Physicians' attitudes towards the use of complementary therapies (CTs) by cancer patients in Finland

This study describes physicians' attitudes towards the use of complementary therapies (CTs) by cancer patients in Finland. Responses to 33 Likert-type statements were received from 234 physicians; the response rate was 50.6%. The questionnaire items were analysed separately and using five sum variables. Data analysis was based on descriptive statistics, chi-square and t-tests and analysis of variance. Attitudes among physicians and oncologists in particular were quite critical. Over four-fifths of the physicians (86%) were doubtful whether CTs should be used at all, given the scarcity of solid research evidence on their benefits. Three quarters (75%) referred to unknown risk factors, half (51%) were of the opinion that CTs should not be used in cancer care at all. On the other hand 58% believed that CTs could help to relieve stress and anxiety among cancer patients, and 79% wanted to see scientific testing to establish the effects of CTs. The most positive attitude towards CTs was shown by general practitioners and non-specialized physicians. Positive attitudes were associated with personal CT use, with recommending CTs to patients and with a high level of interest to participate in CT training. The physicians did not believe the specific CTs singled out for investigation would help patients to recover from cancer. They thought that the use of CTs by cancer patients was motivated by future hope, a determination to do everything possible to cure the cancer and the perception of CTs as a last resort. The result that professional attitudes towards CTs are quite critical in Finland presents a very special challenge to the relationship between physicians and patients: it is crucial that physicians know enough about CTs so that they can discuss the issue with patients and provide relevant advice and guidance on their use.

Attitudes of patients with breast and prostate cancer toward complementary therapies in Finland

This study aimed to describe the attitudes of patients with breast cancer and those with prostate cancer toward complementary therapies. The data were collected with a postal questionnaire administered to 216 patients with breast cancer (response rate, 55.4%) and 1 90 patients with prostate cancer (response rate, 54.9%) in southern and southwestern Finland. The questionnaire was composed of 44 Likert-type statements, which were analyzed using descriptive statistics, chi2 tests, t tests, and two-way analyses of variance. More than half (54%) of the patients with breast cancer and 45% of the patients with prostate cancer believed that people with cancer may benefit from complementary therapies, although they did not think these therapies actually could cure cancer. More than half of the respondents were dubious about using complementary therapies as long as there was no solid scientific evidence. Most believed that complementary therapies were used because they gave people hope (women, 88%; men, 72%) or "something to cling to" (women, 83%; men, 76%). The respondents believed most in dietary therapies and least in healing. There was much confusion and uncertainty about the professional competencies and expertise of the people who provided complementary therapies. Approximately one fourth of the respondents had spoken to their physician about complementary therapies. Only a few had talked about the matter with nursing staff. About half of the respondents thought that physicians and nurses took a negative attitude toward complementary therapies. In both groups, patients who had talked with their physician about complementary therapies tended to show a more positive attitude.

Oncology nurses' attitudes towards alternative medicine

Little is known about nurses' attitudes towards alternative medicine. The purpose of this study was to describe attitudes towards alternative medicine among nurses working on oncology wards in three university and one central hospital in Finland. The data were collected with a questionnaire specifically developed for this project. The response rate was 68.1% (n = 92). The nurses did not regard alternative medicine as a safe and natural method in the treatment of cancer. On the contrary, many nurses believed that alternative therapies are offered by quack doctors for financial gain. However, the nurses considered it important that cancer patients have the opportunity to talk about their use of alternative medicine both with nurses and physicians. Overall the results indicated that nurses' attitudes are for the most part negative. An interesting question that deserves further attention is whether this attitude is reflected in nursing practice.

The apolipoprotein E phenotype has a strong influence on tracking of serum cholesterol and lipoprotein levels in children: a follow-up study from birth to the age of 11 years

The extent to which an individual maintains his position relative to the rest of the population is called tracking. The objective of this study was to examine the effect of the apolipoprotein E (apoE) phenotype on the tracking of serum cholesterol and lipoproteins from birth to the age of 11 y. In a longitudinal follow-up study of healthy children, concentrations of total serum cholesterol and triglyceride were determined at birth (n = 193), and at the ages of 2 (n = 192), 4 (n = 192), 6 (n = 190), 9 (n = 188), and 12 mo (n = 196), and 5 (n = 162) and 11 y (n = 153). Concentrations of total HDL, HDL2, and HDL3, VLDL, and LDL cholesterol were determined at 2, 6, 9, and 12 mo (n = 36), and 5 (n = 162) and 11 y (n = 153). The apoE phenotype was determined in 151 children. The children had the following apoE phenotypes: 4 had type 4/4 and 40 type 3/4 (group apoE4), 94 had type 3/3 (group apoE3), and 11 had type 2/3 and 2 type 2/4 (group apoE2). The correlation coefficients for total cholesterol levels during childhood compared with the level at 11 y of age were: 0.03 at birth, 0.26 (p < 0.001) at 2 mo, 0.24 (p < 0.001) at 4 mo, 0.24 (p < 0.001) at 6 mo, 0.28 (p < 0.001) at 9 mo, 0.41 (p < 0.001) at 12 mo, and 0.60 (p < 0.001) at 5 y. When the children were divided into three groups according to their apoE phenotypes, these three groups had the following correlation coefficients at 4 mo, 12 mo, or 5 y of age compared with the level at the age of 11 y; group apoE2: r = 0.65 (p < 0.01), r = 0.59 (p < 0.01), and r = 0.72 (p < 0.01); group apoE3: r = 0.27 (p < 0.01), 0.43 (p < 0.001), and r = 0.64 (p < 0.001); and group apoE4: r = 0.14 (p = NS), r = 0.33 (p < 0.05), and 0.42 (p < 0.01). The apoE phenotype also strongly influenced the tracking of the LDL cholesterol levels; the correlation coefficients between 5 and 11 y of age were for group apoE2 r = 0.84 (p < 0.001), for group apoE3 r = 0.70 (p < 0.001), and for group apoE4 r = 0.37 (p < 0.05). Our results indicate that the apoE phenotype strongly influences the tracking of lipids. The children having apoE 2/3, 2/4, and 3/3 phenotypes maintained their relative cholesterol and lipoprotein levels better than the others throughout the first 11 y of age. Because the apoE phenotype strongly affects the tracking of serum cholesterol, the usefulness of cholesterol screening in predicting future cholesterol values should be analyzed, keeping the apoE phenotype in mind.

Apoprotein E phenotype determines serum cholesterol in infants during both high-cholesterol breast feeding and low-cholesterol formula feeding

Our objective was to establish the role of the apoprotein (apo) E phenotype in determining serum cholesterol levels in infants fed exclusively on high-fat, high-cholesterol human milk and in those fed a low-cholesterol, high-unsaturated fat formula. The total and lipoprotein cholesterol, apoB, and triglyceride concentrations in serum were quantified and related to the apoE phenotype in 151 infants at birth and at 2, 6, 9, and 12 months of age. Forty-four had the E3/4 or 4/4 phenotype (E4 group), 94 had the E3/3 phenotype (E3 group), and 13 had the E2/3 or 2/4 phenotype (E2 group). In cord blood, cholesterol concentrations tended to be higher in the E4 than in the E2 group. With exclusive breast-feeding, the concentrations rose significantly faster and higher in the E4 group than in the E3 group or, especially, the E2 group. The values (mmol/L, mean +/- SEM) were 1.6 +/- 0.15, 1.5 +/- 0.05, 1.4 +/- 0.1 (P = n.s.) at birth; 4.2 +/- 0.1, 3.8 +/- 0.08, 3.4 +/- 0.2 (P < 0.001) at 2 months; 4.4 +/- 0.15, 3.9 +/- 0.1, 3.4 +/- 0.15 (P < 0.001) at 4 months; 4.3 +/- 0.17, 4.0 +/- 0.13, 3.7 +/- 0.26 (P < 0.001) at 6 months; 4.8 +/- 0.28, 4.4 +/- 0.11, 3.8 +/- 0.05 (P < 0.001) at 9 months; and 4.7 +/- 0.11, 4.4 +/- 0.08, 4.1 +/- 0.19 (P < 0.001) at 12 months, for the E4, E3, and E2 groups, respectively. Increases in LDL cholesterol and LDL apoB behaved similarly. The total triglyceride, and total HDL, HDL2, and HDL3 cholesterol concentrations did not depend on the apoE phenotype. Among infants fed high-fat, high-cholesterol human milk, the total and LDL-cholesterol concentrations and the LDL apoB concentration of those with the apoE phenotype 4/4 or 3/4 rose faster and to higher levels than in other infants. Among formula-fed infants, receiving a low-cholesterol, high-unsaturated fat diet, the differences between the apoE groups were smaller.

Detecting subclinical deficiency of essential trace elements in children with special reference to zinc and selenium

OBJECTIVE

This article reviews situations in which we should be alert to the risk of trace element deficiencies, and the difficulties of assessing trace element status, as illustrated by states of potential subclinical deficiency of zinc and selenium in infants.

CONCLUSION

Deficiency states of many trace elements have been documented in infants, and there is probably an underdiagnosed group of infants with subclinical deficiency, from which however the great majority are protected by effective regulatory systems. Specific, sensitive, and reliable methods are needed for the detection of trace element imbalances.

Developmental dental defects associated with long breast feeding

Despite its unequivocal advantages, breast feeding may be associated with undesired side-effects. Recently, we have shown an association between exposure via mother's milk to dioxins and developmental defects of the child's teeth. The present study was undertaken to analyze further the association between the duration of breast feeding and the occurrence of dental defects. For this purpose, 2 different populations were selected. The first population comprised 40 children who had mineralization defects in the permanent 1st molars, and their age-living area- and sex-matched controls. The median duration of breast feeding was 9 months in the affected children compared to 6 months in the controls. The defects were more extensive after prolonged breast feeding. The second population consisted of 97 children whose mothers had been encouraged to extensive and prolonged breast feeding. Of these children, 24 had mineralization defects. They all had been breastfed longer than 8 months. In both study populations mineralization defects were associated with the duration of breast feeding. The result suggests that long breast feeding may increase the risk of mineralization defects in healthy children, possibly because of environmental contaminants that interfere with tooth development.

Risk of low vitamin B6 status in infants breast-fed exclusively beyond six months

Our aim was to ascertain the adequacy of human milk as the sole source of vitamin B6 and the associations between maternal and infant status during extended exclusive breast-feeding. Vitamin B6 status was followed in lactating mothers and their exclusively breast-fed infants by determinations of erythrocyte pyridoxal 5'-phosphate concentration and the erythrocyte aspartate transaminase stimulation test at 2 months (n = 118), 4 months (n = 118), 6 months (n = 112), 7.5 months (n = 70), 9 months (n = 36), 10 months (n = 14), 11 months (n = 11), and 12 months (n = 7) postpartum. Of the mothers, 54% had used vitamin B6 supplement during pregnancy, and all received a pyridoxine hydrochloride supplement of 1 mg/day throughout lactation. The infants had a higher vitamin B6 status than their mothers. During the first 4 months, infant vitamin B6 status was generally adequate independently of the actual vitamin status of the nursing mother. Most of the infants with low status at 2 months were those born to mothers who were not supplemented during pregnancy. By 6 months of exclusive breast-feeding, 30% of cases of low vitamin B6 status in nursing mothers were reflected in their infants. Thereafter, the risk of low vitamin B6 status in exclusively breast-fed infants increased even if the mother's status was adequate. Our findings suggest that gestationally accumulated stores are important for the maintenance of adequate vitamin B6 status of infants during the early months and that for some infants, human milk alone, without supplementary foods, may be insufficient to meet vitamin B6 needs after 6 months of age.

Vitamin B-6 status during childhood: tracking from 2 months to 11 years of age

To examine the development and tracking of long-term vitamin B-6 status from infancy to early adolescence, measurements of erythrocyte pyridoxal 5'-phosphate concentration (EPLP), the erythrocyte aspartate transaminase (EAST) stimulation test including measurements of basal activity (EASTo) and activation coefficient (alpha EAST), were made in a follow-up study of healthy children aged 2 (n = 139), 4 (n = 147), 6 (n = 157), 9 (n = 159) and 12 mo (n = 188) and 5 y (n = 148). The EAST stimulation test was repeated at 11 y (n = 153). Vitamin B-6 status, high during infancy, reached the adult level by 5 y of age. The 10th to 90th percentile ranges for EPLP values were 61-201 nmol/L at 4 mo, 49-101 nmol/L at 12 mo and 27-59 nmol/L at 5 y. The respective ranges for Easto were 16-24 microkat/L at 4 mo, 13-19 microkat/L at 12 mo, 9-14 microkat/L at 5 y and 25-39 microkat/L at 11 y of age. For alpha EAST values were 1.29-1.54 at 4 mo, 1.48-1.77 at 12 mo, 1.70-2.07 at 5 y and 2.00-2.57 at 11 y. Values for EPLP and the EAST stimulation test in the first year of life correlated with the values at 5 and 11 y. The individuals with values at the extreme ends of the distributions remained there from infancy to childhood up to 3.3 times more often than expected from random variation.(ABSTRACT TRUNCATED AT 250 WORDS)

Low vitamin B6 status associated with slow growth in healthy breast-fed infants

To evaluate the effect of vitamin B6 status on infant growth, we studied longitudinally anthropometry and the erythrocyte parameters that reflect long-term vitamin B6 status [erythrocyte pyridoxal 5'-phosphate concentration (EPLP), erythrocyte aspartate transaminase basal activity (EAST0), and its activation co-efficient (alpha EAST)] in 44 infants. The infants were exclusively breast-fed for 6 mo, given additional solids according a uniform schedule from 6-9 mo, and formula after 9 mo, if needed. In seven of these infants, a low vitamin B6 status (EPLP < 10th, and EAST0 > 10th or alpha EAST > 90th percentile for these values in reference infants) was observed between 4 and 6 mo of age. These seven infants showed slower length velocity (0.30 +/- 0.05 versus 0.40 +/- 0.02 mm/d, p < or = 0.02) and deeper fall in length-for-age (-0.69 +/- 0.20 versus -0.25 +/- 0.07 SD score, p < or = 0.03) from 6 to 9 mo of age than the similarly fed infants with higher vitamin B6 status. Preceding vitamin B6 status remained a significant explanatory factor for length velocity and change in length-for-age in addition to preceding and concomitant weight velocity, when sex, birth size, preceding length gain, and mid-parent height were taken into account. Change in weight-for-age alone explained 16% and 18% and, together with vitamin B6 status, 23 and 27% of the variation in length velocity and in change in length-for-age, respectively. Thus, in healthy breast-fed infants, according to our results, low vitamin B6 status is associated with reversibly reduced gain in length.

Infant vitamin B-6 status changes with age and with formula feeding

To study the effect of type of feeding on infant vitamin B-6 status, we determined erythrocyte pyridoxal 5'-phosphate concentration (EPLP) and erythrocyte aspartate aminotransferase basal activity (EASTo) and its activation coefficient (alpha EAST) in 109 infants at 2, 4, 6, 9, and 12 mo of age. Thirty-six infants were exclusively breast-fed for 9 mo. Forty-six infants were exclusively breast-fed for 6 mo, and then given solid foods in addition. Twenty-seven infants were weaned by 2-3 mo to an adapted cow milk-based formula (15 g protein/L and 0.6 mg pyridoxine/L) and given solid foods from 3 to 4 mo. Infant vitamin B-6 status was age-dependent; it was highest at 4 mo and thereafter gradually approached adult values. The larger the intake of formula, the higher the vitamin B-6 status. In formula-fed infants at ages 2-6 mo, 71-96% of the EPLP values and 57-70% of the EASTo values were above the 95th percentile, and 35-53% of the alpha EAST values were below the 5th percentile for these values in breast-fed infants. These findings raise the question of whether the vitamin B-6 content of formulas, especially in relation to protein content, should be reduced.

Reference ranges for erythrocyte pyridoxal 5'-phosphate concentration and the erythrocyte aspartate transaminase stimulation test in lactating mothers and their infants

We determined reference ranges for erythrocyte pyridoxal 5'-phosphate concentrations (EPLP) and erythrocyte aspartate transaminase basal activities (EASTo) and activation coefficients (alpha EAST) in lactating mothers and infants from data of mothers receiving a vitamin B-6 supplement and infants breast-fed by mothers with adequate vitamin B6 status. The mothers' vitamin B6 status was assessed on the third day postpartum (pp) (n = 91) and at 2 mo (n = 114), 4 mo (n = 117), 6 mo (n = 110), and 9 mo (n = 40) pp and that of the exclusively breast-fed infants at 2 mo (n = 90), 4 mo (n = 106), and 6 mo (n = 99). We also examined 9-mo-old infants (n = 39) who, besides breast milk, had received solids after 6 mo, and 12-mo-old infants (n = 100) who had received solids beginning at 4-6 mo and dairy products at 9 mo. Values indicating deficiency for at least two of the three indexes distinguished the 5-10% of mothers and infants with the lowest vitamin B6 status. The reference ranges for EPLP, EASTo, and alpha EAST for infants and for mothers during the first months of lactation differ from those reported earlier for adults.

Zinc supplementation of infant formula

The effect of zinc supplementation of infant formula on zinc nutrition and growth of healthy infants was studied longitudinally from birth to age 12 mo. The zinc-supplemented group (n = 16) received the same formula as the unsupplemented group (n = 16) except for the addition of 61 mumol (4 mg) Zn/L as sulfate. After age 2 mo in the breast-fed and unsupplemented groups the mean serum zinc concentration remained stable at approximately 9.9 mumol/L. The zinc supplement increased the mean serum zinc concentration to 13.0 mumol/L by age 6 mo. With increasing intake of solid foods, the concentration fell by age 9 mo to the same concentration as in the other groups. The supplement did not increase the velocity of weight or length growth. In their growth the unsupplemented infants were not inferior to the breast-fed or zinc-supplemented infants.

Low zinc intake during exclusive breast-feeding does not impair growth

We studied zinc nutrition in exclusively breast-fed infants whose growth deviated from the norm. Their number fell from 200 at birth to 116 at the age of 6 months and 36 at the age of 9 months. The mothers received 0, 20, or 40 mg Zn++ as sulfate daily. Breast milk intake and concentrations of zinc in milk as well as in maternal and infant serum were measured. Individual zinc concentrations in milk showed channeling. The 20-mg supplement had no effect on the parameters measured. In contrast, 40 mg increased the maternal serum zinc concentration by 2 months and slowed the normal decline of milk zinc concentration by 6 months. Maternal supplementation had no effect on infant serum concentrations; they remained lower than adult levels throughout the 1st year of life. Zinc intake was low (about one-tenth of RDA), but it seemed to be adequate; the serum concentrations of the infants were stable after the age of 2 months. Low zinc concentrations in serum were not associated with impaired growth. On the contrary, the infants with the highest rates of growth had the lowest zinc concentrations. The infant serum zinc concentrations were channeled, but they were also influenced by the zinc intake. Reference values for breast-fed infants are given.

Erythropoiesis of very low-birth-weight infants dependent on prenatal growth rate and protein status

This study investigated erythropoiesis in very low-birth-weight infants with special reference to the role of protein status in the regulation of erythropoiesis in 22 appropriate- and 11 small-for-gestational-age infants. Blood samples were drawn at three and six weeks of age. The serum concentrations of erythropoietin, estimated by a solid-phase enzyme immunoassay, were similar in the two groups at both study ages. The total circulating erythrocyte volume and the serum concentration of prealbumin were higher in the appropriate- than in the small-for-gestational-age infants at three and six weeks of age. The former group had a better protein status, although their protein intake was similar or lower. We conclude that erythropoiesis in very low-birth-weight infants is influenced more by protein status and prenatal growth than by serum concentration of erythropoietin.

Effect of heredity on hemoglobin concentration

We studied 5-year-old children and their patients in 80 families and observed an association between the hemoglobin concentrations of the children and their parents before and after iron medication. We speculate that inheritance may exert a significant influence; iron deficiency did not explain the finding.

Tracking of serum cholesterol and lipoprotein levels from the first year of life

OBJECTIVE

To examine the development of tracking of serum cholesterol concentration from birth to childhood.

DESIGN

In a longitudinal study of healthy children, concentrations of total serum cholesterol and triglyceride were determined at birth (n = 193); at 2 (n = 192), 4 (n = 192), 6 (n = 190), 7.5 (n = 118), 9 (n = 188), and 12 months (n = 196); and at 5 years of age (n = 162). Concentrations of cholesterol--very-low-density lipoprotein, low-density lipoprotein, high-density lipoprotein-2 (HDL2), and HDL3--were determined at 2, 6, 9, and 12 months (n = 36) and at 5 years (n = 162).

RESULTS

The correlation coefficients of total cholesterol levels during the first year of life with the level at 5 years of age were as follows: at birth .04, at 2 months .36 (P < .001), at 4 months .26 (P < .001), at 6 months .28 (P < .001), at 7.5 months .25 (P < .001), at 9 months .35 (P < .001), and at 12 months .48 (P < .001). The correlation for exclusively breast-fed children between 6 months and 5 years of age was r = .37, P < .001, while that for children receiving partially breast milk, formula, or solid foods was r = .12, P = not significant (NS), and between 9 months and 5 years r = .38, P < .01, and r = .28, P < .05, respectively. The correlation coefficients of the lipoprotein levels between ages 12 months and 5 years were as follows: low-density lipoprotein cholesterol .58 (P < .001), total HDL cholesterol .30 (P < .05), HDL2 cholesterol .34 (P < .05), HDL3 cholesterol .17 (P = NS), very-low-density lipoprotein cholesterol .24 (P = NS), total triglyceride .37 (P < .05), and triglyceride-very-low-density lipoprotein .37 (P < .05). Of the children whose total serum cholesterol level was above the 90th percentile at birth, or at 2, 4, 6, 7.5, 9, or 12 months, 6%, 35%, 29%, 30%, 31%, 33%, and 45%, respectively, were above the 90th percentile at 5 years of age. In retrospect, 45% of the children whose serum cholesterol level was above the 90th percentile at 5 years were above the 90th percentile at the age of 12 months and 80% were in the highest quartile.

CONCLUSIONS

The results indicate that tracking of serum cholesterol concentration during the first year of life is stronger when examining children who are receiving a relatively homogenous diet, such as exclusive breast-feeding, and weaker as children are weaned to formula and solid foods. After the weaning process is completed, children's relative serum cholesterol levels have become established and the tracking of serum cholesterol is of the same magnitude as for older children and adolescents.

Serum cholesterol and lipoprotein concentrations in mothers during and after prolonged exclusive lactation

The effect of exclusive lactation on lipid levels was investigated by evaluating serum concentrations of total and lipoprotein cholesterol, triglyceride (TG), and apoprotein (apo) B in mothers during and after exclusive, prolonged lactation. Serum total cholesterol concentrations were measured at delivery (n = 195), at 2 (n = 165), 6 (n = 119), 9 (n = 74), and 12 months (n = 32) of lactation, and 2 months (n = 27) after ending this exclusive lactation. In a subgroup of 34 mothers, serum levels of very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL), high-density lipoprotein 2 (HDL2), HDL3, and LDL apo B were determined at 2, 6, 9, and 12 months of lactation. The mean value of serum total cholesterol concentrations decreased from 6.2 +/- 0.12 (SEM; n = 195) at delivery to 4.8 +/- 0.1 mmol/L (n = 116) at 6 months of exclusive lactation (P < .001). The average decrement in total cholesterol level was 0.80 mmol/L (P < .001) from delivery to 2 months of lactation and 0.55 mmol/L (P < .001) from 2 to 6 months of lactation, and levels were stable thereafter. In the 27 mothers who were exclusively breast-feeding their infants at 9 months of lactation and whose serum cholesterol levels were measured 2 months after the end of lactation, cholesterol levels increased rapidly to 5.7 +/- 0.21 mmol/L (P = .001). In the subgroup of 34 mothers who were examined more closely, the course just described was also true for serum TG, LDL and VLDL cholesterol, and LDL apo B levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Exclusive breast-feeding and weaning: effect on serum cholesterol and lipoprotein concentrations in infants during the first year of life

The total serum cholesterol concentration of infants was investigated at birth (n = 193) and at the ages of 2 (n = 192), 4 (n = 192), 6 (n = 190), 9 (n = 188), and 12 months (n = 196). Concentrations of cholesterol--very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL), high-density lipoprotein-2 (HDL2), HDL3--and apoprotein B were analyzed in 36 infants at 2, 6, 9, and 12 months of age. Serum cholesterol concentration rose significantly more slowly in the weaned infants compared with exclusively breast-fed infants. The mean difference in total serum cholesterol value between the exclusively breast-fed and weaned infants was largest at ages 2 (0.9 mmol/L, P less than .001), 4 (0.6 mmol/L, P less than .01), and 6 months (0.5 mmol/L, P less than .01). The LDL cholesterol concentration was lower in weaned infants compared with exclusively breast-fed infants at age 2 and 6 months; the mean difference in LDL cholesterol value was 0.9 mmol/L at age 2 months (P less than .001) and 0.7 mmol/L at age 6 months (P less than .025). Also, the apoprotein B concentration was lower in weaned infants; the mean difference was 24 mg/dL at age 2 months (P less than .01) and 30 mg/dL at age 6 months (P less than .05). The apoprotein B-LDL cholesterol ratio was stable and similar in both feeding groups through the year. The HDL2 cholesterol concentration was lower in the formula-fed than in breast-fed infants at 2 months of age while the VLDL and HDL3 cholesterol concentrations were independent of the diet.(ABSTRACT TRUNCATED AT 250 WORDS)

Low colostral IgA associated with cow's milk allergy

During a nutritional study of 198 infants, seven became allergic to cow's milk. The seven infants showed acute cutaneous manifestations during cow's milk challenge tests in hospital and six had increased levels of IgE cow's milk-specific antibodies. Neither in the development of the levels of immunoglobulins G, A and M, nor in that of the cow's milk-specific antibodies of these isotypes did these seven patients differ from the remaining infants. Beta-lactoglobulin content and levels of cow's milk-, and beta-lactoglobulin-specific antibodies and of immunoglobulins A, G and M were measured in samples of colostrum and milk from the mothers of the seven infants with cow's milk allergy and from a comparison group (non-atopic mothers of non-atopic infants). The milk of the mothers whose infants became allergic to cow's milk contained less IgA through the lactation: 95% confidence intervals of the groups did not overlap. The difference was most marked in the colostrum. All other measurements were similar in the two groups. This suggests that an infant is more likely to develop cow's milk allergy if the mother's colostrum had a low total IgA content.

Biphasic reduction and concanavalin A binding properties of serum alpha-fetoprotein in preterm and term infants

Reference values for postnatal serum alpha-fetoprotein (AFP) and concanavalin A (ConA) binding subfractions of AFP in preterm and term infants are presented. Preterm infants had 10-fold higher serum concentrations of AFP than did term infants at birth. The reduction of serum values of AFP was biphasic in both groups and differed significantly between the two groups. The first declining phase continued for approximately 4 months in preterm and for 2 months in term infants, and was related to the degree of prematurity. The AFP values reached adult levels by 12 months in preterm and by 9 months in term infants. The developmental pattern of the carbohydrate moiety of AFP was determined by ConA fractioning. The proportion of the ConA nonreactive subfraction of AFP in preterm and term infants at birth was 6% and 13%, respectively; it increased more rapidly in term than in preterm infants but reached 85% to 95% by the age of 6 months in both infant groups. Our results indicate that the postnatal maturation of AFP synthesis is dependent on gestational age. Malignant recurrences of neonatal sacrococcygeal teratomas were associated with an increase in serum concentration of AFP and a decrease in the proportion of the ConA nonreactive subfraction of AFP.

Prevalence of caries and salivary levels of mutans streptococci in 5-year-old children in relation to duration of breast feeding

144 children with a known breast feeding history were studied for their caries prevalence and level of salivary mutans streptococci. 19% of the children were exclusively breast-fed for more than 9 months and 38% of the children were weaned after the age of 12 months (max. 34 months). The results of the study showed an equal caries prevalence at the age of 5 among children with a longer or shorter period of exclusive breast-feeding (chi 2 = 3.68, 9 df, NS). Exclusive breast-feeding also did not affect the levels of salivary mutans streptococci (chi 2 = 4.87, 9 df, NS). Children who were weaned late did not differ from those who were weaned early with respect to caries experience (chi 2 = 6.12, 9 df, NS), level of salivary mutans streptococci (chi 2 = 5.49, 9 df, NS) or presence of mutans streptococci (chi 2 = 1.53, 4 df, NS). On the basis of our sample we concluded that breast feeding alone cannot be connected with an increased or lowered caries prevalence.

Cholesterol and its precursors in human milk during prolonged exclusive breast-feeding

Concentrations of cholesterol and its precursors were investigated in human milk from 88 mothers at 2 mo, 28 mothers at 6 mo, and 6 mothers at 9 mo of lactation. These mothers, who were exclusively breast-feeding their infants, collected fore- and hindmilk samples at every feeding over a 24-h period. Samples were analyzed by gas-liquid chromatography and mass spectrometry. Mean (+/- SD) cholesterol concentrations were 0.41 +/- 0.094, 0.46 +/- 0.094, and 0.49 +/- 0.10 mmol/L, respectively. The following cholesterol precursors were identified: squalene, lanosterol, dimethylsterol, delta 8.24-methostenol, lathosterol, and desmosterol. Mean concentrations were 0.04 +/- 0.11, 0.35 +/- 0.13, and 0.29 +/- 0.012 mmol/L for desmosterol, 0.0094 +/- 0.0027, 0.012 +/- 0.0039, and 0.011 +/- 0.0039 mmol/L for squalene, and from 0.0011 to 0.0027 mmol/L for all the other precursors. The precursors' equally low concentrations, except for desmosterol and squalene, and the significant correlations with each other suggest that the mammary gland synthesizes cholesterol from lanosterol by preserving the side-chain double bond and that the rate-limiting step may be the conversion of desmosterol to cholesterol.

The weanling: iron for all or one

Mild iron deficiency remains to be a problem of healthy infants even in Europe. In this paper we discuss some of the potential reasons. There are physiological variations which result in elevated need of iron during infancy. These include growth that is unusually rapid, change in hemoglobin level from low normal to high normal and quality of milk nutrition during infancy. Prolonged exclusive breast feeding is a particularly interesting mode of nutrition since the iron absorption seems to be extremely effective. Infants may compensate their increased needs of iron either by stimulation of intestinal absorption of iron or of mobilization of iron from the relatively large tissue stores. We conclude that healthy full-term infants need to be fed with iron supplemented infant milk formulas or solid foods fortified with iron to order guarantee an optimal iron nutrition.

Copper supplementation: failure to increase plasma copper and ceruloplasmin concentrations in healthy infants

Plasma copper and ceruloplasmin concentrations at ages 0, 2, 4, 6, 9, and 12 mo were longitudinally evaluated in our Finnish nutritional survey of 200 infants. The infants, who were weaned by age 3.5 mo, were randomly assigned to receive either a liquid cow-milk-based formula containing 1.3 mumol Cu/L (n = 16) or the same formula supplemented with 7.8 mumol Cu/L as Cu sulfate (n = 16). They were compared with exclusively breast-fed infants. Plasma Cu and ceruloplasmin concentrations increased steadily and similarly in all three groups from 4.6 +/- 0.2 mumol/L (means +/- SEM) and 0.9 +/- 0.1 mumol/L, respectively, in umbilical samples to 19.7 +/- 0.3 mumol/L and 3.2 +/- 0.1 mumol/L, respectively, at age 12 mo. Our results indicate that concentrations of plasma Cu and ceruloplasmin in healthy full-term infants are resistant to dietary supplementation.

Plasma antibodies to cow's milk are increased by early weaning and consumption of unmodified milk, but production of plasma IgA and IgM cow's milk antibodies is stimulated even during exclusive breast-feeding

We measured levels of cow's milk-specific (CM) antibodies of immunoglobulin classes G, A and M by enzyme-linked immunosorbent assay in plasma of 198 healthy infants; a variable number of samples taken at birth and at ages of 2, 4, 6, 9, 12 and 28 months were available (altogether 765 samples). The rise in the level of IgG CM antibodies was highest and most rapid in infants exposed to CM formula before the age of 1 month. The level fell by 9 months, but rose again by 12 months. This second rise was attributed to the introduction of dairy milk. Partially breast-fed and fully weaned infants had similar levels of IgG CM antibodies. The levels of IgG CM antibodies were unaffected by the infants' own atopy, their heredity for atopy, and the umbilical serum level of IgG CM antibodies. IgA and IgM CM antibodies were absent at birth. Their levels increased similarly in exclusively breast-fed infants and infants fed CM formula. We conclude that plasma IgG antibodies to cow's milk are increased by early weaning and by consumption of unmodified cow's milk. Production of plasma IgA and IgM antibodies to cow's milk is stimulated even during exclusive breast-feeding.

Effects of feeding regimen on blood glucose levels and plasma concentrations of pancreatic hormones and gut regulatory peptides at 9 months of age: comparison between infants fed with milk formula and infants exclusively breast-fed from birth

Little is known about the development of gut endocrine responses to food intake in infants after the first postnatal month. To examine this question and to ascertain whether the mode of feeding from birth affects postprandial endocrine changes, blood glucose levels and the plasma concentrations of 11 regulatory peptides were measured at 9 months of age before and after a breast feeding in 13 exclusively breast-fed infants and before and after a formula feeding in 7 infants weaned during the first 3 months of life. In the prefeeding concentrations of these substances, no significant differences were found between the two groups, with the possible exception of the plasma concentration of pancreatic polypeptide (p = 0.06). Postprandially, the responses were significantly smaller in the breast-fed infants, whose plasma concentrations of insulin, gastric inhibitory polypeptide, pancreatic polypeptide, and cholecystokinin were lower than in the formula-fed infants. In addition, the overall level of the insulin-glucagon ratio was lower (p = 0.03) in the breast-fed infants. A difference in the opposite direction was observed for plasma gastrin levels. No significant differences appeared between the groups for blood glucose, or plasma glucagon, vasoactive intestinal polypeptide, motilin, enteroglucagon, secretin, or neurotensin concentrations after feeding. It is concluded that at 9 months of age, the gut regulatory responses to milk feeding are of lower magnitude than during the neonatal period, but even at this age the response patterns still depend on the mode of feeding.

Risk factors for infantile recurrent otitis media: atopy but not type of feeding

We followed 183 infants from birth to 2.3 yr of age. Of these infants 28 had recurrent otitis media (ROM), defined as five or more separate episodes of otitis media (OM) during the first 2 yr of life or four such episodes during their 2nd yr. The OM presented during their 1st yr (early-onset ROM) in 12 infants and during their 2nd yr (2nd yr ROM) in 16. Eighty infants had no OM and served as a comparison group. Regarding type of feeding, the infants with early-onset ROM did not differ from their age-matched pairs in the comparison group either 1 month before the first OM or at the time of first episode of OM. Exclusive breast-feeding did not prevent OM and early weaning was not a risk factor for ROM. Atopy was associated with ROM with a relative risk of 1.9 (95% confidence limits 1.2-3.2). It was particularly prevalent among the infants with early-onset ROM, in 67 versus in 25% in the comparison group (p less than 0.01). During the 2nd yr daily contact with five or more children was associated with ROM with a relative risk of 2.1 (1.3-3.3). The infants with 2nd-yr ROM were in daily contact with more children than the comparison group (mean 11 versus 5; p less than 0.001). Parental smoking was more frequent among the infants with ROM than in the comparison group (54 versus 33%; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Prolonged exclusive breast feeding and heredity as determinants in infantile atopy

We followed 183 infants for two years, 31 of whom were breast fed less than three and a half months (median 70 days; short breast feeding group) and a further 31 of whom were exclusively breast fed for more than nine months (long breast feeding group). We assessed heredity for atopy, number of infections, and duration of breast feeding as determinants of atopy. During the first year of life 14 infants has signs of atopy. During the second year parents reported signs of atopy in a further 31. Heredity was the only significant predictor of atopy. Atopy was seen in 33% of infants with a positive heredity and in 16% without family history for atopy. The duration of breast feeding affected the incidence of atopy only among the infants without family history for atopy: fewer in the short breast feeding group (1/18) had atopy than in the long breast feeding group (5/13). Duration of breast feeding did not associate with incidence of respiratory infections. Diarrhoea was more common in the short breast feeding group than in the long breast feeding group during the first year of life. We conclude that prolonging exclusive breast feeding from the median of 70 days to nine months did not contribute to the prevention of infantile atopy and respiratory tract infections.

Prolonged exclusive breast-feeding results in low serum concentrations of immunoglobulin G, A and M

Serum levels of IgG, IgA and IgM were measured in 198 infants at ages 2, 4, 6, 9 and 12 months. By age 9 months 30 infants were still exclusively breast-fed; their IgG and IgM levels were significantly lower than those of infants weaned early to formula (before age 3.5 months). By 12 months 6 infants were still exclusively breast-fed; their IgA levels were by then also similarly lower. There was no significant difference in the number of infections experienced by these groups of infants. After 2 months on formula feeding, the IgG and IgM levels of the infants who were exclusively breast-fed for 9 months had caught up with the levels of the infants weaned early to formula. Only at 12 months of age prealbumin levels of the exclusively breast-fed infants showed a positive correlation to IgG and IgA levels; no correlation was found between immunoglobulin levels and levels of serum iron and zinc.

Formula feeding results in lower selenium status than breast-feeding or selenium supplemented formula feeding: a longitudinal study

Thirty-two infants completely weaned by age 3.2 mo were randomized into two groups. Unsupplemented group was fed cow's milk-based liquid formula containing 3-5 micrograms Se/L. Se-supplemented group received the same formula supplemented with 20 micrograms Se/L. A third group consisted of exclusively breast-fed infants (51 at age 4 mo, 41 at 6 mo, 12 at 9 mo). Mean serum Se concentration in unsupplemented group decreased from 41 to 31 micrograms/L during the first 2 mo and remained constant until age 6 mo increasing gradually thereafter. In Se-supplemented group it increased steadily from 41 to 68 micrograms/L at age 6 mo and remained constant while supplemented formula was used. In breast-fed group it increased steadily until age 9 mo, between the levels of the two formula-fed groups, when it reached the concentration of Se-supplemented group. At age 12 mo no significant differences were present among the three groups.

Carnitine during prolonged breast feeding

To assess carnitine levels during prolonged sole breast feeding we measured serum and breast milk carnitine concentrations in 37 lactating mothers and their healthy term infants from birth to the age of 1 yr. The number of solely breast-fed infants decreased to 31 at 2 months of age, to 28 at 6 months, and to seven at 9 months, because formula and/or solid food was added when there was not enough breast milk. In mothers the mean serum carnitine increased from 35 to 50 mumol/liter during the first 2 months after delivery and remained unchanged thereafter. Irrespective of the type of feeding, the mean serum carnitine in infants increased from 29 to 59 mumol/liter during the first 2 months, remained unchanged during 2-9 months, and decreased to the mean level of mothers thereafter. The mean carnitine concentration of breast milk was high (106 mumol/liter) immediately after delivery. During the first 2 months the mean carnitine concentration of milk decreased to the mean serum level of mothers and remained unchanged thereafter. The carnitine concentrations of serum and breast milk did not correlate, however. The mean daily carnitine intake of the breast-fed infants was 5.7 mumol/kg at 4 months of age, 4.7 mumol/kg at 6 months, and 6.0 mumol/kg at 9 months whereas the mean daily carnitine intake of the infants receiving formula was 28.9 mumol/kg at 1 month of age and 30.7 mumol/kg at 2 months. The serum concentration of carnitine in our infants did not correlate with carnitine intake. Our results indicate that serum carnitine concentrations are maintained during prolonged sole breast feeding.

Folate nutrition is optimal in exclusively breast-fed infants but inadequate in some of their mothers and in formula-fed infants

Plasma concentrations of folate were studied in a group of exclusively breast-fed infants and their mothers (their numbers gradually decreased from 200 at birth to 7 at 12 months) and in infants completely weaned to a cow's milk formula (containing 35 micrograms of folate/L) and solid foods. The exclusively breast-fed infants were in no danger of folate deficiency; their plasma levels were elevated after the age of 2 months and, on average, were 2.0-3.3-fold higher than maternal levels throughout the study. None of these infants had an inadequate plasma concentration, whereas up to 5% of the mothers had values less than or equal to 3 micrograms/L, despite supplementation during lactation with 0.1 mg folate/day. In the formula-fed infants, 69-94% of the plasma folate concentrations lay below the lowest concentration for the breast-fed infants. Although no infant had signs of anemia or macrocytosis in red cell indices, the infants weaned earliest had the lowest hemoglobin concentrations (p = 0.09) and the highest mean corpuscular volume (MCV) values (p = 0.06) at 9 months of age. Thus, an infant fed a formula containing the recommended amount of folate runs a risk of folate deficiency.

Cu nutrition in infants during prolonged exclusive breast-feeding: low intake but rising serum concentrations of Cu and ceruloplasmin

We studied Cu intake and nutrition in exclusively breast-fed infants by determining Cu and ceruloplasmin concentrations in maternal and infant sera, as well as milk intakes and concentrations. The infants numbered 200 at birth, 116 at age 6 mo, 36 at 9 mo, and 7 at 12 mo. Postpartum the mean maternal serum concentrations of Cu and ceruloplasmin were high, but decreased in 4 mo to the level of nonpregnant women, and remained thereafter stable. The median milk Cu concentration decreased throughout lactation. In contrast, the mean infant serum concentrations of Cu and ceruloplasmin increased with age reaching adult levels by age 6 mo. The infant serum concentrations were independent of the milk concentrations which in turn were independent of the maternal serum concentrations and the degree of maternal supplementation (none, 2, or 4 mg Cu++ with Fe++ and Zn++). Neither maternal nor infant serum concentrations reflected intake of Cu. The daily Cu intake varied up to 10-fold between infants. No signs of Cu deficiency were detected during exclusive breast-feeding.

Selenium status of exclusively breast-fed infants as influenced by maternal organic or inorganic selenium supplementation

A longitudinal dietary Se supplementation study on lactating mothers was performed to determine the possibilities of improving the Se status of exclusively breast-fed infants. A total of 200 mothers randomized into three groups received either no Se supplements, 100 micrograms of selenite, or 100 micrograms of yeast-Se daily. Maternal and infant serum Se concentrations showed a linear correlation during exclusive breast-feeding. Yeast-Se in the dose administered was safe and more effective than selenite in increasing the Se concentrations of maternal serum and milk, and infant serum. The mean estimated daily Se intakes of the infants were 7.7 +/- 2.2, 8.9 +/- 2.2, and 11.5 +/- 4 micrograms, in the control, selenite, and yeast-Se groups respectively. Though the infant Se intakes of the unsupplemented and selenite-supplemented mothers were below the lower limit of the safe and adequate range as set by the US National Research Council, their serum Se concentrations increased steadily over the 6-mo study period. As maternal serum Se also increased by over 50% during the same period the results suggest that a maternal daily intake of 50-75 micrograms is adequate during lactation.

Exclusively breast-fed healthy infants grow slower than reference infants

We have studied the nutritional adequacy of exclusive breast-feeding by following prospectively the growth and protein nutrition of healthy infants during the 1st yr of life. The number of exclusively breast-fed infants was 116 at the age of 6 months and 36 at 9 months. These infants had slower length velocity after age 3 months than a comparison group of 32 infants who were weaned early and given formula plus solids. As a group, the exclusively breast-fed infants lagged slightly, but progressively, behind in relative length. By 9 months, 45% of them versus 18% of the comparison group showed a greater than 1 SD decrease in relative length. No such decrease was found in relative weight. Skinfolds and weight for length index showed that they were heavier for their length than the comparison infants. At 6 and 9 months the calculated protein intake (0.9 g/kg/day) was much less than the recommended amount (2.0 g/kg/day). Serum prealbumin concentration was lower than in the comparison group but this was noted as early as 4 months. No relation was found between the parameters of growth and protein nutrition either individually or in general. Whether the slower growth of the exclusively breast-fed infants represents appropriate physiological growth or whether it indicates nutritional deficiency is not known but we did not find any evidence of protein deficiency. Six infants did, however, show subsequent catch-up growth which could indicate previous malnutrition.

Vitamin C nutrition during prolonged lactation: optimal in infants while marginal in some mothers

Prolonged breast-feeding is practiced by mothers in the hope of improving their infants' health and preventing diseases. In this study of the nutritional adequacy of breast-feeding, 200 mothers with healthy, full term newborns were encouraged to breast-feed exclusively. At age 6 months 116 infants and at age 9 months 36 infants remained exclusively breast-fed. The control infants were weaned early and they received vitamin C through a supplemented milk formula and solid food. The exclusively breast-fed infants were able to maintain their plasma vitamin C concentration at the same or a higher concentration than the vitamin C-supplemented controls. Their plasma concentration was about 2-fold compared with the maternal concentration. It was relatively independent of maternal nutrition and of vitamin C concentration in milk. The mother's intake of vitamin C influenced their plasma and milk concentrations. About 6% of the mothers had subnormal plasma concentrations without symptoms. The lowest concentrations occurred 2 months postpartum and during the spring. Thus, exclusively breast-fed infants are well protected against vitamin C deficiency, but marginal intake in lactating mothers is more common than assumed for a well-nourished population.

Exclusive breast-feeding for 9 months: risk of iron deficiency

Thirty-six infants who were exclusively breast-fed were observed for 9 months. Thirty-two infants who were completely weaned prior to age 3 1/2 months served as controls; these infants received iron supplementation in formula and solid foods. A great majority of exclusively breast-fed infants were able to maintain their iron status at the same level as that of the control infants. The mean concentration of hemoglobin was higher in breast-fed infants than in control infants at ages 4 and 6 months. However, six breast-fed infants required iron medication because they had laboratory evidence of iron deficiency, although none had anemia. Maternal iron supplementation during breast-feeding, even in large daily doses, did not have any effect on the infants' iron nutrition, nor prevent infants from developing some signs of iron deficiency. Our data indicate that it is safe in exclusively breast-fed infants to shift the starting age for introduction of iron to 6 months.