Transcript infant formua products

INFANT FORMUA PRODUCTS
Introduction
• Human milk is most physiologically suited
to infants
• Optimal source for feeding infants till 12
months
• Human milk is the only source of nutrition
till 6 months of life.
• For infants whose mother cannot or will not
breast feed them, alternatives are needed
Infant Formula Products: Introduction
Infant physiology and growth: GI and renal systems
GI maturation
Second trimester of pregnancy: all segments of GIT are
formed
Third trimester; maximal GI growth and differentiation.
Preterm infants (before 32 weeks of gestation)
Transition from intrauterine to extra uterine feeding
requires maturation of many physiologic processes,
e.g….
Nutritive sucking: 33-34 weeks of gestation. No
problem in term infants, but in premature,,,,,
Preterm (before 34 weeks) cannot coordinate sucking,
swallowing and breathing
Definition of Premature Birth
􀂃 The WHO and AAP define premature birth as the
delivery of an infant before 37 weeks of gestation.
A full term infant: 37-42 weeks of gestation
􀂃 The NCHS of the CDC generally reports data
on three categories of preterm birth:
1. Overall preterm, less than 37 weeks
2. Moderately preterm, 32 and 36 weeks
3. Very preterm births, less than 32 weeks
• Early infancy:
- Liquid nutrition only: poor coordination of
complex tongue movements and swallowing
- Frequent feeding: limited stomach capacity:
20-90 ml at birth, 90-150 ml at 1 month
- Term infants: gastric and pepsin secretion
peaks at 10 days, in preterm basal acid
output is low
- Milk in the stomach increases pH, poor
pepsin activity
- CHO digestion: lactase, sucrase, maltase,
isomaltase, glucoamylase are mature.
Lactase activity may be immature in
premature infants.
- Pancreatic amylase is low in full term
infants, till 1 year of life. Salivary amylase
may compensate for that
- Low pancreatic lipase concentration, bile salt
synthesis is low, lingual and gastric lipases
compensate
- Protein digestion and absorption are mature
• Kidney maturation:
Ability of the kidney to excrete solute load
Glomerular filtration starts in the 9th week of
fetal life
GFR increases after birth and reaches adult
level at age of 3
Growth:
-Average birth weight: 3.5 Kg
-Premature infants: LBW: less than 2500 gm
-VLBW: less than 1500 gm
-6-10% weight loss after birth
-Weight gain: 20-25gm daily till 4th month, 12gm/day
for the coming 8 months
- Double the weight by 4 months and triple by 12
months
-Changes in body composition occurs as well: at
birth, total boy water is 70% and decreases to 60%
at 1 year. Adipose tissue increases
Normal values are expressed as percentiles: see
growth charts
Introduction, cont.
Nutritional standards
- Acceptable growth needs a balance between adequate intake:
absorption and utilization of energy.
- Recommended Dietary Allowance (RDA), energy requirements
- Components of a healthy infant diet
1. Fluid:100ml/kg per day for the first 10 kg + 50ml/kg for each
additional kg. Water intake in the first 6 months is derived from
breast milk or formula
2. CHO: 40-50% of total calories. Should be balanced with fat intake
to allow better development.
Lactose is the primary source.
Lactose intolerance: lactase deficiency
Congenital lactase deficiency is rare
Secondary lactase deficiency: in some cases of gastroenteritis
Introduction, cont.
3. Protein and amino acids: 2.2gm/kg/day (birth-6 months),
1.6gm/kg/day (6-12 months)
Composition
-Essential a.a.: isoleucine, leucine, lysine, methionine,
phenylalanine, threonine, tryptophan, valine
-Conditionally essential a.a.:cystein, taurine, tyrosine, histidine
4. Fat and essential fatty acids
-Most dense source of calories in the diet
-Supplies 40-50% of the energy intake of infants
- Essential PUFA: Linoliec acid, linolenic acid: precursors for LCPUFA:
DHA and ARA
5. Micronutrients
-Vitamins
-Biotin, choline, inositol
-Minerals: calcium, phosphorous, Iron, zinc, copper, manganese
Milk production
Lactating mammary gland:
 Branching network of ducts formed of epithelial cells ending in
extensive lobulo alveolar clusters that are the site of milk secretion
 Alveoli are surrounded by myoepithelial cells that function in milk
ejection, and a vascularized connective tissue containing adipocytes
and fibroblasts
 Ejection of milk requires contraction of the myoepithelial cells
stimulated by oxytocin
Lactating alveolar cell: highly active secretory cell
- numerous mitochondria
- Extensive rough endoplasmic reticulum
- Well developed Golgi apparatus
- Epithelium is connected by tight junctions
- Basal side contacts myoepithelial cells and the basement mem