Beate Pietschnig

Interactions between Infections, Malnutrition and Ironnutritional Status in Pakistani Infants A Longitudinal Study

The interactions between infections, malnutrition and poor iron nutritional status in infants at weaning ages are poorly defined. Therefore, four groups of infants from an area with a high incidence of malnutrition (Lahore, Pakistan) were enrolled in a prospective, randomized nutritional intervention study. Between 122 and 365 days of age, the infants from one community received either a milk cereal without iron fortification (n= 29), a milk cereal fortified with ferrous fumarate (7.5 mg/100 g; n= 30), or a milk cereal fortified with ferric‐pyrophosphate (7.5 mg/100 g; n= 27). Forty‐four infants from a neighbouring community did not receive a nutritional supplement and served as the control group. Calculated mean daily energy‐ and protein intake with the cereals was between 259–287 kcal, and 9.6–10.6 g at 12 months of age, respectively. Mean daily iron intake with the fortified cereals was between 4.1–5.1 mg at corresponding age. Nutritional supplementation resulted in significantly lower incidence of malnutrition and heigher weight gain. Incidence of acute diarrhoea was significantly (p<0.05) lower in the supplemented groups. The infants fed the iron‐fortified milk cereals had significantly higher hemoglobin (mean 10.4 vs. 9.8 gdl‐1) and serum ferritin (mean 13.3 vs. 8.5 ngml‐1) values than the infants fed the non‐fortified milk cereals. However, no differences in the incidence of infections were found between the supplemented groups. It is concluded that poor nutritional intake between 122 and 365 days of age substantially contributed to the high incidence of diarrhoea and malnutrition in Pakistani infants.

Iron nutrition and growth of breast- and formula-fed infants during the first 9 months of life.

Feeding of iron (Fe)-fortified (12–15 mg/L) infant formulas is an effective and convenient means to protect infants from Fe deficiency. To study lower levels of Fe fortification of infant formulas (3 or 6 mg/L) compared with those currently in use, we compared Fe intake and Fe nutritional status of three groups of healthy, term infants between 90 and 274 days of age. One group received an Fe-fortified whey-predominant formula (3 mg/ L) and the second group received the same formula with a higher Fe level (6 mg/L). A comparison group was breast-fed at least until 274 days of age. All infants received infant foods and cereals according to European Community recommendations. Mean Fe intake of infants fed formula fortified with 3 mg/L was significantly lower at 183 and 274 days of age (p < 0.05) than that of infants fed formula fortified with 6 mg/L. None of the infants fed the formula fortified with 3 mg/L met the recommended daily allowance value (10 mg) for infants between 6 and 12 months of age. Hemoglobin, hematocrit, mean corpuscular volume, free erythrocyte protoporphyrin, and serum ferritin levels were similar in the formula-fed groups; none of the infants had depleted Fe stores (ferritin < 10 μg/L) at 183 and 274 days of age. Thirteen percent of breast-fed infants had depleted Fe stores at 183 days of age, but only 3% were depleted at 273 days of age, when Fe-fortified beikost was already part of the diet. No influence of Fe nutritional status was found on zinc and copper nutritional status or on growth. We conclude that regular consumption of an infant formula fortified with 3 mg Fe/L, a level substantially below present recommendations, prevents healthy, term infants from developing Fe deficiency during the first 6 months of life. It is preferable that infants 6 months of age and older receive an Fe-fortified formula and a judicious selection of beikost to ensure an adequate dietary intake of Fe.

Smoking, cereal consumption, and supplementation affect cadmium content in breast milk

Breast milk might be a source of potentially toxic metals such as cadmium (Cd). The purpose of the present study is to provide data pertaining to the influence of maternal lifestyles on Cd concentrations in breast milk in the Austrian setting. Breast milk was obtained from 124 Austrian women. Each participant provided 10 ml of milk. A second group of eight mothers were recruited to investigate changes in their milk cadmium levels at 1, 3, 5, 7 and 9 weeks post partum. The study participants filled a questionnaire concerning nutrition, supplementation, and smoking habits. The samples were analyzed using GF-Atomic Absorption Spectrophotometer (AAS). The mean Cd content in breast milk was among the lowest in Europe (0.086±0.085 μg/l, 95% CI: 0.07–0.10; n=124). Increased Cd levels in breast milk were found to be significantly associated with frequent cereal consumption and smoking. Smokers had a two-fold higher concentration than did non-smokers (0.15 versus 0.07 μg/l; P=0.000). In contrast, low Cd levels in breast milk were associated with the intake of supplements containing trace elements or vitamins and trace elements (P<0.05). This protective effect of supplements on Cd levels was only observed in non-smokers. The Cd levels registered in the present investigation were far below critical levels. We conclude that the current maternal Cd levels in Austria signify no risk for the breastfed infant of a healthy mother. Further research will have to focus on the specific effects of supplementation and smoking on Cd concentrations.

32 CESIUM 134 + 137 IN BREAST MILK, COW'S MILK AND INFANT FORMULAS IN AUSTRIA AFTER THE CHERNOBYL ACCIDENT

Austria was among the countries with the highest deposition of 134 Cs and 137 Cs after the accident on April 26, 1986. Therefore, we carefully monitored these radioisotopes through January, 1988. Using a sodium iodide scintillation detector, we analyzed 2131 samples of cows milk from Austrian dairies, 221 pooled and individual breast milk samples and 242 samples of powdered infant formula. The detection limit for both 137 Cs and 134 Cs in 100 ml of milk was 3 Bq. Concentrations of 134 + 137 Cs combined (median; 95th percentile) in cows milk were highest in May (48;491 Bq) and June (89; 213 Bq) 1986 and decreased until October 1986 (9; 38 Bq). A second increase was observed during the winter months 1986/87 with concentrations reaching their peak in April 1987 (69; 196 Bq). This was caused by the feeding of silage or hay that had been contaminated during the summer 1986. Since June 1987, the 95th percentile has not exceeded 37 Bq, the upper limit for infant food set by the EEC. The 95th percentile in breast milk and in infant formulas (imported from non-contaminated areas) never exceeded 21 Bq. Mothers were advised to continue breast-feeding as long as possible or to use infant formulas and until June 1987, mothers were advised to avoid feeding of cows milk.

190 PCBS, PCDDS AND PCDFS IN HUMAN MILK DOES A SHORT TERM-CHANGE IN MATERNAL DIET INFLUENCE THEIR CONCENTRATION?

INTRODUCTION: Polychlorinated Biphenyls (PCBs), Dibenzodioxins (PCDDs) and -Furans (PCDFs) are found mainly in animal fat and in human milk.OBJECTIVES: To elucidate the influence of a short-term change in maternal diet in the PCB, PCDD and PCDF content of human milk.STUDY GROUP: 6 breastfeeding mothers of healthy, term, single infants 3-10 months old. Diet: 24-hours fasting and weekly change of a weighed recorded diet containing high (“HIGH”) or extremely low (“LOW”) fat, cross-over design. Samples: 1 human milk sample before the study (“start-up”), 1 sample after fasting (“fasting”) and 1 sample at the end of every diet week (“HIGH” and “LOW”) in pre-washed bottles (WHO protocoll), stored at −20° until analysis.METHODS: Lipid extraction using polyethylene film dialysis and silica column, HPLC- separation of the congeners, analysis on High- resolution gas chromatograph (HP-5898) and a high- resolution- mass spectrometer (VG-70-250S).STATISTICAL ANALYSIS: Latin- square test.RESULTS: Mean animal fat intake of the mothers during “LOW” weeks 9.13 (9.65)g/day vs 108.04 (56.46)g/day during “HIGH” weeks.(p<0.01)Latin-square analysis: PCBs, PCDDS, PCDFs: No influence of dietary changes.CONCLUSION: No dietary changes for breastfeeding mothers.

RADIOACTIVITY IN INFANT FOOD IN AUSTRIA AFTER THE CHERNOBYL ACCIDENT - A SIX - YEAR FOLLOW - UP

After the Chernobyl accident Austria was among the countries with the highest radioactive fallout. In order to have a sufficient data base for further risk evaluation for the infant population, we monitored 131I and 134+137Cs (Na-scintillation detector and Germanium detector) in cows milk (n=2347), human milk (n=238) and infant formula (n=118) longitudinally from 1986 to 1992. From these data and from average food consumption values, we calculated averago nucleid intake for hypothetical infants under different feeding regimens. Using previously published dose equivalent factors, we calculated the internal radiation doses for the infants.A hypothetical infant (breast or formula fed 0-12 months) born at the time of the event received 110 uSv until 1992 (30% was accumulated during the first year). If the infant was switched to cows milk at 6 months of age, the accumulated cumulative dose was 195 uSv (50% was accumulated in the first year). A cows milk fed infant who was 6 months of age at the time of the event received 675 uSv until 1092 (80% accumulated during the first year). An additional done of 675 uSv can result in adverse health effects. Thus, the countermeasures (avoidance of cows milk) were effective in reducing the risk for infants.

74 EFFICIANCY OF CARROT-RICE SOUP IN THE TREATMENT OF ACUTE DIARRHEA

The treatment of acute diarrhea with glucose- based solutions results in rehydration but does not reduce the severity of diarrhea. Oral rehydration solutions (ORS) based on rice cereal and carrots may reduce stool output and restore fluid volume more quickly.In a prospective, randomized study we evaluated the efficacy of a commercial carrot/rice- based ORS A (Na 52 mmol/L) and two glucose- based ORS B (Na 55 mmol/L) and C (Na 90 mmol/L). Fluid intake, fecal and urine output and absorption of fluid was measured in 161 infants and children (3-48 months of age) during the first 48 hours after admission. The number of stools (p < 0.01)and the mean fecal output (p < 0.05) per kg body weight were significantly lower in group A. Children in group A also had significantly (p < 0.01) greater fluid absorption (mean 464 ml/kg) than in groups C (312 ml/kg) and B (140 ml/kg).A carrot/rice- based ORS was effective in the rehydration of infants and children with dehydration due to diarrhea. The solution decreased stool output and promoted greater absorption of fluid than did the two glucose- based solutions.

NO INFLUENCE OF MATERNAL VITAMIN K SUPPLEMENTATION ON VITAMIN K CONCENTRATION IN BREASTMILK

Haemorrhagic disease in breastfed infants caused by vitamin K deficiency can be prevented by oral or parenteral vitamin K administration. Low vitamin K intake with breastmilk may be responsible for the late onset vitamin K deficiency. Therefore we measured vitamin K intake of 28 healthy term breastfed infants at 6, 28 and 90 days of age in a longitudinal randomized study. 16 mothers received a daily oral vitamin K1 supplement (100ug, Milusan®). Milk intake was evaluated by 24 hour testweighing and vitamin K1 concentration in milk was measured employing the HPLC-technique. Vitamin K, intake was similar in the two groups and no influence of age was detected. (Tab., intake in ug/d).However, vitamin K1 intake of all infants was substantially below the RDI value of 10ug/day. (Am.J.Clin.Nutr;1987;45;687-92). Therefore low vitamin K intake with breastmilk might be responsible for late onset vitamin K deficiency in some infants.

4 HIGH IRON INTAKE DOES NOT NEGATIVELY AFFECT ZINC AND COPPER NUTRITIONAL STATUS OF TERM INFANTS

Studies in animals and metabolic balance studies in infants showed that iron negatively interacts with zinc and copper at the site of absorption. Most infants receive formulas fortified with iron up to a level of 2mg/100kcal. Therefore we studied iron, zinc and copper intake and nutritional status of healthy, term infants receiving an iron fortified (1.6mgFe/100kcal; group Fe; n=15) or a non fortified (0.05mgFe/100kcal; group non Fe; n=13) cows milk formula (BebaR, Nestle) from 122 through 365 days of age in a randomized, prospective study. Iron intake at 183, 274 and 365 days of age (from 3 day food record) was significantly higher in the group Fe (p<:0.0001) but zinc and copper intake was similar. Body iron stores estimated from serum ferritin concentration (RIA) were better filled in the Fe group at 365 days of age (p<0.05). We found no difference in serum zinc and serum copper concentrations (ICP) between the two groups from 122 through 365 days of age. Moreover, the copper binding protein ceruloplasmin and the zinc binding proteins a-2 macroglobulin, albumine, prealbumine, retinol-binding protein and transferrin (all determined by radial immunodiffusion) were similar. We conclude that iron intakes in the range of the present infant feeding recommendations (ESPGAN) did not affect zinc and copper natritional status.