Lower Protein Intake Supports Normal Growth of Full-Term Infants Fed Formula: A Randomized Controlled Trial.

Infant formulas have been conventionally prepared with an excess of total protein in order to provide sufficient amounts of essential amino acids to the rapidly growing infant. However, this practice leads to higher than necessary protein intake during early infant development, inducing accelerated growth patterns correlated with the development of chronic diseases later in life. This study was aimed at assessing the safety of an infant formula enriched with bovine alpha-lactalbumin containing a total protein concentration very close to that of human milk, and determining its efficacy in the support of healthy infant growth from the first month to the fourth month of age. Healthy full-term infants ≤40 days of age were randomized in this controlled single blind trial to one of the following infant formulas: IF 1 (containing 1.0 g protein/dL; n = 30), IF 2 (containing 1.3 g protein/dL; n = 24), and IF 3 (containing 1.5 g protein/dL; n = 42). A control group consisting of exclusively breastfed infants (HM; n = 212) was included in the study. Anthropometric measurements and Z-scores were evaluated at baseline, at 1 month of age, and at 4 months of age. Weight gain (g/day) was similar in the IF 1 and the HM groups (p = 0.644), and it was significantly greater in the IF 2 and IF 3 groups than in the HM group. Growth patterns in both breastfed or IF-fed infants were in accordance with the World Health Organization (WHO) growth standards. At four months of age, the mean weight-for-age Z-score (WAZ) adjusted for initial value in the IF 1 group was similar to that of the HM group and significantly lower than that of the IF 2 and IF 3 groups (p = 0.031 and p = 0.014 for IF 2 and IF 3, respectively). Length-for-age (LAZ) adjusted for initial value was similar among all groups at four months of age. From 1 to 4 months of life, IF 1 containing 1.0 g protein/dL promotes growth and weight gain similar to those observed in exclusively breastfed infants. As this is a first approach to studying an IF containing total protein in a level below that recommended by international committees on nutrition, further investigations are needed to support these findings evaluating infant’s metabolic profile and growth in the long term.

Intake of milk with added micronutrients increases the effectiveness of an energy-restricted diet to reduce body weight: a randomized controlled clinical trial in Mexican women.

BACKGROUND: Micronutrient deficiencies have been associated with an increase in fat deposition and body weight; thus, adding them to low-fat milk may facilitate weight loss when accompanied by an energy-restricted diet. OBJECTIVE: The objective was to evaluate the effect of the intake of low-fat milk and low-fat milk with added micronutrients on anthropometrics, body composition, blood glucose levels, lipids profile, C-reactive protein, and blood pressure of women following an energy-restricted diet. DESIGN: A 16-week randomized, controlled intervention study. PARTICIPANTS/SETTINGS: One hundred thirty-nine obese women (aged 34±6 years) from five rural communities in Querétaro, Mexico. INTERVENTION: Women followed an energy-restricted diet (-500 kcal) and received in addition one of the following treatments: 250 mL of low-fat milk (LFM) three times/day, 250 mL of low-fat milk with micronutrients (LFM+M) three times/day, or a no milk control group (CON). Weight, height, and hip and waist circumferences were measured at baseline and every 4 weeks. Body composition measured by dual-energy x-ray absorptiometry, blood pressure, and blood analysis were done at baseline and at the end of the 16 weeks. MAIN OUTCOME MEASURES: Changes in weight and body composition. STATISTICAL ANALYSIS: One-factor analysis of variance, adjusted by age, baseline values, and community random effects. RESULTS: After the 16-week intervention, participants in the LFM+M group lost significantly more weight (-5.1 kg; 95% CI: -6.2 to -4.1) compared with LFM (-3.6 kg; 95% CI: -4.7 to -2.6) and CON (-3.2 kg; 95% CI: -4.3 to -2.2) group members (P=0.035). Body mass index change in the LFM+M group (-2.3; 95% CI: -2.7 to -1.8) was significantly greater than LFM group members (-1.5; 95% CI: -2.0 to -1.1) and CON group members (-1.4; 95% CI: -1.9 to -0.9) (P=0.022). Change in percent body fat among LFM+M group members (-2.7%; 95% CI: -3.2 to -2.1) was significantly higher than LFM group members (-1.8%; 95% CI: -2.3 to -1.3) and CON group members (-1.6%; 95% CI: -2.2 to -1.0) (P=0.019). Change in bone mineral content was significantly higher in LFM group members (29 mg; 95% CI: 15 to 44) and LFM+M group members (27 mg; 95% CI: 13 to 41) compared with CON group members (-2 mg; 95% CI: -17 to -14) (P=0.007). No differences were found between groups in glucose level, blood lipid profile, C-reactive protein level, or blood pressure. CONCLUSIONS: Intake of LFM+M increases the effectiveness of an energy-restricted diet to treat obesity, but had no effect on blood lipid levels, glucose levels, C-reactive protein, or blood pressure.

Efficacy of different strategies to treat anemia in children: a randomized clinical trial.

BACKGROUND: Anemia continues to be a major public health problem among children in many regions of the world, and it is still not clear which strategy to treat it is most effective. OBJECTIVE: To evaluate the efficacy and children's acceptance of several recognized strategies to treat anemia. METHODS: Non-breastfed children (n = 577), 6 to 43 mo of age, were screened for the trial; 267 were anemic (hemoglobin < 11.7 g/dL), and 266 of those were randomized into 1 of 5 treatments to received daily either: an iron supplement (IS), an iron+folic acid supplement (IFS), a multiple micronutrient supplement (MMS), a micronutrient-fortified complementary food as porridge powder (FCF), or zinc+iron+ascorbic acid fortified water (FW). The iron content of each daily dose was 20, 12.5, 10, 10 and 6.7 mg respectively. Hemoglobin (Hb), ferritin, total iron, weight and height were measured at baseline and after 4 months of treatment. Morbidity, treatment acceptability and adherence were recorded during the intervention. RESULTS: All treatments significantly increased Hb and total iron concentration; ferritin did not change significantly. Groups MMS, IS and IFS increased Hb (g/dL) [1.50 (95%CI: 1.17, 1.83), 1.48 [(1.18, 1.78) and 1.57 (1.26, 1.88), respectively] and total iron ((µg/dL) [0.15 (0.01, 0.29), 0.19 (0.06, 0.31) and 0.12(-0.01, 0.25), respectively] significantly more than FCF [0.92 (0.64, 1.20)] but not to FW group [0.14 (0.04, 0.24)]. The prevalence of anemia was reduced to a greater extent in the MMS and IFS groups (72% and 69%, respectively) than in the FCF group (45%) (p < 0.05). There were no significant differences in anthropometry or in the number of episodes of diarrhea and respiratory infections among treatment groups. The supplements MMS and IS were less acceptable to children, than IFS, FCF and FW. CONCLUSION: The three supplements IS, ISF and MMS increased Hb more than the FCF; the supplements that contained micronutrients (IFS and MMS) were more effective for reducing the prevalence of anemia. In general, fortified foods were better accepted by the study participants than supplements. CLINICALTRIAL.GOV IDENTIFIER: NCT00822380.

An increase of cereal intake as an approach to weight reduction in children is effective only when accompanied by nutrition education: a randomized controlled trial.

BACKGROUND: The main emphasis of dietary advice for control of obesity has been on reducing dietary fat. Increasing ready to eat cereal (RTEC) consumption could be a strategy to reduce fat intake and increase carbohydrate intake resulting in a diet with lower energy density. OBJECTIVES: 1. To determine if an increase in RTEC intake is an effective strategy to reduce excess body weight and blood lipids in overweight or at risk of overweight children. 2. To determine if a nutrition education program would make a difference on the response to an increase in cereal intake. 3) To determine if increase in RTEC intake alone or with a nutrition education program has an effect on plasma lipid profile. EXPERIMENTAL DESIGN: One hundred and forty seven overweight or at risk of overweight children (6-12 y of age) were assigned to one of four different treatments: a. One serving of 33 +/- 7 g of RTEC for breakfast; b. one serving of 33 +/- 7 g of RTEC for breakfast and another one for dinner; c. one serving of 33 +/- 7 g of RTEC for breakfast and a nutrition education program. d. Non intervention, control group. Anthropometry, body composition, physical activity and blood lipids were measured at baseline, before treatments, and 12 weeks after treatments. RESULTS: After 12 weeks of intervention only the children that received 33 +/- 7 g of RTEC and nutrition education had significantly lower body weight [-1.01 (-1.69, -0.34) ], p < 0.01], lower BMI [-0.95 (-1.71, -0.20), p < 0.01] and lower total body fat [-0.71 (-1.71, 0.28), p < 0.05] compared with the control group [1.19 (0.39, 1.98), 0.01 (-0.38, 0.41), 0.44 (-0.46, 1.35) respectively]. Plasma triglycerides and VLDL were significantly reduced [-20.74 (-36.44, -5.05), -3.78 (-6.91, -0.64) respectively, p < 0.05] and HDL increased significantly [6.61 (2.15, 11.08), p < 0.01] only in this treatment group. The groups that received 1 or 2 doses of RTEC alone were not significantly different to the control group. CONCLUSION: A strategy to increase RTEC consumption, as a source of carbohydrate, to reduce obesity is effective only when accompanied by nutrition education. The need for education could be extrapolated to other strategies intended for treatment of obesity. TRIAL REGISTRATION: Australian New Zealand Clincial Trial Registry. Request no: ACTRN12608000025336.