James K. Friel

Zinc supplementation in very-low-birth-weight infants

Inadequate zinc intake may lead to poor growth and developmental outcome in very-low-birth-weight (VLBW; < 1,500 g) infants. Fifty-two infants (mean birth weight, 1,117 +/- 287 g; mean gestational age, 29 +/- 2.9 weeks) were randomly allocated to two groups. SUPP infants received a regular term formula plus zinc supplements (4.4 mg/L; final content, 11 mg/L); PLAC infants received the same formula plus placebo (final content, 6.7 mg/L). Infants started their formula at 1,853 +/- 109 g and consumed the formula for 6 months. All subjects were evaluated at 3, 6, 9, and 12 +/- 0.75 months corrected-for-gestational-age. At each evaluation, weight, length, and head circumference were measured, a Griffiths developmental assessment was performed, and a blood sample was taken. Higher plasma zinc levels (p < 0.05) were found in the SUPP group at 1 and 3 months, and improved linear growth velocity was found in the SUPP group over the study period for the whole group as well as for girls alone. Maximum motor development scores were higher (p = 0.018) in the SUPP (98 +/- 10) than the PLAC (90 +/- 8) group, indicating that increased zinc intake in early infancy may be beneficial to VLBW infants.

A double-masked, randomized control trial of iron supplementation in early infancy in healthy term breast-fed infants

OBJECTIVES To test whether iron supplementation affects hematologic, biochemical, and developmental status in term breast-fed infants. STUDY DESIGN Term breast-fed infants (n=77) were randomly selected to receive either 7.5 mg per day of elemental iron as ferrous sulfate or placebo from 1 to 6 months of age. Investigators and families were unaware of group assignment. Complete blood count and ferritin, red cell superoxide dismutase, catalase, plasma ferric reducing antioxidant power, and zinc and copper levels were analyzed at 1, 3.5, 6, and 12 months of age. Bayley mental and psychomotor developmental indexes (MDI and PDI) and visual acuity (with the use of Teller acuity cards) were assessed from 12 to 18 months of age. Analysis performed by analysis of variance and t tests was by intention to treat. RESULTS Iron supplementation resulted in higher hemoglobin and mean corpuscular volume at 6 months of age and significantly higher visual acuity and PDI at 13 months of age (100+/-12 vs 93+/-9 [+/-SD]). Treatment and placebo groups did not differ in anthropometric indexes, compliance, biochemical status, or demographic characteristics. CONCLUSIONS Iron supplementation of breast-fed infants appears safe and might have beneficial hematologic and developmental effects for some infants.

Evidence of oxidative stress in full-term healthy infants.

We hypothesized that early infancy would be a time of oxidative stress due to the difficulty of adapting to ambient oxygen. Therefore, we measured levels of products of lipid peroxidation (F2-isoprostanes), antioxidant enzyme activity (catalase (CAT) and superoxide dismutase (SOD)), and ability to resist oxidative stress (ferric reducing ability of plasma (FRAP)) in full-term infants (38–42 wk) fed human milk from birth. Seventy-seven infants were followed at 1, 3.5, 6, and 12 mo of age. F2-isoprostanes in plasma declined significantly (p < 0.05) from 1 to 6 mo (160 ± 43; 90 ± 33; 41 ± 27 pg/mL (mean ± SD)). FRAP values (775 ± 196, 723 ± 133, 697 ± 126, 669 ± 145 μM) 1, 3.5, 6, and 12, respectively) declined (p = 0.06) from 1 to 3.5 mo and from 3.5 to 6 mo of age. RBC-SOD (2.7 ± 2, 3.2 ± 2.8, 2.1 ± 1.8, 2.5 ± 1.8 U, 1, 3.5, 6, 12 mo, respectively) declined from 3.5 to 6 mo. RBC-CAT (76 ± 23, 94 ± 28, 81 ± 22, 85 ± 31 U, 1, 3.5, 6, 12 mo, respectively) also declined between 3.5 and 6 mo, after a significant increase between 1 and 3.5 mo. These data suggest that the human infant is under oxidative stress early in infancy and further study may be warranted to assess the potential benefits of antioxidant supplementation for either the mother or the infant.

Analysis of biological reference materials, prepared by microwave dissolution, using inductively coupled plasma mass spectrometry

A procedure has been developed for the analysis of biological materials by inductively coupled plasma mass spectrometry (ICP-MS). Fast, efficient and complete sample digestion is achieved by a combined microwave-nitric acid/open beaker-nitric acid-hydrogen peroxide procedure. The ICP-MS analysis is performed with an on-line five-element internal standard to correct for matrix and instrumental drift effects. Results are presented for 24 elements in three biological reference materials (National Institute of Standards and Technology Standard Reference Materials 5277a Liver and 1566 Oyster and International Atomic Energy Agency Certified Reference Material H4 Animal Muscle). For all elements significantly above the detection limit and reagent blank concentrations, good agreement exists between ICP-MS and certified values.

Superoxide dismutase and glutathione peroxidase content of human milk from mothers of premature and full-term infants during the first 3 months of lactation.

Background Human milk contains various bioactive compounds including numerous immunologic factors, enzymes, growth factors, and hormones. However, the change during the course of lactation in many of these compounds has not been fully characterized. Therefore, the objective of the present study was to measure the activity of the enzymes superoxide dismutase (SOD; Enzyme Commission number [EC] 1.15.1.1) and glutathione peroxidase (SeGSHPx; EC 1.11.1.9) in human milk, to record changes in enzyme activity over time and to determine whether there are differences in activity between the milk of mothers of full-term (FT) and premature (PT) infants. Methods Nine samples were collected from each of 15 mothers (32 ± 4 years of age; mean ± standard deviation) of FT infants (gestational age, 40 ± 1 weeks; birth weight, 3544 ± 417 g) and 19 mothers (28 ± 5 years of age) of healthy PT infants (gestational age, 29 ± 4 weeks; birth weight, 1312 ± 479 g). Samples were collected within a week of birth (±1 day) and thereafter for 8 weeks, with a final collection at 12 weeks. Results During the 12-week study period, in both groups, total milliunits of GHSPx and SeGHSPx per milligram protein and SOD per per milligram protein increased, whereas protein content declined. SeGHSPx per milliliter milk was higher in the PT group at week 1 (92 ± 30 mU/mL vs. 73 ± 21 mU/mL), week 2 (93 ± 28 mU/mL vs. 75 ± 24 mU/mL), and week 7 (85 ± 24 mU/mL vs. 68 ± 22 mU/mL). The SOD activity per milliliter milk and milligram protein was higher throughout the entire study in the FT milk. Conclusions Because mothers of PT infants may produce less milk than those of FT infants, PT infants may be at a disadvantage for antioxidant protection from these enzymes.

Tryptophan Released From Mother's Milk Has Antioxidant Properties

Bioactive factors in human milk (HM) are crucial to the health of newborns, especially preterm infants. These compounds assist in reducing the oxidative stress that may occur as a result of combined exposure to supplemental oxygen and immature physiologic defenses. To identify the components in HM that contribute to its greater resistance to oxidative stress compared with infant formulae, enzymatic hydrolysates of HM were prepared, ultrafiltered, separated, and analyzed for antioxidant potential. The antioxidant activity [μM Trolox equivalent (TE/g)] of nondigested milk, whole digested milk, and derived ultrafiltrates were 80.4 ± 13.3, 159.0 ± 5.6, and 127.4 ± 3.1, respectively. An HPLC fraction denoted as fraction 23 (5274 ± 630 μM TE/g) was obtained and its constituents identified as tryptophan (Trp), peptides HNPI, and PLAPQA. Scavenging activity was not observed for PLAPQA, whereas moderate activity was associated with HNPI (144 ± 10.7 μM TE/g) and very high activity to Trp (7986 ± 468 μM TE/g). Trp addition to HM and two infant formulas significantly increased formulae antioxidant properties. Trp appeared to be a powerful free radical scavenger naturally present in HM. Its antioxidant effects and potential application in the diets of infants, particularly preterm, must be examined further.

ELEMENTAL COMPOSITION OF HUMAN MILK FROM MOTHERS OF PREMATURE AND FULL-TERM INFANTS DURING THE FIRST 3 MONTHS OF LACTATION

To examine longitudinal and gestational effects of mineral content in human milk, we analyzed human milk from lactating mothers of premature (PRT,n = 24, < 2000g birth weight, < 37 wk gestation) and fullterm (FT,n = 19, > 2500g, 39–41 wk gestation), living in Newfoundland, Canada. Samples were collected once a week for 8 wk with one final sample collected at 3 mo. Milk samples collected in acid-washed containers were wet ashed with concentrated HNO3, and barium, cadmium, calcium, cesium, cobalt, copper, cerium, lanthanum, magnesium, manganese, molybdenum, nickel, lead, rubidium, tin, strontium, and zinc were measured using inductively coupled plasma-mass spectrometry. Data were analyzed using standard multiple-regression procedures with correlated data analyses to take account of the relationship between successive weeks. Results indicated lower Ca and Pb in PRT milk. Calcium was the only nutritionally significant element to differ between groups. Molybdenum in both PRT and FT milk showed a definite decrease with time, suggesting that the Mo content in milk is homeostatically regulated. However, Ce, La, Ba, and Sn did not display any pattern indicative of biological regulation and potential human requirement.

Evaluation of antioxidant capacity and aroma quality of breast milk.

OBJECTIVE It is important to understand the difference and similarity in antioxidant capacity and aroma quality between formula and breast milk for purposes of modifying infant formulas. We evaluated the antioxidant properties and aroma quality of infant formula and breast milk. METHODS Six breast milk samples and four infant formulas were used. Antioxidant properties were measured using the following methods: 2,2-diphenyl-1-picryhydrazyl free radical scavenging capacity, oxygen radical absorbance capacity, total phenolic content, and phenolic composition. Aroma quality was determined using the electronic nose. RESULTS The 2,2-diphenyl-1-picryhydrazyl free radical scavenging activity for formula and breast milk ranged from 45.3% to 61.8% and from 52.8% to 61.2%, respectively. Oxygen radical absorbance capacity ranged from 28.8 to 31.9 g/kg for formula and from 25.5 to 39.2 g/kg for breast milk. Total phenolic content ranged from 422 to 751 mg/kg and from 329to 797 mg/kg for formula and milk, respectively. p-Hydroxybenzoic acid, p-coumaric acid, and ferulic acid were detected with values ranging from 614 to 635, 1391 to 1444, and 1425 to 1490 microg/kg in breast milk and from 783 to 3594, 1449 to 1510, and 1447 to 1561 microg/kg in formulas. Electronic nose results indicated that the aroma quality of formula controls 2, 3, and 4 was similar to that of breast milk. CONCLUSION Differences and similarities in antioxidant properties and aroma quality were found among some of the formulas and breast milk. The contribution of phenolic acids to total antioxidant capacity was limited.

Determinants of oxidant stress in extremely low birth weight premature infants

Early in life, premature neonates are at risk of oxidant stress. They often require total parenteral nutrition (TPN), which is, however, contaminated with oxidation products. Coadministration of parenteral multivitamins (MVP) with a lipid emulsion (LIP) prevents lipid peroxidation. We hypothesized that LIP+MVP induces a lower oxidant load compared to preparations in which MVP is administered with an amino acid solution (AA+MVP). The aim of this study was to compare markers of oxidant stress in premature neonates receiving LIP+MVP, either exposed to or protected from light, or AA+MVP. Antioxidant vitamins, the redox potential of glutathione, isoprostane, and dityrosine were measured in urine or blood sampled on days 7 and 10 from babies requiring low (<0.25) vs high (≥0.25) fractional inspired O(2). Oxygen supplementation induced a more oxidized redox potential and increased dityrosine with AA+MVP only. Adding MVP in the lipid rather than the amino acid moiety of TPN protects against the oxidant stress associated with O(2) supplementation. Photoprotection added no benefit. Blood transfusions were found to produce a pronounced oxidant load masking the beneficial effect of LIP+MVP. The impact of these findings relates to a strong association between a more oxidized redox potential and later bronchopulmonary dysplasia, a clinical marker of oxidant stress.

Evidence of oxidative stress in relation to feeding type during early life in premature infants.

Morbidity in the premature (PT) infant may reflect difficult adaptation to oxygen. We hypothesized that feeding including formula feeding (F) and feeding mothers milk (HM) with added fortifier would affect redox status. Therefore, 65 PT infants (birth weight: 1146 ± 261 g; GA: 29 ± 2.5 wk; mean ± SD) were followed biweekly, once oral feeds were introduced. Feeding groups: F (>75% total feeds) and HM (>75% total feeds) were further subdivided according to human milk fortifier (HMF) content of 0–19, 20–49, and ≥50%. Oxidative stress was quantified by F2-isoprostanes (F2-IsoPs) in urine, protein carbonyls, and oxygen radical absorbance capacity (ORAC) in plasma. F2-IsoPs (ng/mg creatinine): 0–2 wk, 125 ± 63; 3–4 wk, 191 ± 171; 5–6 wk, 172 ± 83; 7–8 wk, 211 ± 149; 9–10 wk, 222 ± 121; and >10 wk, 183 ± 67. Protein carbonyls from highest [2.41 ± 0.75 (n = 9)] and lowest [2.25 ± 0.89 (n = 12) pmol/μg protein] isoprostane groups did not differ. ORAC: baseline, 6778 ± 1093; discharge, 6639 ± 735 [full term 4 and 12 M, 9010 ± 600 mg (n = 12) TE]. Highest isoprostane values occurred in infants with >50% of their mothers milk fortified. Further research on HMF is warranted.