Micronutrient and Glucose-Related Biomarkers Until 24 Mo of Age in Infants Receiving Formula With Added Bovine Milk Fat Globule Membrane Through the First Year of Life: An RCT

Objectives

Bovine milk fat globule membrane (bMFGM) added in routine infant formula supports normal growth and safety through 24 mo of age in term infants. The impact on micronutrients and glucose-related biomarkers is assessed here.

Methods

In this double-blind, randomized, controlled trial, formula-fed infants were enrolled (<120 days of age) and randomized to receive a standard cow´s milk-based infant formula (SF, n = 174) or a similar formula with added whey protein-lipid concentrate (5 g/L; bMFGM; EF n = 173); exclusively breastfed infants were enrolled as a reference (HM, n = 235). In 50% of infants (chosen at random), parents agreed to blood collection (2–4 h fasting) at baseline, 6, 12, and 24 mo of age. Serum micronutrients (zinc, iron, ferritin, transferrin receptor) and glucose-related biomarkers (glucose, insulin, HOMA-IR [Homeostatic Model Assessment-Insulin Resistance], IGF-1) were analyzed.

Results

At baseline, significant differences in markers of iron status (serum iron, ferritin) and glucose-related biomarkers (glucose, HOMA-IR, and IGF-1) were detected between HM and study formula groups. At 6 and 12 mo, no differences in any measure were detected between study formula groups. Serum iron and ferritin at 12 mo as well as glucose-related biomarkers at 6 mo (insulin, HOMA-IR, IGF-1) and 12 mo (IGF-1 only) were lower in the HM vs study formula groups. By 24 mo, micronutrients and glucose-related biomarkers were similar between study formula groups (with the exception of significantly lower serum iron in the SF group); for HM vs study formula groups, differences included significantly lower zinc and IGF-1.

Conclusions

Patterns of micronutrients and glucose-related biomarkers were similar through two years of age in infants who received formula through one year. This study add to the body of data available for glucose-related biomarkers in children at two years of age and younger.

Funding Sources

The study was funded by Mead Johnson Nutrition (MJN). TMP, SSW, and JLW are currently, and CLB was previously employed by MJN.

Assessing Early Behavioral Indicators of Tolerance in Infants Receiving Formula with Added Lactobacillus rhamnosus GG (LGG)

Objectives

To evaluate the nutritive effects of an infant formula with added LGG on early behavioral indicators of tolerance in infants experiencing crying and fussing often associated with infantile colic.

Methods

In this single-center, double-blind, controlled, parallel, prospective study, infants (14 to 28 days of age) determined to cry and/or fuss ≥3 hours/day for ≥3 days/week (in a one-week period) were randomized to receive one of two formulas over a 21-day feeding period: marketed partially hydrolyzed (PH) cow's milk-based infant formula (PH: n, 35) or a similar formula with added LGG (PH-LGG: n, 36). Parents/caregivers used a validated parent-report diary to record crying/fussing and awake/content behavior at three time points: Study Days 2–4 (baseline), Days 10–12, and Days 18–20 (Study End). The primary outcome, duration (hours/day) of crying/fussing (averaged over each three-day period), was analyzed by repeated measures, mixed-effects models.

Results

Birth characteristics (sex, race, weight) and age (days; mean ± SE) at study entry (PH: 19.7 ± 0.8; PH-LGG: 19.3 ± 0.8) were similar for study groups. No group differences in mean study formula intake (g/day) or mean achieved weight (g) at any study time point were detected. Completion rates were similar through Day 21 (PH: n = 33, 94%; PH-LGG: n = 33, 92%). Duration of crying/fussing (mean ± SE) decreased over time with no significant differences detected in the PH vs PH-LGG group at Baseline (4.8 ± 0.3 vs 4.0 ± 0.3; P = 0.086), Days 10–12 (3.5 ± 0.3 vs 2.6 ± 0.3; P = 0.056), and Days 18–20 (2.1 ± 0.3 vs 1.5 ± 0.3; P = 0.227). Duration of awake/content behavior increased over time with no significant differences detected in PH vs PH-LGG: Baseline (1.0 ± 0.5 vs 1.2 ± 0.5; P = 0.786), Days 10–12 (1.3 ± 0.5 vs 1.6 ± 0.5; P = 0.627), and Days 18–20 (2.1 ± 0.5 vs 2.2 ± 0.5; P = 0.884). By Study End, only 8 (24%) in the PH and 9 (27%) in the PH-LGG group continued to cry and/or fuss ≥3 hours/day for ≥3 days/week.

Conclusions

In the present pilot study, we identified a study population of infants early in life experiencing crying and fussing often associated with infantile colic. Both study formulas were well tolerated. Crying/fussiness decreased and awake/content behavior increased in both study groups over the course of the study.

Funding Sources

Mead Johnson Nutrition.

Growth Through 24 Months of Age in Infants Receiving Formulas with or Without Added Bovine Milk Fat Globule Membrane (MFGM) or Human Milk Through the First Year of Life: An RCT

Objectives

To evaluate growth through 24 months of age in infants receiving added bovine milk fat globule membrane (MFGM) in infant formula through 12 months of age. Concentration of MFGM from bovine milk fractions and incorporation in infant formula may better approximate the composition of complex milk lipids in human milk.

Methods

In the double-blind, randomized, controlled Chilean Infant Nutrition Trial (ChiNuT; NCT0262613), term infants whose mothers chose to initiate exclusive infant formula feeding before 4 months of age were randomized to receive: a standard cow's milk-based infant formula (SF, n = 174) or a similar formula with added whey protein-lipid concentrate (5 g/L; source of bovine MFGM) (bMFGM, n = 176). A reference group of infants exclusively receiving human milk (HM, n = 236) was also recruited. Growth through 24 months of age was the primary outcome. Length-for-age (LAZ), weight-for-age (WAZ) and body mass index (BMI)-for-age (BAZ) growth z-scores were analyzed by mixed-effects multiple linear regression models adjusted by sex, age (days), and maternal pregestational BMI (kg/m2).

Results

No significant group differences in sex, gestational age at birth, birthweight, maternal age and maternal education were detected, with the exception of maternal pregestational BMI (mean(SD)) (HM: 27.0(5.2) lower vs SF: 28.6(6.2) or bMFGM: 28.9(6.1); P = 0.002). Groups were similar at baseline (weight, length, WAZ, BAZ) with the exception of LAZ (lower in the bMFGM compared to HM group; P < 0.05). No significant differences in growth z-scores (absolute at 6, 9, 12, and 24 months of age or change between baseline and each study time point) were detected between SF and MFGM groups. Both randomized study formula groups were associated with higher growth z-score increases from baseline compared to the HM reference group between 6 and 24 months (P less than 0.05). Mean growth z-scores fell within the range of −1 to 1 (16th to 84th percentile) for SF, bMFGM, and HM groups at all study time points.

Conclusions

Added bovine MFGM in a routine cow's milk-based infant formula through 12 months of age supported normal growth through 24 months of age.

Funding Sources

The study was funded by Mead Johnson Nutrition (MJN). Teresa Murguia-Peniche, Steven Wu, and Jennifer Wampler are currently employed by MJN. Carol Lynn Berseth was previously employed by MJN.

Assessing Early Indicators of Tolerance and Stool Microbiome in Infants Receiving Formula with Added Lactobacillus rhamnosus GG (LGG)

Objectives

To evaluate stool microbiome and calprotectin in infants receiving partially hydrolyzed protein formula with or without Lactobacillus rhamnosus GG (LGG).

Methods

In this single-center, double-blind, controlled, parallel, prospective study, infants (14-28 days of age) experiencing crying/fussing often associated with infantile colic were randomized to receive one of two formulas over a 21-day feeding period: marketed partially hydrolyzed (PH) cow's milk-based infant formula (PH: n, 35) or a similar formula with added LGG (PH-LGG: n, 36). Stool samples were collected at Baseline and Study End (Days 19–21). Stool calprotectin (μg/g) was determined by immunoassay and analyzed (Kruskal-Wallis). LGG colonization was determined by qPCR analysis.16S rRNA gene sequencing was performed (Illumina MiSeq) and QIIME operational taxonomic units (OTUs) were assigned (Greengenes database). Alpha and beta diversity were analyzed by study group and time point.

Results

A significantly higher abundance of LGG was demonstrated at Study End vs Baseline for the PH-LGG (P < 0.001) but not PH group (P = 0.89). Alpha diversity (Shannon) was significantly higher at Study End vs Baseline in the PH group (P = 0.014). By Study End, members of Phylum Firmicutes were significantly higher (P = 0.002) and Family Enterococcaceae were significantly lower (P = 0.02) in the PH-LGG group. No group differences in stool calprotectin (median) were detected at Baseline (PH: 12.4, n = 26; PH-LGG: 13.9, n = 30) or Study End (PH: 12.4, n = 30; PH-LGG: 12.9, n = 30).

Conclusions

In infants receiving a partially hydrolyzed protein formula with added LGG over a 21-day feeding period, LGG was established in the stool microbiome. Associated potentially beneficial bacterial taxa were also increased.

Funding Sources

Mead Johnson Nutrition.

Stool Microbiota in Infants Receiving Extensively Hydrolyzed Formula, Amino Acid Formula, or Human Milk Through Two Months of Age (FS04-07-19)

Objectives

Infant feeding practices play a central role in development of gut microbiome and community structure. Our goal was to test the hypothesis that diets with intact or extensively hydrolyzed proteins or free amino acids may differentially affect the intestinal microbiota composition and immune reactivity.

Methods

This multicenter, double-blind, controlled, parallel-group, pilot study compared stool microbiota outcomes from Baseline (1-7 days of age) up to 60 days of age in healthy term infants. Infants received mother's own milk (assigned to human milk [HM] reference group) (n = 25) or were randomized to receive one of two infant formulas: amino-acid based (AAF; n = 25) or extensively hydrolyzed cow's milk protein (EHF; n = 28). Neither study formula included added Lactobacillus rhamnosus GG. DNA was extracted (Baseline, Day 30, Day 60), 16S rRNA genes were amplified and sequenced (Illumina MiSeq), and exact amplicon sequence variants (ASV) were assigned using the DADA2 model. Alpha (Shannon, Simpson, Chao1) and beta diversity (Bray Curtis distance) and differential abundance in taxa were analyzed. Relative ASV enrichment (Baseline vs Day 60) was visualized using heat maps and taxa abundance was analyzed by DESEq2 in R (ver 3.4.3).

Results

Complete stool data (all study time points) were available for 49 participants. Baseline alpha diversity measures were similar among groups. The HM group remained stable throughout the study. However, alpha diversity measures by Day 60 were significantly higher for AAF and EHF groups compared to HM. Significant group differences in beta diversity at Day 60 were detected (P < 0.001); AAF and EHF clustered more closely compared to the HM group. Relative Bifidobacterium abundance increased over time and was significantly enriched at Day 60 in the HM group (Figure, A). At Day 60, a significant increase in members of Firmicutes was detected for AAF and EHF groups; a decrease in Enterobacteriaceae (Escherichia) was observed for EHF (Figure, B).

Conclusions

Distinct patterns of early neonatal microbiome establishment were demonstrated for infants receiving mother's own milk compared to amino acid-based or extensively hydrolyzed protein infant formulas. Providing different sources of dietary protein early in life may impact gut microbiome development.

Funding Sources

Mead Johnson Pediatric Nutrition Institute.

Supporting Tables, Images and/or Graphs

Stool pH and Short/Branched Chain Fatty Acids in Infants Receiving Extensively Hydrolyzed Formula, Amino Acid Formula, or Human Milk Through Two Months of Age (P11-076-19)

Objectives

Infant feeding influences early development of the gut microbiome, colonization pattern, and community structure. Metabolites, including short- and branched-chain fatty acids (S/BCFA) (e.g., butyrate, propionate), produced by colonic bacteria serve as signaling molecules, influence immunity, and reduce luminal pH in the gastrointestinal environment. The objective of this study was to evaluate stool S/BCFA and pH in infants fed with different sources of dietary protein.

Methods

In this multicenter, double-blind, controlled, parallel-group, pilot study, healthy term infants were randomized to receive one of two infant formulas (IF): amino-acid based (AAF; n = 25) or extensively hydrolyzed cow's milk protein (EHF; n = 28) from Baseline (1-7 days of age) up to 60 days of age. A human milk reference group (HM; n = 25) received mother's own milk over the same period. Diethyl ether extractions of S/BCFA from stool samples (Baseline, Day 30, and Day 60) were quantified by gas chromatography (Clarus 580; PerkinElmer) using a fused silica capillary column (Nukol 30m × 0.25mm id × 0.25μm film). Mean stool S/BCFA (μmol/g) and pH were analyzed by repeated measures analysis of variance (ANOVA).

Results

Complete stool data (all study time points) were available for 49 participants. Stool pH (∼6) was similar among groups at Baseline with no significant changes for HM and EHF groups through Day 60. The AAF group was significantly higher at Days 30 and 60 (Figure 1). Total SCFA were similar for all groups through Day 60. Butyrate increased significantly from Baseline to Day 60 in the EHF group (P = 0.026) and was significantly higher vs HM at Days 30 and 60 (P = 0.0009 and 0.0004 respectively). Butyrate was significantly higher for AAF vs HM at Day 60 only (P = 0.038). Propionate was significantly higher for EHF and AAF at Day 30 (P = 0.0009 and < 0.0001 respectively) and AAF only at Day 60 (P = 0.005) vs HM. Total and individual BCFA increased for AAF and EHF groups vs HM through Day 60.

Conclusions

Distinct patterns of pH and microbial metabolites were demonstrated for infants receiving mother's own milk compared to amino acid-based or extensively hydrolyzed protein formula. Providing different sources of dietary protein early in life may influence gut microbiota and metabolites.

Funding Sources

Mead Johnson Pediatric Nutrition Institute.

Supporting Tables, Images and/or Graphs

Search for superconductivity in micrometeorites

We have developed a very sensitive, highly selective, non-destructive technique for screening inhomogeneous materials for the presence of superconductivity. This technique, based on phase sensitive detection of microwave absorption is capable of detecting 10⁻¹² cc of a superconductor embedded in a non-superconducting, non-magnetic matrix. For the first time, we apply this technique to the search for superconductivity in extraterrestrial samples. We tested approximately 65 micrometeorites collected from the water well at the Amundsen-Scott South pole station and compared their spectra with those of eight reference materials. None of these micrometeorites contained superconducting compounds, but we saw the Verwey transition of magnetite in our microwave system. This demonstrates that we are able to detect electro-magnetic phase transitions in extraterrestrial materials at cryogenic temperatures.

Evolvable work-centred support systems for command and control: creating systems users can adapt to meet changing demands

Military command and control (C2) organizations are complex socio-technical systems which must constantly adapt to meet changing operational requirements. We describe our experiences in developing a work-centred support system (WCSS) to aid weather forecasting and monitoring in a military airlift C2 organization as an illustrative case. As part of the development process we conducted field observations both before and after introduction of the WCSS in their operations centre. A striking finding was the constant changes that operations personnel faced (changes in goals and priorities, changes in scale of operations, changes in team roles and structure, and changes in information sources and systems). We describe the changes in workplace demands that we observed and the modifications we needed to make to the WCSS in response. For today's fielded systems, it is seldom possible to make changes that are responsive to users' changing requirements in a timely manner. We argue for the need to incorporate facilities that enable users to adapt their systems to the changing requirements of work and point to some promising directions towards evolvable work-centred support systems.

Pulmonary sequestration with primary blastomycosis. Failure of ketoconazole therapy after resection

Infection with Blastomyces dermatitidis developed in a girl with occult pulmonary sequestration. Six months after resection, while receiving ketoconazole, she developed an abscess due to B dermatitidis over the scar from thoracotomy, with a sinus tract to the eighth rib. This was successfully managed with débridement, rib resection, and amphotericin B. Contiguous bone involvement should be suspected in sequestra infected with this organism; débridement and therapy with amphotericin B might be indicated.

Modified aortoseptoplasty for anular abscess and erosion of the membranous septum

Surgery for bacterial endocarditis may require extensive debridement and appropriate reconstruction for optimal results. Excision of the aortic valve and eroded membranous septum due to pneumococcal endocarditis with modified aortoseptoplasty was successfully accomplished in a six-year-old child.