first 6 mo of life, and postnatal factors are contributing to early depletion of iron stores and development of anemia. At the same time, there are concerns about negative effects of excess iron in infants. Maternal iron status, infant birth weight and gestational age, as well as the timing of umbilical cord clamping at birth all contribute to the establishment of adequate total body iron at birth. Postnatally, feeding practices and growth rate are factors that will affect how quickly birth iron is depleted during the first 6 mo of life. Under conditions in which maternal iron status, birth weight, gestational age, and umbilical cord clamping time are optimal, and exclusive breast-feeding is practiced, infants should have adequate iron stores for the first 6-8 mo of life. Under suboptimal conditions, infants may not reach this goal and may need to be targeted for iron supplementation before 6 mo of age.

Intestinal blood loss as an aggravating factor of iron deficiency in infants aged 9 to 12 months fed whole cow's milk

GOALS

To verify the occurrence of occult intestinal blood loss and iron deficiency in infants aged 9 to 12 months.

STUDY

A consecutive sample of 98 infants of the Pediatric Public Health Primary Care Unit in the town of Arapongas, Parana State, Brazil was involved in this cross-sectional study. Dietary history, hemoglobin, serum iron, transferrin saturation, ferritin, and an occult fecal blood loss investigation, by the immune chromatographic method specific for human hemoglobin were performed.

RESULTS

Presence of occult intestinal blood occurred in 8/23 of the breast-fed (plus complementary feed) infants and in 30/64 of the infants who were fed with cow's milk (plus complementary feed) (P=0.449). The comparison of body iron indicators in accordance to positive or negative occult fecal blood, did not show any significant difference in the 23 breast-fed infants. Serum ferritin (median=4.2 ng/mL) was significantly lower (P=0.004) in infants who received whole cow's milk and had positive occult fecal blood, than in those infants who received whole cow's milk but were without occult fecal blood (median=12.1 ng/mL).

CONCLUSIONS

In breast-fed infants with negative occult fecal blood, iron deficiency severity is not greater than in those with positive results. In infants fed whole cow's milk, occult fecal blood loss is an aggravating factor of iron deficiency.

Iron deficiency in infancy: applying a physiologic framework for prediction

BACKGROUND

Infants aged 6-24 mo are at high risk of iron deficiency. Numerous studies worldwide have sought to identify predictors of iron deficiency in this age group.

OBJECTIVE

The objectives of the study were to apply a physiologic model to identify risk factors for iron deficiency and to consider those risk factors under different conditions of iron supplementation. We predicted that factors related to iron status at birth (lower gestational age and lower birth weight), postnatal needs for iron (more rapid growth), and bioavailable iron (more cow milk) would be major risk factors.

DESIGN

The physiologic framework was assessed in 1657 Chilean infants (aged 12 mo) with birth weights >or=3 kg who were randomly assigned at age 6 mo to high or low iron supplementation or no added iron. Based on venous blood, the analysis used mean corpuscular volume and concentrations of hemoglobin, free erythrocyte protoporphyrin, and ferritin. Logistic regression models were used to identify predictors of iron deficiency anemia and iron deficiency without anemia.

RESULTS

The prevalence of iron deficiency (>or=2 abnormal iron measures) was 34.9% at age 12 mo. Of 186 infants with hemoglobin concentrations <110 g/L, 158 (84.9%) were iron deficient. The only consistent (and the strongest) predictor of iron deficiency or iron deficiency anemia was lower 6-mo hemoglobin. Factors related to poorer iron status at birth (lower birth weight, shorter gestation though full-term, or both) were predictors in the no-added-iron and high-iron groups. Otherwise, predictors varied by iron supplementation.

CONCLUSION

Variations in predictors of iron deficiency or iron deficiency anemia according to iron supplementation suggest that direct comparisons across studies are tenuous at best without data on early iron status and certainty that specific conditions are comparable.

Concentração de hemoglobina e anemia em crianças no Estado de Pernambuco, Brasil: fatores sócio-econômicos e de consumo alimentar associados

Este estudo teve como objetivo avaliar a associação entre a concentração de hemoglobina e prevalência de anemia com variáveis sócio-econômicas e de consumo alimentar. O estudo seccional, realizado em Pernambuco, Brasil, no ano 1997, utilizou a amostragem em três estágios. A amostra compreendeu 746 crianças de 6-59 meses, nas quais foram realizados dosagem de hemoglobina e inquérito dietético recordatório de 24 horas. A prevalência de anemia foi de 40,6%, sendo maior no Interior Rural e diminuindo com o aumento da idade, da renda e da escolaridade materna. A maioria das crianças (88,9%) consumia leite de vaca. A anemia apresentou tendência de aumento com a elevação da proporção de calorias do leite e de redução com o aumento da densidade de ferro (total, heme e não-heme). A idade da criança, a área geográfica, a renda familiar per capita, a escolaridade materna, a densidade de ferro e a proporção de calorias do leite de vaca na dieta são fatores determinantes da anemia no grupo estudado.