Type of milk feeding affects hematological parameters and serum lipid profile in Japanese infants

Relationship between lipid profile, anthropometric indicators, and appetite-regulating hormones in infants according to type of feeding

Introduction

Background: infants receiving full breastfeeding (FBF) regulate their appetites differently from those receiving human milk substitutes (HMS). In addition, early exposure to the dietary cholesterol in human milk could lead to better cholesterol regulation in later stages of life. Therefore, the purpose was to compare lipid profiles in 4-month-old infants and to correlate lipid profile with anthropometric indicators and appetite-regulating hormones according to the type of feeding. Methods: this was a cross-sectional and correlational study, which included 145 mother-infant dyads according to the type of feeding; 64 received FBF, 47 partial breastfeeding (PBF), and 34 HMS. The complete lipid profile, total ghrelin, leptin, peptide YY, and glucagon-like peptide type 1 were measured. Z-scores for weight/age, length/age, weight/length, triceps (TSF) and subscapular folds (SSF) and body mass index for age were also obtained. Results: there were significant differences in triglycerides and LDL cholesterol according to the type of feeding. In the HMS group, an inverse relationship was observed between ghrelin and triglycerides (p = 0.038), ghrelin and total cholesterol (TC) (p = 0.026), and peptide YY and HDL cholesterol (p = 0.017). In the PBF group, a direct relationship was observed between length/age (z) and triglycerides (p = 0.001) and between subscapular folds and TC (p = 0.049). In infants receiving HMS, a direct correlation was observed between weight/age (z) and TC (p = 0.045) and between length/age (z) and LDL cholesterol (p = 0.010). Conclusion: these findings show a relationship between growth, energy reserve, lipid profile, and modulation of appetite-regulating hormones according to the type of feeding they received.

Daily protein and energy intakes of infants fed a commercial infant formula with a reduced protein concentration of 2.2 g/100 kcal: an impact of feeding interval on energy intake

We evaluated the protein and energy intakes of infants fed commercial infant Formula A (protein, 2.2 g/100 kcal; energy, 68 kcal/100 mL) and examined whether changes in feeding intervals are involved in constant energy intake. Daily nutritional intake of 378 Formula A-fed infants was assessed using reference values and compared to that of infants fed Formulas B (protein: 2.3 g/100 kcal, energy: 68 kcal/100 mL) and C (protein: 2.4 g/100kcal, energy: 70 kcal/100 mL). From 15 to 149 days of age, the mean formula volume and protein intake were 758-887 mL/day and 11.4-13.3 g/day, respectively, higher than the protein intake of breast-fed infants. Daily energy intake (86-129 kcal/kg/day) was comparable to the estimated energy requirements. Feeding intervals were shorter in infants fed Formulas A and B than in those fed Formula C, whereas energy intake was similar. The protein intake of infants decreased as the protein concentration per energy in infant formula was reduced, and accordingly the protein intake of Formula A-fed infants was significantly lower than that of Formula C-fed infants. In conclusion, the new composition of Formula A is suitable in protein and energy intake of infants, and daily energy intake remains constant by shortening in feeding intervals when the energy concentration in infant formula is reduced.Clinical Trial Registration: UMIN000023110.

Prevalence of infant and maternal anemia during the lactation period in Japan

BACKGROUND

The perinatal period is associated with a high risk of infant anemia. The aim of the present study was to determine the prevalence of infant and maternal anemia during the late lactation period and the risk factors for anemia in Japan.

METHODS

This retrospective cohort study was based on data from health checkups of healthy infants at 6-7 and 9-10 months of age and their mothers who visited Akitsu Children's Clinic between September 2013 and August 2015. Complete blood count data from infant blood samples obtained at 6-7 months and 9-10 months and from maternal blood samples obtained at 6-7 months, information on feeding methods, and other related parameters were analyzed.

RESULTS

Data from 388 mother-infant pairs were analyzed. The prevalence of infant anemia was 21.1% at 6-7 months and 29.1% at 9-10 months. The prevalence of anemia in exclusively breast-fed infants was 28.4% at 6-7 months and 40.0% at 9-10 months. The risk factors for infant anemia at 9-10 months were exclusive breast-feeding, lower gestational age at birth, male sex, and high weight gain. The prevalence of maternal anemia was 10.5%. There was no correlation between infant and maternal hemoglobin in exclusively breast-fed infants.

CONCLUSIONS

Japanese infants who were breast-fed exclusively had a high prevalence of anemia. A nationwide strategy to prevent anemia is required to prevent infant anemia, even in a nutrition-rich country such as Japan.

Relationships of carotenoid-related gene expression and serum cholesterol and lipoprotein levels to retina and brain lutein deposition in infant rhesus macaques following 6 months of breastfeeding or formula feeding

The purpose of this study was to investigate if the enhanced bioaccumulation of lutein in retina and brain of breastfed, compared to formula-fed, infant monkeys was associated with higher levels of serum total and HDL cholesterol, apolipoproteins, or mRNA/protein expression of carotenoid-related genes. Newborn rhesus macaques were either breastfed, fed a carotenoid-supplemented formula, or fed an unsupplemented formula for 6 months (n = 8, 8, 7). Real-time qPCR and western blotting were performed in two brain regions (occipital cortex and cerebellum) and two retina regions (macular and peripheral retina). Breastfed infants had higher serum total cholesterol, HDL cholesterol, apoA-I, and apoB-100 levels than the combined formula-fed groups (P < 0.05). Breast milk or infant formulas did not alter expression of the nine genes (CD36, SCARB1, SCARB2, LDLR, STARD3, GSTP1, BCO1, BCO2, RPE65) examined except for SCARB2 in the retina and brain regions. In conclusion, dietary regimen did not impact the expression of carotenoid-related genes except for SCARB2. However, carotenoid-related genes were differentially expressed across brain and retina regions. Breastfed infants had higher serum total and HDL cholesterol, and apolipoproteins, suggesting that lipoprotein levels might be important for delivering lutein to tissues, especially the macular retina, during infancy.

High prevalence of anemia in 10-month-old breast-fed Japanese infants

BACKGROUND

Anemia in infancy is still prevalent in developing countries. Commercial iron-fortified complementary foods or iron drops are not available in Japan, and breast-fed infants have a higher risk of anemia. We studied anemia screening in 10-month-old infants to determine whether breast-feeding is a risk factor for anemia.

METHODS

Anemia screening was performed during regular health check for 10-month-old children at four local pediatric clinics in Shimane Prefecture, Japan. Venous blood was obtained for complete blood count. The clinical characteristics of each child were obtained via questionnaire. Anemia was defined as hemoglobin <11.0 g/dL. Children were categorized into anemia and no-anemia groups, and univariate analysis was conducted on comparison of the clinical variables. Multivariate logistic regression analysis for anemia was performed to adjust for several clinical variables.

RESULTS

We analyzed data in 325 children. On univariate analysis, anemia was associated with breast-feeding, monthly bodyweight gain and gestational week. On multivariate logistic regression analysis, anemia was associated with feeding type and gestational week (OR of partial breast-feeding and formula feeding, 0.446; 95%CI: 0.208-0.957; and 0.223; 95%CI: 0.075-0.660, respectively, compared with exclusive breast-feeding, OR, 1.0; and gestational week, OR, 0.753; 95%CI: 0583-0.972).

CONCLUSION

Breast-feeding is an important factor for anemia in 10-month-old Japanese infants. Breast-fed infants after 6 months of age may need iron supplements or iron-fortified complimentary foods.

Neurological effects of iron supplementation in infancy: finding the balance between health and harm in iron-replete infants

Iron mediates many biochemical processes in neural networks that proliferate during brain development. Insufficient iron causes irreversible neurodevelopmental deficits, and most high-income countries recommend that infants older than 4-6 months receive additional iron via food fortification or supplementation to prevent iron-deficiency anaemia. Now that the prevalence of iron-deficiency anaemia in children has decreased to less than 10% in most developed countries, concerns that the recommended intakes far exceed those required to prevent iron-deficiency anaemia have been raised, and emerging evidence suggests that iron overexposure could be linked to adverse outcomes later in life. In this Viewpoint, we discuss the importance of iron for neurodevelopment, investigate the biochemical markers used to assess iron stores, summarise the disparity in public health policies among high-income countries, and discuss the potential association between iron overexposure and adverse neurological outcomes later in life. We present a case for new studies to establish the optimal amount of iron that both prevents deficiency and reduces the potential risk of long-term negative health outcomes.

Differences in Postprandial Lipid Response to Breast- or Formula-feeding in 8-Week-Old Infants

OBJECTIVE

Lipids play important roles in infant growth and development. In this exploratory observational single-center study, we investigated postmeal responses of infants to dietary lipids and differences between breast-feeding (BF) and formula-feeding (FF).

METHODS

Two capillary blood samples were collected from each subject, before and randomly assigned at either 30, 60, 90, 120, 180, or 240 minutes after their respective feeding, followed by measurement of lipid-related plasma parameter concentrations using enzyme-linked immunosorbent assay-based or combined enzymatic and colorimetric methods.

RESULTS

The intermeal interval before testing was shorter in the BF (182.91 ± 22.85 minutes, n = 33) versus FF group (214.1 ± 30.76 minutes, n = 34); BF subjects fed 5 minutes longer (BF 20.27 ± 7.7 minutes; FF 14.82 ± 3.57 minutes). Composite postmeal concentration profiles were generated from 59 plasma sample pairs with sufficient volume (BF = 30): triglyceride (TG) baselines were not different. A TG difference was indicated for BF over FF subjects at 30 minutes, for FF over BF subjects at 60 minutes when corrected for baseline. TG responses in both groups appeared and seemed to clear much faster than those reported for adults. The TG:apolipoprotein B48 (ApoB48) ratio suggests that chylomicrons in BF subjects may carry a higher fat load (P < 0.05), compensated by a higher chylomicron number in FF subjects (P < 0.05). Cholesterol in BF subjects was higher and showed an increase after feeding when corrected for baseline.

CONCLUSIONS

Our results indicate that lipids from either BF or FF may be handled differently in young healthy infants.

Excessive early-life dietary exposure: a potential source of elevated brain iron and a risk factor for Parkinson's disease

Iron accumulates gradually in the ageing brain. In Parkinson's disease, iron deposition within the substantia nigra is further increased, contributing to a heightened pro-oxidant environment in dopaminergic neurons. We hypothesise that individuals in high-income countries, where cereals and infant formulae have historically been fortified with iron, experience increased early-life iron exposure that predisposes them to age-related iron accumulation in the brain. Combined with genetic factors that limit iron regulatory capacity and/or dopamine metabolism, this may increase the risk of Parkinson's diseases. We propose to (a) validate a retrospective biomarker of iron exposure in children; (b) translate this biomarker to adults; (c) integrate it with in vivo brain iron in Parkinson's disease; and (d) longitudinally examine the relationships between early-life iron exposure and metabolism, brain iron deposition and Parkinson's disease risk. This approach will provide empirical evidence to support therapeutically addressing brain iron deposition in Parkinson's diseases and produce a potential biomarker of Parkinson's disease risk in preclinical individuals.

Enhanced delivery of lipophilic nutrients to the infant brain via high density lipoprotein

Lipoproteins are the primary carriers of lipophilic cognitive nutrients such as docosahexaenoic acid, lutein, and α-tocopherol within circulation. The critical roles these nutrients play in growth and development are well established, and as such, their efficient delivery to the infant brain is crucial. Given the selectivity of the blood brain barrier, the lipoprotein fraction primarily responsible for brain delivery of these nutrients must be determined so that efforts aimed at increasing brain nutrient uptake, via lipoprotein profile manipulation, can be appropriately focused. Based on the preclinical and clinical data reviewed here, we hypothesize that high density lipoprotein is the fraction chiefly responsible for delivery of docosahexaenoic acid, lutein, and α-tocopherol to the infant brain. As high density lipoprotein levels tend to be lower in preterm, formula-fed infants as compared to their full-term, breast-fed counterparts, efforts aimed at increasing circulating high density lipoprotein levels, and subsequent delivery of cognitive lipophilic nutrients to the brain via manipulation of formula composition, may be most effective if targeted to this group. These efforts include (1) limiting the polyunsaturated: saturated fatty acid ratio; (2) increasing the casein: whey ratio; (3) altering the proportion of saturated fatty acids found in the sn-2 position of the parent triglyceride; (4) cholesterol supplementation; and (5) nucleotide supplementation.

Cholesterol transport and regulation in the mammary gland

The milk-producing alveolar epithelial cells secrete milk that remains after birth the principal source of nutrients for neonates. Milk secretion and composition are highly regulated processes via integrated actions of hormones and local factors which involve specific receptors and downstream signal transduction pathways. Overall milk composition is similar among mammalian species, although the content of individual constituents such as lipids may significantly differ from one species to another. The milk lipid fraction is essentially composed of triglycerides, which represent more than 95 % of the total lipids in human and commercialized bovine milk. Though sterols, including cholesterol, which is the major milk sterol, represent less than 0.5 % of the total milk lipid fraction, they are of key importance for several biological processes. Cholesterol is required for the formation of biological membranes especially in rapidly growing organisms, and for the synthesis of sterol-based compounds. Cholesterol found in milk originates predominantly from blood uptake and, to a certain extent, from local synthesis in the mammary tissue. The present review summarizes current knowledge on cellular mechanisms and regulatory processes determining intra- and transcellular cholesterol transport in the mammary gland. Cholesterol exchanges between the blood, the mammary alveolar cells and the milk, and the likely role of active cholesterol transporters in these processes are discussed. In this context, the hormonal regulation and signal transduction pathways promoting active cholesterol transport as well as potential regulatory crosstalks are highlighted.

Biological determinants linking infant weight gain and child obesity: current knowledge and future directions

Childhood obesity rates have reached epidemic proportions. Excessive weight gain in infancy is associated with persistence of elevated weight status and later obesity. In this review, we make the case that weight gain in the first 6 mo is especially predictive of later obesity risk due to the metabolic programming that can occur early postpartum. The current state of knowledge regarding the biological determinants of excess infant weight gain is reviewed, with particular focus on infant feeding choice. Potential mechanisms by which different feeding approaches may program the metabolic profile of the infant, causing the link between early weight gain and later obesity are proposed. These mechanisms are likely highly complex and involve synergistic interactions between endocrine effects and factors that alter the inflammatory and oxidative stress status of the infant. Gaps in current knowledge are highlighted. These include a lack of data describing 1) what type of infant body fat distribution may impart risk and 2) how maternal metabolic dysfunction (obesity and/or diabetes) may affect milk composition and exert downstream effects on infant metabolism. Improved understanding and management of these early postnatal determinants of childhood obesity may have great impact on reducing its prevalence.