Steven E. Nelson

INFLUENCE OF FORMULA CONCENTRATION ON CALORIC INTAKE AND GROWTH OF NORMAL INFANTS

ABSTRACT: Fomon, S. J., Filer, L. J., Jr, Thomas, L. N., Anderson, T. A. and Nelson, S. E. (Department of Pediatrics, University Hospital, University of Iowa, Iowa City, USA). Influence of formula concentration on caloric intake and growth of normal infants. Acta Paediatr Stand, 64:172, 1975.–Fifteen fullterm female infants were enrolled in each of two feeding groups and all but one completed the proposed period of observation to age 112 days. Formulas prepared from the same ingredients (fat‐free milk solids, a mixture of corn and coconut oils, lactose, vitamins and minerals) were fed ad libitum to both groups. Formula concentration was 54 kcal/100 ml for one group and 100 kcal/100 ml for the other. A limited selection of commercially prepared strained foods was permitted after 28 days of age. Weighed intakes of food were recorded for each day of study. During the interval 8 through 41 days of age, the infants fed the 54 kcal/100 ml formula consumed a considerably greater quantity of food but fewer calories than did those fed the 100 kcal/100 ml formula. Those fed the 54 kcal/100 ml formula also gained less weight. These differences between feeding groups were statistically significant. After 41 days of age, mean caloric intakes (kcal/kg/day) and rates of gain in weight were similar for the two feeding groups. The data provide a basis for speculation on the possible difference in allocation of calories to growth and non‐growth in the two groups.

Cow milk feeding in infancy: gastrointestinal blood loss and iron nutritional status.

Eighty-one normal infants were studied between 112 and 196 days of age. Thirty-nine infants were fed pasteurized cow milk and the remainder were fed either Enfamil or heat-treated cow milk. During the age interval of 112 to 140 days, the proportion of infants with guaiac-positive stools was significantly (P less than 0.01) greater among infants fed pasteurized cow milk than among those fed Enfamil or heat-treated cow milk. Similarly, infants fed cow milk had a significantly (P less than 0.001) greater number of guaiac-positive stools than did the other infants. After 140 days of age, there was no difference between feeding groups in the number of guaiac-positive stools. No significant differences were observed in mean hemoglobin, hematocrit, serum iron, total iron-binding capacity, or transferrin saturation between feeding groups nor between infants with and those without guaiac-positive stools, It is concluded that pasteurized cow milk should not be fed before 140 days of age.

Gain in weight and length during early infancy.

Although rate of growth is generally recognized as a valuable indicator of health status, few reference data are available for gain in weight or length during the period of most growth in infancy. We have therefore summarized our data concerning gains in length and weight of 203 breast-fed males, 216 breast-fed females, 380 formula-fed males, and 340 formula-fed females. Seven sets of measurements (at ages 8, 14, 28, 42, 56, 84 and 112 days) were made with each infant. The 5th, 10th, 25th, 50th, 75th, 90th and 95th centile values together with the means and standard deviations are presented for selected age intervals on a feeding-specific (i.e. breast-fed or formula-fed) and sex-specific basis. We believe that these data will be useful as a reference for interpreting results of infant studies.

Absorption of Fat and Calcium by Infants Fed a Milk- Based Formula Containing Palm Olein

OBJECTIVE The study tested the hypothesis that inclusion of palm olein (45% of fat) in the fat blend of a milk-based infant formula decreases the absorption of fat and calcium. METHODS Formula PO contained palm olein (45%) in addition to soy, coconut and high-oleic sunflower oils (20%, 20%, and 15%, respectively); Formula HOS contained high-oleic safflower oil (42%) in addition to coconut and soy oils (30% and 28%, respectively) and no palm olein. Fat and calcium levels in the two formulas were similar. In a balanced crossover design, fat and calcium absorption were determined in 10 normal infants ranging in age from 22 to 192 days. In three infants metabolic balance studies with complete separation of urine and feces were performed, whereas in seven infants excreta were in part collected at home, resulting in incomplete separation of urine and feces. RESULTS Mean (+/- SD) fecal excretion of fat was higher when Formula PO was fed than when Formula HOS was fed (0.55 +/- 0.29 vs. 0.09 +/- 0.04 g/kg/day; p < 0.001). Hence % fat absorption was lower with PO than with HOS (90.0 +/- 6.4 vs. 98.5 +/- 0.6% of intake; p < 0.01). The difference in percent fat absorption was explained by significantly (p < 0.05) lower % absorption of palmitic (16:0) and stearic (18:0) acids when Formula PO was fed than when Formula HOS was fed. Fecal excretion of calcium was higher with Formula PO than with Formula HOS (53.4 +/- 12.0 vs. 37.4 +/- 14.9 mg/kg/day; p < 0.01), and hence % calcium absorption was lower with Formula PO than with Formula HOS (37.5 +/- 11.5 vs. 57.4 +/- 14.9%; p < 0.001). CONCLUSION Absorption of fat and calcium by normal infants is lower when palm olein provides a substantial proportion of formula fat than when formula does not contain palm olein.

Iron supplementation of breastfed infants from an early age

BACKGROUND In breastfed infants, iron deficiency at <6 mo of life, although uncommon, is observed in industrialized countries. Iron supplementation starting at an early age may prevent iron deficiency. OBJECTIVE The study assessed the effect of early iron supplementation of breastfed infants and tested the hypothesis that iron supplementation enhances iron status. Potential adverse effects (tolerance and growth) were monitored. DESIGN The prospective, placebo-controlled study involved exclusively breastfed infants who were randomly assigned at 1 mo of age to iron (n = 37) or placebo (n = 38). Iron (7 mg/d as multivitamin preparation with ferrous sulfate) or placebo (multivitamin preparation without iron) was given from 1 to 5.5 mo of age. Complementary foods were allowed at >4 mo. Infants were followed to 18 mo. Blood concentrations of ferritin, transferrin receptor, hemoglobin, and red cell indexes were determined at bimonthly intervals. Stool consistency and color and feeding behavior were recorded. RESULTS Iron supplementation caused modest augmentation of iron status during the intervention at 4 and 5.5 mo but not thereafter. Iron supplements were well tolerated and had no measurable effect on growth. One infant developed iron deficiency anemia by 5.5 mo of age. Plasma ferritin and hemoglobin tracked over time. CONCLUSION Early iron supplementation of breastfed infants is feasible and transiently increases iron status but not hematologic status. Iron is tolerated by most infants. The prevalence of iron deficiency anemia is low (3%) among unsupplemented breastfed infants in the first 6 mo of life.

Cow’s milk and intestinal blood loss in late infancy ☆ ☆☆ ★

OBJECTIVES Young infants commonly show occult intestinal blood loss when fed cows milk, but in older infants blood loss may be less common. This study examined intestinal blood loss in response to cows milk feeding in normal 7(1/2)-month-old and 12-month-old infants. STUDY DESIGN Infants (n = 62) were fed formula for 1 month and then pasteurized cows milk for 2 months. Stools were collected for quantitative determination of hemoglobin. Iron nutritional status was assessed. RESULTS Infants fed cows milk from 7(1/2) months of age showed a significant increase in guaiac-positive stools and in stool hemoglobin concentration. These effects were largely limited to those infants who had been breast fed early in life. Infants fed cows milk from 12 months of age at baseline had greater stool hemoglobin concentrations than 7(1/2)-month-old infants, but cows milk produced no significant increase. In neither age group did cows milk affect iron nutritional status. CONCLUSION The response to cows milk is attenuated in infants aged 7(1/2) months compared with younger infants. By 12 months of age, the response has disappeared entirely. We conclude that the gastrointestinal tract of healthy infants gradually loses its responsiveness to cows milk.

Iron status of breastfed infants is improved equally by medicinal iron and iron-fortified cereal

BACKGROUND Although uncommon, iron deficiency (ID) occurs in breastfed infants. The regular provision of iron may prevent ID. OBJECTIVE The objective was to test the feasibility and effectiveness of 2 modalities of providing iron (medicinal iron or iron-fortified cereal) to breastfed infants. The study tested the hypothesis that regular provision of iron improves iron status of breastfed infants without adverse effects. DESIGN In this prospective, randomized, open-label trial, breastfed infants received on a regular basis either medicinal iron (n = 48) or an iron-fortified fruit-cereal combination (n = 45) from 4 to 9 mo or no intervention (control group; n = 59). The interventions provided 7.0-7.5 mg ferrous sulfate/d. Infants were enrolled at 1 mo and were followed to 2 y. Iron-status indicators were determined periodically, stool characteristics were recorded, and growth was monitored. RESULTS The regular provision of iron led to improved iron status during and for some months after the intervention. Both sources of iron were about equally effective. Iron affected stool color but had no effect on feeding-related behavior. However, medicinal iron was associated with a small but significant reduction in length gain and a trend toward reduced weight gain. ID anemia was observed in 4 infants (2.3%), most of whom had a low birth iron endowment. Mild ID was common in the second year of life. CONCLUSIONS Regular provision of medicinal iron or iron-fortified cereal improves the iron status of breastfed infants and may prevent ID. Both modalities are equally effective, but medicinal iron leads to somewhat reduced growth. This trial was registered at ClinicalTrials.gov as NCT00760890.

Absorption and Retention of Dietary and Supplemental Fluoride by Infants

There is a widespread belief that an adequate intake of fluoride during the pre-eruptive stage of enamel formation (i. e., from the diet in frequent small doses throughout the day) will be protective against caries in later life. To obtain data on bio-availability and retention of fluoride in one age group (infants), we studied 3 treatment regimens: In Regimen A, small amounts of fluoride were obtained from the diet in frequent doses throughout the day; in Regimen B, a fluoride supplement (0.25 mg) was given once each day with a feeding; Regimen C was similar to regimen B except that the fluoride supplement was given 1 h before a feeding. For the 3 regimens, the respective mean absorptions of fluoride were 90.1, 88.9, and 96.0% of intake, and the respective retentions were 12.5, 47.1, and 52.3% of intake. Neither the difference in absorption nor the difference in retention between regimens B and C was statistically significant. By subtracting the background urinary excretion of fluoride (i.e., excretion of fluoride while diet was the sole source of fluoride) from the excretion after administration of the fluoride supplement, we calculated that 68.1% of the supplement was retained in Regimen B and 73.0% of the supplement in Regimen C. The difference was not significant.

Sweetness of Diet and Food Consumption by Infants

Abstract Normal female infants were studied from 8 to 112 days of age to determine the effect on food consumption of feeding formulas that differed widely in sweetness. One formula contained sucrose and the other a bland-tasting cornstarch hydrolysate. In a balanced, crossover design, it was found that food consumption was significantly greater during intervals in which the sweeter formula was fed.

Influence of fat and carbohydrate content of diet on food intake and growth of male infants.

ABSTRACT. Two groups of normal fullterm infants were studied from 8 to 112 days of age while receiving formulas of the same caloric density and prepared from the same ingredients. A limited selection of strained foods was permitted. From the combination of formula and strained foods, one group received 29% of calories from fat and 62% from carbohydrate whereas the other received 57% from fat and 34% from carbohydrate. Fifteen infants in each group completed the study as planned. Energy intakes per kilogram and rates of gain in length and weight were similar in the two feeding groups.