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Lazare FB, Brand DA, Fazzari MJ, Noor A, Daum F. Maternal Dairy Consumption and Hematochezia in Exclusively Breastfed Infants. J Hum Lact 2020; 36:168-172. [PMID: 31013175 DOI: 10.1177/0890334419838476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND When an exclusively breastfed infant develops hematochezia, the pediatrician may recommend elimination of dairy and soy products from a mother's diet, but there is limited scientific evidence to indicate that altering the maternal diet will lead to resolution of the problem. RESEARCH AIM To estimate the likelihood that maternal dairy and soy avoidance will resolve rectal bleeding in an exclusively breastfed infant. METHODS This was a prospective, longitudinal, one-group pre/post study involving mothers of exclusively breastfed infants at least 2 weeks but less than 6 months of age with a positive stool guaiac test in the absence of an intestinal lesion or other explanation for the blood. Participants agreed to follow a dairy and soy elimination/rechallenge protocol, maintain a food diary, and have their infant re-tested at 3-week intervals to determine the outcome of the dietary changes. One participant was lost to follow-up, leaving a final sample size of N = 19. RESULTS All infants continued to test positive for blood in the stool after their mothers eliminated foods containing dairy or soy. Therefore, 0% (0/19) of infants responded to their mother's restricted diet, 95% confidence interval (one-sided [0%, 15%]). CONCLUSION Given these results, we must call into question the rationale for advising breastfeeding mothers to eliminate dairy and soy from their diet in response to their infant's unexplained rectal bleeding.
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Affiliation(s)
- Farrah B Lazare
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, NYU Winthrop Hospital, Mineola, NY, USA
| | - Donald A Brand
- Office of Health Outcomes Research, NYU Winthrop Hospital, Mineola, NY, USA.,Department of Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Melissa J Fazzari
- Department of Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Asif Noor
- Division of Pediatric Infectious Disease, Department of Pediatrics, NYU Winthrop Hospital, Mineola, NY, USA
| | - Fredric Daum
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, NYU Winthrop Hospital, Mineola, NY, USA
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Prince E, Lazare FB, Treem WR, Xu J, Iqbal J, Pan X, Josekutty J, Walsh M, Anderson V, Hussain MM, Schwarz SM. Ω-3 fatty acids prevent hepatic steatosis, independent of PPAR-α activity, in a murine model of parenteral nutrition-associated liver disease. JPEN J Parenter Enteral Nutr 2013; 38:608-16. [PMID: 23757305 DOI: 10.1177/0148607113491436] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 04/30/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVES ω-3 Fatty acids (FAs), natural ligands for the peroxisome proliferator-activated receptor-α (PPAR-α), attenuate parenteral nutrition-associated liver disease (PNALD). However, the mechanisms underlying the protective role of ω-3 FAs are still unknown. The aim of this study was to determine the effects of ω-3 FAs on hepatic triglyceride (TG) accumulation in a murine model of PNALD and to investigate the role of PPAR-α and microsomal triglyceride transfer protein (MTP) in this experimental setting. METHODS 129S1/SvImJ wild-type or 129S4/SvJaePparatm/Gonz/J PPAR-α knockout mice were fed chow and water (controls); oral, fat-free PN solution only (PN-O); PN-O plus intraperitoneal (IP) ω-6 FA-predominant supplements (PN-ω-6); or PN-O plus IP ω-3 FA (PN-ω-3). Control and PN-O groups received sham IP injections of 0.9% NaCl. Hepatic histology, TG and cholesterol, MTP activity, and PPAR-α messenger RNA were assessed after 19 days. RESULTS In all experimental groups, PN feeding increased hepatic TG and MTP activity compared with controls. Both PN-O and PN-ω-6 groups accumulated significantly greater amounts of TG when compared with PN-ω-3 mice. Studies in PPAR-α null animals showed that PN feeding increases hepatic TG as in wild-type mice. PPAR-α null mice in the PN-O and PN-ω-6 groups demonstrated variable degrees of hepatic steatosis, whereas no evidence of hepatic fat accumulation was found after 19 days of oral PN plus IP ω-3 FAs. CONCLUSIONS PN induces TG accumulation (steatosis) in wild-type and PPAR-α null mice. In PN-fed wild-type and PPAR-α null mice given IP ω-3 FAs, reduced hepatic TG accumulation and absent steatosis are found. Prevention of steatosis by ω-3 FAs results from PPAR-α-independent pathways.
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Affiliation(s)
- Esther Prince
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Farrah B Lazare
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, State University of New York Downstate Medical Center, Brooklyn, New York Department of Pediatrics, Winthrop University Medical Center, Mineola, New York
| | - William R Treem
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, State University of New York Downstate Medical Center, Brooklyn, New York Johnson & Johnson Pharmaceutical Research and Development, LLC, Titusville, New Jersey
| | - Jiliu Xu
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Jahangir Iqbal
- Department of Cell Biology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Xiaoyue Pan
- Department of Cell Biology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Joby Josekutty
- Department of Cell Biology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Meghan Walsh
- Department of Cell Biology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Virginia Anderson
- Department of Pathology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - M Mahmood Hussain
- Department of Cell Biology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Steven M Schwarz
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, State University of New York Downstate Medical Center, Brooklyn, New York
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