The contribution of milks and formulae to micronutrient intake in 1-3 years old children in urban China: a simulation study.

BACKGROUND AND OBJECTIVES: A recent dietary survey in 5 big cities in China provided information on various milk options consumed by 1-3 years old children. To investigate the nutritional role of these milks (young-child formula (YCF), cow's milk, others), simulation analyses based on this survey were performed. METHODS AND STUDY DESIGN: We studied daily intakes of calcium, iron, zinc, vitamins A, B-1, B-2, C and E and compared these to the Chinese DRIs. In Scenario 1, consumption of cow's milk, kid's milk and/or soy milk was replaced with matching amounts of YCF (n=66 children). In Scenario 2, where 348 children exclusively consumed YCF, YCF was replaced with matching amounts of cow's milk. RESULTS: Scenario 1 revealed significant increases in total dietary intakes of iron, vitamins A, B-1, C and E upon substitution of the various milks with YCF. The proportions of children not meeting the Estimated Average Requirement (EAR) for these nutrients dropped from 29, 26, 61, 53 and 54 % to 12, 11, 50, 27 and 24%, respectively. In Scenario 2, the hypothetical substitution of YCF by cow's milk increased the proportions of children not meeting the EAR for these nutrients, calcium and zinc from 11, 6, 49, 15, 28, 42, and 8 to 45, 24, 78, 69, 59, 44, and 20, respectively. Execution of Scenario 2 in subgroups of 1-2- and 2-3 years old children revealed similar results. CONCLUSIONS: YCF may help to reduce the risk of insufficient intake of several key micronutrients for toddlers, independent of age.

A dietary and nutritional status survey among young children in five big cities of China.

BACKGROUND AND OBJECTIVES: To investigate the dietary patterns and nutritional status of young children living in urban environments in China. METHODS AND STUDY DESIGN: A cross-sectional study was conducted of 750 children aged 6 - 35 months living in 5 large cities in China. The survey methodology included a physical exami-nation, blood hemoglobin measurements and a 24 hour dietary recall questionnaire Results: The educational lev-el of participant mothers was high (79% had attended college or university or higher), which may not be fully representative across all areas of urban China. Overall anthropometric nutritional status indicators were within acceptable ranges based on national recommendations, and there was no evidence of severe micronutrient defi-ciencies. However, we identified three significant nutritional issues that warrant attention: 1.) Later than optimal introduction and low-intake of animal-based iron-containing foods into the diet, and a need for greater inclusion of vitamin B-1 rich foods among 12-35 month old children. 2.) Presence of significant rates of anemia in 6-11 and 12-23 month old children. 3.) An increased risk of overweight/obesity. CONCLUSIONS: Since food availability and affordability are no longer major issues in the well developed parts of urban China, achieving further im-provements in the diet and nutrition of young children in these environments is likely require more specific edu-cation to parents and other significant carers such as grandparents. The relatively high educational level and so-cio-economic status of the population group is likely to facilitate the uptake of such measures in this population group.

Dietary survey of anaemic infants and young children in urban areas of China: a cross-sectional study.

BACKGROUND AND OBJECTIVES: To explore the diet characteristics of anaemic infants and young children of China, blood tests and diets surveys were conducted in five cities. METHODS AND STUDY DESIGN: About 150 children aged 6-36 mo were selected in a typical community health center of each city, and the total sample was 750. Nutritional status was measured through 24h dietary recall method and HEMO Cue was used for Haemoglobin concentration testing. RESULTS: The average prevalence of anaemia was 17.2% in 6-12 mo children, which was higher than in other age groups. Median intakes of 8 nutrients (protein, vitamin A, B-1 and C, calcium, iron, zinc and copper) in anaemic children were less than non-anaemic children (p<0.05) in 6-12 mo olds; at age 12-24 mo the intake of vitamin A in anaemic children was less than in non-anaemic children (p<0.05). Market complementary food was the main source of iron in both anaemic and non-anaemic children (6-12 mo olds: 2.28 and 3.69 mg; 12-24 mo olds: 2.06 and 2.09 mg, respectively). Iron intake from formula was lower in anaemic children than in nonanaemic children (6-12 mo olds: 0.88 vs 2.54 mg; 12-24 mo olds: 1.59 vs 2.87 mg). The proportion of children obtaining continued breastfeeding in anaemic children was significantly higher than in non-anaemic children aged 6-12 mo (65% vs 37%, p<0.05). CONCLUSIONS: Appropriate practices around continuing breastfeeding and complementary feeding particularly targeted to breast fed older infants and young children are needed to reduce anaemia in infants and young children.

Enteral feeding enriched with carotenoids normalizes the carotenoid status and reduces oxidative stress in long-term enterally fed patients.

BACKGROUND & AIMS: Circulating carotenoid levels decrease progressively in patients receiving long-term enteral tube feeding with carotenoid-free formulas. Low dietary intake and low blood levels of carotenoids are associated with a higher risk of morbidity and mortality from chronic diseases. The aim of this study was to examine the effects of a low dose carotenoid mixture (3-mg/1500kcal) for 3 months on serum carotenoid levels and oxidative stress in patients receiving long-term enteral nutrition as the sole source of nutrition. METHODS: This randomized, double blind, controlled study compared patients receiving enteral nutrition with carotenoids (N=26) and without carotenoids (control group; N=25). RESULTS: Patients on long-term enteral nutrition had low baseline serum carotenoid levels. Three months of enteral feeding enriched with carotenoids significantly (P<0.01) increased serum carotenoid levels compared with the control group. Oxidative stress as measured by NF-kappaB levels was decreased at 3 months compared with the control group (P<0.05). No significant changes in MDA levels were observed during the study period in either group. CONCLUSIONS: This study demonstrated that enteral nutrition containing small amounts of carotenoids (3-mg/1500kcal) in patients requiring long-term enteral feeding normalizes serum carotenoid levels to the lower end of the range found in age-matched controls. The NF-kappaB data indicate a reduction in oxidative stress in these patients. Therefore, the use of formulas containing a mixture of carotenoids should be recommended for long-term enteral nutrition.

Dietary fructo-oligosaccharides in healthy adults do not negatively affect faecal cytotoxicity: a randomised, double-blind, placebo-controlled crossover trial.

Fructo-oligosaccharides (FOS) are widely used in commercial food products. Most studies on FOS concern the health benefits, but some negative effects were recently reported concerning the faecal cytotoxicity and excretion of mucin-type oligosaccharides in combination with a Ca-restricted diet. The present study was performed to investigate whether these effects of FOS are observed in adults consuming a regular diet unrestricted in Ca. The study was a randomised, double-blind, placebo-controlled crossover trial, involving eleven healthy adults, who consumed 25-30 g FOS or maltodextrin (control) in a random order for 2 weeks in addition to their regular diet. Stools were collected for analysis of pH and SCFA (as markers of fermentation), for the assessment of faecal water cytotoxicity, and for the analysis of alkaline phosphatase activity (as a marker of epithelial cell turnover) and O-linked oligosaccharides (to estimate the excretion of mucin-type oligosaccharides). FOS consumption significantly altered bacterial fermentation (increased percentage of acetate, decreased percentage of butyrate) and tended to decrease stool pH. Furthermore, FOS consumption resulted in a significantly higher stool frequency and in significantly more complaints of flatulence. No significant differences between the control and FOS period were observed in the mean cytotoxicity of faecal water (37.5 (SEM 6.9)% v. 18.5 (SEM 6.9)%; P=0.084), in mean alkaline phosphatase activity (27.7 (SEM 2.9) v. 24.6 (SEM 3.2) U/g dry faeces; P=0.496) or in the mean excretion of mucin-type oligosaccharides (49.9 (sem 4.0) v. 53.5 (SEM 4.3) mg/g dry faeces; P=0.553). We conclude that dietary FOS in a dose up to 25-30 g/d altered the bacterial fermentation pattern but did not affect faecal cytotoxicity or the faecal concentration of mucin-type oligosaccharides in human adults consuming a regular diet.

Bifidogenic effects of solid weaning foods with added prebiotic oligosaccharides: a randomised controlled clinical trial.

OBJECTIVES: Breast-fed infants have relatively high proportions of faecal bifidobacteria. This bifidogenic microbiota is at least partly explained by the high levels of prebiotic oligosaccharides in human milk. The present study aimed at testing the effect of solid foods with added prebiotic galacto- and fructo-oligosaccharides (GOS/FOS) on the composition of the intestinal microbiota of fully formula-fed infants during the weaning period. METHODS: The study was a double-blind, randomised trial with an intervention period of 6 weeks. Infants aged 4 to 6 months who were about to start consuming solid foods were randomised to receive either weaning products with a mixture of GOS/FOS or control weaning products with maltodextrin. After an adjustment period, the presented daily dose of GOS/FOS was 4.5 g. Total numbers of bacteria and bifidobacteria in faecal samples were analysed with fluorescent in situ hybridization. RESULTS: Thirty-five infants were included in the study, and 20 infants were included in a per-protocol analysis. In the GOS/FOS group, the faecal percentage of bifidobacteria significantly increased from 43% to 57% (P = 0.031) from week 0 to week 6, but did not significantly change in the control group (36% and 32%, respectively; P = 0.387). The change in the percentage of bifidobacteria between week 0 and week 6 in the GOS/FOS was significantly different from this change in the control group (P = 0.026). CONCLUSIONS: We conclude that addition of GOS/FOS to solid foods induces an increase in the faecal proportion of bifidobacteria in the intestinal microbiota of fully formula-fed infants with an established, mixed-type microbiota in the weaning period.

Effects of infant formula containing a mixture of galacto- and fructo-oligosaccharides or viable Bifidobacterium animalis on the intestinal microflora during the first 4 months of life.

Adding prebiotics or probiotics to infant formula to improve the intestinal flora of formula-fed infants is considered to be a major innovation. Several companies have brought relevant formulations onto the market. However, comparative data on the effects of pre- and probiotics on the intestinal microflora of infants are not available. The present study aimed to compare the effects of infant formula containing a mixture of galacto- and fructo-oligosaccharides or viable Bifidobacterium animalis on the composition and metabolic activity of the intestinal microflora. Before birth, infants were randomised and double blindly allocated to one of three formulas. The prebiotic (GOS/FOS) group (n 19) received regular infant formula supplemented with a mixture of galacto-oligosaccharides and fructo-oligosaccharides (6 g/l). The probiotic (Bb-12) group (n 19) received the same formula supplemented with 6.0x10(10) viable cells of B. animalis per litre. The standard group (n 19) received non-supplemented regular formula. A group of sixty-three breast-fed infants was included as a reference group. Faecal samples were taken at postnatal day 5 and 10, and week 4, 8, 12 and 16. Compared with the groups fed Bb-12 and standard formula, the GOS/FOS formula group showed higher faecal acetate ratio (69.7 % (sem 2.7), 69.9 % (sem 3.9) and 82.2 % (sem 5.3); P<0.05) and lactate concentration (11.3 (sem 7.9), 3.1 (sem 2.3) and 34.7 (sem 10.7) mmol/kg faeces) and lower pH (6.6 (sem 0.2), 7.1 (sem 0.2) and 5.6 (sem 0.2); P<0.05) at 16 weeks. Differences in percentage of bifidobacteria between the GOS/FOS (59.2 % (sem 7.7)), Bb-12 (52.7 % (sem 8.0)) and the standard (51.8 % (sem 6.4)) groups were not statistically significant at 16 weeks. Feeding infants GOS/FOS formula resulted in a similar effect on metabolic activity of the flora as in breast-fed infants. In the Bb-12 group, composition and metabolic activity of the flora were more similar to those of the standard group.

Effect of an enriched drink on cognitive function in frail elderly persons.

BACKGROUND: Many elderly persons report that they have difficulties learning new things and remembering names, plans, and conversations. Because decreased cognitive function in elderly persons is potentially related to their poor nutritional status, provision of essential nutrients may improve cognitive function. The authors wanted to determine whether consumption of an enriched drink, including moderate doses of all essential micronutrients, improves cognitive function in frail elderly persons. METHODS: Frail, white adults (n=101) who were aged 65 years or older with a body mass index

Clinical outcome of immunonutrition in a heterogeneous intensive care population.

OBJECTIVE: To study the effect of a high-protein enteral formula enriched with arginine, glutamine, and antioxidants and containing omega3 fatty acids and a mixture of fibers, on the clinical outcome of a heterogeneous intensive care (ICU) population. DESIGN AND SETTING: A randomized, prospective, double blind, controlled, two-center clinical trial in two intensive care units in The Netherlands. PATIENTS AND PARTICIPANTS: A total of 597 adult ICU patients expected to require enteral tube feeding for more than 2 days were randomized to receive immunonutrition or an isocaloric control formula. INTERVENTIONS: Patients received either the immunonutrition or the control feed. MEASUREMENTS AND RESULTS: Intention-to-treat and per-protocol analyses showed no statistically significant difference in clinical outcome parameters between the two groups. Results of the intention-to-treat analysis in control vs. immunonutrition were: median ICU length of stay in days, 8.0 (IQR 5.0-16.0) vs. 7.0 (4.0-14.0); median hospital length of stay in days, 20.0 (IQR 10.0-34.0) vs. 20.0 (10.0-35.0); median days of ventilation, 6.0 (IQR 3.0-12.0) vs. 6.0 (IQR 3.0-12.0); ICU mortality, 26.8% vs. 28.2%; in-hospital mortality, 36.4% vs. 38.5%; infectious complications, 41.7% vs. 43.0%. CONCLUSIONS: The results of this largest randomized, controlled trial found that in the general ICU population immunonutrition has no beneficial effect on clinical outcome parameters. These results are consistent with the literature that is currently available.

Alpha-lactalbumin combined with a regular diet increases plasma Trp-LNAA ratio.

Brain serotonin influences food intake and mood. It is synthesised from tryptophan (Trp) of which uptake in the brain is dependent on plasma ratio of tryptophan to the sum of other large neutral amino acids (Trp-LNAA). A carbohydrate-rich diet increases this ratio, whereas a protein-rich diet decreases it. Yet, if the protein source is alpha-lactalbumin the ratio increases. It is, however, unknown whether this also happens in the context of a regular diet (15% protein). We studied the effect of an alpha-lactalbumin supplement combined with regular diet on plasma Trp-LNAA ratio, serum prolactin (marker of serotonin synthesis), food intake, appetite, macronutrient preference and mood. Eighteen healthy males participated in a double-blind, randomised, placebo-controlled, crossover study. One hour after breakfast they received a drink containing alpha-lactalbumin and carbohydrates (AS) or carbohydrates (PS) only. Plasma Trp-LNAA ratio, serum prolactin, food intake, appetite, macronutrient preference and mood were assessed before and 90 min after consumption of the supplement. Changes of plasma Trp-LNAA ratio differed (P<.001) between both supplements, increasing by 16% after AS and decreasing by 17% after PS. Decrease of serum prolactin was slightly smaller after AS than after PS (P=.083). Appetite, food intake, macronutrient preference or mood did not differ between supplements. We conclude that an alpha-lactalbumin-enriched supplement combined with a regular diet increases plasma Trp-LNAA ratio and may influence serum prolactin, but we could not demonstrate effects on appetite, food intake, macronutrient preference and mood.

Biochemical antioxidant levels respond to supplementation with an enriched drink in frail elderly people.

OBJECTIVE: To investigate whether a drink enriched with essential vitamins and minerals can improve biochemical status of enzymatic and non-enzymatic antioxidants in frail elderly people. METHODS: A six-month randomized, double blind, placebo controlled intervention study. Frail elderly people 65 years of age or older, with a body mass index (BMI) below 25 kg/m(2) and residing in a home for the elderly or in sheltered housing. Enriched (with essential vitamins and minerals in 30% to 150% of RDA and higher levels of antioxidants) drink (n = 28) or placebo (n = 27) to be taken twice a day in addition to the normal food consumed. Plasma levels of vitamin C, vitamin E, antioxidant capacity (TEAC), cysteine, uric acid and whole blood levels of total thiol and glutathione peroxidase (GSH-Px), dietary intake. RESULTS: Changes in vitamin E (16 +/- 2 vs. 2 +/- 1 mmol/L), vitamin C (37 +/- 5 vs. 1 +/- 5 mmol/L), TEAC (38 +/- 15 vs. -10 +/- 11 mmol/L Trolox eq) and cysteine (17 +/- 10 vs. 0.4 +/- 6 mmol/L) were significantly different between groups (p < 0.05). There was a trend towards significant changes in erythrocyte glutathione peroxidase (-0.2 +/- 3 vs. -10 +/- 7 U/mg Hb, p = 0.097). Baseline dietary intake of antioxidant vitamins was below 2/3 RDA for a substantial proportion (43% to 76%) of subjects. CONCLUSIONS: Supplementation with an enriched drink can raise plasma levels of enzymatic and non-enzymatic antioxidants in frail elderly people.