Transcript Infant formulas, why?

The Ideal Formula
• An infant formula should contain optimal amounts of
all nutrients in levels that support normal growth but
does not stress the infants still-developing systems.
• The infant formula should minimize feeding
problems.
Infant formulas, why? Contents of various milks
Human milk vs Cow milk
-Both are liquid
-Quantity and availability of nutrients is different
-Both have similar amount of water, calories, calorie source is different
(proteins supply 7% of calories in human milk, 20% in cow milk).
Lactose supplies 42% in human milk and 30% in cow milk, % of
calories from fat is the same.
CHO: lactose in both cases, cow milk<<human milk
Proteins: cow milk 3X minerals and protein, composition is different
Two fractions: casein and whey.
Casein: precipitated at low pH, constitutes 20–30% of human milk proteins.
A heterogeneous group of proteins, molecular weights: 20 000–30 000
Whey: contains a large number of proteins, which are derived from both milk
and plasma. Mainly
Whey: casein ratio: Human milk (60:40), cow milk (20:80)
The large amount of curd may cause GI distress
a.a. content is inappropriate to the immature enzyme systems
Infant formulas, why? Contents of various milks
Fat: both have similar fat content
Linoleic acid (supplies 7% of calories in human milk, 1% cow milk,
Formula 10%)
Cholesterol level is different (higher in human milk)
Fat in human milk is different from cow milk in 2 ways:
TG types: cow milk, short and long chain FA, in human milk medium
chain
Degree of saturation: human milk:PUFA, cow milk: butter fat
LCPUFA
Lipoprotein lipase
Minerals and electrolytes: several times more in cow milk than
human milk
Calcium and phosphorus: higher level in cow milk (4-7 times more)
and the ratio is different
Iron, Zinc
Na, K and Cl
Infant formulas, why? Contents of various milks
Reduced fat cow milk
Whole cow milk
Evaporated milk
Types, uses and selection of commercial infant
formulas
1. Milk based formulas: nonfat cow milk, vegetable oils
(corn oil, sunflower, soy oil) and lactose are added.
Supplemented with vitamins and minerals, iron and
zinc
2. Milk based formulas with added whey protein
Therapeutic Formulas
a. Lactose free formula: for lactose intolerance
b. Soy protein formula: soy protein instead of animal
protein (fortified with methionine). Vegetable oil as fat
source, corn syrup or sucrose supply the CHO.
• Infanct with CMA: respiratory tract, skin, dairrhea
• Minerals and supplements
• Lactose free,, no animal protein or fat
• High PRSL
• Not suitable for premature or LBW infants. Have to add
Ca and P
Therapeutics formulas
c. Casein hydrolysate fromula: infants with severe GI abnormalities,
malabsorption of CHO, protein and fat.
Fortified with amino acids
CHO source is corn syrup, conr starch, dextrose
Fat source: medium chain triglycerides
d. Amino acid based formula: infants who are intolerant to casein
hydrolysate
e. Whey hydrolysate formula
LACTOSE INTOLERANCE
Medical Need for LF Formulas
• Lactose intolerance (L I) often a complication of
diarrhea.
– Secondary lactase deficiency most common
cause of LI.
– About 23% of well-nourished infants with acute
diarrhea develop LI.
– Incidence greater in malnourished infants.
• Lactose intolerance may cause colic in some infants.
Symptoms Of Lactose Intolerance:
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Nausea (?)
Abdominal pain and distension
Flatulence
Watery diarrhea
Lactose Free Formulas
• LF Formulas appropriate for
– Infants with secondary lactase deficiency.
– Infants with congenital lactase deficiency.
– Children and adults with acquired lactase deficiency.
Corn syrup solids, or corn syrup solids with sucrose
instead of lactose
REGURGITATION
REGURGITATION
• Mild regurgitation is a common occurrence in
infancy.
• Often considered to be a normal physical
phenomenon of early development.
• Usually no serious health risks.
• Spontaneously resolves with time.
• Often considered as a source of parental anxiety.
SYMPTOMS
Common symptoms •
-Regurgitation
-Esophagitis
-Excessive crying
-Feeding problems
-Respiratory
problems
-Parental anxiety
Unusual Symptoms •
-Failure to thrive
-Respiratory problems
???-Hematemisis
REFLUX & REGURGITATION
• Reflux:
Backward flow of gastric juices out of the stomach
up through esophagus.
• Regurgitation:
Backward flow of undigested food ‘spitting-up’
Recommendation
• Step I
Parents Reassurance
• Step II
Feed Thickeners
• Step III
Feed Thickener + Medications
Rational of AR Formula
• Regurgitation or spit-up is a common occurrence in
infancy
• 15-30% of infants suffer from GER.
• Baby can’t thrive on formula that won’t stay down.
• AR formula reduces parents’ anxiety.
• Iron fortified formula containing CHO blend of
lactose, rice starch and maltodextrin
Galactosemia
• It is a metabolic disorder caused by a deficiency in
the activity of the enzyme galactose-1-phosphate
uridyl transferase (Type 1).
• As a result, toxic levels of galactose-1-phosphate
accumulate in the body.
• Without treatment, this disorder is usually fatal.
• Treatment should eliminate galactose and lactose
from the diet.
• Soya bean formulas may be indicated for these
infants.
NUTRITIONAL NEEDS OF
LBW INFANTS
Low-Birth-Weight Infants
• Infants who are born prior to term, i.e., 38-42
weeks, are classified as premature or preterm by
the AAP.
• Approximately, 12% of infants are born preterm
each year.
• Preterm infants tend to weigh less than term
infants (<2,500gm) and are considered LBW.
Cont., Low-Birth-Weight Infants
• The digestive, metabolic and excretory systems of
these infants are less mature than those of term
infants, and require special care.
• Optimal nutrition that meets the special nutritional
needs of LBW infants to achieve post-natal
growth that approximates intra-uterine growth
without placing undue stress on under developed
body systems, often creates a dilemma.
Low-Birth-Weight Formulas
•
LBW formulas must be designed to address
the most important problems impeding optimal
growth in LBW infants:
• LBW infants may not have a fully active sucking
reflex, making breast feeding impossible.
• LBW infants have a limited capacity to consume
high volumes of formula, and are incapable of
complete digestion and absorption.
Cont., Low-Birth-Weight Formulas
• Fat absorption in the intestine is less efficient, as
bile salts concentrations are reduced.
• LBW infant’s inability to properly absorb, digest,
and achieve metabolism of food has severe
implications.
• The renal system and liver are not fully developed:
– Immature liver: reduced glycogen storage.
– Less developed kidneys will not be able to obtain
normal absorption mechanisms.
Cont., Low-Birth-Weight Formulas
• Excessive concentrated feedings are not welltolerated.
• RSL must be kept within manageable limits.
• LBW formulas must be fortified with extra
calcium, magnesium, phosphorus, and LCPUFAs
to meet the special nutritional requirements.
• Whey is predominant, CHO mixture, additional
calcium and phosphorus is needed
supplements
The need for vitamin and mineral supplements
Breast fed full term infants
-vitamin D
-Iron (after 4-6 months)
Formula fed full term infants
Preterm infants
Potential problems with infant
formulas
• Diarrhea: can lead to failure to thrive or
dehydration. Improper dilution or preparation of
the formula
• GI problems: hypersensitivity to cow milk
proteins, GI distress
• Tooth decay: bottle feeding beyond 1 year, caries
Infant formula preparation
TIPS IN BOTTLE FEEDING
Choosing the right bottle: variety of types, selection of the appropriate
volume
Choosing nipples or teats:
Type of teat: rubber latex, or silicon
Shape: Orthodontic- type, nubbin-type
Nipple hole
Sterilizing
After a feeding, thoroughly rinse the bottle and nipple under warm water and
leave them on a clean towel by the sink, ready for your next sterilizing
session.
Wash all the equipment in hot soapy water, rinse thoroughly in hot water, and
remove the milk scum with a bottle brush.
Pad the bottom of a large pan with a towel or dishcloth. Immerse open bottles,
nipples, and other equipment in the pan (place bottles on their side to be
sure that they are filled with the sterilizing water) and boil for ten minutes
with the pan covered. Allow to cool to room temperature while still
covered. Remove the bottles and nipples with tongs or a spoon and place
the bottles upside down on a clean towel with the nipples and caps
alongside. Let the equipment dry.