Peter Aggett

Dietary products used in infants for treatment and prevention of food allergy.: Joint statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition

For more than 50 years, many children with food protein allergies and other forms of dietary protein intolerance have been treated successfully with protein hydrolysates with highly reduced allergenicity and, more recently, also with products based on amino acid mixtures. Strategies for the prevention of allergy have been proposed, including the use of products with extensively reduced allergenicity. Products designed to have a moderately reduced allergenicity have also been proposed and marketed in Europe as hypoallergenic formulas. The European Society for Paediatric Allergology and Clinical Immunology (ESPACI) and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) have commented previously on these issues,1 2 and the Commission of the European Union has issued a regulation for the requirements of infant formulas with reduced allergenicity or reduced antigenicity.3 This paper comments on the current developments and unresolved issues in the dietary treatment and prevention of food allergy in infancy to help inform paediatricians and other health care professionals, as well as manufacturers of infant foods. Adverse reactions to foods are a problem, particularly in infancy and early childhood, and can present with a wide spectrum of clinical reactions such as cutaneous, gastrointestinal, respiratory, or other symptoms. Reproducible adverse reactions to food(s) can be the result of one or more immune mechanism(s) or they can be non-immunologically mediated. Immunologically mediated reactions, which are often immediate IgE mediated reactions, are defined as food protein allergy. Non-immunologically mediated reactions can be divided into enzymatic or transport defects (for example, lactase deficiency, or glucose/galactose malabsorption), pharmacological or other (undefined) reactions.2 4 The pattern and threshold of adverse reactions to foods varies. None of the symptoms related to immunologically or non- immunologically mediated adverse reactions to foods are pathognomonic, and no single laboratory test is diagnostic of food allergy. Therefore, the diagnosis …

Comment on the content and composition of lipids in infant formulas. ESPGAN Committee on Nutrition

Comment on the content and composition of lipids in infant formulas. ESPGAN Committee on Nutrition.

Feeding preterm infants after hospital discharge : a commentary by the ESPGHAN Committee on Nutrition

ABSTRACT Survival of small premature infants has markedly improved during the last few decades. These infants are discharged from hospital care with body weight below the usual birth weight of healthy term infants. Early nutrition support of preterm infants influences long-term health outcomes. Therefore, the ESPGHAN Committee on Nutrition has reviewed available evidence on feeding preterm infants after hospital discharge. Close monitoring of growth during hospital stay and after discharge is recommended to enable the provision of adequate nutrition support. Measurements of length and head circumference, in addition to weight, must be used to identify those preterm infants with poor growth that may need additional nutrition support. Infants with an appropriate weight for postconceptional age at discharge should be breast-fed when possible. When formula-fed, such infants should be fed regular infant formula with provision of long-chain polyunsaturated fatty acids. Infants discharged with a subnormal weight for postconceptional age are at increased risk of long-term growth failure, and the human milk they consume should be supplemented, for example, with a human milk fortifier to provide an adequate nutrient supply. If formula-fed, such infants should receive special postdischarge formula with high contents of protein, minerals and trace elements as well as an long-chain polyunsaturated fatty acid supply, at least until a postconceptional age of 40 weeks, but possibly until about 52 weeks postconceptional age. Continued growth monitoring is required to adapt feeding choices to the needs of individual infants and to avoid underfeeding or overfeeding.

Iron metabolism and requirements in early childhood: Do we know enough?: A commentary by the ESPGHAN Committee on Nutrition

*University of Lancashire, Lancashire, United Kingdom; †University of Milano, Milano, Italy; ‡University of Lund, Malmo, Sweden; §Hopital des Enfants Malades, Paris, France; Hopital Necker Enfants-Malades, Paris, France, ¶Umea University, Umea, Sweden; #University of Munich, Munich, Germany; **Free University of Amsterdam, Amsterdam, The Netherlands; ††Royal Veterinary and Agricultural University, Frederiksberg, Denmark; ‡‡CHUV University Hospital, Lausanne, Switzerland; §§University of Liege, Liege, Belgium; Medical University of Warsaw, Warsaw, Poland; and ¶¶University of Glasgow, Glasgow, United Kingdom

Nondigestible carbohydrates in the diets of infants and young children: A commentary by the ESPGHAN Committee on Nutrition

The consumption of nondigestible carbohydrates is perceived as beneficial by health professionals and the general public, but the translation of this information into dietary practice, public health recommendations, and regulatory policy has proved difficult. Nondigestible carbohydrates are a heterogeneous entity, and their definition is problematic. Without a means to characterize the dietary components associated with particular health benefits, specific attributions of these cannot be made. Food labeling for “fiber” constituents can be given only in a general context, and the development of health policy, dietary advice, and education, and informed public understanding of nondigestible carbohydrates are limited. There have, however, been several important developments in our thinking about nondigestible carbohydrates during the past few years. The concept of fiber has expanded to include a range of nondigestible carbohydrates. Their fermentation, fate, and effects in the colon have become a defining characteristic; human milk, hitherto regarded as devoid of nondigestible carbohydrates, is now recognized as a source for infants, and the inclusion of nondigestible carbohydrates in the diet has been promoted for their “prebiotic” effects. Therefore, a review of the importance of nondigestible carbohydrates in the diets of infants and young children is timely. The aims of this commentary are to clarify the current definitions of nondigestible carbohydrates, to review published evidence for their biochemical, physiologic, nutritional, and clinical effects, and to discuss issues involved in defining dietary guidelines for infants and young children.

The nutritional and safety assessment of breast milk substitutes and other dietary products for infants: a commentary by the ESPGHAN Committee on Nutrition.

*University of Lancashire, Lancashire, United Kingdom; †University of Milano, Milano, Italy; ‡University of Umea, Umea, Sweden; §Committee Chairman, University of Munich, Munich, Germany; Free University of Amsterdam, Amsterdam, The Netherlands; ¶Committee Secretary, Royal Agricultural and Veterinary University, Fredricksburg, Denmark; #University of Liege, Liege, Belgium; **University of Glasgow, Glasgow, United Kingdom

Comment on antigen-reduced infant formulae. ESPGAN Committee on Nutrition.

Infant feeds based on high-degree hydrolysates of different protein sources (mainly casein and/or whey proteins) have been available for almost 50 years and have been used extensively and successfully to manage malabsorption arising from exocrine pancreatic insufficiency, short bowel syndrome, enteropathies and proven allergies to cow’s milk protein. These products for therapeutic use contain high-degree protein hydrolysates with peptide sizes usually less than 1200 relative molecular mass. Many such products have had further modifications to their lipid and carbohydrate content to enhance their potential nutritional benefit. Apart from these classic semi-elemental products, other formulae, based on hydrolysed proteins have recently been marketed for infants. These new products, promoted as being “hypoallergenic”, are based on a greater or less extensive hydrolysis of cows’ milk protein, soya protein and/or beef collagen (“high-” and “low-degree’’ hydrolysates). They are sold in five EC member states and in the USA and Canada. The manufacturers claim that these formulae reduce the frequency of adverse reactions to foods in the first months of life and, at least for one product, the frequency of atopic disease in infants and young children at risk. However, although this new class of products conforms to the criteria for infant formulae set by the Codex Alimentarius and the Scientific Committee for Foods, they pose several important questions relating to their antigenicity, efficacy, prophylactic use and nutritional adequacy.

Committee report: childhood diet and prevention of coronary heart disease

Summary Coronary heart disease is a major cause of morbidity and mortality in Europe, particularly northern, central, and eastern Europe. Several strategies have been recommended for children and adolescents to promote a healthy lifestyle and thereby reduce the risk of coronary heart disease in later life. The European Society of Pediatric Gastroenterology and Nutrition (ESPGAN) Committee on Nutrition reviewed some of these strategies, and our conclusions and recommendations are reported herein.

Comment on the Composition of Soy Protein Based Infant and Follow‐up Formulas ESPGAN COMMITTEE ON NUTRITION:

Comment on the composition of soy protein based infant and follow-up formulas. ESPGAN Committee on Nutrition.

Comment on the Composition of Cow's Milk Based Follow-up Formulas ESPGAN COMMITTEE ON NUTRITION:

The ESPGAN Committee on Nutrition published ( I ) recommendations for the composition of follow-up formula and Beikost in 1981 in anticipation of reviews by the Codex Alimentarius Commission and the Commission of the European Communities. Although the 39th World Health Assembly in May 1986 had adopted a resolution that “the practice . . . of providing infants with specially formulated milks (so-called ‘follow-up milks’) is not necessary”, the Codex Alimentarius Commission indicated that the resolution did not mean a priori that follow-up formula should not be the subject of a Codex standard to ensure the appropriateness of its essential composition and quality factors. Therefore, the Codex Committee on Foods for Special Dietary Uses (Codex Alimentarius Commission) agreed on a final document in 1988 (2), which stated that follow-up formula means a food intended for use as a liquid part of the weaning diet for the infant from the 6th month on and for children between 12 and 36 months of age. Similarly, the Scientific Committee for Food (SCF) of the Commission of the European Communities published its first report on the essential requirements of follow-up milks based on cow’s milk proteins in 1983 (3) and it was proposed in 1986 that the council should issue a directive on the approximation of the laws (4). The Commission further indicated that the provisions which were published in the proposal also apply to follow-up milks which are intended for export to third world countries (4). It is the opinion of the ESPGAN Committee on Nutrition that “infant formulas” (2, 4), which were previously called “adapted formulas” (3, can be satisfactorily used for feeding infants between 6 and 12 months of age provided that the formula is fortified with iron (4). However, since cow’s milk is less expensive than such formulas, it is often introduced early into the infants diet: in European countries it is given to 40% of the infants by 6 months and to 75 % by 9 months of age (6). In view of the recent evidence it is questionable whether cow’s milk is a suitable food during the first year of life. It has been demonstrated that (a) The median protein intake of infants fed cow’s milk is 20-100% higher than that of infants fed “infant formulas’’ or “follow-up formulas’’ between 6 and 12 months of age (7-10) and it is 2 to 3 times higher than the calculated “safe level of protein intake” (1 1). High protein intake is accompanied by modest elevations in blood urea nitrogen (12) and increased renal solute load (13). Thus, it is not justifiable to assume that a high protein intake is necessarily ideal. (b) Consumption of pasteurized cow’s milk leads to increased gastrointestinal blood loss without signs of cow’s milk intolerance in the majority of normal infants between 3 and 12 months of age (14). Although, usually, the severity of the blood loss diminishes with the duration of feeding cow’s milk, a minority of the infants experience quite a large blood loss.