[Tolerance and adequacy of a 100% lactose infant formula. A controlled randomized double-blind study]

Human milk oligosaccharide effects on intestinal function and inflammation after preterm birth in pigs

Human milk oligosaccharides (HMOs) may mediate prebiotic and anti-inflammatory effects in newborns. This is particularly important for preterm infants who are highly susceptible to intestinal dysfunction and necrotizing enterocolitis (NEC). We hypothesized that HMO supplementation of infant formula (IF) improves intestinal function, bacterial colonization and NEC resistance immediately after preterm birth, as tested in a preterm pig model. Mixtures of HMOs were investigated in intestinal epithelial cells and in preterm pigs (n=112) fed IF supplemented without (CON) or with a mixture of four HMOs (4-HMO) or >25 HMOs (25-HMO, 5-10 g/L given for 5 or 11 days). The 25-HMO blend decreased cell proliferation and both HMO blends decreased lipopolysaccharide-induced interleukin-8 secretion in IPEC-J2 cells, relative to control (P<.05). All HMOs were found in urine and feces of HMO-treated pigs, and short-chain fatty acids in the colon were higher in HMO vs. CON pigs (P<.05). After 5 days, NEC lesions were similar between HMO and CON pigs and 25-HMO increased colon weights (P<.01). After 11 days, the 4-HMO diet did not affect NEC (56 vs. 79%, P=.2) but increased dehydration and diarrhea (P<.05) and expression of immune-related genes (IL10, IL12, TGFβ, TLR4; P<.05). Bacterial adherence and diversity was unchanged after HMO supplementation.

CONCLUSION

Complex HMO-blends affect intestinal epithelial cells in vitro and gut gene expression and fermentation in preterm pigs. However, the HMOs had limited effects on NEC and diarrhea when supplemented to IF. Longer-term exposure to HMOs may be required to improve the immature intestinal function in formula-fed preterm neonates.

Comparison Among Commonly Available Infant Formula Milks in the Iraqi Market

Breast-feeding is the best method of feeding infants. In some cases, formula milk can be a suitable alternative, so this study aimed to compare the safety and nutritional adequacy of commonly available formula milks in the Iraqi market. An observational study for the commonly available formula milks was conducted in the largest supermarkets of Baghdad, Iraq, during January-March 2015. The macronutrient and micronutrient contents as presented in the label of each type of formula milk was compared with the standard requirement of formula milk according to the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines. Dielac formula milk is the commonest formula milk in the Iraqi market, with the lowest price when compared with other formula milks. All infant formula milks (Similac, Guigoz, and S-26 Gold) except Dielac have the mandatory contents within the specified ranges, according to the ESPGHAN guidelines. Dielac lacks more than 1 of the major mandatory contents besides lacking all optional contents in its formula. Guigoz formula milk lacks the optional ingredients arachidonic acid, docosahexaenoic acid, and nucleotides. Similac milk was supplemented with a higher-than-specified level of nucleotides, and its l-carnitine contents were not declared. Only S26 Gold formula milk contained all mandatory and optional ingredients within the specified range, according to the ESPGHAN guidelines. In conclusion, no formula milk can resemble breast milk; however, S26 Gold formula milk is the most acceptable formula, and Dielac formula milk is the worst. Therefore, it is recommended that Dielac be withdrawn from the Iraqi market.

[Expert consensus on the nutritional aspects of initial and follow-on infant formulas]

INTRODUCTION

Infant feeding in the first months/years of life affects the health in the short and long term. Breastfeeding is the perfect food due to its many benefits. However, when breastfeeding is not possible, infant formulas are the best alternative. The aim of this study is to define the role of the supplemented formulas in infant nutrition using the opinion of a panel of experts in infant gastroenterology and nutrition.

MATERIAL AND METHODS

A survey, using 62 items, stratified into 5 blocks, was performed by 48 panelists using the Delphi method to achieve a professional criteria consensus on nutritional aspects of infant formulas.

RESULTS

A consensus was reached in 64.6% of the items, with a non-unified agreement being established as regards the nutritional aspects of infant formulas, and their influence in body and brain development and immune maturity.

CONCLUSIONS

According to the experts surveyed, there is consensus as regards the suitable composition of lipids, lactose, calcium, vitamin D, and prebiotics in infant formulas, for a correct cerebral, immune and somatic development. There was no consensus on the not yet well-defined subjects, such as nutritional quality of proteins, use of thickeners, taurine supplementation, probiotic, and symbiotic aspects. More studies are necessary to confirm these subjects.