Soy-based infant milk formulas and passive intestinal permeability

Intestinal permeability in relation to birth weight and gestational and postnatal age

OBJECTIVE

To determine the relation between intestinal permeability and birth weight, gestational age, postnatal age, and perinatal risk factors in neonates.

STUDY DESIGN

Intestinal permeability was measured by the sugar absorption test within two days of birth and three to six days later in preterm and healthy term infants. In the sugar absorption test, the urinary lactulose/mannitol ratio is measured after oral ingestion of a solution (375 mosm) of lactulose and mannitol.

RESULTS

A first sugar absorption test was performed in 116 preterm (26-36 weeks gestation) and 16 term infants. A second test was performed in 102 preterm and nine term infants. In the preterm infants, the lactulose/mannitol ratio was not related to gestational age (r = -0.09, p = 0.32) or birth weight (r = 0.07, p = 0.43). The median lactulose/mannitol ratio was higher if measured less than two days after birth than when measured three to six days later (0.427 and 0.182 respectively, p<0.001). The lactulose/mannitol ratio was higher in preterm infants than term infants if measured within the first 2 days of life (0.404 and 0.170 respectively, p < 0.001), but not different three to six days later (0.182 and 0.123 respectively, p = 0.08). In multiple regression analysis of perinatal risk factors, only umbilical arterial pH correlated with the lactulose/mannitol ratio in preterm infants less than 2 days of age (T = -1.98, p = 0.05).

CONCLUSIONS

In preterm infants (26-36 weeks gestation), intestinal permeability is not related to gestational age or birth weight but is higher during the first 2 days of life than three to six days later. It is higher in preterm infants than in healthy term infants only if measured within two days of birth. This suggests rapid postnatal adaptation of the small intestine in preterm infants.

Aluminum content of infant formulas used in Turkey

In the past few years, there has been an upsurge of interest in aluminum (Al) and human health. The well-recognized manifestations of systemic Al toxicity include fracturing osteomalacia, dialysis encephalopathy, and microcytic hypochromic anemia. The role of Al in causing childhood diseases is also becoming clearer, but the safe plasma level still remains to be determined in newborns, especially in premature newborns, implying that it should be kept low. Premature infants receiving iv fluid therapy show evidence of Al loading. Additionally, the infant-feeding mixtures, especially the soy-based infant formulas, tested may be a significant additional source of Al in the diet of infants with low birthweights, and in infants and in young children with impaired renal function. Careful clinical and biochemical monitoring is warranted to determine whether it will be necessary to eliminate Al contamination of both oral and parenteral preparations used in infants and children who may be at risk for Al intoxication. In this present study, the Al content of infant feeds was measured by electrothermal atomic absorption spectrophotometry, and also compared with those of breast milk, cow's milk, milk powder, and some starches that are commonly used for preparation of infant feed in Turkey. Our results show that Al content of commercially available powdered infant formulas, most of which are imported from Europe, ranged from 1.211 to 10.925 micrograms/g. The mean value was higher than that of breast milk. It was also found that the Al content of cow's milk in various containers was higher than that of breast milk. The highest Al level among cow's milk samples was in the aluminized carton box.

Aluminum levels in human milk

Aluminium levels in human milk in the winter period of 1992/93 ranged from 0.004 mg/l to 2.67 mg/l and the mean value was 0.38 mg/l. The nursing women were divided into several groups according to the results of a questionnaire, i.e. according to their social status (if they were refugees or not), number of deliveries, post partum day, the weight they put on during pregnancy, their age, and smoking habits. The mean levels of aluminium for each group were presented. The measurement of aluminium was done by graphite furnace atomic absorption spectrophotometry.