Zinc and copper in infants fed breast-milk or different formula

Zinc concentrations in human milk and infant serum during the first six months of lactation

Normal supply of zinc to the newborn via milk is essential for normal development. Using ICP-OES, we analyzed changes in the level of Zn in milk and infant serum in the neonatal period (Day 1 and Day 28 post partum) and at 6 months after delivery, in the cohort of 60 mothers and exclusively breastfed babies. Zn level in the serum showed increase (significant at 6 months) during this period (mg/mL): Day 1: 0.52±0.12; Day 28: 0.59±0.19; 6 months: 0.68±0.28. The concentration of Zn in the milk showed an opposite (decreasing) trend during the follow up: Day 1: 4.70±1.74mg/L; Day 28: 2.65±1.06; 6 months: 0.46±0.36. A significant negative correlation was established between serum and milk [Zn] at day 28 (R=-0.338; p=0.008), whereas a positive correlation was found at 6 months between these parameters (R=0.306; p=0.018). There was no significant correlation between [Zn] in the milk and serum and infants' body mass, mothers' age and mass at delivery. The level of Zn in the milk at 6 months of lactation is not sufficient to meet the recommended values. This implies that in Serbian population, Zn supplementation might be needed in the later phase of lactation.

Copper to Zinc Ratio as Disease Biomarker in Neonates with Early-Onset Congenital Infections

Copper (Cu) and zinc (Zn) are essential trace elements for regular development. Acute infections alter their metabolism, while deficiencies increase infection risks. A prospective observational case-control study was conducted with infected (n = 21) and control (n = 23) term and preterm newborns. We analyzed trace element concentrations by X-ray fluorescence, and ceruloplasmin (CP) by Western blot. Median concentration of Cu at birth (day 1) was 522.8 [387.1-679.7] μg/L, and Zn was 1642.4 ± 438.1 μg/L. Cu and Zn correlated positively with gestational age in control newborns. Cu increased in infected newborns from day 1 to day 3. CP correlated positively to Cu levels at birth in both groups and on day 3 in the group of infected neonates. The Cu/Zn ratio was relatively high in infected newborns. Interleukin (IL)-6 concentrations on day 1 were unrelated to Cu, Zn, or the Cu/Zn ratio, whereas C-reactive protein (CRP) levels on day 3 correlated positively to the Cu/Zn -ratio at both day 1 and day 3. We conclude that infections affect the trace element homeostasis in newborns: serum Zn is reduced, while Cu and CP are increased. The Cu/Zn ratio combines both alterations, independent of gestational age. It may, thus, constitute a meaningful diagnostic biomarker for early-onset infections.

The Serum Concentrations of Trace Elements and Vitamin A in Turkish Six-Month-Old Infants with Different Feeding Practices

Breast feeding is the first and most important step of a healthy diet. Breast milk contains important vitamins and trace elements such as iron, zinc, copper, and vitamin A. The aim of our study was to evaluate the levels of hemoglobin, hematocrit, mean corpuscular volume, serum iron, iron binding capacity, ferritin, serum zinc, copper and vitamin A in three groups of infants, which were determined based on feeding practices. The infants in all groups were not given prophylactic iron in the first 6 mo. Two hundred fifty-nine infants were included in the study. One hundred fifty-one (58.3%) were fed with breast milk, 91 (35.1%) were fed with breast milk+formula, and 17 (6.6%) were fed with formula only. Serum copper and vitamin A levels were found to be low in formula-only fed infants compared to other groups with a statistically significant difference (p=0.017, p=0.022 respectively). The serum zinc level was found to be low in 15.9% of the breast fed infants, 17.6% of the breast milk+formula fed infants, and 23.5% of the formula-only fed infants. Although the formula-only fed infants had lower values, the difference was not statistically significant among groups (p=0.716). We think that formula fed infants potentially have low levels of copper and vitamin A in the first 6 mo and may be offered supplements. Alternatively, formula mineral and vitamin contents could be enriched. We think that further studies on this subject are needed.

Micronutrient deficiencies in normal and overweight infants in a low socio-economic population in north-east Brazil

BACKGROUND

Micronutrient deficiencies are the most prevalent form of malnutrition worldwide. Although commonly related to underweight, micronutrient deficiencies can occur in both normal and overweight children in medium- and low-income populations undergoing nutritional transition.

OBJECTIVE

To describe haemoglobin and micronutrient levels in infants from a low-income area in Brazil in relation to their weight-for-length Z-score.

METHODS

A cross-sectional survey was undertaken of 2-11-month-old infants in Laranjeiras, a small urban community in North-east-Brazil between April 2009 and February 2010. Anthropometry and assays for haemoglobin, ferritin, plasma zinc, copper and selenium and erythrocyte zinc and copper concentrations were investigated.

RESULTS

The total number of full-term infants born in the study period was 222, of whom 153 were available for the study. Three (2%) children were wasted, 98 (66%) were of normal weight, 37 (25%) were at risk of overweight and 11 (7%) were overweight or obese. Nearly all (97%) children had at least one micronutrient deficiency, 102 (67%) had anaemia, 86 (58%) and 100 (67%) had plasma and erythrocyte zinc deficiency, respectively, and 7 (5%) and 113 (76%) had plasma and erythrocyte copper deficiency, respectively. 138 (91%) children had selenium deficiency. Except for plasma zinc, the proportion of infants with micronutrient deficiencies did not differ by weight-for-length status.

CONCLUSIONS

The increased risk of overweight and micronutrient deficiencies in this population highlights the need to address the double burden of excess weight with micronutrient deficiencies in medium- and low-income settings.

Zinc and infant nutrition

Zinc is essential for a wide variety of cellular processes in all cells. It is a critical dietary nutrient, particularly in the early stages of life. In the early neonatal period, adequate sources of zinc can be obtained from breast milk. In rare circumstances, the mammary gland produces zinc deficient milk that is potentially lethal for exclusively breast-fed infants. This can be overcome by zinc supplementation to the infant. Alterations to key zinc transporters provide insights into the mechanisms of cellular zinc homeostasis. The bioavailability of zinc in food depends on the presence of constituents that may complex zinc. In many countries, zinc deficiency is a major health issue due to poor nourishment. Young children are particularly affected. Zinc deficiency can impair immune function and contributes to the global burden of infectious diseases including diarrhoea, pneumonia and malaria. Furthermore, zinc deficiency may extend its influence across generations by inducing epigenetic effects that alter the expression of genes. This review discusses the significance of adequate zinc nutrition in infants, factors that influence zinc nutrition, the consequences of zinc deficiency, including its contribution to the global burden of disease, and addresses some of the knowledge gaps in zinc biology.

Infusionstherapie und Ernährung von Risikogruppen

Besondere Situationen erfordern ein besonderes Vorgehen. Während bisher das »Standardvorgehen« bezüglich der Ernährung von pädiatrischen Patienten dargestellt wurde, beschäftigt sich das vorliegende Kapitel mit »Sondersituationen« der pädiatrischen Infusionstherapie und Ernährung. Behandlungssituationen, die ein besonderes Vorgehen bei der Therapie oder spezielle Aufmerksamkeit bei der Anpassung der Ernährung erfordern, entstehen in der Regel durch 4 mögliche Situationen:

spezifische Physiologie von Patientengruppen (z. B. Früh- oder Neugeborene),

Auswirkungen von therapeutischen Maßnahmen (z. B. Operationen),

Pathophysiologie von Erkrankungen (z. B. angeborene Stoffwechselerkrankungen, Erkrankungen des onkologischen, rheumatischen oder atopischen Formenkreises, Anorexia nervosa, Bulimie oder Adipositas) oder

besondere körperliche Belastungen [z. B. (Leistungs-)Sport].

Bekannte Strategien werden systematisch und prägnant dargestellt und diskutiert.

Die Beschäftigung mit der Ernährung von »Risikogruppen« übt das Erkennen und den Umgang von potenziellen Gefahrensituationen bei der Verordnung von bilanzierter Ernährung. So sollte auch derjenige von dem Kapitel profitieren, der sich mit den behandelten Patientengruppen, Situationen, Erkrankungen üblicherweise nicht beschäftigen muss.

Zinc transfer to the breastfed infant

Zinc is a micronutrient which is critical to normal growth and development. Zinc concentrations in human milk decline sharply during the early months post partum, regardless of maternal zinc intake. Milk zinc concentrations do not increase in response to increased maternal zinc intake if maternal zinc status is adequate. The mechanism of zinc secretion into milk is not fully understood. A mutation in the gene for a zinc transporter protein may account for abnormally low milk zinc concentrations associated with severe zinc deficiency in breastfed infants. The zinc requirements of breastfed infants are generally met with exclusive breastfeeding through 5-6 months of age, due to the favorable bioavailability of the zinc in human milk. Because of declining milk zinc concentrations and intake, zinc status in exclusively breastfed infants is likely to become marginal beyond 6 months of age, and may become suboptimal for some infants if exclusive breastfeeding continues. The choice of complementary foods is important to maintain adequate zinc status in breastfed infants after 6 months.

Concentrations of trace elements in sera of newborns, young infants, and adults

Concentrations of trace elements in newborns, infants, and adults may be significantly different from each other. Serum trace element reference ranges for different age groups are of value for diagnostic purposes. Inductively coupled plasma-mass spectrometry was applied to the determination of the 21 trace elements Ba, Be, Bi, Ca, Cd, Co, Cs, Cu, La, Li, Hg, Mg, Mn, Mo, Pb, Rb, Sb, Sn, Sr, TI, and Zn in a total of 117 sera of individuals representing different age groups. After microwave-assisted acid digestion with high-purity reagents, 20 umbilical cord sera, 5 sera of fully breast-fed infants, 6 sera of formula-fed infants, 66 sera of patients suffering internal diseases, and 20 sera of healthy blood donors were analyzed for trace elements. One serum and two whole-blood reference materials were analyzed for quality control. Experimental concentrations were in good agreement with certified values. Umbilical cord serum concentrations of the essential elements Ca, Co, Cu, and Mg and of the nonessential and toxic elements Ba, Be, Li, Pb, and Sb were elevated compared to the elemental concentrations in the sera of infants and adults. Serum levels of Ba, Ca, Co, Mn, Pb, and Sb of infants were much higher and serum Cu was significantly lower than in adults. Serum Cu increased significantly with age (newborns: 353 microg/L; infants: 755 microg/L; healthy adults: 810 microg/L), whereas for other trace elements no age-dependence could be established.

Changes in the concentrations of trace elements in human milk during lactation

Inductively coupled plasma mass spectrometry (ICP-MS) was used to determine 18 trace elements (Ba, Be, Bi, Cd, Co, Cs, Cu, La, Li, Mn, Mo, Pb, Rb, Sb, Sn, Sr, Tl, and Zn) in 55 human milk samples from 46 healthy mothers collected during lactation periods extending to 293 days after birth. Se was quantified by hydride generation atomic absorption spectrometry (HG-AAS). To test the accuracy and the precision of the analytical procedure, milk powder reference materials (BCR 063 and BCR 150) were analyzed. The results obtained by ICP-MS and HG-AAS showed good agreement with the certified values. Whenever available, trace element concentrations determined in the human milk samples were compared to reliable literature data. The concentrations of Be (< 0.05 to 0.9 microgram/kg), Bi (< 0.09 to 2.0 micrograms/kg), Cs (1.7 to 7.7 micrograms/kg), La (< 0.05 to 3.7 micrograms/kg), Rb (440 to 1,620 micrograms/kg), and Tl (< 0.08 to 0.5 microgram/kg) are the first to be reported for human milk. The concentrations of the essential trace elements Cu (p < 0.005), Mn (p < 0.05), Mo (p < 0.0005), Se (p < 0.001), and Zn (p < 0.0005) significantly decreased and the concentrations of cobalt significantly increased (p < 0.005) in human milk during the course of lactation. All concentrations for the essential trace element tin in the human milk samples were below the method detection limit of 0.3 microgram/kg. Among the not essential and toxic elements-with the exception of Ba, Pb, and Tl-the trend toward lower concentrations with continuing lactation is much less pronounced than for the essential trace elements. With the exception of Se, the daily intakes of essential trace elements of fully breast-fed infants are considerably lower than dietary recommendations.

Trace elements in formulas based on cow and soy milk and in Austrian cow milk determined by inductively coupled plasma mass spectrometry

With inductively coupled plasma-mass spectrometry (ICP-MS), the 18 trace elements Ba, (Be), (Bi), Cd, Co, Cs, Cu, La, Li, Mn, Mo, Pb, Rb, (Sb), (Sn), Sr, (Tl), and Zn were quantified in the digests of 13 formulas based on cow milk, of two formulas based on soy protein, of two milk powders, from which formulas were prepared, of two samples of Austrian cow milk, and in the water, with which the powders were suspended. Concentrations in parentheses were at or below the method detection limits in the formulas. The accuracy and precision of the analytical procedure tested with milk powder reference materials BCR 063 and BCR 150 were satisfactory. The concentrations of trace elements in the powders vary considerably from batch to batch. The ratios of high to low concentrations ranged from 1.1 to 4.8 and were higher for the essential trace elements Co, Cu, Mn, Mo, Sn, and Zn than for nonessential or toxic elements. The contribution of tap water from the water system of the city of Graz, Austria to the concentrations of trace elements in the formulas ranges from 45% for Pb to 0.2% for Rb and is negligible, for instance, for Cd, Cs, La, Mo, and Sn. Preformulas and follow-up formulas are partly supplemented with the essential trace elements Cu, Mn, and Zn and, therefore, concentrations of these trace elements in the formulas vary considerably. However, supplementation of a formula with a particular element must not necessarily result in higher concentrations compared to non-supplemented formulas. Concentrations of the essential elements were in the following ranges for preformulas, follow-up formulas, soy-based formulas (in microg/kg): Co, 8.3-11.2, 4.5-13, 5.0-5.7; Cu, 330-750, 27-730, 440-530; Mn, 33-580, 40-390, 440-530; Mo, 10-32, 9-39, 44-46; Sn, <0.44-3.8, <0.44-1.0, <0.44-5.8; Zn, 3340-11,380, 4120-7100, 5590-6,840. A preformula supplemented with Mn had a 10 times higher manganese concentration than preformulas without supplementation. Concentrations of all trace elements quantified were lower in cow milk than in formulas and do not meet the dietary requirements of infants.