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Shang J, Ning J, Bai X, Cao X, Yue X, Yang M. Identification and analysis of miRNAs expression profiles in human, bovine, and donkey milk exosomes. Int J Biol Macromol 2023; 252:126321. [PMID: 37586635 DOI: 10.1016/j.ijbiomac.2023.126321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/25/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023]
Abstract
The purpose of this study is to identify and characterize mirnas in mammalian exosomes. Using Illumina sequencing technology, we sequenced miRNAs in the exosomes of mammalian human milk, bovine milk, and donkey milk. 36 known mature miRNAs and 256 novel miRNAs were identified in human milk. 61 known mature miRNAs and 346 novel miRNAs were identified in milk. 16 known mature miRNAs and 196 novel miRNAs were identified in donkey milk, and miRNAs target genes were predicted. Gene Ontology analysis showed that the miRNAs of human, bovine and donkey milk exosomes all labeled the functions related to body metabolism. Kyoto Encyclopedia pathway analysis showed that human, bovine and donkey milk miRNAs enriched AGE-RAGE signaling pathway in Complications of diabetes. Diabetes is a Metabolic disorder. Based on this pathway, we screened out hsa-miR-8485, bta-miR-342, miR-29c and other genes related to diabetes. This study has a new understanding of the physiological function of mammalian milk miRNAs, and also provides a new way to explore diabetes related miRNAs.
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Affiliation(s)
- Jingwen Shang
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, PR China
| | - Jianting Ning
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, PR China
| | - Xue Bai
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, PR China
| | - Xueyan Cao
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, PR China
| | - Xiqing Yue
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, PR China
| | - Mei Yang
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, PR China.
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Živkov Baloš M, Ljubojević Pelić D, Jakšić S, Lazić S. Donkey Milk: An Overview of its Chemical Composition and Main Nutritional Properties or Human Health Benefit Properties. J Equine Vet Sci 2023; 121:104225. [PMID: 36649829 DOI: 10.1016/j.jevs.2023.104225] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
The donkey milk has a remarkable similarity to human milk, in addition to its valuable nutritional composition and content of numerous immune factors. The donkey milk is the subject of research worldwide, and data from the literature suggest significant differences with respect to the contents of individual components. However, some basic characteristics of donkey milk have been established: low contents of fat and cholesterol, total proteins and casein and high contents of lactose, whey proteins, calcium, selenium, and Vitamin D3. The donkey milk is rich in various protective proteins (α-lactalbumin, lysozyme, lactoferrin, lactoperoxidase, and immunoglobulins), and shows strong antioxidant, antibacterial, antiviral, antifungal, hypoglycemic, antiparasitic, and antitumor activity. Donkey milk can be considered functional food, having in mind that its fatty-acid profile and content of essential fatty acids are beneficial for cardiac health. The total fat content in donkey milk is low compared to human milk, and for this reason it is necessary to enrich donkey milk with other fat in order to provide enough calories in a diet for children. Commercialization of donkey milk and dairy products is still limited due to low production levels, that is lack of products on the market, and lack of product information. Considering the research data from the literature, there is a need for human clinical trials in order to obtain a stronger evidence of the therapeutic properties of donkey milk.
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Affiliation(s)
| | | | - Sandra Jakšić
- Scientific Veterinary Institute "Novi Sad", Novi Sad, Republic of Serbia
| | - Sava Lazić
- Scientific Veterinary Institute "Novi Sad", Novi Sad, Republic of Serbia
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Supplementing human milk with a donkey or bovine milk derived fortifier: consequences on proteolysis, lipolysis and particle structure under in vitro dynamic digestion. Food Chem 2022; 395:133579. [DOI: 10.1016/j.foodchem.2022.133579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/22/2022]
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4
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Papademas P, Mousikos P, Aspri M. Valorization of donkey milk: Technology, functionality, and future prospects. JDS COMMUNICATIONS 2022; 3:228-233. [PMID: 36338810 PMCID: PMC9623768 DOI: 10.3168/jdsc.2021-0175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/22/2022] [Indexed: 05/05/2023]
Abstract
Donkey milk has been in the spotlight for the past 2 decades, mainly because of its potential as a functional food that has positive effects on human health. Nevertheless, challenges remain regarding farming practices, milk yield and milk processing, the introduction of minimal technology, and the use of donkey milk to produce dairy products. In this review, we highlight the fact that interdisciplinary research is needed to provide the scientific community with new knowledge on donkey milk, especially through human clinical trials.
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Messias TB, Sant’Ana AM, Araújo EO, Rangel AH, Vasconcelos AS, Salles HO, Morgano MA, Silva VS, Pacheco MTB, Queiroga RC. Milk from Nordestina donkey breed in Brazil: Nutritional potential and physicochemical characteristics in lactation. Int Dairy J 2022. [DOI: 10.1016/j.idairyj.2021.105291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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GOMES RDDS, BEZERRA MDF, MACÊDO CS, OLIVEIRA ILSD, BORBA LHF, URBANO SA, ANAYA K, CHAGAS BME, ANDRADE NETO JCD, OLIVEIRA JPFD, RANGEL AHDN. Chemical evaluation of donkey milk yoghurt mixed with milk from different animal species. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.80521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | | | | | | | | | | | - Katya ANAYA
- Universidade Federal do Rio Grande do Norte, Brasil
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Hossain Z, Qasem WA, Friel JK, Omri A. Effects of Total Enteral Nutrition on Early Growth, Immunity, and Neuronal Development of Preterm Infants. Nutrients 2021; 13:2755. [PMID: 34444915 PMCID: PMC8401306 DOI: 10.3390/nu13082755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 11/16/2022] Open
Abstract
The feeding of colostrum and mother's transitional milk improves immune protection and neurodevelopmental outcomes. It also helps with gut maturation and decreases the risks of infection. The supply of nutrients from human milk (HM) is not adequate for preterm infants, even though preterm mother's milk contains higher concentrations of protein, sodium, zinc, and calcium than mature HM. The human milk fortifiers, particularly those with protein, calcium, and phosphate, should be used to supplement HM to meet the necessities of preterm infants. The management of fluid and electrolytes is a challenging aspect of neonatal care of preterm infants. Trace minerals such as iron, zinc, copper, iodine, manganese, molybdenum, selenium, chromium, and fluoride are considered essential for preterm infants. Vitamins such as A, D, E, and K play an important role in the prevention of morbidities, such as bronchopulmonary dysplasia, retinopathy of prematurity, and intraventricular hemorrhage. Therefore, supplementation of HM with required nutrients is recommended for all preterm infants.
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Affiliation(s)
- Zakir Hossain
- Department of Fisheries Biology and Genetics, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Wafaa A Qasem
- Department of Surgery, Mubarak AlKabeer Hospital, Hawally 32052, Kuwait;
- Community Medicine Department, Faculty of Medicine, Kuwait University, Kuwait City 13003, Kuwait
| | - James K. Friel
- Richardson Centre for Functional Foods and Nutraceuticals, Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, MB R3T 6C5, Canada;
| | - Abdelwahab Omri
- The Novel Drug and Vaccine Delivery Systems Facility, Department of Chemistry and Biochemistry, Laurentian University, Sudbury, ON P3E 2C6, Canada;
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Bridges KM, Newkirk M, Byham-Gray L, Chung M. Comparative effectiveness of liquid human milk fortifiers: A systematic review and meta-analysis. Nutr Clin Pract 2021; 36:1144-1162. [PMID: 34101248 DOI: 10.1002/ncp.10663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 03/07/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of liquid human milk fortifiers (HMFs) derived from exclusive HM or hydrolyzed protein on growth, necrotizing enterocolitis (NEC), or late-onset sepsis in North American very low-birth-weight (VLBW) infants compared with powder HMFs (control). METHODS Prospective trials published between 2009 and 2020 were systematically reviewed, and meta-analysis was conducted by using a random-effects model. RESULTS Five studies were identified for up to 591 participants across 39 centers. Study treatments included whey or casein hydrolysate HMF and exclusive HM HMF. Infants fed whey or casein hydrolysate HMF had growth differences compared with the control. No differences were found across treatments in regard to NEC or sepsis. CONCLUSION Very low-quality evidence suggests greater linear growth in VLBW infants fed whey hydrolysate liquid HMF, as well as greater weight gain in those fed casein hydrolysate HMF, compared with the control. Additional prospective, multicenter randomized controlled trials are needed to confirm these estimates because of sparsity of evidence. There is insufficient evidence to support HMF decisions regarding NEC or late-onset sepsis prophylaxis.
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Affiliation(s)
- Kayla M Bridges
- Department of Clinical and Preventive Nutrition Sciences, Rutgers, The State University of New Jersey, Newark, New Jersey, USA.,Neonatal Intensive Care Unit, Beaumont Children's Hospital, Royal Oak, Michigan, USA
| | - Melanie Newkirk
- Neonatal Intensive Care Unit, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
| | - Laura Byham-Gray
- Department of Clinical and Preventive Nutrition Sciences, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - Mei Chung
- Department of Clinical and Preventive Nutrition Sciences, Rutgers, The State University of New Jersey, Newark, New Jersey, USA.,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
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Verna G, Sila A, Liso M, Mastronardi M, Chieppa M, Cena H, Campiglia P. Iron-Enriched Nutritional Supplements for the 2030 Pharmacy Shelves. Nutrients 2021; 13:378. [PMID: 33530485 PMCID: PMC7912282 DOI: 10.3390/nu13020378] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 12/18/2022] Open
Abstract
Iron deficiency (ID) affects people of all ages in many countries. Due to intestinal blood loss and reduced iron absorption, ID is a threat to IBD patients, women, and children the most. Current therapies can efficiently recover normal serum transferrin saturation and hemoglobin concentration but may cause several side effects, including intestinal inflammation. ID patients may benefit from innovative nutritional supplements that may satisfy iron needs without side effects. There is a growing interest in new iron-rich superfoods, like algae and mushrooms, which combine antioxidant and anti-inflammatory properties with iron richness.
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Affiliation(s)
- Giulio Verna
- Department of Pharmacy, University of Salerno, 84084 Fisciano, Italy
| | - Annamaria Sila
- National Institute of Gastroenterology “S. de Bellis”, Institute of Research, 70013 Castellana Grotte, Italy; (A.S.); (M.L.); (M.M.); (M.C.)
| | - Marina Liso
- National Institute of Gastroenterology “S. de Bellis”, Institute of Research, 70013 Castellana Grotte, Italy; (A.S.); (M.L.); (M.M.); (M.C.)
| | - Mauro Mastronardi
- National Institute of Gastroenterology “S. de Bellis”, Institute of Research, 70013 Castellana Grotte, Italy; (A.S.); (M.L.); (M.M.); (M.C.)
| | - Marcello Chieppa
- National Institute of Gastroenterology “S. de Bellis”, Institute of Research, 70013 Castellana Grotte, Italy; (A.S.); (M.L.); (M.M.); (M.C.)
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri I.R.C.C.S, 27100 Pavia, Italy
| | - Pietro Campiglia
- Department of Pharmacy, University of Salerno, 84084 Fisciano, Italy
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Pica V, Stuknytė M, Masotti F, De Noni I, Cattaneo S. Bovine milk fortifiers and fortified pasteurized donor human milk for premature infant nutrition. Peptidomic overview. Lebensm Wiss Technol 2021. [DOI: 10.1016/j.lwt.2020.110037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Peila C, Spada E, Deantoni S, Iuliano E, Moro GE, Giribaldi M, Cavallarin L, Cresi F, Coscia A. The "Fortilat" Randomized Clinical Trial Follow-Up: Neurodevelopmental Outcome at 18 Months of Age. Nutrients 2020; 12:nu12123807. [PMID: 33322629 PMCID: PMC7764145 DOI: 10.3390/nu12123807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/06/2020] [Accepted: 12/09/2020] [Indexed: 01/03/2023] Open
Abstract
Adequate nutrition is fundamental to neonatal survival and short-term outcomes, but it also has long-term consequences on quality of life and neurologic development of preterm infants. Donkey milk has been suggested as a valid alternative for children allergic to cows’ milk proteins, due to its biochemical similarity to human milk; we, hence, hypothesized that donkey milk could be a suitable basis for developing an innovative human milk fortifier for feeding preterm infants. The aim of the current study was to extend the findings and to evaluate the neurodevelopmental outcomes at 18 months of corrected age of the infants enrolled in the clinical trial named “Fortilat”. Infants born ≤1500 g and <32 weeks of gestational age were randomized to receive either a combination of bovine milk-based multicomponent fortifier and protein supplement or a combination of a novel multicomponent fortifier and protein supplement derived from donkey milk. The followed fortification protocol was the same for the two groups and the two diets were designed to be isoproteic and isocaloric. All infants enrolled were included in a developmental assessment program. The neurodevelopmental assessment was performed at 18 ± 6 months of corrected age. Minor and major neurodevelopmental impairment and General Quotient (GQ) at the Griffiths-II Mental Development Scale were considered. The GQ was considered both in continuous and as two classes: lower than and higher than (or equal to) a defined cutoff (GQcl). The difference in GQ and GQcl between the two arms was estimated using Mann–Whitney–Wilcoxon test or Fischer exact test, respectively, on the assumption of casual loss at follow-up. A further analysis was performed using generalized linear models. There were 103 children (bovine milk-derived fortifier arm = 54, donkey milk-derived fortifier arm = 49) included for the neurodevelopmental follow-up. All observations were included in the interval of 18 ± 6 months of corrected age. No significant difference was observed between the two arms in the incidence of neurologic sequelae and the GQs were similar in the two arms. Our results demonstrated no difference for the donkey milk-derived fortifier compared to standard bovine-derived fortifier regarding long-term neurodevelopmental outcomes.
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Affiliation(s)
- Chiara Peila
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (S.D.); (E.I.); (F.C.); (A.C.)
- Correspondence:
| | - Elena Spada
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (S.D.); (E.I.); (F.C.); (A.C.)
| | - Sonia Deantoni
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (S.D.); (E.I.); (F.C.); (A.C.)
| | - Ester Iuliano
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (S.D.); (E.I.); (F.C.); (A.C.)
| | - Guido E. Moro
- Italian Association of Human Milk Banks, Via Libero Temolo 4, 20126 Milan, Italy;
| | - Marzia Giribaldi
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco, Italy; (M.G.); (L.C.)
- Research Centre for Engineering and Agro-Food Processing, Council for Agricultural Research and Economics, Strada delle Cacce 73, 10135 Turin, Italy
| | - Laura Cavallarin
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco, Italy; (M.G.); (L.C.)
| | - Francesco Cresi
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (S.D.); (E.I.); (F.C.); (A.C.)
| | - Alessandra Coscia
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (S.D.); (E.I.); (F.C.); (A.C.)
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Peila C, Spada E, Bertino E, Deantoni S, Percivati F, Moro GE, Giribaldi M, Cavallarin L, Cresi F, Coscia A. The "Fortilat" Randomized Clinical Trial Follow-Up: Auxological Outcome at 18 Months of Age. Nutrients 2020; 12:nu12123730. [PMID: 33287300 PMCID: PMC7761645 DOI: 10.3390/nu12123730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 11/23/2022] Open
Abstract
Human milk fortification is a routine clinical practice for feeding preterm infants. We hypothesized that donkey milk can be a suitable basis for developing an innovative human milk fortifier. Our randomized controlled single-blind clinical trial, named “Fortilat”, evaluated the feeding tolerance, growth and clinical short-term outcomes in a population of preterm infants fed with a novel multi-component fortifier and a protein concentrate derived from donkey milk. The aim of the current study is to extend the previous findings and to evaluate the auxological outcomes of the infants enrolled in the “Fortilat” trial at 18 months of age. In the previous trial “Fortilat”, the fortification protocol followed was the same for the two groups, and the two diets were designed to be isoproteic and isocaloric. All infants enrolled in the trial were included in a premature infant developmental evaluation program consisting of hospital visits at 40 ± 1 weeks of postmenstrual age, and at 6, 12 and 18 months of corrected age. Weight, head circumference and length were expressed in z-score using neonatal Intergrowth21st and INeS charts at birth, and WHO 0–5 years growth charts at 18 months. 122 children (Bovine-arm = 62, Donkey-arm = 60) were included in this study. All the observations were recorded in the interval of 18 ± 3 months of the correct age. The two groups did not differ for head circumference, length or weight at 18 months of age. Our data show that fortifiers derived from donkey milk had not different long term auxological outcomes of standard bovine-derived fortifier, but the new donkey milk fortifier was well tolerated in our population.
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Affiliation(s)
- Chiara Peila
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
- Correspondence:
| | - Elena Spada
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
| | - Enrico Bertino
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
| | - Sonia Deantoni
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
| | - Federica Percivati
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
| | - Guido E. Moro
- Italian Association of Human Milk Banks, Via Libero Temolo 4, 20126 Milan, Italy;
| | - Marzia Giribaldi
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco, Italy; (M.G.); (L.C.)
- Research Centre for Engineering and Agro-Food Processing, Council for Agricultural Research and Economics (CREA), Strada delle Cacce 73, 10135 Turin, Italy
| | - Laura Cavallarin
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco, Italy; (M.G.); (L.C.)
| | - Francesco Cresi
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
| | - Alessandra Coscia
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
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Gao C, Miller J, Collins CT, Rumbold AR. Comparison of different protein concentrations of human milk fortifier for promoting growth and neurological development in preterm infants. Cochrane Database Syst Rev 2020; 11:CD007090. [PMID: 33215474 PMCID: PMC8092673 DOI: 10.1002/14651858.cd007090.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Human milk alone may provide inadequate amounts of protein to meet the growth requirements of preterm infants because of restrictions in the amount of fluid they can tolerate. It has become common practice to feed preterm infants with breast milk fortified with protein and other nutrients but there is debate about the optimal concentration of protein in commercially available fortifiers. OBJECTIVES To compare the effects of different protein concentrations in human milk fortifier, fed to preterm infants, on growth and neurodevelopment. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search CENTRAL (2019, Issue 8), Ovid MEDLINE and CINAHL on 15 August 2019. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA We included all published and unpublished randomised, quasi-randomised and cluster-randomised trials comparing two different concentrations of protein in human milk fortifier. We included preterm infants (less than 37 weeks' gestational age). Participants may have been exclusively fed human milk or have been supplemented with formula. The concentration of protein was classified as low (< 1g protein/100 mL expressed breast milk (EBM)), moderate (≥ 1g to < 1.4g protein/100 mL EBM) or high (≥ 1.4g protein/100 mL EBM). We excluded trials that compared two protein concentrations that fell within the same category. DATA COLLECTION AND ANALYSIS We undertook data collection and analyses using the standard methods of Cochrane Neonatal. Two review authors independently evaluated trials. Primary outcomes included growth, neurodevelopmental outcome and mortality. Data were synthesised using risk ratios (RR), risk differences and mean differences (MD), with 95% confidence intervals (CI). We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We identified nine trials involving 861 infants. There is one trial awaiting classification, and nine ongoing trials. The trials were mostly conducted in infants born < 32 weeks' gestational age or < 1500 g birthweight, or both. All used a fortifier derived from bovine milk. Two trials fed infants exclusively with mother's own milk, three trials gave supplementary feeds with donor human milk and four trials supplemented with preterm infant formula. Overall, trials were small but generally at low or unclear risk of bias. High versus moderate protein concentration of human milk fortifier There was moderate certainty evidence that a high protein concentration likely increased in-hospital weight gain compared to moderate concentration of human milk fortifier (MD 0.66 g/kg/day, 95% CI 0.51 to 0.82; trials = 6, participants = 606). The evidence was very uncertain about the effect of high versus moderate protein concentration on length gain (MD 0.01 cm/week, 95% CI -0.01 to 0.03; trials = 5, participants = 547; very low certainty evidence) and head circumference gain (MD 0.00 cm/week, 95% CI -0.01 to 0.02; trials = 5, participants = 549; very low certainty evidence). Only one trial reported neonatal mortality, with no deaths in either group (participants = 45). Moderate versus low protein concentration of human milk fortifier A moderate versus low protein concentration fortifier may increase weight gain (MD 2.08 g/kg/day, 95% CI 0.38 to 3.77; trials = 2, participants = 176; very low certainty evidence) with little to no effect on head circumference gain (MD 0.13 cm/week, 95% CI 0.00 to 0.26; I² = 85%; trials = 3, participants = 217; very low certainty evidence), but the evidence is very uncertain. There was low certainty evidence that a moderate protein concentration may increase length gain (MD 0.09 cm/week, 95% CI 0.05 to 0.14; trials = 3, participants = 217). Only one trial reported mortality and found no difference between groups (RR 0.48, 95% CI 0.05 to 5.17; participants = 112). No trials reported long term growth or neurodevelopmental outcomes including cerebral palsy and developmental delay. AUTHORS' CONCLUSIONS Feeding preterm infants with a human milk fortifier containing high amounts of protein (≥ 1.4g/100 mL EBM) compared with a fortifier containing moderate protein concentration (≥ 1 g to < 1.4 g/100 mL EBM) results in small increases in weight gain during the neonatal admission. There may also be small increases in weight and length gain when infants are fed a fortifier containing moderate versus low protein concentration (< 1 g protein/100 mL EBM). The certainty of this evidence is very low to moderate; therefore, results may change when the findings of ongoing studies are available. There is insufficient evidence to assess the impact of protein concentration on adverse effects or long term outcomes such as neurodevelopment. Further trials are needed to determine whether modest increases in weight gain observed with higher protein concentration fortifiers are associated with benefits or harms to long term growth and neurodevelopment.
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Affiliation(s)
- Chang Gao
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Jacqueline Miller
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Carmel T Collins
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
- Discipline of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Alice R Rumbold
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
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Giribaldi M, Peila C, Coscia A, Cavallarin L, Antoniazzi S, Corbu S, Maiocco G, Sottemano S, Cresi F, Moro GE, Bertino E, Fanos V, Cesare Marincola F. Urinary Metabolomic Profile of Preterm Infants Receiving Human Milk with Either Bovine or Donkey Milk-Based Fortifiers. Nutrients 2020; 12:E2247. [PMID: 32727157 PMCID: PMC7468788 DOI: 10.3390/nu12082247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 12/11/2022] Open
Abstract
Fortification of human milk (HM) for preterm and very low-birth weight (VLBW) infants is a standard practice in most neonatal intensive care units. The optimal fortification strategy and the most suitable protein source for achieving better tolerance and growth rates for fortified infants are still being investigated. In a previous clinical trial, preterm and VLBW infants receiving supplementation of HM with experimental donkey milk-based fortifiers (D-HMF) showed decreased signs of feeding intolerance, including feeding interruptions, bilious gastric residuals and vomiting, with respect to infants receiving bovine milk-based fortifiers (B-HMF). In the present ancillary study, the urinary metabolome of infants fed B-HMF (n = 27) and D-HMF (n = 27) for 21 days was analyzed by 1H NMR spectroscopy at the beginning (T0) and at the end (T1) of the observation period. Results showed that most temporal changes in the metabolic responses were common in the two groups, providing indications of postnatal adaptation. The significantly higher excretion of galactose in D-HMF and of carnitine, choline, lysine and leucine in B-HMF at T1 were likely due to different formulations. In conclusion, isocaloric and isoproteic HM fortification may result in different metabolic patterns, as a consequence of the different quality of the nutrients provided by the fortifiers.
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Affiliation(s)
- Marzia Giribaldi
- CREA Research Centre for Engineering and Agro-Food Processing, 10135 Turin, Italy;
| | - Chiara Peila
- Neonatal Unit, University of Turin, City of Health and Science of Turin, 10126 Turin, Italy; (C.P.); (G.M.); (S.S.); (F.C.); (E.B.)
| | - Alessandra Coscia
- Neonatal Unit, University of Turin, City of Health and Science of Turin, 10126 Turin, Italy; (C.P.); (G.M.); (S.S.); (F.C.); (E.B.)
| | - Laura Cavallarin
- Institute of the Science of Food Production—National Research Council, 10095 Grugliasco (TO), Italy; (L.C.); (S.A.)
| | - Sara Antoniazzi
- Institute of the Science of Food Production—National Research Council, 10095 Grugliasco (TO), Italy; (L.C.); (S.A.)
| | - Sara Corbu
- Department of Chemical and Geological Sciences, Cittadella Universitaria, University of Cagliari, 09042 Cagliari, Italy; (S.C.); (F.C.M.)
| | - Giulia Maiocco
- Neonatal Unit, University of Turin, City of Health and Science of Turin, 10126 Turin, Italy; (C.P.); (G.M.); (S.S.); (F.C.); (E.B.)
| | - Stefano Sottemano
- Neonatal Unit, University of Turin, City of Health and Science of Turin, 10126 Turin, Italy; (C.P.); (G.M.); (S.S.); (F.C.); (E.B.)
| | - Francesco Cresi
- Neonatal Unit, University of Turin, City of Health and Science of Turin, 10126 Turin, Italy; (C.P.); (G.M.); (S.S.); (F.C.); (E.B.)
| | - Guido E. Moro
- Italian Association of Human Milk Banks (AIBLUD), 20126 Milan, Italy;
| | - Enrico Bertino
- Neonatal Unit, University of Turin, City of Health and Science of Turin, 10126 Turin, Italy; (C.P.); (G.M.); (S.S.); (F.C.); (E.B.)
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section, Azienda University Polyclinic, University of Cagliari, 09124 Cagliari, Italy;
| | - Flaminia Cesare Marincola
- Department of Chemical and Geological Sciences, Cittadella Universitaria, University of Cagliari, 09042 Cagliari, Italy; (S.C.); (F.C.M.)
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Effects on Gastroesophageal Reflux of Donkey Milk-Derived Human Milk Fortifier Versus Standard Fortifier in Preterm Newborns: Additional Data from the FortiLat Study. Nutrients 2020; 12:nu12072142. [PMID: 32708446 PMCID: PMC7400944 DOI: 10.3390/nu12072142] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/11/2020] [Accepted: 07/16/2020] [Indexed: 02/08/2023] Open
Abstract
Background: Feeding intolerance is a frequent diagnosis in very preterm infants. As seen in the FortiLat trial, human milk fortification with the new donkey milk-derived human milk fortifier (DF) seems to improve feeding tolerance in these infants. The aim of this study was to evaluate the effects of using the DF compared with bovine milk-derived fortifier (BF) on gastroesophageal reflux (GER) in very low birth weight (VLBW) infants. Methods: Over a total of 156 preterm infants were enrolled into the FortiLat trial (GA <32 weeks and birth weight <1500 g) and randomized into the BF arm or DF arm, and we selected all infants with clinical signs of GER and cardiorespiratory (CR) symptoms. All the infants underwent CR and multichannel intraluminal impedance and pH (MII/pH) monitoring associated with gastric ultrasound to evaluate GER and gastric emptying time. Results: 10 infants were enrolled, and 5 were in the DF arm. At MII/pH, infants enrolled into the DF arm showed a lower GER frequency than BF arm infants (p = 0.036). Half gastric emptying time was similar in DF and BF arm infants (p = 0.744). Conclusion: The use of donkey-derived human milk fortifier reduced the GER frequency and consequently should be recommended in infants with feeding intolerance.
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16
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Premkumar MH, Massieu LA, Anderson DM, Gokulakrishnan G. Human Milk Supplements: Principles, Practices, and Current Controversies. Clin Perinatol 2020; 47:355-368. [PMID: 32439116 DOI: 10.1016/j.clp.2020.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Human milk is the most optimal source of nutrition for preterm and term infants. However, in most preterm infants, breast milk fails to meet the energy needs of the newborn infant. Overwhelming evidence supports the fortification of breast milk in preterm infants to facilitate better short-term outcomes. Several single-nutrient and multinutrient breast milk supplements and fortifiers are used to improve the macronutrient and micronutrient content of breast milk. An individualized fortification strategy has the potential to offer better results compared with standard fortification strategies. Human milk-derived fortification is promising, but the benefits in exclusively human milk-fed preterm infants are unclear.
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Affiliation(s)
- Muralidhar H Premkumar
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
| | | | - Diane M Anderson
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Ganga Gokulakrishnan
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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17
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Maiocco G, Migliaretti G, Cresi F, Peila C, Deantoni S, Trapani B, Giuliani F, Bertino E, Coscia A. Evaluation of Extrauterine Head Growth From 14-21 days to Discharge With Longitudinal Intergrowth-21st Charts: A New Approach to Identify Very Preterm Infants at Risk of Long-Term Neurodevelopmental Impairment. Front Pediatr 2020; 8:572930. [PMID: 33330271 PMCID: PMC7711073 DOI: 10.3389/fped.2020.572930] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/01/2020] [Indexed: 11/29/2022] Open
Abstract
Background: ExtraUterine Growth Restriction (EUGR) is a common definition for in-hospital growth failure of very preterm infants. Wide heterogeneity is found in definitions and anthropometric charts used to describe EUGR. Aim: We aim to compare two traditional definitions of EUGR with a newly proposed one, based on a longitudinal evaluation, that takes into account the physiological period of fluid loss after birth. We also wish to detect which definition could better predict neurodevelopmental impairment at 24 months of corrected age (CA). Methods: A total of 195 infants with GA < 30 were included. EUGR was calculated both for weight and head circumference (HC). Cross-sectional EUGR was defined as measurements < 10th percentile at discharge; longitudinal EUGR was defined as Δz-score < -1 between birth and discharge measurements. The new longitudinal "post-loss" EUGR definition was proposed as Δz-score < -1 between measurements taken at 14-21 days of life and at discharge. Longitudinal postnatal Intergrowth-21st charts specifically built on preterm infants were used. Association with major and minor neurodevelopmental impairment at 24-month CA was assessed for each definition. K coefficient and ROC curve were evaluated. Results: Longitudinal "post-loss" definition of EUGR for HC is the one predicting minor neurodevelopmental impairment at the multivariate analysis (OR = 3.94), and it is also associated with a worse General Quotient. The chosen cut-off (Δz-score < -1) is the proper one. Conclusion: HC in-hospital growth could be a more accurate tool than weight to predict neurodevelopmental outcomes and especially minor neurological impairment. Longitudinal "post-loss" definition of EUGR assessed on longitudinal charts for preterm infants could be the most appropriate definition from the methodological, clinical, and prognostic point of view.
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Affiliation(s)
- Giulia Maiocco
- Neonatal Care Unit, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Giuseppe Migliaretti
- Statistical Unit, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Francesco Cresi
- Neonatal Care Unit, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Chiara Peila
- Neonatal Care Unit, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Sonia Deantoni
- Neonatal Care Unit, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Beatrice Trapani
- Neonatal Care Unit, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Francesca Giuliani
- Neonatal Care Unit, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Enrico Bertino
- Neonatal Care Unit, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Alessandra Coscia
- Neonatal Care Unit, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
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Pozzo L, Cirrincione S, Russo R, Karamać M, Amarowicz R, Coscia A, Antoniazzi S, Cavallarin L, Giribaldi M. Comparison of Oxidative Status of Human Milk, Human Milk Fortifiers and Preterm Infant Formulas. Foods 2019; 8:foods8100458. [PMID: 31597386 PMCID: PMC6835274 DOI: 10.3390/foods8100458] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/28/2019] [Accepted: 10/04/2019] [Indexed: 02/07/2023] Open
Abstract
Preterm and low birth weight infants require specific nutrition to overcome the accumulated growth deficit, and to prevent morbidities related to postnatal growth failure. In order to guarantee an adequate nutrient-intake, mother’s own milk, when available, or donor human milk, are usually fortified with additional nutrients, in particular proteins. Fortification with processed ingredients may result in additional intake in oxidative compounds, deriving from extensive heat treatments, that are applied during processing. The aim of the present work was to compare the in vitro antioxidant activity and oxidative compound content conveyed by different preterm infant foods and fortifiers, namely raw and pasteurized human milk, two different preterm infant formulas, three bovine milk-based fortifiers and two experimental donkey milk-based fortifiers. Univariate and multivariate statistical analyses revealed significant differences between the different products. The use of human milk minimizes the intake of dietary oxidative compound in comparison to infant formulas, irrespective of pasteurization or fortification, especially as far as malondialdehyde content is concerned. The addition of fortifiers to human milk increases its antioxidant capacity, and the choice of the protein source (hydrolysed vs. whole proteins) differently impacted the resulting total antioxidant capacity of the diet.
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Affiliation(s)
- Luisa Pozzo
- Institute of Agricultural Biology and Biotechnology, National Research Council, 56124 Pisa, Italy.
| | - Simona Cirrincione
- Institute of Sciences of Food Production, National Research Council, 10095 Grugliasco (TO), Italy.
| | - Rossella Russo
- Institute of Agricultural Biology and Biotechnology, National Research Council, 56124 Pisa, Italy.
| | - Magdalena Karamać
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, 10748 Olsztyn, Poland.
| | - Ryszard Amarowicz
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, 10748 Olsztyn, Poland.
| | - Alessandra Coscia
- Neonatal Intensive Care Unit, University of Torino, Città della Scienza e della Salute, 10126 Torino, Italy.
| | - Sara Antoniazzi
- Institute of Sciences of Food Production, National Research Council, 10095 Grugliasco (TO), Italy.
| | - Laura Cavallarin
- Institute of Sciences of Food Production, National Research Council, 10095 Grugliasco (TO), Italy.
| | - Marzia Giribaldi
- Research Center for Engineering and Agro-Food Processing, Council for Agricultural Research and Economics, 10035 Torino, Italy.
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A Review of the Appropriate Nutrition Welfare Criteria of Dairy Donkeys: Nutritional Requirements, Farm Management Requirements and Animal-Based Indicators. Animals (Basel) 2019; 9:ani9060315. [PMID: 31159459 PMCID: PMC6616590 DOI: 10.3390/ani9060315] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 11/17/2022] Open
Abstract
Simple Summary The increase in dairy donkey farms in Europe, as a consequence of the increasing scientific interest in donkey milk for paediatric nutrition, has led to the need for a better understanding of the welfare of dairy donkeys. Taking into account the Animal Welfare Indicator’s (AWIN) welfare assessment protocol for donkeys, the aim of this review has been to obtain insight into good feeding welfare principles, in order to identify and discuss the nutritional requirements, the farm management requirements and the animal-based indicators that may be used to achieve an overall assessment of the appropriate nutrition welfare criteria of dairy donkeys. Abstract Data are available in the scientific literature concerning the quality and usefulness of donkey milk for human consumption. However, there is a lack of studies related to the understanding of the welfare of dairy donkeys. The only attempt, at a European Union level, to assess the welfare of donkeys is that of the Animal Welfare Indicator’s (AWIN) welfare assessment protocol for donkeys, where the appropriate nutrition welfare criteria have been assessed, but only through the evaluation of the body condition score. However, several other indicators that take into account the importance of good feeding welfare principles should be considered for the correct management of dairy donkeys. Therefore, it is hoped that this review of the available scientific literature will be useful to help establish a set of appropriate welfare requirements and indicators for the management of dairy donkeys. The review is aimed at identifying and discussing other requirements and indicators, such as nutritional requirements, farm management requirements and animal-based indicators, which may be important for the correct assessment of the appropriate nutrition welfare criteria and to establish best practices for the feeding of dairy donkeys.
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20
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Ahnfeldt AM, Hyldig N, Li Y, Kappel SS, Aunsholdt L, Sangild PT, Zachariassen G. FortiColos - a multicentre study using bovine colostrum as a fortifier to human milk in very preterm infants: study protocol for a randomised controlled pilot trial. Trials 2019; 20:279. [PMID: 31118098 PMCID: PMC6530095 DOI: 10.1186/s13063-019-3367-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Very preterm infants (< 32 weeks gestation) have a relatively high nutrient requirement for growth and development. The composition of human milk is often inadequate to ensure optimal growth so it is common to fortify human milk for very preterm infants with nutrient fortifiers based on bovine milk. However, there are concerns that bovine milk-based fortifiers may increase the risk of feeding intolerance, necrotizing enterocolitis and late-onset sepsis. We hypothesize that a bovine colostrum-based product is a suitable alternative to bovine milk-based products when used as a fortifier to human milk in very preterm infants. METHODS/DESIGN In an open-label multicentre randomised controlled pilot trial, 200 very preterm infants (26 + 0 to 30 + 6 weeks gestation at birth) will be randomly allocated to a bovine colostrum-based or a bovine milk-based fortifier added to mother's own milk and/or human donor milk. Outcomes are growth rate, incidence of necrotizing enterocolitis and late-onset sepsis, a series of paraclinical endpoints, and practical feasibility of using the novel fortifier for very preterm infants. DISCUSSION The optimal enteral diet and feeding regimen for very preterm infants remain debated; this clinical trial will document the feasibility, safety and preliminary efficacy of using bovine colostrum, rich in nutrients and bioactive factors, as a novel fortifier for human milk to very preterm infants. Data on infant growth, metabolism, gut function and immunity will be assessed from clinical data as well as blood and stool samples. TRIAL REGISTRATION Registered retrospectively 25 May 2018 at ClinicalTrials.gov: NCT03537365 .
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Affiliation(s)
- Agnethe M. Ahnfeldt
- Section of Comparative Pediatrics and Nutrition, IVH, University of Copenhagen, Frederiksberg, Denmark
| | - Nana Hyldig
- University of Southern Denmark, Odense, Denmark
- OPEN Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Yanqi Li
- Section of Comparative Pediatrics and Nutrition, IVH, University of Copenhagen, Frederiksberg, Denmark
| | - Susanne Soendergaard Kappel
- Section of Comparative Pediatrics and Nutrition, IVH, University of Copenhagen, Frederiksberg, Denmark
- Department of Neonatology, Rigshospitalet, Copenhagen, Denmark
| | - Lise Aunsholdt
- Department of Neonatology, Rigshospitalet, Copenhagen, Denmark
| | - Per T. Sangild
- Section of Comparative Pediatrics and Nutrition, IVH, University of Copenhagen, Frederiksberg, Denmark
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Department of Neonatology, Rigshospitalet, Copenhagen, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
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Arslanoglu S, Boquien CY, King C, Lamireau D, Tonetto P, Barnett D, Bertino E, Gaya A, Gebauer C, Grovslien A, Moro GE, Weaver G, Wesolowska AM, Picaud JC. Fortification of Human Milk for Preterm Infants: Update and Recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification. Front Pediatr 2019; 7:76. [PMID: 30968003 PMCID: PMC6439523 DOI: 10.3389/fped.2019.00076] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/25/2019] [Indexed: 01/03/2023] Open
Abstract
Evidence indicates that human milk (HM) is the best form of nutrition uniquely suited not only to term but also to preterm infants conferring health benefits in both the short and long-term. However, HM does not provide sufficient nutrition for the very low birth weight (VLBW) infant when fed at the usual feeding volumes leading to slow growth with the risk of neurocognitive impairment and other poor health outcomes such as retinopathy and bronchopulmonary dysplasia. HM should be supplemented (fortified) with the nutrients in short supply, particularly with protein, calcium, and phosphate to meet the high requirements of this group of babies. In this paper the European Milk Bank Association (EMBA) Working Group on HM Fortification discusses the existing evidence in this field, gives an overview of different fortification approaches and definitions, outlines the gaps in knowledge and gives recommendations for practice and suggestions for future research. EMBA recognizes that "Standard Fortification," which is currently the most utilized regimen in neonatal intensive care units, still falls short in supplying sufficient protein for some VLBW infants. EMBA encourages the use of "Individualized Fortification" to optimize nutrient intake. "Adjustable Fortification" and "Targeted Fortification" are 2 methods of individualized fortification. The quality and source of human milk fortifiers constitute another important topic. There is work looking at human milk derived fortifiers, but it is still too early to draw precise conclusions about their use. The pros and cons are discussed in this Commentary in addition to the evidence around use of fortifiers post discharge.
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Affiliation(s)
- Sertac Arslanoglu
- Division of Neonatology, Department of Pediatrics, Istanbul Medeniyet University, Istanbul, Turkey
| | - Clair-Yves Boquien
- PhAN, Institut National de la Recherche Agronomique (INRA), Université de Nantes, CRNH-Ouest, Nantes, France
| | - Caroline King
- Department of Nutrition and Dietetics, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Delphine Lamireau
- Lactariums de Bordeaux-Marmande, Pôle Pédiatrique, Centre Hospitalo-Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Paola Tonetto
- Neonatal Unit of Turin University, City of Health and Science of Turin, Turin, Italy
| | - Debbie Barnett
- Greater Glasgow and Clyde Donor Milk Bank, Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - Enrico Bertino
- Neonatal Unit of Turin University, City of Health and Science of Turin, Turin, Italy
| | - Antoni Gaya
- Banc de Teixits, Fundaciò Banc Sang i Teixits de les Illes Balears, Palma de Mallorca, Spain
| | - Corinna Gebauer
- Abteilung Neonatologie Klinik und Poliklinik für Kinder und Jugendliche, Leipzig, Germany
| | - Anne Grovslien
- Neonatal Unit, Milk Bank, Oslo University Hospital, Oslo, Norway
| | - Guido E. Moro
- Associazione Italiana Banche del Latte Umano Donato (AIBLUD), Milan, Italy
| | - Gillian Weaver
- Hearts Milk Bank, Rothamsted Research Institute, Harpenden, United Kingdom
| | | | - Jean-Charles Picaud
- CarMeN Unit, INSERM U1060, INRA U1397, Claude Bernard University Lyon 1, Pierre Bénite, France
- Division of Neonatology, Hôpital de la Croix-Rousse, Lyon, France
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Abstract
OBJECTIVES The purpose of the present randomized controlled clinical trial was to compare the use of donkey milk-derived fortifier (DF) with commercial bovine milk-derived fortifier (BF) in very preterm or very-low-birth-weight newborns, in terms of feeding tolerance. METHODS This trial included 156 newborns born at <32 weeks of gestational age and/or with a birth weight ≤1500 g. Newborns were randomized 1:1 to receive enteral feeding with either a BF-arm, or a new, DF-arm for 21 days. The fortification protocol was the same for both study arms, and the 2 diets were designed to be isoproteic and isocaloric. Feeding tolerance was assessed by a standardized protocol. RESULTS The risk of feeding intolerance tended to be lower in DF-arm than in BF-arm, with a relative risk reduction of 0.63 (95% confidence interval: -0.29, +0.90). The mean number of episodes per newborn of feeding intolerance and feeding interruptions (any duration) were consistently lower in the DF-arm than in the BF-arm. Episodes of bilious gastric residuals and vomiting were significantly lower in the DF-arm. Time needed to reach full enteral feeding (150 mL · kg · day) and daily weight increase between the first day of exclusive enteral feeding (ie, without administering intravenous fluids) and discharge were similar in the BF- and DF-arms. CONCLUSIONS These results suggest that DF improve feeding tolerance when compared with standard bovine-derived fortifiers, with a similar auxological outcome.
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Analysis of Environmental Factors’ Impact on Donkeys’ Colostrum Quality. SUSTAINABILITY 2018. [DOI: 10.3390/su10092958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Colostrum is a natural product, issued by both mammals and humans in the first week of lactation. Among different species, donkey colostrum is considered to have, in addition to a valuable composition in nutrients and immune factors, an outstanding similitude with human colostrum. In this context, and taking into account the scarcity of available data concerning the interaction between climate factors and colostrum quality, a trial was conducted aiming to identify the possible influence of environmental factors on donkey colostrum nutritional traits. A stock of 175 jennies from 7 farms located in Cluj and Sălaj Counties was analyzed over a 7-day postpartum period. During the experimental period, the daily temperature, humidity, and wind velocity data were collected. Strong positive correlations are reported between the studied colostrum nutritional traits (fat, protein and lactose). Testing the impact of some environmental parameters upon nutritional content of donkey colostrum indicated three factors that have an influence on the nutritional quality of donkey milk colostrum, labelled as: colostrum nutritional traits, environmental air traits and some colostrum nutritional traits, and climatic traits and some colostrum nutritional traits.
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Souroullas K, Aspri M, Papademas P. Donkey milk as a supplement in infant formula: Benefits and technological challenges. Food Res Int 2018; 109:416-425. [PMID: 29803466 DOI: 10.1016/j.foodres.2018.04.051] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/30/2018] [Accepted: 04/23/2018] [Indexed: 12/17/2022]
Abstract
The aim of this review paper is to assess the applicability of donkey's milk to infants suffering from Cow Milk Protein Allergy (CMPA) compared to human and other available milk types. The bioactive and immune-supportive character which could be beneficial as a fortifier to the formula-fed infants is described while limitations of this type of milk are also discussed. Studies showed that human and donkey's milk have similar, overall, chemical composition as well as protein homogeneity and antigenic similarities. Several in vitro and in vivo studies showed that donkey's milk has nutraceutical and functional properties that can support immunity, alter metabolism and beneficially modify gut microbiota. Clinical studies illustrated that donkeys' milk is well tolerated (82.6%-88%) by infants. Finally, the effect that processing (i.e. thermal, non-thermal treatments, drying methods) has on donkey milk components is also discussed pointing out the need for minimally processing this type of milk.
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Affiliation(s)
- Kallis Souroullas
- Department of Agricultural Sciences, Biotechnology & Food Science, Cyprus University of Technology, 3036 Limassol, Cyprus
| | - Maria Aspri
- Department of Agricultural Sciences, Biotechnology & Food Science, Cyprus University of Technology, 3036 Limassol, Cyprus
| | - Photis Papademas
- Department of Agricultural Sciences, Biotechnology & Food Science, Cyprus University of Technology, 3036 Limassol, Cyprus.
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