Osmolality of a fortified human preterm milk: The effect of fortifier dosage, gestational age, lactation stage, and hospital practices.

OBJECTIVE: The purpose of this study was to evaluate the dose-dependent effect of human milk fortifier (HMF) on the osmolality of various preterm human milks (PHMs) at different gestational and lactation stages, and with different storage and treatment conditions that are routinely used in neonatal intensive care units (NICUs). STUDY DESIGN: Twenty-four mothers who had given birth to their baby before 28 or between 29 and 31 weeks of pregnancy participated in the study after 1-2 weeks or 3-4 weeks breastfeeding after delivery. The study was a prospective, multicenter, comparative, and noninterventional study. Osmolality of fresh or pasteurized human milk stored at 4°C was measured (cryoscopy) at baseline, and 24hours after adding Suppletine® Human Milk fortifier (SHMF) at 3%, 4%, 4.5%, and 5% (w/v). RESULTS: PHM without supplementation had an osmolality (mean±SD) of 301±8 mOsm/kgH2O (n=40; 95% CI: [298; 303]). Adding 3-5% SHMF induced a linear increase of osmolality (P<0.001; r2=0.975). With 4% SHMF, the osmolality measure was 443±13mOsm/kg H2O (95% CI: [439-447]). Neither a 24-hour storage at 4°C nor pasteurization induced a modification of osmolality compared to the fresh samples. CONCLUSION: Whatever the origin and quality of milk as well as hospital practices, adding up to 4% (w/v) SHMF to PHM increases its nutritional quality and osmolality without exceeding 450mOsm/kgH2O, which is generally recognized as safe.

L. fermentum CECT 5716 prevents stress-induced intestinal barrier dysfunction in newborn rats.

BACKGROUND: Intestinal epithelial barrier (IEB) dysfunction plays a critical role in various intestinal disorders affecting infants and children, including the development of food allergies and colitis. Recent studies highlighted the role of probiotics in regulating IEB functions and behavior in adults, but their effects in the newborn remain largely unknown. We therefore characterized in rat pups, the impact of Lactobacillus fermentum CECT 5716 (L. fermentum) on stress-induced IEB dysfunction, systemic immune response and exploratory behavior. METHODS: Newborn rats received daily by gavage either L. fermentum or water. Intestinal permeability to fluorescein sulfonic acid (FSA) and horseradish peroxidase (HRP) was measured following maternal separation (MS) and water avoidance stress (WAS). Immunohistochemical, transcriptomic, and Western blot analysis of zonula occludens-1 (ZO-1) distribution and expression were performed. Anxiety-like and exploratory behavior was assessed using the elevated plus maze test. Cytokine secretion of activated splenocytes was also evaluated. KEY RESULTS: L. fermentum prevented MS and WAS-induced IEB dysfunction in vivo. L. fermentum reduced permeability to both FSA and HRP in the small intestine but not in the colon. L. fermentum increased expression of ZO-1 and prevented WAS-induced ZO-1 disorganization in ileal epithelial cells. L. fermentum also significantly reduced stress-induced increase in plasma corticosteronemia. In activated splenocytes, L. fermentum enhanced IFNγ secretion while it prevented IL-4 secretion. Finally, L. fermentum increased exploratory behavior. CONCLUSIONS & INFERENCES: These results suggest that L. fermentum could provide a novel tool for the prevention and/or treatment of gastrointestinal disorders associated with altered IEB functions in the newborn.

Impact of Lactobacillus fermentum and dairy lipids in the maternal diet on the fatty acid composition of pups' brain and peripheral tissues.

The aim of the study was to determine the effect of maternal diets administered since day 1 of gestation and containing dairy lipids or vegetable oils differing in the supply of n-3 polyunsaturated fatty acids (n-3 PUFAs) (equilibrated or deficient) and of Lactobacillus fermentum (L. fermentum) on the docosahexaenoic acid (DHA) accretion in the pups at postnatal day 14 in the prefrontal cortex (PFC) and hippocampus (HC) for brain structures and in the liver and adipose tissue for peripheral tissues. Maternal milk fatty acid composition was also assessed by analyzing the fatty acid composition of the gastric content of the pups. DHA was higher in mice supplemented with L. fermentum than in mice in the deficient group in HC and PFC and also in liver and adipose tissue. This increase could be linked to the slight but significant increase in C18:3n-3 in the maternal milk. This proportion was comparable in the dairy lipid group for which the brain DHA level was the highest. L. fermentum may have a key role in the protection of the brain during the perinatal period via the neuronal accretion of n-3 PUFAs, especially during n-3 PUFA deficiency.

Enriched dairy fat matrix diet prevents early life lipopolysaccharide-induced spatial memory impairment at adulthood.

Polyunsaturated fatty acids (PUFAs) are essential fatty acids, which are critical for brain development and later life cognitive functions. The main brain PUFAs are docosahexaenoic acid (DHA) for the n-3 family and arachidonic acid (ARA) for the n-6 family, which are provided to the post-natal brain by breast milk or infant formula. Recently, the use of dairy lipids (DL) in replacement of vegetable lipids (VL) was revealed to potently promote the accretion of DHA in the developing brain. Brain DHA, in addition to be a key component of brain development, display potent anti-inflammatory activities, which protect the brain from adverse inflammatory events. In this work, we evaluated the protective effect of partial replacement of VL by DL, supplemented or not with DHA and ARA, on post-natal inflammation and its consequence on memory. Mice were fed with diets poor in vegetal n-3 PUFA (Def VL), balanced in vegetal n-3/n-6 PUFA (Bal VL), balanced in dairy lipids (Bal DL) or enriched in DHA and ARA (Supp VL; Supp DL) from the first day of gestation until adulthood. At post-natal day 14 (PND14), pups received a single administration of the endotoxin lipopolysaccharide (LPS) and brain cytokine expression, microglia phenotype and neurogenesis were measured. In a second set of experiments, memory and neurogenesis were measured at adulthood. Overall, our data showed that lipid quality of the diet modulates early life LPS effect on microglia phenotype, brain cytokine expression and neurogenesis at PND14 and memory at adulthood. In particular, Bal DL diet protects from the adverse effect of early life LPS exposure on PND14 neurogenesis and adult spatial memory.

Tolerancia y eficacia de una fórmula extensamente hidrolizada en lactantes con alergia a proteínas de leche de vaca mediada por IgE. Estudio JUNGLO (I): hidrolizado extenso de caseína / Tolerance and efficacy of an extensively hydrolyzed formula for infants with IgE-mediated cow’s milk protein allergy. JUNGLO study (part I): Extensively hydrolyzed casein formula

Objetivos: El principal objetivo de este estudio fue evaluar la tolerancia de un nuevo hidrolizado de caseína y su eficacia durante un periodo de 3 meses en lactantes diagnosticados de alergia a las proteínas de leche de vaca (APLV) mediada por IgE. Métodos: El estudio forma parte de un ensayo clínico multicéntrico, aleatorizado y doble ciego, que se llevó a cabo en 15 hospitales españoles. En este artículo se presentan los resultados del grupo de tratamiento que recibió un hidrolizado extenso de caseína, comportándose como un estudio observacional. Se incluyeron lactantes diagnosticados de APLV una vez que se confirmó con la titulación de IgE específica, con el fin de comprobar la tolerancia a la nueva fórmula en más del 97% de los niños. La principal variable de estudio fue la tolerancia a la fórmula, y se evaluó mediante una prueba de provocación realizada en el hospital. La evolución de los síntomas clínicos y del crecimiento se evaluó durante un periodo de 3 meses tras la inclusión. Resultados: Se incluyeron 25 niños y 22 niñas. Todos toleraron la introducción de la fórmula de estudio sin reacciones adversas en el primer día, lo que significa que más del 97% de los lactantes toleraron el tratamiento en el momento de su introducción (p= 0,0112). Ocurrieron tres acontecimientos adversos, a los 4, 6 y 10 días de la introducción de la fórmula, que se consideraron posible o probablemente relacionados con la misma, por lo que la tolerancia efectiva fue del 93%. Al cabo de 1 mes de seguimiento, la situación clínica de los lactantes había mejorado, con una disminución del 40,4 al 13% para los síntomas digestivos, y la desaparición total de todos los demás síntomas. El patrón de crecimiento, levemente disminuido al inicio, se normalizó o al menos mejoró a los 3 meses de tratamiento. Conclusiones: El nuevo hidrolizado de caseína se toleró en más del 97% de los lactantes, y mejora los síntomas clínicos de forma rápida en lactantes con APLV mediada por IgE, al tiempo que se mantiene un crecimiento normal (AU)

Objectives: The main objective of this study was to evaluate the tolerance of a new casein hydrolyzate formula, and its efficacy during a 3 months consumption period by infants with IgE-mediated cow’s milk protein allergy (CMPA). Methods: This study was part of randomized, double blind study performed in 15 Spanish hospitals. In the present paper the results of the arm that received an extensively hydrolyzed casein formula are reported. Full term infants aged up to 9 months were included to check that 97% of them tolerate the formula at introduction. The CMPA was confirmed by a specific IgE dosage before inclusion. An oral food challenge was made with the formula. Over 3 months, the evolution of the clinical symptoms and the growth were evaluated. Results: The 25 boys and 22 girls included tolerated the formula at introduction without any adverse reaction during the first day of formula intake, meaning that 97% of the infants tolerated the treatment at introduction (p= 0.0112). Three adverse events were reported 4, 6 and 10 days later and were considered possibly or probably related to the study formula indicating an effective delayed tolerance of more than 93% of infants. At 1 month of follow-up, the condition of the infants was greatly improved as indicated by the dramatic decrease of the digestive symptoms from 40.4% to 13%, and the total regression of all the other symptoms. The growth of the infants over 3 months showed a normal pattern, in agreement with the World Health Organization (WHO) growth references. Conclusion: This new casein hydrolyzate formula shows a rate of tolerance >97%, it is efficient to rapidly improve clinical symptoms and allows a normal growth pattern in infants with CMPA (AU)