Effect of supplementation with an iron-fortified milk on incidence of diarrhea and respiratory infection in urban-resident infants.

To address the hypothesis that increased infectious morbidity is associated with iron supplementation, 783 randomly selected infants were provided with a powdered full fat cow's milk (non-fortified group) and 872 with a powdered acidified full fat cow's milk fortified with 15 mg of iron as ferrous sulfate (fortified group). All infants were followed from birth to 15 months of age with a monthly home visit by a nurse who recorded morbidity occurring during the previous 30 days. At 9 months of age, 15% of infants in each cohort were receiving breast milk only; data for these infants were segregated to make the third group. Episodes (mean +/- SD) of diarrhea/infant/year were 1.06 +/- 1.29, 1.14 +/- 1.37, and 0.82 +/- 1.04 for the fortified, non-fortified and breast-fed groups, respectively; the fortified and non-fortified bottle-fed groups had a very similar incidence of respiratory illness; 2.66 +/- 2.07 and 2.74 +/- 2.24 episodes/infant/year, respectively. The incidence of respiratory illness for both bottle-fed groups was significantly higher than that for the breast-fed group (2.22 +/- 1.84 respiratory episodes/infant/year). We conclude that for the infants the tested form of iron fortified milk, which is sufficient to lower iron deficiency anemia, does not result in an increased incidence of diarrhea or respiratory illness.

Zinc supplementation impairs monocyte function.

Zinc has been shown to be involved in many functions of the immune system. This study was conducted to examine the effect of zinc supplementation on phagocytic, fungicidal and metabolic activity of blood monocytes of marasmic infants during nutritional rehabilitation. A controlled, double-blind design was used in which 19 infants fed a zinc-fortified formula were compared with 20 infants fed the same, unfortified formula. Evaluation of phagocytic-fungicidal capacity, growth, zinc, copper and iron status was performed in both groups on admission and after 60 and 105 days of nutritional rehabilitation. Although energy, copper and iron intakes were similar in the two groups, a decrease in the number of infants able to phagocytose one or more Candida buds was observed after 60 days of zinc supplementation compared to admission (p < 0.03). No change in phagocytic ability was detected between admission and 60 days in the control group. The number of infants with depressed fungicidal activity increased significantly after 105 days of nutritional rehabilitation in the zinc-fortified group as compared to controls (p < 0.04). The number and duration of impetigo episodes was significantly greater in the group fed the zinc-fortified formula. These results suggest that zinc supplements at the RDA level may impair monocyte function.

Effect of bovine-hemoglobin-fortified cookies on iron status of schoolchildren: a nationwide program in Chile.

The Chilean School Lunch program, which serves one million children nationwide, was supplied with three 10-g cookies fortified with 6% bovine hemoglobin concentrate, designed to provide 1 mg bioavailable iron per day. A survey of 1000 children was performed after 3 y. Significant differences in hemoglobin concentrations were found in the children from the fortified vs the nonfortified province (P < 0.01). Low serum ferritin values were also significantly more prevalent in the nonfortified group. The effect was evident despite the very low prevalence of anemia in both the fortified and the unfortified school groups. Heme-iron-fortified cookies are a feasible and effective way to improve the iron status of school-age children. In regions of high prevalence of iron-deficiency anemia, the effect of a heme-fortified cookie program should be even more important.

Effect of a zinc-fortified formula on immunocompetence and growth of malnourished infants.

This study attempted to define the possible contribution of zinc nutrition to immunocompetence and growth in severely malnourished infants. The effect of zinc supplementation was evaluated in marasmic infants during nutritional rehabilitation by using a controlled double-blind design in which 19 infants fed a zinc-fortified formula were compared with 20 infants fed the same non-supplemented formula. Evaluation of immunocompetence, growth, and zinc, copper, and iron status was performed on admission and at 30, 60, and 105 d of nutritional rehabilitation. Although energy intake was similar in both groups, the zinc-supplemented infants had significantly higher linear growth gain, and their immune function improved as demonstrated by conversion of their delayed hypersensitivity skin reactions, enhanced lymphoproliferative response to PHA, and increased salivary IgA concentrations. Thus, the use of a zinc-fortified formula during nutritional rehabilitation can prevent the development of zinc deficiency and improve growth and immune function.

Haemoglobin fortified cereal: a source of available iron to breast-fed infants.

We tested in the field an extruded rice flour, fortified with a bovine haemoglobin concentrate (Fe:14 mg/100 g of powder). This cereal has a high iron bioavailability, good protein quality and amino acid score. Healthy, term breast-fed infants were prospectively studied. One group (n = 92) received the fortified cereal (from 4 to 12 months of age). As control, 96 infants received regular solid foods (cooked vegetables and meat) from age 4 months. At the end of the field trial, a subsample of infants in both groups was supplemented with 45 mg Fe during 90 d. Iron nutrition status was determined at 9, 12 and 15 months. At 12 months, iron deficiency anaemia was present in 17 per cent of controls, in 10 per cent of fortified infants as a whole, but only in 6 per cent of the babies who consumed over 30 g of cereal/d. In addition, this latter group did not show any significant changes in iron nutrition status after the supplementation trial. Results demonstrate that the consumption of a haemoglobin fortified cereal is effective in markedly reducing the incidence of iron deficiency in breast-fed infants.

Haemoglobin-fortified cereal: an alternative weaning food with high iron bioavailability.

Extruded rice flour was fortified with 5 per cent bovine haemoglobin concentrate (BHC). The amino acid score of the product was 59 per cent. The protein efficiency ratio (PER) for the fortified cereal alone was 1.4; however, when given as a mixed diet of cereal and humanized milk (providing 41 and 59 per cent of the protein, respectively) PER was 2.6 (casein standard = 2.5). Iron absorption studies were performed with a double isotope technique, on 10 infants 8-10 months of age. Geometric mean absorption of the rice-BHC iron was 14.2 per cent, as measured with a tag of 55Fe-haemoglobin. The 59Fe-ferrous ascorbate reference dose had a mean absorption of 38.5 per cent. The use of a haem-iron fortified cereal as a weaning food seems feasible and advantageous, supplying an appropriate amount of absorbed iron, an adequate energy density, and a protein which could complement milk protein.

[Nutritional intake of folic acid in breast-fed infants]. / Ingreso nutricional de ácido fólico en lactantes que reciben lactancia materna.

The relationship of natural and artificial feeding to serum and red cell folate levels, as a means of evaluating nutritional intake of this vitamin, was studied. First a cross-sectional study was undertaken in which a group of 112 infants still being breast-fed at 4, 6, and 9 months of age had significantly higher folate concentrations than another group of 102 infants who had been weaned before 2 months. At 6 months of age the prevalence of folic acid deficiency (red cell folate less than 160 micrograms/l of erythrocytes) was 0% in the first group and 15.4% in the second (P less than 0.02), and at 9 months the respective proportions were 3.6 and 28.9% (P less than 0.01). In a second study, 50 nursing infants were followed longitudinally during their first 15 months of life, and up to 9 months of age a direct correlation was observed between the folate concentrations and the duration of breast-feeding. In order to prevent a deficiency of this vitamin, it is recommended that infants be exclusively breast-fed at least through the age of 6 months or, failing this, that they be fed infant formula enriched with folic acid.

Ingreso nutricional de ácido fólico en lactantes que reciben lactancia materna / Nutritional intake of folic acid in breast-fed infants

The relationship of natural and artificial feeding to serum and red cell folate levels, as a means of evaluating nutritional intake of this vitamin, was studied. First a cross-sectional study was undertaken in which a group of 112 infants still being breast-fed at 4, 6, and 9 months of age had significantly higher folate concentrations than another group of 102 infants who had been weaned before 2 months. At 6 months of age the prevalence of folic acid deficiency (red cell folate less than 160 micrograms/l of erythrocytes) was 0 per cent in the first group and 15.4 per cent in the second (P less than 0.02), and at 9 months the respective proportions were 3.6 and 28.9 per cent (P less than 0.01). In a second study, 50 nursing infants were followed longitudinally during their first 15 months of life, and up to 9 months of age a direct correlation was observed between the folate concentrations and the duration of breast-feeding. In order to prevent a deficiency of this vitamin, it is recommended that infants be exclusively breast-fed at least through the age of 6 months or, failing this, that they be fed infant formula enriched with folic acid (Au)

Prevention of iron deficiency by milk fortification. The Chilean experience.

A large proportion of the milk consumed by infants in Chile is distributed by a National Food Supplementary Program. Efforts to prevent iron deficiency by milk fortification started several years ago. Initially a field study involving the simple addition of ferrous sulfate to a low-fat powdered milk was only partially successful due to the relatively low iron absorption from this product. Following the observation that the enrichment of milk with ascorbic acid markedly improved iron bioavailability, a new fortified formula was developed and has been tested in the field since 1976. This is powdered full-fat milk, biologically acidified and fortified with 15 mg Fe, as ferrous sulfate, and 100 mg ascorbic acid per 100 g powder. In a pilot study, 276 infants spontaneously weaned before 3 months of age received the fortified milk, and 278 infants receiving unfortified milk served as controls. At the end of the study (15 months of age) anemia (Hb less than 11 g/dl) was present in 25.7% of unfortified infants compared with only 2.5% in those fortified. Saturation of Transferrin less than 9% was present in 33.8% and serum ferritin less than 10 micrograms/l in 39.1% of the nonfortified infants. The figures for the fortified group were 7% and 8.5% respectively. Acceptance of the fortified formula was good. Following these observations, and as a previous step to the use of the fortified milk in the national program, the formula was tested in 7 National Health Service inner city community clinics under regular milk distribution.(ABSTRACT TRUNCATED AT 250 WORDS)

Ingreso nutricional de ácido fólico en lactantes que reciben lactancia materna / Nutritional intake of folic acid in breast-fed infants

The relationship of natural and artificial feeding to serum and red cell folate levels, as a means of evaluating nutritional intake of this vitamin, was studied. First a cross-sectional study was undertaken in which a group of 112 infants still being breast-fed at 4, 6, and 9 months of age had significantly higher folate concentrations than another group of 102 infants who had been weaned before 2 months. At 6 months of age the prevalence of folic acid deficiency (red cell folate less than 160 micrograms/l of erythrocytes) was 0 per cent in the first group and 15.4 per cent in the second (P less than 0.02), and at 9 months the respective proportions were 3.6 and 28.9 per cent (P less than 0.01). In a second study, 50 nursing infants were followed longitudinally during their first 15 months of life, and up to 9 months of age a direct correlation was observed between the folate concentrations and the duration of breast-feeding. In order to prevent a deficiency of this vitamin, it is recommended that infants be exclusively breast-fed at least through the age of 6 months or, failing this, that they be fed infant formula enriched with folic acid (Au)

Effect of a milk-based food supplement on maternal nutritional status and fetal growth in underweight Chilean women.

The effects on pregnancy outcome and maternal iron status of powdered milk (PUR) and a milk-based fortified product (V-N) were compared in a group of underweight gravidas. These take-home products were distributed during regular prenatal visits. Women in the V-N group had greater weight gain (12.29 vs 11.31 kg, p less than 0.05) and mean birth weights (3178 vs 3105 g, p less than 0.05) than those in the PUR group. Values for various indicators of maternal Fe status were also higher in the V-N group. Compared with self-selected noncompliers, similar in all control variables to compliers, children of women who consumed powdered milk or the milk-based fortified product had mean birth weights that were higher by 258 and 335 g, respectively. Data indicate a beneficial effect of the fortified product on both maternal nutritional status and fetal growth.

PIP: The effects on maternal and infant weight gain and maternal iron status of powdered milk (PUR) and a milk-based fortified product (V-N) were compared in underweight women attending prenatal clinics in Santiago, Chile. All pregnant women attending 9 prenatal clinics of the Southeast Health Area, over 18 years old, parity 0-5, nonsmoking, nonalcohol-consuming and underweight (95% of standard) joined the study. They were given either the PUR, powdered milk with 26% milkfat, or V-N, (Vita-Nova Mother-food, Melkunie Holland, Woerden) which contained micronutrients and added vegetable fat, as mandated by law. Those who failed to consume supplements were relegated to the control group. The V-N group had greater weight gain (12.29 vs 11.31 kg, p0.05), mean birth weights (3178 vs 3105 g, p0.05) than the PUR group. Iron status, shown by significantly higher mean hematocrit, hemoglobin, mean corpuscular volume, transferrin saturation and plasma ferritin levels near term, was also better in the V-N group than in the PUR. Other significant differences in favor of the V-N supplement were number of intrauterine growth retarded infants and birth weights under 3001 g. The V-N group had greater fluid retention: the import of this is unknown. The infants of non-compliers had birthweights 258 and 335 g lower than the women consuming PUR and V-N, respectively. The babies of V-N mothers gained 74 g/kg maternal weight gain, higher than many previously reported increments, perhaps due to the micronutrients in the supplement.

Prevention of iron deficiency by milk fortification. II. A field trial with a full-fat acidified milk.

In a longitudinal study from age 3 to 15 mo, 276 term, healthy, spontaneously weaned infants received a full-fat acidified milk fortified with 15 mg of elemental Fe as ferrous sulfate and 100 mg of ascorbic acid/100 g of powder and 278 control infants received milk without additives. At ages 9 and 15 mo significant differences were encountered in all measures of Fe nutriture in favor of the fortified group (p less than 0.001). Anemia (Hg less than 110 g/L) was present in 25.7% of unfortified infants compared with only 2.5% in those fortified at age 15 mo. Saturation of transferrin less than 9% was present in 33.8% and serum ferritin less than 10 micrograms/L in 39.1% of the nonfortified infants. The figures for the fortified group were 7 and 8.5% respectively. The efficiency of the fortified acidified milk in eradicating Fe deficiency in the infants while discouraging use by other family members make this milk a useful targeted product in programs of supplementary food distribution in the underdeveloped world.

Determination of iron in stools as a method to monitor consumption of iron-fortified products in infants.

We describe a quantitative method for determination of iron in stool to monitor consumption of iron-fortified milk in infants. The method is simple, fast, and inexpensive. Stool samples from infants consuming fortified milk or nonfortified milk were ashed, and ashes were diluted in hydrochloric acid and reacted with bathophenantroline disulphonate. Mean iron excretion per subject was obtained. Anemia was present in 25.7% of infants in the nonfortified group (upper level of 95% confidence limit for mean iron excretion was 14.9 mg iron/100 g stool) and in 22.2% of infants from the noncompliant fortified group (mean excretion less than 15 mg iron/100 g stool). In contrast, only 0.8% of infants who had properly consumed the fortified milk had anemia. We conclude that this method for determination of stool iron should be considered for estimating compliance in evaluation of results of field trials of iron-fortified products in infants.

Effect of iron therapy on phagocytosis and bactericidal activity in neutrophils of iron-deficient infants.

Phagocytosis and bactericidal capacity of neutrophils were measured in 10 iron-deficient infants age 6-23 mo. All infants had hemoglobins less than 11 mg/dL with low saturation of transferrin and serum ferritin but were otherwise in good health. Neutrophil function and iron status were assessed at 0, 3-5, 15, 30, and 90 days of oral iron therapy. Phagocytosis was unaffected in iron deficiency and remained unchanged during therapy. Bactericidal capacity was severely impaired prior to treatment. After 3-5 days of ferrous sulfate administration, there was no significant improvement. At day 15 it returned to normal ranges and remained so at days 30 and 90. The sequence of events suggests that iron does not have a direct effect upon circulating neutrophils but, rather, that it is required during the development of neutrophils in the bone marrow.

[Prevention of iron deficiency in infants by fortified milk. Field study of a low-fat milk]. / Prevención de la carencia de hierro en lactantes, mediante la fortificación de la leche. I. Estudio sobre el terreno de una leche semidescremada.

Healthy term infants were given a low-fat powdered milk fortified with 15 mg/100g of iron, as ferrous sulphate, for one year, starting at three months of age. The control group received non-fortified milk. A total of 510 infants entered the study, and 314 could be studied at the age of 15 months. Consumption of the fortified formulas was monitored through iron determinations in stools. Groups had a comparable hemoglobin concentration at the age of three months. Hemoglobin was higher in the fortified group at nine months (11.7 +/- 1.0 vs 11.4 +/- 1.1 g/dl, p less than 0.02), and 15 months (12.0 +/- 1.1 vs 11.4 +/- 1.2, p less than 0.001). The percentage of subjects with anemia (Hb less than 11.0 g/dl) was lower in the fortified group: 14.8% vs 27.7% of the controls at nine months and 7.0% vs 35.3% at 15 months. Percentages of subjects with iron deficiency (Fe/TIBC less than 9%) were lower in the fortified group: 28.0% vs 49.1% of the controls at nine months, and 20.0% vs 41.8% at 15 months. Although the fortified milk markedly improved iron nutrition, deficiency of this mineral was still high in the group receiving it. This was probably due to the low bioavailability of iron when administered with non-modified milks.

Bioavailability of iron in soy-based formula and its effect on iron nutriture in infancy.

Soy products have been reported to inhibit absorption of nonheme food iron and fortification iron. Iron bioavailability from a soy formula (Prosobee-PP 710) (iron added as ferrous sulfate: 12 mg/L; ascorbic acid: 54 mg/L) was examined in 16 adult women using the extrinsic radioactive tag method. The geometric mean absorption from the soy formula was only 1.7%. The effect of this formula on iron nutrition in infants was studied in 47 healthy term infants weaned spontaneously before 2 months of age and who received the formula ad libitum until 9 months of age. For control, 45 infants received a cow's milk formula fortified with ferrous sulfate (iron: 15 mg/L; ascorbic acid: 100 mg/L), which has been shown to be effective in preventing iron deficiency, and 49 additional breast-fed infants were also followed. All babies received solid foods (vegetables and meat) starting at 4 months of age. Iron nutritional status was determined at 9 months. Infants fed soy formula and iron-fortified cow's milk had similar mean values of hemoglobin, mean corpuscular volume, transferrin saturation, free erythrocyte protoporphyrin, and serum ferritin; both formula groups differed significantly (P less than .05) from the breast-fed group in all measurements except free erythrocyte protoporphyrin. Anemia (hemoglobin less than 11 g/dL) was present in only 4.3% and 2.2% of infants receiving the soy and the fortified formulas, respectively, v 27.3% in the breast-fed group. These results indicate that soy formula, in spite of the lower iron bioavailability when measured in adults, is essentially as effective as iron-fortified cow's milk in preventing iron deficiency in infants.