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Albinsson E, Grönlund AB, Paulsson M, Wikström S, Ahlsson F. Unpredictable supplementation of vitamin D to infants in the neonatal intensive care unit: An experimental study. Acta Paediatr 2024. [PMID: 38972986 DOI: 10.1111/apa.17351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/09/2024]
Abstract
AIM Extremely premature infants receive nutrition and medication through nasogastric tubes. Breastmilk given accordingly is subject to fat loss. This study aimed to investigate whether this could also apply to vitamin D. METHODS A questionnaire investigated vitamin D administration at a level III neonatal intensive care unit in Sweden in 2021. Feeding simulations with breastmilk and various vitamin D mixtures were done accordingly. After administration, vitamin D3 concentration was analysed using chromatography with mass spectrometry, followed by repeated simulations with vitamin D mixtures without breastmilk in 2023. RESULTS The questionnaire was completed by 10 persons. Vitamin D was administered as drops using an enteral syringe and a nasogastric tube in conjunction with a breastmilk meal. In the feeding simulations, vitamin D3 concentration after administration was significantly higher using a syringe alone compared to standard administration. When vitamins were administered according to standard but without breastmilk, 100% of the vitamin D and 40% of the multivitamins were lost. The vitamins adhered to the material, mainly in the nasogastric tube. CONCLUSION Our findings indicate that standard vitamin D supplementation in the neonatal intensive care unit may be unpredictable when administered by enteral syringe and nasogastric tube. We suggest using direct oral administration whenever possible.
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Affiliation(s)
- Eva Albinsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research and Education, County Council of Värmland, Karlstad, Sweden
| | | | - Mattias Paulsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sverre Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research and Education, County Council of Värmland, Karlstad, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Fredrik Ahlsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Premkumar MH, Soraisham A, Bagga N, Massieu LA, Maheshwari A. Nutritional Management of Short Bowel Syndrome. Clin Perinatol 2022; 49:557-572. [PMID: 35659103 DOI: 10.1016/j.clp.2022.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Short bowel syndrome (SBS) of infancy is a cause of prolonged morbidity with intolerance to enteral feeding, specialized nutritional needs, and partial/total dependence on parenteral nutrition. These infants can benefit from individualized nutritional strategies to support and enhance the process of intestinal adaptation. Early introduction of enteral feeds during the period of intestinal adaptation is crucial, even though the enteral feedings may need to be supplemented with an effective, safe, and nutritionally adequate parenteral nutritional regimen. Newer generation intravenous lipid emulsions can be effective in preventing and treating intestinal failure-associated liver disease. Prevention of infection(s), pharmaceutical interventions to enhance bowel motility and prevent/mitigate bacteria overgrowth, and specialized multidisciplinary care to minimize the injury to other organs such as the liver, kidneys, and the brain can assist in nutritional rehabilitation and lower the morbidity in SBS.
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Affiliation(s)
- Muralidhar H Premkumar
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin, Suite 6104, Houston, TX 77030, USA.
| | - Amuchou Soraisham
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nitasha Bagga
- Department of Neonatology, Rainbow Children's Hospital, Hyderabad, India
| | - L Adriana Massieu
- Department of Clinical Nutrition Services, Texas Children's Hospital, Houston, TX, USA
| | - Akhil Maheshwari
- Global Newborn Society (https://www.globalnewbornsociety.org/), Clarksville, MD, USA
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Correa KDP, Silva MET, Ribeiro OS, Matta SLP, Peluzio MDCG, Oliveira EB, Coimbra JSDR. Homogenised and pasteurised human milk: lipid profile and effect as a supplement in the enteral diet of Wistar rats. Br J Nutr 2022; 127:711-721. [PMID: 33902762 DOI: 10.1017/s0007114521001380] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The retention of human milk (HM) fat in nasogastric probes of infusion pumps can be observed during the feed of infants unable to suck at the mother's breast. The lack of homogenisation of HM could contribute to the fat holding. Therefore, the present study evaluated (i) the influence of homogenisation on milk fat retaining in infant feeding probes and (ii) the in vivo effect of the homogenisation on lipid absorption by Wistar rats. The animals were fed with HM treated following two processing conditions, that is, pasteurised and homogenised-pasteurised. The animals were randomly subdivided into four experimental groups: water-fed (control), pasteurised milk, homogenised-pasteurised milk and pasteurised-skimmed milk. The results of food consumption, mass body gain, corporate metrics and plasma blood levels of total cholesterol did not show any difference (P < 0·05) among the three types of HM used in the experiments. The liver, intestine and intra-abdominal adipose tissue of the four groups of animals presented normal and healthy histology. The composition of fatty acids in the brain tissue of animals fed with homogenised HM increased when compared with the groups fed with non-homogenised HM. These values were 11·08 % higher for arachidonic acids, 6·59 % for DAH and 47·92 % for nervous acids. The ingestion of homogenised HM promoted higher absorption of milk nutrients. Therefore, the addition of the homogenisation stage in HM processing could be an alternative to reduce fat retention in probes and to improve the lipids' absorption in the body.
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Affiliation(s)
- Kely de Paula Correa
- Departamento de Tecnologia de Alimentos, Universidade Federal de Viçosa (UFV), Av. P.H. Rolfs, s/n, 36570-900 Viçosa, MG, Brasil
| | - Monique E T Silva
- Departamento de Tecnologia de Alimentos, Universidade Federal de Viçosa (UFV), Av. P.H. Rolfs, s/n, 36570-900 Viçosa, MG, Brasil
| | - Otávio S Ribeiro
- Departamento de Tecnologia de Alimentos, Universidade Federal de Viçosa (UFV), Av. P.H. Rolfs, s/n, 36570-900 Viçosa, MG, Brasil
| | - Sérgio L P Matta
- Departamento de Biologia Vegetal, Universidade Federal de Viçosa (UFV), Av. P.H. Rolfs, s/n, 36570-900 Viçosa, MG, Brasil
| | - Maria do Carmo G Peluzio
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV), Av. P.H. Rolfs, s/n, 36570-900 Viçosa, MG, Brasil
| | - Eduardo B Oliveira
- Departamento de Tecnologia de Alimentos, Universidade Federal de Viçosa (UFV), Av. P.H. Rolfs, s/n, 36570-900 Viçosa, MG, Brasil
| | - Jane S Dos R Coimbra
- Departamento de Tecnologia de Alimentos, Universidade Federal de Viçosa (UFV), Av. P.H. Rolfs, s/n, 36570-900 Viçosa, MG, Brasil
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Chen XC, Tong YF, Han ZM, Lin ZL. The Effects of Early Oropharyngeal Administration of Microdosed Colostrum on Feeding Status in Ventilated Extremely Low-Birth-Weight Infants. Breastfeed Med 2021; 16:648-653. [PMID: 33983840 DOI: 10.1089/bfm.2020.0244] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: For extremely low-birth-weight infants (ELBWIs), mechanical ventilation and total parenteral nutrition are generally required in the early stages and lose the protective effect of early gastrointestinal nutrition of colostrum. We conducted a prospective randomized controlled trial to explore the effectiveness of early colostrum oropharyngeal administration on the feeding status of ELBWIs on mechanical ventilation. Materials and Methods: We randomly divided mechanically ventilated ELBWIs into an intervention group and a control group. In the intervention group, we provided oropharyngeal administration of colostrum during mechanical ventilation. The first colostrum oropharyngeal administration ended within 24 hours of birth. In the control group, we gave colostrum only for gastrointestinal nutrition, and other interventions were the same as for the intervention group. We collected the 1st and 6th day of life airway secretions and urine specimens from both groups. We recorded feeding status, including corrected gestational age at onset of enteral nutrition, corrected gestational age of no gastric retention during feeding, corrected gestational age of full enteral nutrition, corrected gestational age of sucking began, and corrected gestational age of per oral feeding. We also recorded growth of body mass, the incidence of feeding intolerance, and necrotizing enterocolitis (NEC). Results: On the 6th day of life, concentrations of secretory immunoglobulin A, and lactoferrin in airway secretions and urine of the intervention group were significantly higher than those of the control group (p < 0.05). The intervention group showed younger corrected gestational age of no gastric retention during feeding, corrected gestational age of full enteral nutrition, the corrected gestational age of sucking began and per oral feeding than those in the control group (p < 0.05). The day of recovery to birth weight was earlier than those in the control group (p < 0.05). The rate of feeding intolerance and NEC incidence in the intervention group was significantly lower than in the control group (p < 0.05). Conclusions: Early oropharyngeal administration of colostrum improves immune function of the gastrointestinal tract and the systemic anti-infective capability in ELBWI on mechanical ventilation, promoting the maturity of gastrointestinal function, improving feeding condition, and reducing the risk of feeding intolerance and NEC.
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Affiliation(s)
- Xiao-Chun Chen
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yan-Fen Tong
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zi-Min Han
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhen-Lang Lin
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Factors Influencing Breast Milk Fat Loss during Administration in the Neonatal Intensive Care Unit. Nutrients 2021; 13:nu13061939. [PMID: 34198748 PMCID: PMC8228982 DOI: 10.3390/nu13061939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022] Open
Abstract
The objective of this study was to investigate factors influencing fat loss during tube feeding of breast milk to preterm infants. An experimental study with 81 feeding simulations was performed, with nine continuous infusions in each of six modalities: Horizontal Higher, Horizontal Matched, Horizontal Lower, Tilted Higher, Tilted Matched, and Tilted Lower, and for comparison, 27 bolus feedings: nine flushed with air, nine with water, and nine that were not flushed, done at matched height. Each simulation utilized 16 mL of breast milk given over four hours. Continuous infusions were given with a flow rate of 4 mL/h. Bolus was given as 8 mL over the course of 15–20 min every other hour. Analysis for fat, true protein, carbohydrate, total solids, and energy was performed before and after each simulation. The percent of macronutrient loss was compared between all simulations. Continuous infusion resulted in an average fat loss of 40%. Bolus feedings resulted in an average fat loss of 11% (p ≤ 0.001). Considerable fat loss is seen during continuous tube feeding. Neither height in relation to the infant nor tilting of the pump reduce fat loss. To limit fat loss, the bolus feeding method should be utilized.
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Yadav A, Siddiqui N, Debata PK. Two-hourly vs Three-hourly Feeding in Very Low Birthweight Neonates: A Randomized Controlled Trial. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2189-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abdelrahman K, Jarjour J, Hagan J, Yang H, Sutton D, Hair A. Optimizing Delivery of Breast Milk for Premature Infants: Comparison of Current Enteral Feeding Systems. Nutr Clin Pract 2020; 35:697-702. [PMID: 31713294 PMCID: PMC7383482 DOI: 10.1002/ncp.10436] [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] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Incomplete delivery of fat from expressed breast milk (EBM) during enteral feeding to premature neonates remains a significant problem. Feeding system manufacturers have introduced changes to the enteral syringe design to improve fat delivery that have not yet been evaluated in the literature. METHODS This study compares percentage delivery of fat from EBM using 2 major enteral feeding systems in various configurations with silicone and polyurethane tubing material and ENFit and Legacy connection systems at 3 clinically relevant infusion rates. RESULTS The percent of fat delivery from EBM was significantly higher for the eccentric syringe system than the concentric system (P = 0.036) but did not vary significantly across infusion rates (P = 0.081). Silicone tubing had a significantly higher percent of fat delivery than polyurethane tubing within the eccentric syringe system (P = 0.039) but did not vary significantly across infusion rates (P = 0.105). There was no significant difference between ENFit and Legacy connectors using eccentric syringes with silicone tubing (P = 0.360). CONCLUSION We demonstrate that changes to syringe design and tubing material are effective and improve fat delivery from EBM, which may result in improved growth and outcomes in premature infants. The eccentric syringe marginally improves fat delivery in comparison with the concentric syringe, and silicone tubing significantly improves fat delivery compared with polyurethane tubing.
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Affiliation(s)
| | - Jane Jarjour
- Department of PediatricsUniversity of Colorado School of MedicineDenverColoradoUSA
| | - Joseph Hagan
- Department of PediatricsSection of Neonatology, Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - Heeju Yang
- Department of PediatricsSection of Neonatology, Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - Danielle Sutton
- Department of PediatricsSection of Neonatology, Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - Amy Hair
- Department of PediatricsSection of Neonatology, Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
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Martini S, Aceti A, Furini M, Munarini A, La Riccia C, Mantovani V, Faldella G, Corvaglia L. Effect of Different Tube Feeding Methods on the Delivery of Docosahexaenoic and Arachidonic Acid: An In Vitro Pilot Study. JPEN J Parenter Enteral Nutr 2018; 43:550-556. [PMID: 30260487 DOI: 10.1002/jpen.1448] [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: 06/07/2018] [Revised: 08/17/2018] [Accepted: 08/22/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Arachidonic acid (AA) and docosahexaenoic acid (DHA) are crucial for neural and visual development after premature birth. Preterm infants usually require tube feeding (TF) until the achievement of adequate oral feeding skills; the impact of TF on DHA and AA delivery has not been investigated yet. This study aimed to evaluate the effect of different TF techniques on the delivery of AA and DHA contained in human milk (HM). METHODS HM samples (65 mL each) were collected and divided into three 20-mL aliquots. The remaining 5 mL served as baseline. Three TF techniques were simulated (1 for each aliquot): gravity bolus feeding (BF), 3-hour continuous feeding using a horizontal feeding pump, and 3-hour continuous feeding with the feeding pump angled at 45°. For horizontal continuous feeding (HCF) and 45° angled continuous feeding (ACF), aliquots delivered between 0 and 90 minutes (T1) and 91 and 180 minutes (T2) were collected separately. AA and DHA concentration was analyzed by gas chromatography/mass spectrometry and compared among the TF methods. DHA and AA delivery at T1 and T2 was also evaluated. RESULTS Fifty-one simulated feeds were performed. DHA and AA amounts after BF and ACF did not differ significantly compared with baseline, whereas HCF resulted in significantly lower DHA and AA concentration. During T2, ACF delivered almost twice the DHA and AA amounts compared with T1. CONCLUSION The delivery of HM AA and DHA is significantly affected by TF, with potential clinical implications. When BF is not tolerated, ACF might represent a feasible alternative to reduce TF-related DHA and AA loss.
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Affiliation(s)
- Silvia Martini
- Neonatal Intensive Care Unit, St. Orsola-Malpighi University Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Arianna Aceti
- Neonatal Intensive Care Unit, St. Orsola-Malpighi University Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Martina Furini
- Neonatal Intensive Care Unit, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Alessandra Munarini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Centre of Applied Biomedical Research, Department of Clinical Medicine, University of Bologna, Bologna, Italy
| | - Cristina La Riccia
- Centre of Applied Biomedical Research, Department of Clinical Medicine, University of Bologna, Bologna, Italy
| | - Vilma Mantovani
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Centre of Applied Biomedical Research, Department of Clinical Medicine, University of Bologna, Bologna, Italy
| | - Giacomo Faldella
- Neonatal Intensive Care Unit, St. Orsola-Malpighi University Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luigi Corvaglia
- Neonatal Intensive Care Unit, St. Orsola-Malpighi University Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Abstract
BACKGROUND The timely establishment of enteral feeds and a reduction in the number of feeding interruptions are key to achieving optimal nutrition in premature infants. Nutritional guidelines vary widely regarding feeding regimens and there is not a widely accepted consensus on the optimal feeding interval. PURPOSE To critically examine the evidence to determine whether there is a relationship to feeding intervals and feeding outcomes in premature infants. METHODS A systematic review of the literature in the following databases: PubMed, CINAHL, Embase and the Cochrane Library. The search strategy used the terms infant premature, low birth weight, enteral feeding, feed tolerance and feed intervals. RESULTS Search results yielded 10 studies involving 1269 infants (birth weight ≤1750 g). No significant differences in feed intolerance, growth, or incidence of necrotizing enterocolitis were observed. Evidence suggests that infants fed at 2 hourly intervals reached full feeds faster than at 3 hourly intervals, had fewer days on parenteral nutrition, and fewer days in which feedings were withheld. Decrease in the volume of gastric residuals and feeding interruptions were observed in the infants fed at 3 hourly intervals than those who were continuously fed. IMPLICATIONS FOR PRACTICE Reducing the feed interval from 3 to 2 hourly increases nurse workload, yet may improve feeding outcomes by reducing the time to achieve full enteral feeding. IMPLICATIONS FOR RESEARCH Studies varied greatly in the definition and management of feeding intolerance and in how outcomes were measured, analyzed, and reported. The term "intermittent" is used widely but can refer to a 2 or 3 hourly interval.
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Impact of homogenization of pasteurized human milk on gastric digestion in the preterm infant: A randomized controlled trial. Clin Nutr ESPEN 2017; 20:1-11. [DOI: 10.1016/j.clnesp.2017.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/01/2017] [Indexed: 12/14/2022]
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de Oliveira SC, Bellanger A, Ménard O, Pladys P, Le Gouar Y, Dirson E, Kroell F, Dupont D, Deglaire A, Bourlieu C. Impact of human milk pasteurization on gastric digestion in preterm infants: a randomized controlled trial. Am J Clin Nutr 2017; 105:379-390. [PMID: 28052887 DOI: 10.3945/ajcn.116.142539] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/01/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Holder pasteurization has been reported to modify human milk composition and structure by inactivating bile salt-stimulated lipase (BSSL) and partially denaturing some of its proteins, potentially affecting its subsequent digestion. OBJECTIVE We sought to determine the impact of human milk pasteurization on gastric digestion (particularly for proteins and lipids) in preterm infants who were fed their mothers' own milk either raw or pasteurized. DESIGN In a randomized controlled trial, 12 hospitalized tube-fed preterm infants were their own control group in comparing the gastric digestion of raw human milk (RHM) with pasteurized human milk (PHM). Over a 6-d sequence, gastric aspirates were collected 2 times/d before and after RHM or PHM ingestion. The impact of milk pasteurization digestive kinetics and disintegration was tested with the use of a general linear mixed model. RESULTS Despite inactivating BSSL, instantaneous lipolysis was not affected by pasteurization (mean ± SD at 90 min: 12.6% ± 4.7%; P > 0.05). Lipolysis occurred in milk before digestion and was higher for PHM than for RHM (mean ± SD: 3.2% ± 0.6% and 2.2% ± 0.8%, respectively; P < 0.001). Pasteurization enhanced the proteolysis of lactoferrin (P < 0.01) and reduced that of α-lactalbumin (only at 90 min) (P < 0.05). Strong emulsion destabilization was observed, with smaller aggregates and a higher specific surface for PHM (P < 0.05). Pasteurization did not affect gastric emptying (∼30-min half time) or pH (mean ± SD: 4.4 ± 0.8) at 90 min. CONCLUSIONS Overall, pasteurization had no impact on the gastric digestion of lipids and some proteins from human milk but did affect lactoferrin and α-lactalbumin proteolysis and emulsion disintegration. Freeze-thawing and pasteurization increased the milk lipolysis before digestion but did not affect gastric lipolysis. Possible consequences on intestinal digestion and associated nutritional outcomes were not considered in this study. This trial was registered at clinicaltrials.gov as NCT02112331.
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Affiliation(s)
- Samira C de Oliveira
- Science and Technology of Milk and Eggs, Agrocampus West, French National Institute for Agricultural Research, Rennes, France
| | - Amandine Bellanger
- Department of Pediatrics, Rennes University Hospital, Rennes, France; and.,Faculty of Medicine, University of Rennes 1, Rennes, France
| | - Olivia Ménard
- Science and Technology of Milk and Eggs, Agrocampus West, French National Institute for Agricultural Research, Rennes, France
| | - Patrick Pladys
- Department of Pediatrics, Rennes University Hospital, Rennes, France; and.,Faculty of Medicine, University of Rennes 1, Rennes, France
| | - Yann Le Gouar
- Science and Technology of Milk and Eggs, Agrocampus West, French National Institute for Agricultural Research, Rennes, France
| | - Emelyne Dirson
- Department of Pediatrics, Rennes University Hospital, Rennes, France; and
| | - Florian Kroell
- Science and Technology of Milk and Eggs, Agrocampus West, French National Institute for Agricultural Research, Rennes, France
| | - Didier Dupont
- Science and Technology of Milk and Eggs, Agrocampus West, French National Institute for Agricultural Research, Rennes, France
| | - Amélie Deglaire
- Science and Technology of Milk and Eggs, Agrocampus West, French National Institute for Agricultural Research, Rennes, France;
| | - Claire Bourlieu
- Science and Technology of Milk and Eggs, Agrocampus West, French National Institute for Agricultural Research, Rennes, France
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