Leena Salmenperä

Exclusively Breast-Fed Healthy Infants Grow Slower than Reference Infants

ABSTRACT: 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 > 1 SD decrease in relative length. No such decrease was found in relative weight. Skinfolds and weight for length2 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.

Low colostral IgA associated with cow's milk allergy.

ABSTRACT. During a nutritional study of 198 infants, seven became allergic to cows milk. The seven infants showed acute cutaneous manifestations during cows milk challenge tests in hospital and six had increased levels of IgE cows milk‐specific antibodies. Neither in the development of the levels of immunoglobulins G, A and M, nor in that of the cows milk‐specific antibodies of these isotypes did these seven patients differ from the remaining infants. Beta‐lactoglobulin content and levels of cows 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 cows milk allergy and from a comparison group (non‐atopic mothers of non‐atopic infants). The milk of the mothers whose infants became allergic to cows 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 cows milk allergy if the mothers colostrum had a low total IgA content.

Risk Factors for Infantile Recurrent Otitis Media: Atopy but Not Type of Feeding

ABSTRACT: 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 < 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 < 0.001). Parental smoking was more frequent among the infants with ROM than in the comparison group (54 versus 33%; p < 0.05). In the infants with early-onset ROM plasma concentration of IgM antibodies to cows milk was highest at the age of 9 months, and the concentration of IgE was highest at the ages of 9 and 12 months. In conclusion atopy, not the type of feeding, is a risk factor for early-onset ROM, and daycare outside the home for ROM during the 2nd yr.

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 concen-trations; 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.

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

Summary: 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 cows milk formula (containing 35 &mgr;g 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 ?? whereas up to 5% of the mothers had values ≤ 3 &mgr;g/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 ??

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.

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)

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

ABSTRACT: 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 (EASTo), and its activation co-efficient (αEAST)] 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 EASTo > 10th or αEAST > 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 ≤ 0.02) and deeper fall in length-for-age (–0.69 ± 0.20 versus 0.25 ± 0.07 SD score, p ≤ 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 breastfed infants, according to our results, low vitamin B6 status is associated with reversibly reduced gain in length.

Carnitine during Prolonged Breast Feeding

ABSTRACT. 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 μmol/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 μmol/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 μmol/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 μmol/kg at 4 months of age, 4.7 μmol/kg at 6 months, and 6.0 μmol/kg at 9 months whereas the mean daily carnitine intake of the infants receiving formula was 28.9 μmol/kg at 1 month of age and 30.7 μmol/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.

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.