Erika Sievers

Longitudinal manganese and copper balances in young infants and preterm infants fed on breast-milk and adapted cow's milk formulas

1. Mn and Cu intake and retention in twenty full-term infants and six preterm infants were studied on the basis of 72 h balances. The age of the infants was 2-16 weeks and the gestational age of the preterm infants (triplets) 34 and 36 weeks. Three nutrition schemes were pursued: breast-fed, formula-fed with unsupplemented adapted formula and formula-fed with trace element supplementation. 2. The mean Mn concentration of all breast-milk samples (n 2339) was 6.2 micrograms/l. The two formulas had similar Mn concentrations (77 and 99 micrograms/l) but had different Fe, Cu (121 and 619 micrograms/l), Zn and I contents. The mean Cu concentration in mothers milk was 833 micrograms/l. 3. The following mean daily Mn intakes and retentions (micrograms/kg) respectively were measured: breast-fed full-term 1.06 (SD 0.43) and 0.43 (SD 0.65), formula-fed full-term 14.2 (SD 3.1) and 2.8 (SD 4.8), formula-fed preterm 15.0 (SD 2.2) and 0.06 (SD 5.87). The results for Cu were 114.5 (SD 22.3) and 88.0 (SD 46.5) micrograms/kg in breast-fed, 19.8 (SD 4.2) and 4.6 (-11.5-9.6) in the unsupplemented formula-fed and 106.4 (SD 18.9) and 55.5 (SD 20.3) in the supplemented formula full-term infant group. No significant influence of the trace element contents of the formulas on the relative retention of Mn or Cu was found. 4. Young preterm infants, and to some degree young full-term infants, often had negative Mn balances caused by a high faecal excretion. The formulas with a Mn concentration below 100 micrograms/l gave a sufficient supply of Mn. Preterm infants fed on the unsupplemented formula had a marginal Cu supply and their first balances were negative (-3.8 (SD 1.8) micrograms/kg). 5. In accordance with the estimated safe and adequate daily dietary intakes (recommended dietary allowances), formula-fed infants receive much more Mn than breast-fed infants and their absolute retention is higher. 6. Cu from breast-milk had a significantly better biological availability than that from cows milk formula. If retentions similar to those in breast-fed infants are intended, we conclude, therefore, that cows milk formula should be fortified with Cu up to a level of at least 600 micrograms/l.

Molybdenum metabolism: stable isotope studies in infancy.

The essential trace element molybdenum (Mo) is bound to and required for the function of molybdoenzymes, e.g. sulfite and xanthine oxidase. Dietary recommendations for early infancy are based on limited knowledge about its metabolism. 100Mo was used as an extrinsic tag to study the absorption and kinetics of excretion in infancy. 10 infants with a gestational age of 35 (30-39) weeks, a birth weight of 2.0 (0.9-2.3) kg and a post-natal age of 20 (10-54) days were studied. They received 25 microg 100Mo/kg with a feed of human milk or formula. Fractional urinary and fecal collections were conducted preceding the 100Mo intake and for 48-72 hours afterwards. The materials were analyzed by atomic absorption spectroscopy and inductively coupled plasma mass spectrometry. The median absorption of 100Mo intake was 97.5 (96.3 to 99.1) %. The retention of nutritive Mo intake and 100Mo in the study period was 11.2 (3.8-15.7) microg Mo/kg, equivalent to 35.7 (12.7-55.6) %. The Mo concentration increased to a peak value in urine within 8 (6-13) hours and in feces within 24 (7-48.5) hours. In addition, increases of copper in feces and urine were observed in 8 of 9 infants studied. Mo given orally is well resorbed in premature infants, and predominantly excreted in the urine. Dietary recommendations should prevent excessive intakes in infancy.

Molybdenum supplementation in phenylketonuria diets: adequate in early infancy?

BACKGROUND Molybdenum concentrations in formulas exceed those in human milk by far. Infants with phenylketonuria require semisynthetic phenylalanine-restricted diets. Because these diets are presently supplemented with molybdenum, a study was conducted to determine whether retention and plasma concentration in the recipients are equivalent to those of healthy breast-fed infants. METHODS Balance and plasma studies were conducted in healthy breast-fed infants (n = 17) and in patients with phenylketonuria (n = 4) at the age of 4 weeks, and the plasma investigations were repeated at the ages of 4 and 12 months. The samples were analyzed by atomic absorption spectroscopy (balance studies) and high-resolution inductively coupled plasma mass spectrometry (plasma). RESULTS Molybdenum intake and retention in all infants with phenylketonuria were more than 18 times those of breast-fed infants. The plasma concentrations reflected these differences. A median of 0.04 microg/l was assessed in breast-fed infants at 4 weeks and less than 0.02 microg/l at 4 months of age. Comparative results of infants with phenylketonuria were 2.9 microg/l and 2.5 microg/l, respectively. There were no significant differences between the groups at 12 months of age. CONCLUSIONS The phenylketonuria diets investigated showed excessive retention and plasma concentrations of the essential trace element molybdenum in early infancy. In view of these findings, the present practice of molybdenum fortification should be revised.

Supplemental Feeding in the First Days of Life – Effects on the Recipient Infant

Aim: Since clinical indications may necessitate the feeding of supplements to newborn infants, the effects of different supplemental feedings on the recipient infants were studied. Methods: Two groups of healthy, term newborn infants (n = 64 in each group) were investigated. The mothers breast-fed their infants, and by indication the babies were additionally fed supplement A (supplementary neonatal formula, 78 kcal/dl) or the traditionally used supplement B (glucosaccharide solution, 100 kcal/dl). The differences in volume and energy intake, weight development and rate of hyperbilirubinemia were assessed in the hospital. The frequency of breast-feeding was evaluated using a structured telephone interview at the ages of 4 and 8 weeks. Results: The energy intake of group B was higher prior to the 3rd day of study (p < 0.05). Afterwards a higher mean intake of human milk, a faster weight gain but a lower frequency of exclusive breast-feeding at discharge were observed in study group A. Hyperbilirubinemia was more frequent in the group B. Fifty-five percent (group A) and 52% (group B) of the participants were exclusively breast-fed at the age of 8 weeks. Conclusions: Despite differences in milk intake and weight gain in the early postpartum period, the breast-feeding patterns at 4 and 8 weeks were not significantly influenced by the use of different supplements.

Manganese Utilization in Breast-fed and Formula-fed Infants

Manganese balance data from newborns or infants are very scarce. There seem to be several reasons for this.

58 TRACE ELEMENT OVERLOAD IN PKU - DIET|[quest]|

The knowledge of the trace element requirements of infants fed a phenylalanine restricted diet due to PKU ( Phenylketonuria ) is very limited. We studied 3 infants with PKU under their diet ( Milupa PKU 1 ) longitudinally in balance studies ( ≥ 72 hours ) under home conditions at the age of 2, 5, 8, 12, 16 weeks. Mn, Cu, Fe concentrations in diet, feces and urine were determined by Atomic Absorption Spectroscopy. Median concentrations found in the final diet were 1.7 mg/l Cu, 6 mg/l Fe, 0.5 mg/l Mn. The comparison of the retention rates with the data of 10 healthy breast-fed ( BF ) infants studied before ( s. table (showed a higher range of Mn and Fe retention.The median absolute retention of copper from PKU-diet exceeded that from human milk. Iron supplementation leading to median retentions sixfold the retentions from human milk seems to be unnecessary. Manganese supplementation should be avoided as neither symptoms of deficiency in formula-fed infants have been described nor possible side effects have been excluded.

Molybdenum (Mo) in preterm and term infants: Balance studies and plasma concentration † 1572

Molybdenum (Mo) in preterm and term infants: Balance studies and plasma concentration † 1572

Acknowledgement to the 2002 Reviewers

Ambrosini, G., Crawley, Australia Azizi, F., Tehran, Iran Baker, P.W., Adelaide, Australia Baumgartner, M., Basel, Switzerland Berg, A., Freiburg, Germany Böhles, H.J., Frankfurt, Germany Bitsch, I., Giessen, Germany Bode, C., Stuttgart, Germany Boeing, H., Bergholz-Rehbrücke, Germany Bretillon, L., Dijon, France Brussaard, J.H., Zeist, The Netherlands Burdan, F., Lublin, Poland Chango, A., Jefferson, USA Cser, A., Budapest, Hungary Cynober, L.A., Paris, France Demirkol, M., Istanbul, Turkey Donaldson, M., Salisbury, USA Elmadfa, I., Vienna, Austria Faist, V., Kiel, Germany Flachowsky, G., Braunschweig, Germany Fogliano, V., Portici, Italy Gazia, N., Assiut, Egypt Genser, D., Vienna, Austria Grandjean, A., Omaha, USA Koletzko, B., Munich, Germany König, J., Vienna, Austria Kosenko, E., Pushchino, Russia Krawinkel, M., Giessen, Germany Lohninger, A., Vienna, Austria Moser, U., Basel, Switzerland Münch, G., Leipzig, Germany Nakamoto, T., New Orleans, USA Nestel, P.J., Melbourne, Australia Niedermüller, H., Vienna, Austria Nogala, M., Poznan, Poland Oliver, P., Palma de Mallorca, Spain Oltersdorf, U., Karlsruhe, Germany Palou, A., Palma de Mallorca, Spain Pedersen, J., Oslo, Norway Pokorny, J., Prague, Czech Republic Pollak, A., Vienna, Austria Prentice, A., Cambridge, UK Remer, T., Dortmund, Germany Renaud, S., Bordeaux, France von Ruecker, A., Bonn, Germany Rust, P., Vienna, Austria Sanchez-Muniz, F., Boston, USA Sanders, T., London, UK Schächinger, V., Frankfurt, Germany Scheppach, W., Würzburg, Germany Schiefermeier, M., Vienna, Austria Simopoulos, A., Washington, USA Sjöström, M., Huddinge, Sweden Stehle, P., Bonn, Germany Steinhart, H., Hamburg, Germany Suetsuna, K., Yamaguchi, Japan Tamura, M., Tsukuba, Japan de Vrese, M., Kiel, Germany Wagner, K.-H., Vienna, Austria Wascher, T., Graz, Austria Wenk, C., Zürich, Switzerland Yoshida, A., Nagoya, Japan Zittermann, A., Bonn, Germany Zunft, J., Bergholz-Rehbrücke, Germany Zwiauer, K. F., St. Pölten, Austria

Plasma selenium (Se) in preterm and term infants during the first 12 months of life

The goal of the present study was to prospectively assess the plasma selenium (Se) concentrations of term and preterm infants during the first year of life in relation to gestational age and nutrition. Blood specimens were collected from orally formula-fed preterm infants (gestational age < 32 weeks, birth weight < 1500 g): 1.) in hospital and 2.) corrected for gestational age parallel to healthy term breast and formula-fed infants at the ages of 1, 4 and 12 months. All infants were fed according to a standardized nutritional concept, solids and follow-up formula were introduced at the age of 4 months. Plasma selenium in preterm infants in hospital was 11.7 (6.5-20.8) microg/l and 11.6 (8.8-16.7) microg/l at 4 weeks corrected for gestational age. At the age of 4 months plasma selenium was still significantly lower than in the other groups: Preterm infants: 17.1 (10.4-30.5) microg/l; formula-fed term infants: 31.3 (24.3-47.5) microg/l; breast-fed term infants: 45.6 (27.1-65.1) microg/l). The levels of breast-fed infants were significantly higher than those of both formula-fed groups up until the introduction of solids. Preterm infants had significantly low plasma selenium levels up until a postnatal age of at least 6 months. The levels were lower than those of term infants fed an identical unsupplemented infant formula during the first 4 months of life. These data support routine monitoring in hospital and selenium supplementation of preterm infants, preferably in hospital before discharge.

210 COPPER/MOLYBDENUM METABOLISM – INTERRELATIONSHIP IN PRETERM INFANTS?

Interferences of copper (Cu) and molybdenum (Mo) metabolism have been described (1). We evaluated in preterm infants 1.Cu balances under consideration of formula Mo content and 2. the course of the Cu concentration in feces and urine in stable isotope studies with 100Mo.1.) Intake, urinary and fecal excretion were collected over 72 hrs. in 14 male infants (gest. age: 32-37, 1.5-2.0 kg birth weight, 22 balances, formula: Prematil (Milupa AG, Germany)); Mo and Cu concentrations were determined by atomic absorption spectrometry :2.) In 10 preterm infants fecal and urinary specimens were collected over 48-72 hrs. after the intake of 25 μg/kg 100Mo added to formula. Within 14 hours urinary Mo increased 13(4-84)fold. For fecal Mo a 3.2(1.1-5.5)fold increase was observed in all but 2 infants within 24(6-26.25)hrs. Compared to the initial values, in 6/9 infants Cu concentrations increased up to 220(183-326)% in urine and 142(120-156)% in feces after the 100Mo intake. In the others, specimens preceeding the 100Mo intake rendered the highest Cu concentrations. Despite their considerable range the results suggest a potential influence of Mo intake on Cu excretion. (1)AmJClinNutr(1972); 25:1022-1037.