S. Borulf

Protein and Energy Intake during Weaning: I. Effects on Growth

ABSTRACT. The growth and food consumption of 30 healthy infants from 4 to 6 months of age have been measured. Two groups were assigned randomly to either a formula with 1.9 g of protein and 72 kcal per 100 ml (F1) or 2.7 g of protein and 69 kcal per 100 ml (F2). A third group of infants were fed breast milk (0.96 g of protein and 65 kcal per 100 ml (HM). All infants received supplementary food according to the same regimen and were fed ad libitum. The mean protein intake was 1.3, 2.6 and 3.6 g/kg/day in the HM‐, F1‐ and F2‐groups respectively. The corresponding mean energy intake was 80, 101 and 94 kcal/kg/day. The formula‐fed infants had significantly higher protein and energy intakes when compared to the breast‐fed group. No significant differences were found in the rate of growth of crown‐heel length, head circumference or in weight gain. The differences in protein intake between the breast‐ and formula‐fed infants without differences in growth indicate that the formulas may provide a protein intake in excess to the needs.

Partial hydrolysis of cow's milk proteins by human trypsins and elastases in vitro

The hydrolysis of bovine alpha-lactalbumin, beta-lactoglobulin, and casein by human anodal and cathodal trypsins and elastases was studied with the aid of electroimmunoassay and sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The rate of hydrolysis of the various proteins by cathodal elastase exceeded that by anodal or cathodal trypsin and anodal elastase. Casein was hydrolyzed more efficiently than alpha-lactalbumin or beta-lactoglobulin. The hydrolysis of the three proteins occurred at a considerably slower rate when present in crude form, as in cows milk, than when in purified form.

Protein and energy intake during weaning. III. Effects on plasma amino acids.

ABSTRACT. Preprandial plasma amino acid concentrations were measured at 5 and 6 months of age in 30 healthy term infants who were either breast‐fed ad libitum or fed one of two different formulas (1.9 g of protein per 100 ml with a whey: casein ratio of 50:50; 2.9 g of protein per 100 ml with a whey: casein ratio of 20:80) ad libitum, plus the same supplementary food regimen. The mean plasma concentrations of total amino acids and especially total essential amino acids were higher in the formula‐fed infants. Those fed formula also had plasma concentrations of methionine, isoleucine, phenylalanine, leucine, valine, threonine, aspartate, proline, lysine, tyrosine, histidine that exceeded plasma concentrations of breast‐fed infants by 2 or more standard deviations. Concentrations of arginine, glutamic acid, glutamine, ornithine, serine, cystine did not differ and taurine was higher in the breast‐fed infants. The data indicate that formulas in common use today during weaning (4–6 months) provide excessive protein intakes when compared to the breast‐fed control infants. A lowering of protein concentration and a further manipulation of the whey: casein ratio is necessary if plasma amino acid patterns similar to those found in breast‐fed infants is to be achieved with artificial feeding.

Protein intake during weaning. II: Metabolic responses

ABSTRACT. Metabolic responses to different feeding regimens during the weaning period have not previously been studied. In this study 30 healthy infants aged 4–6 months were divided into three feeding regimens with 10 infants in each. The regimens were: Human milk (HM‐group), formula F1 with 1.9g protein/100 ml (F1‐group) or formula F2 with 2.7 g protein/100 ml (F2‐group). All infants received the same supplementary food and were fed ad libitum. Concentrations of serum urea were significantly higher (p<0.001) in the formula groups as compared to the breast‐fed infants throughout the entire study period. Serum albumin concentrations were within normal limits in the breast‐fed infants indicating adequate protein nutritional status. There were no differences in the concentrations of creatinine and total nitrogen in urine between the artificially fed and the breast‐fed infants at the beginning of the study (4 months), but at 6 months these concentrations were significantly higher in the formula‐fed infants (p<0.001). The results suggest that formulas now in common use during weaning provide amounts of protein which produce metabolic manifestations implying excessive protein intakes.

Immunoreactive Anionic Trypsin and Anionic Elastase in Human Milk

ABSTRACT. Immunoreactive anionic trypsin and anionic elastase have been demonstrated in human milk, by immunodiffusion and Immunoelectrophoresis. Cationic trypsin and cationic elastase could not be detected by these methods. The anionic trypsin is probably present in complex with IgA. No benzoyl‐DL‐arginine‐p‐nitroanilide (BAPNA) splitting activity was found in human skim milk. Anionic trypsin was isolated by immunoadsorption chromatography. The purified enzyme had a BAPNA‐splitting activity.

Outbreak of coxsackievirus A-14 meningitis among newborns in a maternity hospital ward.

ABSTRACT. During the late winter of 1983, 16 newborns with vague symptoms of failure to thrive, reluctance to feed and a slight rise in body temperature, were found to have meningitis caused by Coxsackievirus A‐14. The cerebrospinal fluid showed pleocytosis with polymorphonuclear cells in excess but was otherwise normal. The clinical course was uneventful in all infants, but two of them demonstrated clinical signs of incipient cerebral oedema during the acute phase of the illness. An electroencephalogram (EEG) during the initial course of the disease and at nine months of age was normal in all. During a follow‐up period of 21/2 years they all developed normally and no sequelae were noted. The presentation also demonstrates the usefulness of Vero cells for the propagation of the responsible virus.

Cholelithiasis during the first year of life : Case reports and literature review

Five cases are reported of children with gallstones diagnosed by ultrasound during their first 7 months of life. Of the four with symptomatic gallstones, one subsequently developed vitamin K deficiency syndrome with profuse bleedings. The children, who belonged to a defined population, were all diagnosed within an 18‐month span, suggesting the frequency of early gallstone formation to be higher than formerly supposed. One child had haemolytic anaemia, but none of the conventional risk factors for stone formation was present in the other four cases.

Immunochemical determination of two trypsins in human duodenal juice

An application of electroimmunoassay to the separate determination of anionic and cationic trypsin in human duodenal juice is presented. The proportions of anionic to cationic immunoactive trypsin in duodenal juice from a group of children averaged 20 : 80. The ratio of immunoactive to esterolytically (BAPNA) active trypsin averaged 1.6 : 1, indicating the presence of inactive forms of trypsin in duodenal juice.

How to approach the child suspected of malabsorption. Experience from a prospective investigation of suspected malabsorption in children 1968-1976 in Malmö.

ABSTRACT. 180 children (mean age 20 months) suspected of malabsorption because of failure to thrive, abnormal stools more than 3 weeks, vomiting, an/or abdominal distension were investigated with peroral small intestinal biopsy at duodeno‐jejunal flexure (172 children) and/or duodenal intubation for analysis of trypsin and amylase activity in duodenal juice before and after a test meal of water (76 children). Results of xylose tolerance test, lactose tolerance test, faecal fat, B‐folate, S‐iron, and S‐albumin were related to morphology of mucosa. A normal finding of one of these tests means in 15–26% a normal mucosa (diagnostic sensitivity). An abnormal finding means in 40–85% a severely damaged mucosa and in 85–100% a slightly, moderately, or severely damaged mucosa (diagnostic specificity). Combinations of these tests increase the diagnostic sensitivity 10–15%. Faecal chymotrypsin seems to be a reliable screening test for exocrine pancreatic function. Border values or low values indicate a direct evaluation of exocrine pancreatic function. The simple test meal (water) method with determination of trypsin in duodenal juice gives, from a practical point of view, good information of the exocrine pancreatic function.

Digestion of Milk Proteins in Infancy

Digestion and absorption of protein is a complex matter. It comprises the combined action of several proteolytic enzymes and different mechanisms for absorption. When discussing the quantity and quality of proteins to be given to infants, especially low birth weight infants, it is important to consider the infants’ capacity to digest and absorb the proteins. There are remarkably few reports about this in literature (1, 2 , 3 , 4) and it is rarely a subject of consideration when early infant nutrition is discussed. However, in recent years some studies have been performed to elucidate this question of digestion and absorption of proteins ( 5 , 6).