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Hoffman-Pennesi D, Winfield S, Gavelek A, Santillana Farakos SM, Spungen J. Infants' and young children's dietary exposures to lead and cadmium: FDA total diet study 2018-2020. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2024:1-16. [PMID: 39236048 DOI: 10.1080/19440049.2024.2396910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/19/2024] [Accepted: 08/19/2024] [Indexed: 09/07/2024]
Abstract
Food can be a source of lead and cadmium exposure for infants and children. Employing a semi-probabilistic approach, dietary exposures to lead and cadmium were assessed for infants 0-11 months (excluding human milk-fed infants) and children 1-6 years using U.S. total diet study data from 2018 to 2020 and food consumption data from 2015 to 2018. Estimated mean lead and cadmium exposures range from 0.7-3.6 µg/day to 0.18-0.47 µg/kg bw/day, respectively, depending on the age group and method for handling non-detected values. Dietary exposures to lead and cadmium are slightly lower and slightly higher than our estimates published in 2019. In addition to the use of more recent datasets for consumption and contamination, differences may be due to the use of refined exposure assessment methodology, particularly a new system of mapping contamination data to intake data. The processed baby food and infant formula food group is the major contributor to lead and cadmium exposure, driven by intake, among infants who do not consume human milk. The food groups contributing most to children's lead and cadmium exposure are grains/baking, dairy and fruit and grains/baking and vegetables, respectively. This work will inform FDA initiatives such as closer to zero, including research needs and regulatory priorities.
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Affiliation(s)
- Dana Hoffman-Pennesi
- Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, MD, USA
| | - Sarah Winfield
- Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, MD, USA
| | - Alexandra Gavelek
- Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, MD, USA
| | | | - Judith Spungen
- Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, MD, USA
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Shahbazi Sighaldeh S, Moridi M, Ghorban Sabagh V, Kazemnejad A, Shateranni F. Improving milk donation behavior through an educational intervention based on the theory of planned behavior: study protocol of a cluster randomized controlled trial. Int Breastfeed J 2023; 18:53. [PMID: 37726855 PMCID: PMC10507972 DOI: 10.1186/s13006-023-00589-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Breastfeeding mothers' decisions to donate their milk is influenced by their knowledge, attitudes, and subjective norms such as their family's opinions on milk donation. In Iran, women have favorable knowledge and positive attitudes toward breastfeeding, but they lack sufficient information and education about milk banks. With respect to current childbearing policies, an increase in the number of infants who will be admitted to neonatal intensive care units is expected. Accordingly, improving milk donation behavior, which requires mothers' intention and ability to donate breast milk, is important for infants' survival and well-being. Therefore, this study aims to evaluate whether an educational program based on the theory of planned behavior affects breastfeeding mothers' decisions to donate their breast milk. METHODS This cluster randomized controlled trial will be conducted in health centers affiliated to Tehran University of Medical Sciences and will enroll 66 breastfeeding mothers (intervention, n = 33; control, n = 33). After collecting baseline data, the intervention group will begin receiving a 60-minute weekly educational program based on Theory of Planned Behavior components for four weeks. The first follow-up assessment will be conducted immediately after the intervention, and the final one will be conducted 12 weeks later. The primary outcomes are the number of mothers who have donated their breast milk and changes in breastfeeding mothers' knowledge, attitude, subjective norms, and perceived behavioral control about donor human milk and intention to donate milk. DISCUSSION This trial will evaluate if a well-designed educational program can improve breastfeeding mothers' knowledge and promote their behavioral factors regarding milk donation and lead to a significant increase in the number of potential milk donors. TRIAL REGISTRATION irct.ir (IRCT20230124057203N1) registered February 14, 2023.
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Affiliation(s)
- Shirin Shahbazi Sighaldeh
- Midwifery and Reproductive Health Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Breastfeeding research center-family health institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Moridi
- Midwifery and Reproductive Health Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Vafa Ghorban Sabagh
- Breastfeeding research center-family health institute, Tehran University of Medical Sciences, Tehran, Iran
- Maternal-Fetal-Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Fatemeh Shateranni
- Midwifery and Reproductive Health Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
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Jochum F, Meyer-Krott M, Hübler T, Lorenz M, Bedikian R, Zakarian J, Litzka A, Judex G, Hertzberg H, Klee D, Maurer L, Schacht M, Al-Radhi A, Maier J, Kröckel A, Faustmann C, Lavalle L, Dahbane S. Real-world evidence study on tolerance and growth in infants fed an infant formula with two human milk oligosaccharides vs mixed fed and exclusively breastfed infants. Mol Cell Pediatr 2023; 10:7. [PMID: 37597076 PMCID: PMC10439867 DOI: 10.1186/s40348-023-00162-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/04/2023] [Indexed: 08/21/2023] Open
Abstract
INTRODUCTION Human milk oligosaccharides (HMOs) are important components of human milk having diverse functions in the development of infants. Randomized controlled trials (RCTs) have demonstrated that infant formulas with the HMOs 2'-fucosyllactose (2'FL) and lacto-N-neotetraose (LNnT) are safe, well-tolerated, and support normal growth. This study aimed to generate real-world evidence (RWE) on growth and gastrointestinal (GI) tolerance in infants consuming a formula with 1 g/L 2'FL and 0.5 g/L LNnT, including a mixed feeding group not studied before in RCTs. PARTICIPANTS AND METHODS This 8-week open-label prospective multicenter study was conducted in Germany and Austria, and included groups of healthy, exclusively breastfed infants (BF), exclusively formula-fed infants (FF) who received the HMO-formula, and infants mixed fed with both HMO formula and human milk (MF). Co-primary outcomes were anthropometry and gastrointestinal tolerance via validated Infant Gastrointestinal Symptom Questionnaire (IGSQ). Secondary outcomes included formula satisfaction and adverse events (AEs). RESULTS One-hundred six infants completed the study (46 FF, 22 MF, and 38 BF). Mean anthropometric z-scores were comparable between groups and generally within ± 0.5 of WHO medians at week 8. IGSQ composite scores demonstrated good GI tolerance in all groups with no significant group differences at week 4 or 8. IGSQ composite scores in FF improved during the course of the study and parents provided high satisfaction ratings for the HMO-formula. Four potentially product-related AEs were reported in FF (no in MF). CONCLUSIONS In this RWE study examining an infant formula with HMOs, growth and GI tolerance outcomes were confirming the good tolerance and safety of this early feeding option previously reported in RCTs.
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Grants
- NCT05150288 Société des Produits Nestlé S.A., Vevey, Switzerland
- NCT05150288 Société des Produits Nestlé S.A., Vevey, Switzerland
- NCT05150288 Société des Produits Nestlé S.A., Vevey, Switzerland
- NCT05150288 Société des Produits Nestlé S.A., Vevey, Switzerland
- NCT05150288 Société des Produits Nestlé S.A., Vevey, Switzerland
- NCT05150288 Société des Produits Nestlé S.A., Vevey, Switzerland
- NCT05150288 Société des Produits Nestlé S.A., Vevey, Switzerland
- NCT05150288 Société des Produits Nestlé S.A., Vevey, Switzerland
- NCT05150288 Société des Produits Nestlé S.A., Vevey, Switzerland
- NCT05150288 Société des Produits Nestlé S.A., Vevey, Switzerland
- NCT05150288 Société des Produits Nestlé S.A., Vevey, Switzerland
- NCT05150288 Société des Produits Nestlé S.A., Vevey, Switzerland
- NCT05150288 Société des Produits Nestlé S.A., Vevey, Switzerland
- NCT05150288 Société des Produits Nestlé S.A., Vevey, Switzerland
- NCT05150288 Société des Produits Nestlé S.A., Vevey, Switzerland
- NCT05150288 Société des Produits Nestlé S.A., Vevey, Switzerland
- NCT05150288 Société des Produits Nestlé S.A., Vevey, Switzerland
- NCT05150288 Société des Produits Nestlé S.A., Vevey, Switzerland
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Affiliation(s)
- Frank Jochum
- Klinik für Kinder- und Jugendmedizin, Ev. Waldkrankenhaus Spandau Stadtrandstr. 555, 13589, Berlin und Medizinische Hochschule Brandenburg - Theodor Fontane (MHB), 16816, Neuruppin, Germany.
| | | | - Tina Hübler
- Gemeinschaftspraxis Kinder- und Jugendarztpraxis, Clemensstraße 4, 47608, Geldern, Germany
| | - Maja Lorenz
- Kinder- und Jugendarzt, Venloer Straße 67, 41751, Viersen, Germany
| | - Raffi Bedikian
- Kinder- und Jugendärztliche Gemeinschaftspraxis, Eugen-Zur-Nieden-Ring 1, 46145, Oberhausen, Germany
| | - Joseph Zakarian
- Kinderarztpraxis, Suitbertusstr. 31, 40223, Düsseldorf, Germany
| | - Anja Litzka
- Facharztpraxis für Kinder- und Jugendmedizin, Regensburger Str. 40, 93133, Burglengenfeld, Germany
| | - Guido Judex
- Zentrum für Kinder- und Jugendgesundheit Regensburg, Dr.-Leo-Ritter-Str. 4, 93049, Regensburg, Germany
| | - Holger Hertzberg
- Kinder- und Jugendarztpraxis, Ludwigstraße 4, 91126, Schwabach, Germany
| | - Daniela Klee
- Kinder- und Jugendarzt, Röntgen-Str. 6, 68642, Bürstadt, Germany
| | - Lothar Maurer
- Fachärzte für Säuglings-, Kinder- und Jugendmedizin, Welschgasse 39, 67227, Frankenthal, Germany
| | - Martin Schacht
- Facharzt für Säuglings-, Kinder- und Jugendmedizin, Schwachhauser Heerstr. 63a, 28211, Bremen, Germany
| | - Adnan Al-Radhi
- Kinder- und Jugendarzt Al-Radhi, Winckelhoferstrasse 3, 89584, Ehingen, Germany
| | - Jan Maier
- Kinder und Jugendarztpraxis, Geranienstr. 11, 70771, Leinfelden-Echterdingen, Germany
| | - Alexander Kröckel
- Kinder- und Jugendarztpraxis, Schwarzwurzelstraße 52/54, 12689, Berlin, Germany
| | - Christian Faustmann
- Facharzt für Kinder- und Jugendheilkunde, Wiener Strasse 8a, 7400, Oberwart, Austria
| | - Luca Lavalle
- Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Samir Dahbane
- Global Medical Affairs, Société des Produits Nestlé S.A., Vevey, Switzerland
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Almaatani D, Zurbau A, Khoshnevisan F, Bandsma RHJ, Khan TA, Sievenpiper JL, Van Den Heuvel M. The association between parents' stress and parental feeding practices and feeding styles: Systematic review and meta-analysis of observational studies. MATERNAL & CHILD NUTRITION 2023; 19:e13448. [PMID: 36284502 PMCID: PMC9749598 DOI: 10.1111/mcn.13448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/31/2022] [Accepted: 09/24/2022] [Indexed: 12/15/2022]
Abstract
In the extended UNICEF framework of early childhood nutrition, parents' stress is associated with parental feeding style. However, no comprehensive review has examined the association between parents' stress and feeding styles and practices. The objective of our review was to synthesise the current literature examining the association between parents' stress and their feeding practices and/or styles, among parents of children ≤ 5 years old. We searched; MEDLINE, EMBASE, PSYCHINFO and CINAHL from 2019 to 2021. Two investigators independently extracted relevant data and assessed the study quality and the certainty of evidence. Data were pooled using generic inverse variance with fixed effects (<5 comparisons) or random effects (≥5 comparisons) and expressed as correlation coefficients with 95% confidence intervals (CI). Between study heterogeneity was assessed using Cochran's Q and quantified with I2 . We identified 6 longitudinal and 11 cross-sectional studies, of which 4 studies provided sufficient data to be pooled. A very small correlation between general stress and restrictive feeding practices was observed (r = 0.06 [95% CI: 0.01-0.12]; no substantial heterogeneity (I2 = 0.00%, PQ < 0.85, very low certainty). No correlation between general stress and feeding pressure was identified (r = 0.06 [95% CI: -0.02 to 0.15]). Results showed that both general and parenting stress were associated with suboptimal breastfeeding practices and unresponsive feeding styles. Conclusion: This study demonstrated a low-to-moderate quality of literature for the inclusion of parents' stress in the extended UNICEF care model of child nutrition. Future research needs to explore this relationship longitudinally and in ethnic diverse populations to inform tailored interventions that promote responsive feeding practices.
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Affiliation(s)
- Dina Almaatani
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Andreea Zurbau
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
| | - Farnaz Khoshnevisan
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Robert H. J. Bandsma
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- Department of PaediatricsUniversity of TorontoTorontoCanada
- Division of Gastroenterology, Hepatology and NutritionHospital for Sick ChildrenTorontoCanada
| | - Tauseef A. Khan
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
| | - John L. Sievenpiper
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Medicine, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Department of Medicine, Division of Endocrinology and MetabolismSt. Michael's HospitalTorontoOntarioCanada
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoOntarioCanada
| | - Meta Van Den Heuvel
- Department of PaediatricsUniversity of TorontoTorontoCanada
- Division of Paediatric MedicineHospital for Sick ChildrenTorontoCanada
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5
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Parker GH, Gillie CE, Miller JV, Badger DE, Kreider ML. Human Health Risk Assessment of Arsenic, Cadmium, Lead, and Mercury Ingestion from Baby Foods. Toxicol Rep 2022; 9:238-249. [PMID: 35198407 PMCID: PMC8850323 DOI: 10.1016/j.toxrep.2022.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 12/07/2022] Open
Abstract
As, Cd and Pb detected in baby foods containing fruit, grain, and root vegetables. Select product HIs exceeded 1 for As and Pb using conservative assumptions. Cancer risks exceeded 10−6 and were driven by As from grain products. Analysis revealed minimal risk under most scenarios using conservative assumptions.
Recently, the U.S. House of Representatives reported on the presence of heavy metals in raw ingredients used in baby foods and in finished baby food products themselves. In light of these concerns, this study aimed to evaluate potential risks associated with the presence of heavy metals in baby food products. We analyzed 36 baby food samples representing four ingredient categories (fruit; leguminous vegetable; root vegetable; or grain) for arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb). We assessed the potential lifetime cancer and non-cancer health risks posed to infants and toddlers following daily consumption of these chemicals in each food type, based on established daily food-specific ingestion rates. Daily doses were compared against selected reference values and oral slope factors to determine non-cancer hazard indices (HIs) and lifetime cancer risks. Hazard indices indicated a potential for non-cancer risk (e.g., HIs > 1.0) under only a few exposure scenarios, including for As and Pb under selected product type and age/concentration assumptions. Increases in lifetime cancer risks for all analytes across the ingredient categories evaluated ranged from 3.75 × 10−5 to 5.54 × 10−5; cancer risks were primarily driven by As from grain products. Though a limited set of exposure scenarios indicated a potential for health risk, the exposure assumptions in this assessment were conservative, and the heavy metal concentrations we found in baby foods are similar to those observed in similar whole foods. Based on these findings and the limited scenarios under which risks were identified, this study indicates that an infant’s typical intake of baby food is unlikely to pose health risks from heavy metals above accepted tolerable risk levels under most exposure scenarios.
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Affiliation(s)
| | | | | | - Deanna E. Badger
- Department of Chemical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Marisa L. Kreider
- Cardno ChemRisk now Stantec, Pittsburgh, PA, USA
- Corresponding author at: 20 Stanwix Street, Suite 505, Pittsburgh, PA, 15222, USA.
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Hupp MK, Papathakis PC, Phelan S, Ventura AK. Associations between mothers' use of food to soothe, feeding mode, and infant weight during early infancy. Appetite 2022; 168:105736. [PMID: 34627981 PMCID: PMC8671361 DOI: 10.1016/j.appet.2021.105736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 12/18/2022]
Abstract
Weight status and rate of weight gain in the first six months postpartum are strong predictors of later obesity; thus, infant feeding practices are an important target for obesity prevention efforts. The use of food to soothe (FTS) is associated with less-favorable eating habits and weight outcomes for older infants and children. However, few studies have examined correlates of use of FTS during early infancy. The primary aim of this cross-sectional study was to explore associations between use of FTS and infant weight status in the first 6 months postpartum. A secondary aim was to identify the combination of maternal and infant characteristics that predicted use of FTS. Mothers of infants aged 6 months or younger (N = 134) completed questionnaires assessing use of FTS, bottle-feeding intensity (i.e., percentage of daily feedings from bottles versus directly from the breast), levels of responsive and pressuring feeding styles, dimensions of infant temperament and eating behaviors, and family demographics. Dyads were observed during feeding to assess maternal sensitivity to infant cues and responsiveness to infant distress and infant clarity of cues and responsiveness to the mother. Infant weight and length at study entry were assessed by a trained research assistant. Use of FTS was not associated with infant weight for age z-score (WAZ), even when bottle-feeding intensity was considered as a moderator. More frequent use of FTS was predicted by the combination of greater levels of pressuring feeding style (p = .005) and infant temperamental negative affectivity (p = .001), and lower levels of infant temperamental surgency/extraversion (p = .018). In conclusion, use of FTS was associated with dimensions of infant temperament and maternal feeding style, but not with WAZ during early infancy.
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Affiliation(s)
- Megan K Hupp
- Center for Health Research, Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA; Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Peggy C Papathakis
- Center for Health Research, Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA; Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Suzanne Phelan
- Center for Health Research, Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Alison K Ventura
- Center for Health Research, Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA.
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7
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Stan SV, Grathwohl D, O'Neill LM, Saavedra JM, Butte NF, Cohen SS. Estimated Energy Requirements of Infants and Young Children up to 24 Months of Age. Curr Dev Nutr 2021; 5:nzab122. [PMID: 34761158 PMCID: PMC8575726 DOI: 10.1093/cdn/nzab122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Establishing energy requirements in infants and young children is important in developing age-appropriate diet recommendations but most published guidelines for energy requirements have 1 or more limitations related to the data underlying the calculations. OBJECTIVE To develop a comprehensive set of daily energy requirements for infants and young children aged 0-24 mo meeting the ideals of worldwide applicability to all healthy children based on the use of the doubly labeled water (DLW) technique to measure total energy expenditure (TEE), the use of recent, international growth charts, and calculation of values across a wide range of body weight. METHODS Daily estimated energy requirements (EERs) were calculated in 1-mo increments from 0 to 24 mo for boys, girls, and combined, using as inputs the following: 1) TEE measured using the DLW technique, 2) energy deposition estimates from the Institute of Medicine, and 3) body weight values from the 25th to 75th percentiles from the 2006 WHO growth charts. EERs were combined for age groups 0 to <6, 6-8, 9-11, and 12-24 mo by averaging EERs from individual months. The EER calculations were supported by a systematic literature review and a meta-regression of existing studies. RESULTS Energy requirements naturally increase with age and are slightly higher in boys than in girls. The EERs derived in this study are similar to those in other recent international efforts. CONCLUSIONS This updated set of EERs for infants and young children expand and improve upon the methodology used to establish previous published guidelines. These estimates have multiple potential uses including planning age-appropriate menus for the complementary feeding period, the development of foods that are more precisely targeted to the needs of infants and children at particular ages, and establishing macronutrient requirements within specific age groups based on a percentage of energy, such as dietary fat.
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Affiliation(s)
- Simona V Stan
- Société des Produits Nestlé S.A., Vevey, Switzerland
| | - Dominik Grathwohl
- Clinical Research Unit, Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Lynda M O'Neill
- Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Jose M Saavedra
- Société des Produits Nestlé S.A., Vevey, Switzerland
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nancy F Butte
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sarah S Cohen
- EpidStrategies, a division of ToxStrategies, Inc., Cary, NC, USA
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Hijazi HH, Alyahya MS, Al Abdi RM, Alolayyan MN, Sindiani AM, Raffee LA, Baniissa WA, Al Marzouqi AM. The Impact of Perceived Social Support During Pregnancy on Postpartum Infant-Focused Anxieties: A Prospective Cohort Study of Mothers in Northern Jordan. Int J Womens Health 2021; 13:973-989. [PMID: 34707417 PMCID: PMC8544270 DOI: 10.2147/ijwh.s329487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/26/2021] [Indexed: 12/26/2022] Open
Abstract
Objective This study aimed to evaluate the association between perceived social support during pregnancy and levels of anxiety among postpartum women using an anxiety-specific screening instrument. Methods Using a prospective cohort design, a two-stage methodology was conducted to collect data from women seeking maternal care at the King Abdullah University Hospital in northern Jordan. In the first stage, perceived social support was assessed among pregnant women using the Medical Outcomes Study Social Support Survey. During the first six months after childbirth, postpartum women were contacted to complete the second stage, wherein their perceptions of infant-focused anxieties were assessed using the Postpartum Specific Anxiety Scale. In our study, two types of infant-focused anxieties were investigated among a final sample of 419 mothers: infant safety and welfare anxieties and practical infant care anxieties. Results The results of multivariate linear regression analysis indicated that providing pregnant women with high levels of emotional support from close social networks (β= −0.08, p= 0.01) and perceiving informational support from health care providers (β= −0.71, p< 0.01) were protective factors for reducing the levels of postpartum anxiety concerning infant safety and welfare. Our findings also demonstrated that pregnant mothers who perceived high informational support from health care providers had a lower level of postpartum anxiety about practical infant care (β= −0.20, p< 0.01). In contrast, mothers who reported receiving high tangible support from close social networks during pregnancy had a significantly higher level of perceived anxiety concerning practical infant care after delivery (β= 0.13, p= 0.02). Conclusion Our study suggests that postpartum anxiety would be reduced if effective informational support were readily available for pregnant women. There is a clear need for building bridges between women, their families, and providers to distinguish the specific type and amount of support that should be provided to mothers during pregnancy.
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Affiliation(s)
- Heba H Hijazi
- Department of Health Services Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad S Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Rabah M Al Abdi
- Department of Biomedical Engineering, Faculty of Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Main N Alolayyan
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Amer M Sindiani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Liqaa A Raffee
- Department of Accident and Emergency Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Wegdan A Baniissa
- Nursing Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Amina M Al Marzouqi
- Department of Health Services Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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9
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Amazouz H, de Lauzon‐Guillain B, Bourgoin‐Heck M, Just J, Beydon N, Lezmi G, Rancière F, Momas I. Infant feeding clusters are associated with respiratory health and allergy at school age in the PARIS birth cohort. Allergy 2021; 76:1223-1234. [PMID: 32815558 DOI: 10.1111/all.14568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/07/2020] [Accepted: 07/28/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND As infant feeding may influence allergy development, we aimed to identify groups of infants based on feeding practices and to examine their associations with respiratory health/allergy at 8 years in the PARIS birth cohort. METHODS Data on breastfeeding, consumption of infant formula (regular, pre-/probiotics, partially hydrolysed with hypoallergenic label [pHF-HA], extensively hydrolysed [eHF], soya) and solid food introduction were collected using repeated questionnaires at 1, 3, 6, 9 and 12 months. Infants with similar feeding practices over the first year of life were grouped using multidimensional longitudinal cluster analysis. Respiratory/allergic morbidity was studied at 8 years as symptoms, doctor's diagnoses (asthma, hay fever, eczema, food allergy), and measurement of lung function, FeNO and specific IgE. Associations between feeding-related clusters and respiratory/allergic morbidity were investigated using multivariable logistic and linear regression models adjusted for potential confounders including early respiratory/allergic outcomes and parental history of allergy. RESULTS Five clusters were identified among 3446 infants: Cluster 1 (45%) mainly fed with regular formula, Cluster 2 (27%) exclusively breastfed during the first 3 months, and three other clusters consuming different types of formula (pre-/probiotics for Cluster 3 [17%], pHF-HA for Cluster 4 [7%], eHF/soya for Cluster 5 [4%]). Compared to Cluster 1, children from Cluster 2 tended to have a lower risk of asthma and children from Cluster 4 had a significant lower lung function (FEV1 , FVC), higher FeNO and higher risk of sensitization at 8 years. CONCLUSION Early pHF-HA use was negatively associated with objective measures of respiratory/allergic morbidity at school age, while children breastfed for at least 3 months seem protected against asthma at 8 years old.
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Affiliation(s)
- Hélène Amazouz
- HERA Team, CRESS Université de Paris, Inserm, INRAE Paris France
| | | | | | - Jocelyne Just
- Service d'Allergologie Pédiatrique Hôpital Armand‐Trousseau, AP‐HP Paris France
| | - Nicole Beydon
- Unité Fonctionnelle de Physiologie‐Explorations Fonctionnelles Respiratoires (EFR) Hôpital Armand‐Trousseau, AP‐HP Paris France
| | - Guillaume Lezmi
- Service de Pneumologie et d'Allergologie Pédiatriques Hôpital Necker‐Enfants malades, AP‐HP Paris France
| | - Fanny Rancière
- HERA Team, CRESS Université de Paris, Inserm, INRAE Paris France
- Faculté de Pharmacie de Paris Université de Paris Paris France
| | - Isabelle Momas
- HERA Team, CRESS Université de Paris, Inserm, INRAE Paris France
- Faculté de Pharmacie de Paris Université de Paris Paris France
- Cellule Cohorte, Direction de l'Action Sociale de l'Enfance et de la Santé Mairie de Paris Paris France
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10
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Radlowski EC, Wang M, Monaco MH, Comstock SS, Donovan SM. Combination-Feeding Causes Differences in Aspects of Systemic and Mucosal Immune Cell Phenotypes and Functions Compared to Exclusive Sow-Rearing or Formula-Feeding in Piglets. Nutrients 2021; 13:1097. [PMID: 33801785 PMCID: PMC8065485 DOI: 10.3390/nu13041097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 02/03/2023] Open
Abstract
Combination feeding (human milk and formula) is common and influences immune development compared to exclusive breastfeeding. Infant formulas contain prebiotics, which influence immune development. Herein, immune development of combination-fed (CF), sow-reared (SR) and formula-fed (FF) piglets, and the effect of prebiotics was tested. Piglets (n = 47) were randomized to: SR, FF, CF, FF+prebiotic (FP), and CF+prebiotic (CP). FP and CP received formula with galactooligosaccharides and inulin (4 g/L in a 4:1 ratio). CF and CP piglets were sow-reared for until d5 and then rotated between a sow and formula every 12 h. On day 21, piglets received an intraperitoneal injection of lipopolysaccharide 2 h prior to necropsy. Immune cells from blood, mesenteric lymph nodes (MLN), and spleen were phenotyped. Classical (nitric oxide synthase) and alternative (arginase activity) activation pathways were measured in isolated macrophages. Serum IL-6 and TNF-α were measured by ELISA. SR piglets had lower (p < 0.0001) CD4+ T-helper cells and higher (p < 0.0001) B-cells in PBMC than all other groups. CP piglets had higher (p < 0.0001) arginase activity compared to all other groups. FF piglets had higher (p < 0.05) IL-6 compared to both CF and SR, but were similar to FP and CP. Thus, CF, with or without prebiotics, differentially affected immunity compared to exclusively fed groups.
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Affiliation(s)
- Emily C. Radlowski
- Department of Nutritional Sciences, Dominican University, River Forest, IL 60305, USA;
| | - Mei Wang
- Department of Food Science and Human Nutrition, University of Illinois, Urbana, IL 61801, USA; (M.W.); (M.H.M.)
| | - Marcia H. Monaco
- Department of Food Science and Human Nutrition, University of Illinois, Urbana, IL 61801, USA; (M.W.); (M.H.M.)
| | - Sarah S. Comstock
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA;
| | - Sharon M. Donovan
- Department of Food Science and Human Nutrition, University of Illinois, Urbana, IL 61801, USA; (M.W.); (M.H.M.)
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11
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Guo J, Ren C, Han X, Huang W, You Y, Zhan J. Role of IgA in the early-life establishment of the gut microbiota and immunity: Implications for constructing a healthy start. Gut Microbes 2021; 13:1-21. [PMID: 33870860 PMCID: PMC8078773 DOI: 10.1080/19490976.2021.1908101] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/05/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
Colonization and maturation of the gut microbiota (GM) during early life is a landmark event that fundamentally influences the (early) immunity and later-life health of various mammals. This is a delicate, systematic process that is biologically actively regulated by infants and their mothers, where (secretory) IgA, an important regulator of microbes found in breast milk and generated actively by infants, may play a key role. By binding to microbes, IgA can inhibit or enhance their colonization, influence their gene expression, and regulate immune responses. IgA dysfunction during early life is associated with disrupted GM maturation and various microbe-related diseases, such as necrotizing enterocolitis and diarrhea, which can also have a lasting effect on GM and host health. This review discusses the process of early GM maturation and its interaction with immunity and the role of IgA (focusing on milk secretory IgA) in regulating this process. The possible application of this knowledge in promoting normal GM maturation processes and immune education has also been highlighted.
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Affiliation(s)
- Jielong Guo
- College of Food Science and Nutritional Engineering, Beijing Key Laboratory of Viticulture and Enology, China Agricultural University, Beijing, China
| | - Chenglong Ren
- College of Food Science and Nutritional Engineering, Beijing Key Laboratory of Viticulture and Enology, China Agricultural University, Beijing, China
| | - Xue Han
- Peking University School of Basic Medical Science, Peking University Health Science Centre
| | - Weidong Huang
- College of Food Science and Nutritional Engineering, Beijing Key Laboratory of Viticulture and Enology, China Agricultural University, Beijing, China
| | - Yilin You
- College of Food Science and Nutritional Engineering, Beijing Key Laboratory of Viticulture and Enology, China Agricultural University, Beijing, China
| | - Jicheng Zhan
- College of Food Science and Nutritional Engineering, Beijing Key Laboratory of Viticulture and Enology, China Agricultural University, Beijing, China
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12
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Qu W, Yue Q, Wang Y, Yang JL, Jin X, Huang X, Tian X, Martin K, Narayan A, Xu T. Assessing the changes in childbirth care practices and neonatal outcomes in Western China: pre-comparison and post-comparison study on early essential newborn care interventions. BMJ Open 2020; 10:e041829. [PMID: 33371038 PMCID: PMC7757506 DOI: 10.1136/bmjopen-2020-041829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/24/2020] [Accepted: 12/05/2020] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To explore the changes in childbirth care practices and health outcomes of newborns after the introduction of early essential newborn care (EENC). DESIGN A pre-comparison and post-comparison study. SETTING The study was conducted in December 2016 and December 2018 in 18 counties in four western provinces of China. PARTICIPANTS 46 hospitals that provide delivery services participated in the study. INTERVENTIONS EENC practices were introduced and implemented in the 46 hospitals. OUTCOME MEASURES The changes of hospital indicators such as incidence of birth asphyxia and neonatal mortality were compared in 2016 and 2018. EENC coverage indicators, such as skin-to-skin (STS) contact, and time of first breast feeding were also compared before and after the intervention via interview with 524 randomly selected postpartum mothers (320 in 2016 and 204 in 2018). RESULTS 54 335 newborns were delivered in the pre-EENC period (2016) and 58 057 delivered in the post-EENC period (2018). According to hospital records, the proportion of newborns receiving immediate STS contact increased from 32.6% to 51.2% (Risk Ratio (RR)=1.57,95% CI 1.55 to 1.59) and the percentage of newborns receiving prolonged STS contact for more than 90 min increased from 8.1% to 26.8% (RR=3.31, 95% CI 3.21 to 3.41). No statistically significant changes were found in neonatal mortality, although slight decreases in birth asphyxiate and neonatal intensive care unit admission rates were detected. Among the mothers interviewed, the proportion of newborns receiving immediate STS contact increased from 34.6% to 80.0% (RR=2.31, 95% CI 1.69 to 3.17). The exclusive breastfeeding rate increased from 43% to 73.4% (RR=1.71, 95% CI 1.43 to 2.04). The average length of the first breast feeding increased from 15.8 min to 17.1 min. CONCLUSIONS The introduction of EENC has yielded significant improvements in newborn care services at the pilot hospitals, including enhanced maternal and newborn care practices, improved STS contact quality and early breastfeeding performance. Further studies are needed to evaluate the long-term impact of EENC on newborn health outcomes.
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Affiliation(s)
- Wen Qu
- Child Health Care Department, National Center for Women and Children's Heath China Center for Disease Control, Beijing, China
| | - Qing Yue
- Child Health Care Department, National Center for Women and Children's Heath China Center for Disease Control, Beijing, China
| | - Yan Wang
- Child Health Care Department, National Center for Women and Children's Heath China Center for Disease Control, Beijing, China
| | - Jin Liuxing Yang
- Child Health Care Department, National Center for Women and Children's Heath China Center for Disease Control, Beijing, China
| | - Xi Jin
- Child Health Care Department, National Center for Women and Children's Heath China Center for Disease Control, Beijing, China
| | - Xiaona Huang
- Health, Nutrition & WASH Section of UNICEF China Office, Beijing, China
| | - Xiaobo Tian
- Health, Nutrition & WASH Section of UNICEF China Office, Beijing, China
| | - Kathryn Martin
- School of Community Medicine, The University of Oklahoma, Tulsa, Oklahoma, USA
| | - Anuradha Narayan
- Health, Nutrition & WASH Section of UNICEF China Office, Beijing, China
| | - Tao Xu
- Child Health Care Department, National Center for Women and Children's Heath China Center for Disease Control, Beijing, China
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13
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Expressed breast milk feeding practices in Hong Kong Chinese women: A descriptive study. Midwifery 2020; 91:102835. [DOI: 10.1016/j.midw.2020.102835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/22/2020] [Accepted: 08/28/2020] [Indexed: 11/23/2022]
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14
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JANSEN SUSIANA, WASITYASTUTI WIDYA, ASTARINI FAJARDWI, HARTINI SRI. Mothers' knowledge of breastfeeding and infant feeding types affect acute respiratory infections. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E401-E408. [PMID: 33150229 PMCID: PMC7595061 DOI: 10.15167/2421-4248/jpmh2020.61.3.1499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/15/2020] [Indexed: 01/12/2023]
Abstract
Introduction World Health Organization (WHO) recommends exclusive breastfeeding for new-borns until 6 months of age. However, exclusive breastfeeding in Indonesia only reached 52.3% in 2014 and 65.16% in 2018. It is known that administration of infant formula and non-formula supplements to infants aged less than 6 months increases the risk of Acute Respiratory Infections (ARIs). In addition, the high prevalence of ARIs in infants in Sleman Regency, Indonesia indicates the need of optimal early prevention. Therefore, we conducted this study to confirm that mothers’ knowledge of breastfeeding and infant feeding types affect the prevalence of Acute Respiratory Infections (ARIs). Methods Data were collected through questionnaires from 50 mothers with infants aged 7-12 months who had experienced ARIs in the last 3 months (case group) and 50 mothers with healthy infants (control group). Collected data were then analysed using Chi-Square, Logistic Regression, Lambda, and Somers’ D tests. Results The results showed that types of infant feeding are associated with the prevalence of ARIs. Non-breastfed infants were 14 times riskier to contract ARIs. Mothers’ knowledge of exclusive breastfeeding influenced their preferences of feeding practice. However, their attitude towards breastfeeding did not appear to significantly affect their choices of feeding practice. Conclusions Exclusive breastfeeding during the first 6 months of an infant’s life can lower the prevalence of ARIs for when they are older. Mothers’ good knowledge of breastfeeding is associated with its practice.
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Affiliation(s)
- SUSIANA JANSEN
- PELNI Nursing Academy of Jakarta, Indonesia
- Master in Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
| | - WIDYA WASITYASTUTI
- Department of Physiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
- Correspondence: Widya Wasityastuti, Department of Physiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl. Farmako, Senolowo, Sekip Utara, Mlati, Kabupaten Sleman, Daerah Istimewa Yogyakarta 55281, Indonesia - Tel. +62-274-6492492 - Fax. +62-274-631185 - E-mail:
| | - FAJAR DWI ASTARINI
- Master in Biomedical Sciences, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
| | - SRI HARTINI
- Department of Pediatric Nursing and Maternity, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
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15
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Real-world study in infants fed with an infant formula with two human milk oligosaccharides. NUTR HOSP 2020; 37:698-706. [PMID: 32698596 DOI: 10.20960/nh.03084] [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: 11/02/2022] Open
Abstract
Introduction Introduction: human milk oligosaccharides (HMOs) are an important component of human milk supporting the development of a balanced intestinal microbiota and immune protection in breastfed infants. Randomized controlled trials (RCTs) have demonstrated that infant formulas supplemented with the HMOs 2'-fucosyllactose (2'FL) and lacto-N-neotetraose (LNnT) are safe, well-tolerated, and support normal growth. This Real-World Evidence (RWE) study aimed to evaluate growth and tolerance in infants consuming a formula supplemented with 1 g/L of 2'FL and 0.5 g/L of LNnT, and included a mixed-feeding group never studied before in RCTs. Participants and methods: this open-label, prospective study was conducted at six centers in Spain, and included healthy, exclusively breastfed infants (BF group), an exclusively formula-fed group (FF) who received a milk-based formula with 2' FL and LNnT, and a group mixed fed with both formula and human milk (MF), for 8 weeks. Co-primary outcomes were growth (anthropometry) and gastrointestinal tolerance (Infant Gastrointestinal Symptom Questionnaire, IGSQ). Secondary outcomes included formula satisfaction and adverse events (AEs). Results: 159 infants completed the study (66 FF, 48 MF, and 45 BF). Mean z-scores for growth were similar between all groups and within ± 0.5 of WHO medians at week 8. Composite IGSQ scores demonstrated low GI distress in all groups, with no significant group differences at baseline, week 4, or week 8. Incidence of AEs was low overall, and comparable across groups. Conclusions: in this RWE study examining a HMO-supplemented infant formula, growth and tolerance outcomes were similar to RCT findings, supporting the effectiveness of this early feeding option.
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16
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Mathias JG, Zhang H, Soto-Ramirez N, Karmaus W. The association of infant feeding patterns with food allergy symptoms and food allergy in early childhood. Int Breastfeed J 2019; 14:43. [PMID: 31666803 PMCID: PMC6813109 DOI: 10.1186/s13006-019-0241-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/10/2019] [Indexed: 12/12/2022] Open
Abstract
Background The role of infant feeding for food allergy in children is unclear and studies have not addressed simultaneous exposures to different foods. The goal of this study was to analyze existing data on feeding practices that represent realistic exposure and assess the risk of food allergy symptoms and food allergy in children. Methods The Infant Feeding Practices Study II conducted by the CDC and US-FDA enrolled pregnant women and collected infant feeding information using nine repeated surveys. Participants were re-contacted after 6 years. Food allergy data were collected at 4, 9, 12, and 72 months. In total, 1387 participants had complete infant feeding pattern data for 6 months and information on food allergy symptoms and doctors’ diagnosed food allergy. Feeding patterns constituted six groups: 3-months of feeding at breast followed by mixed feeding, 3-months of breast milk and bottled milk followed by mixed feeding, 1-month of feeding at breast followed by mixed feeding, 6-months of mixed feeding i.e., concurrent feeding of breast milk, bottled milk and formula, 2–3 months of formula followed by formula and solid food, and formula and solid food since the first month. To estimate risks of food allergy, we used linear mixed models, controlling for potential confounders. Results Of the 328 children with food allergy symptoms in infancy and at 6 years, 52 had persistent symptoms from infancy. Children exposed to mixed feeding had a higher risk of food allergy symptoms (Risk Ratio [RR] 1.54; 95% Confidence Interval [CI] 1.04, 2.29) compared to 3-months of feeding at breast adjusted for confounding. No statistically significant risk of infant feeding patterns was found for doctors’ diagnosed food allergy. Paternal allergy posed a higher risk for food allergy symptoms (RR 1.36; 95% CI 1.01, 1.83). Prenatal maternal smoking increased the risk for doctors’ diagnosed food allergy (RR 2.97; 95% CI 1.53, 5.79). Conclusions Analysis of this prospective birth cohort suggest that introduction of multiple feeding source may lead to food allergy symptoms. Future efforts are needed to determine acceptable approaches to improve the ascertainment of food allergy in children and the role of infant feeding.
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Affiliation(s)
- Joacy G Mathias
- 1Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN USA
| | - Hongmei Zhang
- 1Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN USA
| | | | - Wilfried Karmaus
- 1Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN USA
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17
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Spungen JH. Children's exposures to lead and cadmium: FDA total diet study 2014-16. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2019; 36:893-903. [PMID: 30985263 DOI: 10.1080/19440049.2019.1595170] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Children are at potential risk for adverse effects from lead and cadmium exposures due to the effects of these elements on developing brains. Children's dietary exposures to lead and cadmium were estimated based on lead and cadmium concentration data from FDA's Total Diet Study (TDS) and on food consumption data from What We Eat In America (WWEIA), the food survey portion of the National Health and Nutrition Examination Study (NHANES). Estimated mean exposures vary based on age range (1-3 y, 4-6 y, or 1-6 y) and on substitution scenarios for values below the limit of detection (non-detects = 0; non-detects = limit of detection; hybrid approach). Estimated mean lead exposures range from 1 to 3.4 µg/day, with major contributions from grains, fruit, dairy, and mixtures (e.g. hamburgers, pizza, lasagna, soups). Estimated mean cadmium exposures range from 0.38 to 0.44 µg/kg bw/day, with major contributions from grains, mixtures, and vegetables. Estimated children's lead exposures declined slightly since 2004-08, but cadmium exposures did not decline. No safe level has been identified for lead exposures, and toxicologic reference values for cadmium range from 0.1 to 0.83 µg/kg bw/day. The data on lead and cadmium exposures, and on contributors to exposures, will inform research and regulatory priorities on mitigation of exposures to lead and cadmium.
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Affiliation(s)
- Judith H Spungen
- a US Food and Drug Administration (FDA) , Center for Food Safety and Applied, Nutrition (CFSAN) , College Park , MD , USA
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