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Nicolaou N, Pancheva R, Karaglani E, Sekkidou M, Marinova-Achkar M, Popova S, Tzaki M, Kapetanaki A, Iacovidou N, Boutsikou T, Iliodromiti Z, Papaevangelou V, Sardeli O, Xepapadaki P, Papathoma E, Thijs-Verhoeven I, Kudla U, Ulfman LH, Schaafsma A, Manios Y. The Risk Reduction Effect of a Nutritional Intervention With a Partially Hydrolyzed Whey-Based Formula on Cow's Milk Protein Allergy and Atopic Dermatitis in High-Risk Infants Within the First 6 Months of Life: The Allergy Reduction Trial (A.R.T.), a Multicenter Double-Blinded Randomized Controlled Study. Front Nutr 2022; 9:863599. [PMID: 35694159 PMCID: PMC9174747 DOI: 10.3389/fnut.2022.863599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background The role of partially hydrolyzed formulas (pHF) as part of nutritional interventions to prevent the development of allergic manifestations (AM) is questioned, and efficacy of each specific pHF should be substantiated. Objective To investigate the risk-reduction effect of a whey-based pHF on the development of cow's milk protein allergy (CMPA) and atopic dermatitis (AD) in infants at high-risk for allergy within the first 6 months of life. Materials and Methods In a multicenter double-blinded randomized controlled setting, healthy non-exclusively breastfed full-term infants, received either a specific whey-based pHF or a standard cow's milk-based formula (SF) and were clinically assessed for AM at 2, 4, and 6 months of age, supported by the objective scoring tools SCORAD and CoMiSS. CMPA was confirmed by open food challenge. Intention-to-Treat (ITT) and Per-Protocol (PP) analyses were performed. Results Of 331 randomized subjects (ITT analysis set), 160 received the pHF and 171 the SF. Six (3.8%) infants in the pHF and 12 (7%) in the SF group developed CMPA (p = 0.186). AD incidence was significantly lower in those receiving pHF as compared to SF (10.6% vs. 18.7%, p = 0.024) with a relative risk (RR, 95% CI) of 0.54 (0.32, 0.92), in particular when adjusting for family history of AD [6.5% vs. 27.3%, RR 0.24 (0.07, 0.78), p = 0.018] representing a risk reduction of 76%. The PP analysis showed similar results. Conclusion This specific whey-based pHF reduced the risk of AD development, particularly in those with a family history of AD, and tended to reduce the development of CMPA in non-exclusively breastfed infants at high-risk for allergy. The A.R.T. study suggests that this particular pHF may contribute to measures aimed at prevention of allergic manifestations. However, further studies are needed to confirm this risk-reduction effect.
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Affiliation(s)
- Nicolaos Nicolaou
- Asthma and Allergy Centre, Limassol, Cyprus
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Rouzha Pancheva
- Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Varna, Varna, Bulgaria
- *Correspondence: Rouzha Pancheva
| | - Eva Karaglani
- Department of Nutrition & Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece
| | | | - Miglena Marinova-Achkar
- Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Varna, Varna, Bulgaria
| | - Simoneta Popova
- Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Varna, Varna, Bulgaria
| | | | | | - Nicoletta Iacovidou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, National and Kapodistrian University of Athens, ATTIKON General University Hospital, Athens, Greece
| | - Olympia Sardeli
- Third Department of Pediatrics, National and Kapodistrian University of Athens, ATTIKON General University Hospital, Athens, Greece
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Papathoma
- Neonatal Intensive Care Unit, Alexandra University and State Maternity Hospital, Athens, Greece
| | | | | | | | | | - Yannis Manios
- Department of Nutrition & Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece
- Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
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Karaglani E, Thijs-Verhoeven I, Gros M, Chairistanidou C, Zervas G, Filoilia C, Kampani TM, Miligkos V, Matiatou M, Valaveri S, Sakellariou A, Babilis G, Bos R, Manios Y. A Partially Hydrolyzed Whey Infant Formula Supports Appropriate Growth: A Randomized Controlled Non-Inferiority Trial. Nutrients 2020; 12:nu12103056. [PMID: 33036201 PMCID: PMC7650565 DOI: 10.3390/nu12103056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022] Open
Abstract
The aim of the current study was to investigate the effects of a partially hydrolyzed whey infant formula (PHF) on growth in healthy term infants as compared to a standard infant formula with intact protein (IPF). In a double-blind, non-inferiority, randomized controlled trial, a total of 163 healthy formula-fed infants, 55–80 days old, were recruited and randomly allocated to either the PHF (test) or the IPF (control) group. They were followed up for three months during which they were evaluated monthly on growth and development. In total, 21 infants discontinued the study, while 142 infants completed the study (test n = 72, control n = 70). The primary outcome was daily weight gain during the three months. Secondary outcomes included additional anthropometric indices at every timepoint over the intervention period. Daily weight gain during the three-month intervention period was similar in both groups with the lower bound of 95% confidence interval (CI) above the non-inferiority margin of −3 g/day [mean difference (95% CI) test vs. control: −0.474 (−2.460, 1.512) g/day]. Regarding secondary outcomes, i.e., infants’ weight, length, head circumference, body mass index (BMI), and their Z-scores, no differences were observed between the two groups at any time point. The PHF resulted in similar infant growth outcomes as the standard IPF. Based on these results, it can be concluded that the partially hydrolyzed whey infant formula supports adequate growth in healthy term infants.
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Affiliation(s)
- Eva Karaglani
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave, 17671 Athens, Greece; (E.K.); (C.C.); (C.F.); (T.-M.K.); (A.S.)
| | - Inge Thijs-Verhoeven
- FrieslandCampina, Stationsplein 1, 3818 LE Amersfoort, The Netherlands; (I.T.-V.); (M.G.); (R.B.)
| | - Marjan Gros
- FrieslandCampina, Stationsplein 1, 3818 LE Amersfoort, The Netherlands; (I.T.-V.); (M.G.); (R.B.)
| | - Christina Chairistanidou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave, 17671 Athens, Greece; (E.K.); (C.C.); (C.F.); (T.-M.K.); (A.S.)
| | - Giorgos Zervas
- Mitera Hospital, 6 Erythrou Stavrou Str., 151 23 Athens, Greece; (G.Z.); (V.M.); (M.M.); (S.V.); (G.B.)
| | - Christina Filoilia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave, 17671 Athens, Greece; (E.K.); (C.C.); (C.F.); (T.-M.K.); (A.S.)
| | - Tarek-Michail Kampani
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave, 17671 Athens, Greece; (E.K.); (C.C.); (C.F.); (T.-M.K.); (A.S.)
| | - Vasileios Miligkos
- Mitera Hospital, 6 Erythrou Stavrou Str., 151 23 Athens, Greece; (G.Z.); (V.M.); (M.M.); (S.V.); (G.B.)
| | - Maria Matiatou
- Mitera Hospital, 6 Erythrou Stavrou Str., 151 23 Athens, Greece; (G.Z.); (V.M.); (M.M.); (S.V.); (G.B.)
| | - Stavroula Valaveri
- Mitera Hospital, 6 Erythrou Stavrou Str., 151 23 Athens, Greece; (G.Z.); (V.M.); (M.M.); (S.V.); (G.B.)
| | - Alexandros Sakellariou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave, 17671 Athens, Greece; (E.K.); (C.C.); (C.F.); (T.-M.K.); (A.S.)
| | - Georgios Babilis
- Mitera Hospital, 6 Erythrou Stavrou Str., 151 23 Athens, Greece; (G.Z.); (V.M.); (M.M.); (S.V.); (G.B.)
| | - Rolf Bos
- FrieslandCampina, Stationsplein 1, 3818 LE Amersfoort, The Netherlands; (I.T.-V.); (M.G.); (R.B.)
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave, 17671 Athens, Greece; (E.K.); (C.C.); (C.F.); (T.-M.K.); (A.S.)
- Correspondence: ; Tel.: +30-210-9549156
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Manios Y, Karaglani E, Thijs-Verhoeven I, Vlachopapadopoulou E, Papazoglou A, Maragoudaki E, Manikas Z, Kampani TM, Christaki I, Vonk MM, Bos R, Parikh P. Effect of milk fat-based infant formulae on stool fatty acid soaps and calcium excretion in healthy term infants: two double-blind randomised cross-over trials. BMC Nutr 2020; 6:46. [PMID: 32944265 PMCID: PMC7489008 DOI: 10.1186/s40795-020-00365-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Palmitic acid (PA) is predominantly esterified at the SN-2 position of triacylglycerols in human milk. PA at the SN-2 position is more efficiently absorbed and results in reduced formation of PA soaps, as well as reduced fatty acid (FA) and calcium malabsorption. Bovine milk fat (MF), a natural source of SN-2-palmitate, was used in the fat blend of infant formulae (IF) in the current study to investigate its effect on stool fatty acid soaps, calcium excretion and stool characteristics. Methods Two double-blind, randomised cross-over trials (CS1, CS2) were conducted in parallel with healthy term, formula-fed infants aged 9-14 weeks. After a two-week run-in period, infants in CS1 (n = 17) were randomly allocated to receive either a 50% MF-based formula (50MF) or a 100% vegetable fat (VF) formula; in CS2 (n = 18), infants received either a 20% MF-based formula (20MF) or the VF formula, in a 2 × 2-week cross-over design. At the end of each two-week intervention period, stool samples were collected for FA, FA soaps and calcium excretion analysis and stool consistency was assessed according to the Amsterdam Infant Stool Scale (AISS). Results MF-based groups showed no significant difference in PA in stools compared to VF group, although reduced stool PA soaps (CS1: 111.28 ± 18.33 vs. 220.25 ± 29.35 mg/g dry weight, p < 0.0001; CS2: 216.24 ± 25.16 vs. 233.94 ± 35.12 mg/g dry weight, p = 0.0023), total FA soaps and calcium excretion (CS1: 46.40 ± 5.27 vs. 49.88 ± 4.77 mg/g dry weight, p = 0.0041; CS2: 46.20 ± 4.26 vs. 50.47 ± 6.71 mg/g dry weight, p = 0.0067) were observed. Furthermore, the 50MF group showed a favourable lower mean stool consistency score compared to the VF group (1.64 ± 0.49 vs. 2.03 ± 0.19, p = 0.0008). Conclusions While the use of bovine MF in IF did not affect PA concentrations in stool, lower excretion of palmitate soaps, total FA soaps and calcium was seen in healthy term infants. 50MF formula also showed improved stool consistency. The use of MF in IF could be an interesting approach to improve gut comfort and stool characteristics in infants, warranting further research. Trial registration Netherlands Trial Registry Identifier: NTR6702. Date registered: December 01, 2017.
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Affiliation(s)
- Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Eva Karaglani
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | | | - Elpis Vlachopapadopoulou
- Department of Endocrinology-Growth and Development, Children's Hospital P. & A. Kyriakou, Athens, Greece
| | - Anastasia Papazoglou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Eleni Maragoudaki
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Zafeiris Manikas
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Tarek-Michail Kampani
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Iliana Christaki
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Marlotte M Vonk
- FrieslandCampina, Stationsplein 1, 3818 LE Amersfoort, the Netherlands
| | - Rolf Bos
- FrieslandCampina, Stationsplein 1, 3818 LE Amersfoort, the Netherlands
| | - Panam Parikh
- FrieslandCampina, Stationsplein 1, 3818 LE Amersfoort, the Netherlands
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