Effect of infant formula zinc and iron level on zinc absorption, zinc status, and immune function in infant rhesus monkeys

Review: Effect of Some Components of Milk- and Soy-Based Infant Formulas on Mineral Bioavailability

Infants’ high nutritional needs are fulfilled by mother’s milk or infant formulas to provide all the necessary nutrients, among them minerals. Minerals uptake depends not only on mineral content but also on their bioavailability which, in turn, is affected by the different components of the infant formulas. An understanding of these effects would help to improve mineral bioavailability. This work reviews the influence of endogenous (proteins and phytates) and added (ascorbic and citric acid) components in infant formulas on the bioavailability of nutritionally important mineral elements (calcium, zinc, iron and copper) and their interactions. Special attention is given to the influence of protein, which is positive for calcium and negative for iron absorption. The marked negative effect of phytates on iron and zinc absorption can be counteracted by a dephytinization process. Of the added compounds, ascorbic acid has a positive effect on iron absorption that depends on the molar ratio between ascorbic acid and iron. In fact, adding ascorbic acid can counteract the negative effect of phytic acid on iron absorption but does not alter the effect of phytic acid on zinc absorption. The null effect of an increase in citric acid content can be ascribed to the fact that the citrate contents of infant formulas are already high. One of the most important element interactions is the negative effect of calcium on zinc and iron intestinal absorption and also the interaction between zinc and iron. These interactions deserve our attention because these minerals are essential to infants’ growth and development.

Recent studies of iron deficiency during brain development in nonhuman primates

Recent studies of the effects of developmental iron deficiency (ID) and iron deficiency anemia in nonhuman primates have provided new insights into this widespread and well-recognized human nutritional deficiency. The rhesus monkey was the animal model in these experiments, which used extensive hematological and behavioral evaluations in addition to noninvasive brain measures. Two important findings were as follows: 1) different behavioral consequences depending on the timing of ID relative to brain developmental stages and 2) the potential for long-lasting changes in brain iron regulatory systems. Further work in this model, including integration with studies in humans and in laboratory rodents, is ongoing.

Zinc supplementation does not affect growth, morbidity, or motor development of US term breastfed infants at 4-10 mo of age

BACKGROUND

It has been documented that growth patterns differ between breastfed and formula-fed infants. Some investigators have suggested that these differences may be related to differences in zinc nutriture.

OBJECTIVE

The objective of this study was to examine the effect of zinc supplementation on growth, morbidity, and motor development in healthy, term, breastfed infants.

DESIGN

We conducted a randomized double-blind intervention comparing zinc supplementation (5 mg/d as zinc sulfate) with placebo in breastfed infants aged 4-10 mo. Growth and indexes of body composition and gross motor development were measured monthly from 3 to 10 mo. Morbidity data were collected weekly.

RESULTS

Eighty-five infants were enrolled, and 70 completed the study. The baseline characteristics, attained weight or length at 10 mo, growth velocity, gross motor development, and morbidity did not differ significantly between groups, even after control for potentially confounding variables.

CONCLUSIONS

The dietary zinc intake of these breastfed infants appeared to be adequate, given that zinc supplementation did not affect growth, development, or risk of infection (although sample size for detection of differences in development or infection was limited). Previously described differences in growth between breastfed and formula-fed infants in such populations do not appear to be due to differences in zinc nutriture.

Behavioral consequences of developmental iron deficiency in infant rhesus monkeys

Human studies have shown that iron deficiency and iron deficiency anemia in infants are associated with behavioral impairment, but the periods of brain development most susceptible to iron deficiency have not been established. In the present study, rhesus monkeys were deprived of iron by dietary iron restriction during prenatal (n=14, 10 microg Fe/g diet) or early postnatal (n=12, 1.5 mg Fe/L formula) brain development and compared to controls (n=12, 100 microg Fe/g diet, 12 mg Fe/L formula) in behavioral evaluations conducted during the first four months of life in the nonhuman primate nursery. Iron deficiency anemia was detected in the pregnant dams in the third trimester and compromised iron status was seen in the prenatally iron-deprived infants at birth, but no iron deficiency was seen in either the prenatally or postnatally iron-deprived infants during the period of behavioral evaluation. Neither prenatal nor postnatal iron deprivation led to significant delays in growth, or gross or fine motor development. Prenatally deprived infants demonstrated a 20% reduced spontaneous activity level, lower inhibitory response to novel environments, and more changes from one behavior to another in weekly observation sessions. Postnatally deprived infants demonstrated poorer performance of an object concept task, and greater emotionality relative to controls. This study indicates that different syndromes of behavioral effects are associated with prenatal and postnatal iron deprivation in rhesus monkey infants and that these effects can occur in the absence of concurrent iron deficiency as reflected in hematological measures.

Nutrient requirements for preterm infant formulas

Achieving appropriate growth and nutrient accretion of preterm and low birth weight (LBW) infants is often difficult during hospitalization because of metabolic and gastrointestinal immaturity and other complicating medical conditions. Advances in the care of preterm-LBW infants, including improved nutrition, have reduced mortality rates for these infants from 9.6 to 6.2% from 1983 to 1997. The Food and Drug Administration (FDA) has responsibility for ensuring the safety and nutritional quality of infant formulas based on current scientific knowledge. Consequently, under FDA contract, an ad hoc Expert Panel was convened by the Life Sciences Research Office of the American Society for Nutritional Sciences to make recommendations for the nutrient content of formulas for preterm-LBW infants based on current scientific knowledge and expert opinion. Recommendations were developed from different criteria than that used for recommendations for term infant formula. To ensure nutrient adequacy, the Panel considered intrauterine accretion rate, organ development, factorial estimates of requirements, nutrient interactions and supplemental feeding studies. Consideration was also given to long-term developmental outcome. Some recommendations were based on current use in domestic preterm formula. Included were recommendations for nutrients not required in formula for term infants such as lactose and arginine. Recommendations, examples, and sample calculations were based on a 1000 g preterm infant consuming 120 kcal/kg and 150 mL/d of an 810 kcal/L formula. A summary of recommendations for energy and 45 nutrient components of enteral formulas for preterm-LBW infants are presented. Recommendations for five nutrient:nutrient ratios are also presented. In addition, critical areas for future research on the nutritional requirements specific for preterm-LBW infants are identified.

Extent of thermal processing of infant formula affects copper status in infant rhesus monkeys

BACKGROUND

Infant rhesus monkeys are excellent models in which to study the effect of infant formulas on trace element absorption and status. Infants fed powdered formula from birth exhibit normal growth and have blood variables similar to those of breast-fed infants.

OBJECTIVES

The objectives were to evaluate the effects of feeding ready-to-feed (RTF) formulas exposed to different heat treatments to infant monkeys, and, for one of these formulas, to compare the effect of fortification with 2 iron concentrations.

DESIGN

From birth to age 5 mo, infant monkeys (n = 6/group) were fed one of the following formulas exclusively: 1) 12 mg Fe/L processed in cans (RTF-12), 2) formula in glass bottles with 12 mg Fe/L and manufactured by an ultrahigh-temperature (UHT) process (UHT-12), or 3) formula manufactured by a standard thermal process (STP), containing either 8 (STP-8) or 12 (STP-12) mg Fe/L. All formulas had similar copper concentrations (0.6 mg Cu/L). Anthropometric measures and venous blood samples were taken monthly.

RESULTS

Weight and length gain did not differ among groups; however, the STP-12 group weighed less than the UHT-12 group at ages 2, 4, and 5 mo. Hemoglobin values were significantly lower in the RTF-12 group than in all other groups at ages 4 and 5 mo and serum ferritin was lower in the RTF-12 group than in the STP-12 group at age 5 mo. Copper status was lower in STP-12 infants than in STP-8 infants. There was a progressive and significant decline in plasma copper, ceruloplasmin, and Cu/Zn superoxide dismutase activity in infants fed canned formula (RTF-12). Furthermore, coat color changed from normal brown to silver. These outcomes suggest that the canned formula induced copper deficiency in infant monkeys.

CONCLUSIONS

Excessive heat treatment of formula can have a pronounced negative effect on copper status. High iron concentrations did not improve iron status but may adversely affect copper status.

Inhibition of zinc absorption by iron depends on their ratio

Previous studies upon zinc-iron interactions gave conflicting results that could come from differences in protocol design or in trace element status of subjects. The present work assessed the influence of zinc : iron ratio and iron deficiency upon zinc absorption. The digestive absorption of zinc sulphate (100 micromol Zn/l) in presence of iron gluconate was studied in perfused jejunal loops (n = 6/group) of normal rats (range 0-1000 micromol Fe/l) and iron deficient rats (200-750 micromol Fe/l). In normal rats no significant iron inhibition on zinc absorption occurred at Fe:Zn ratio below 2:1. At higher ratios zinc uptake and net absorption decreased significantly (p<0.05). Between 2:1 and 5:1 a dose dependent inhibition of zinc absorption occurred and reached a plateau beyond this ratio. In iron deficient animals no changes in zinc uptake, mucosal retention and absorption compared to normal animals occurred at ratio 2:1. At higher ratios differences were observed at every zinc absorption step except for mucosal retention at 7.5:1 ratio. Iron-zinc interactions depend on their ratio and on previous trace elements status of subjects. Due to the wide and unknown variations that were likely to occur between the subjects of previous human and experimental studies, these results could explain some of the discrepancies between their results.

Determinants of maternal zinc status during pregnancy

Zinc deficiency in pregnant experimental animals limits fetal growth and, if severe, causes teratogenic anomalies. Although the data from human studies are not consistent, similar outcomes have been observed and were associated with poor maternal zinc status. This paper reviews humans studies of zinc status and pregnancy outcome, describes the physiologic adjustments in zinc utilization during pregnancy to meet fetal needs while maintaining maternal status, and identifies dietary and environmental conditions that may override those physiologic adjustments and put the health of the mother and fetus at risk. Adjustments in intestinal zinc absorption appear to be the primary means by which zinc retention is increased to meet fetal demands. However, transfer of sufficient zinc to the fetus is dependent on maintenance of normal maternal serum zinc concentrations. Conditions that could interfere with zinc absorption include intake of cereal-based diets that are high in phytate, high intakes of supplemental iron, or any gastrointestinal disease. Conditions that may alter maternal plasma zinc concentrations and the transport of zinc to the fetus include smoking, alcohol abuse, and an acute stress response to infection or trauma. Supplemental zinc may be prudent for women with poor gastrointestinal function or with any of these conditions during pregnancy.

Dietary factors influencing zinc absorption

Marginal zinc deficiency and suboptimal zinc status have been recognized in many groups of the population in both less developed and industrialized countries. Although the cause in some cases may be inadequate dietary intake of zinc, inhibitors of zinc absorption are most likely the most common causative factor. Phytate, which is present in staple foods like cereals, corn and rice, has a strong negative effect on zinc absorption from composite meals. Inositol hexaphosphates and pentaphosphates are the phytate forms that exert these negative effects, whereas the lower phosphates have no or little effect on zinc absorption. The removal or reduction of phytate by enzyme (phytase) treatment, precipitation methods, germination, fermentation or plant breeding/genetic engineering markedly improves zinc absorption. Iron can have a negative effect on zinc absorption, if given together in a supplement, whereas no effect is observed when the same amounts are present in a meal as fortificants. Cadmium, which is increasing in the environment, also inhibits zinc absorption. The amount of protein in a meal has a positive effect on zinc absorption, but individual proteins may act differently; e.g., casein has a modest inhibitory effect of zinc absorption compared with other protein sources. Amino acids, such as histidine and methionine, and other low-molecular-weight ions, such as EDTA and organic acids (e.g., citrate), are known to have a positive effect on zinc absorption and have been used for zinc supplements. Knowledge about dietary factors that inhibit zinc absorption and about ways to overcome or remove these factors is essential when designing strategies to improve the zinc nutrition of vulnerable groups.

Effect of reducing the phytate content and of partially hydrolyzing the protein in soy formula on zinc and copper absorption and status in infant rhesus monkeys and rat pups

BACKGROUND

Although soy formulas have been designed to meet the nutrient requirements of human infants, they also contain phytate, which may negatively affect trace element absorption.

OBJECTIVE

We evaluated the effect of removing phytate on zinc and copper absorption and status in infant rhesus monkeys and suckling rat pups and evaluated differences between intact and partially hydrolyzed soy protein.

DESIGN

In monkeys, regular and low-phytate soy formulas were fed exclusively for 4 mo and whole-body absorption and retention of 65Zn, 67Cu, 59Fe, 54Mn, and 47Ca were determined at different time points with a whole-body counter. Subsequently, zinc and copper absorption from several human infant formulas and the effect of phytate concentration were evaluated in suckling rat pups by using 65Zn and 64Cu. Finally, infant rhesus monkeys were fed low-phytate formulas with intact or hydrolyzed soy protein for 4 mo and plasma zinc and copper were measured monthly.

RESULTS

In the first monkey study, zinc absorption at 1 mo was higher from low-phytate soy formula (36%) than from regular soy formula (22%), whereas there was no significant difference between groups in the absorption of other minerals. Plasma copper was significantly lower in monkeys fed low-phytate soy formula from 2 to 4 mo. In rat pups, zinc absorption was significantly higher from low-phytate soy formula (78%) than from regular soy formula (51%) and hydrolysis of the protein had no significant effect. Phytate content or protein hydrolysis did not significantly affect copper absorption. In the second monkey study, plasma copper concentrations were highest in monkeys fed the low-phytate, hydrolyzed-protein soy formula.

CONCLUSION

Reducing the phytate content and partially hydrolyzing the protein in soy formula had a beneficial effect on zinc and copper absorption and status in infant rhesus monkeys.

Long-term effects of iron:zinc interactions on growth in rats

The influence of iron (Fe) on the bioavailability and functional status of zinc (Zn) was studied in young rats using metabolic balances and tissue dosages, which were compared to growth. Diets supplied adequate intakes of Fe (45 and 300 mg/kg diet) and Zn (14 and 45 mg/kg) for 2 mo. Two metabolic balance determinations were performed that were correlated for Zn and Fe during the first and the last weeks of the study. A significant effect of Fe supply, but not of Zn was displayed on Fe absorption; both Fe and Zn diet concentrations had a significant influence on Zn absorption. Fe and Zn organ contents were significantly correlated with the amount absorbed during the two metabolic balances. There was a positive correlation between liver and muscle Fe and Fe absorption, and Fe absorption and muscle Zn, as well as a negative one with liver Zn; a positive correlation was displayed between Zn absorption and Zn organ content. No correlation was found between Zn absorption and Fe tissue content. Growth was correlated with Zn, but not with Fe absorption during both balances. A positive correlation was displayed between growth and Zn liver content, and a negative one with Fe liver content. Care must be taken to give growing subjects balanced diets or supplementation, since the negative interactions between these trace elements are likely to persist as long as the diet is given.

Relationships between iron and zinc metabolism: predictive value of digestive absorption on tissue storage

The responses of animals to intake of a trace element could vary if it is ingested with a single test meal or due to chronic intake. The metabolic relationships between zinc (Zn) and iron (Fe) were assessed in the young animal by comparing their digestive absorption studied at the beginning of the study with their tissue storage after two months of being fed on experimental diet. Diets supplied adequate intakes of Fe (45 and 300mg/kg diet) and Zn (14 and 45 mg/kg). A significant effect of Fe supply (p < 0.0001) but not of Zn was displayed on Fe absorption; both Fe and Zn diet concentrations influenced Zn absorption (p < 0.01, p < 0.0001). Fe and Zn organ contents significantly correlated with the amount absorbed during the metabolic balance (p < 0.0001). There was a positive correlation between liver, bone, and muscle Fe and Fe absorption (mg/d)(p < 0.0001), and Fe absorption and bone and muscle Zn (p < 0.04) and a negative one with liver Zn (p < 0.0001); a positive correlation was displayed between Zn absorption (mg/d) and Zn organ content (p < 0.0001). There was no correlation between Zn absorption and Fe tissue content (p > 0.05). This study suggests that interactions occur at every step of Fe and Zn metabolism; Fe is more efficient in altering Zn storage than the reverse. The organism seems to be unable to diminish the consequences of an unbalanced diet and digestive absorption. Care must be taken to give the young growing balanced diets.