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Formula development

Formula development appears to be proceeding in several direction. Studies are being dirested to improving the immune qualities of animal milks,for example by immunzing cows with specific antigens. Some attempts also are being made to introduce non-specific immune factors.

Breast milk composition is being studied vigorously. It appears that breastfed babies grow equally rapidly on lesser calories than bottle-fed babies, leading to queations regarding specific growth factors in human milk, or other physiological or nutritional components including substances,uniguefatty acid distributionn, andeven minor carbohydrate constituents.

Better foods for prematurely born infants are being sought. While it is recognized that low birth weight infants have unique requirements and that these requirements may change with maturity, it is also known that prematures grow well when fed their own mother’s milk (12). However, it is frequently difficult to maintain this source of nutrients, and substitutes must be available. Electrolyte and mineral imbalances are not incommon in fants fed avialable formulas. Other illnesses, such as retrolental fibroplasia, may be affected by nutritional manipulations. Taurine, present in human milk, is low in many formulars and may be essentail to premature infants (13).

When may have more allergenic proteins, particularly lactoglobulins, than casein. Attempts to denature these proteins are not entirely successful. Other proteins may be used as a basis for formula development. Soy protein has been used, but has been found to be as allergenic as cow’s  proteins. Meats and other vegetables as well as changes in techniques of preparation of proteins are being studied. Stuied. Vegetable sources are deficient in carnitine (14) which may be necessary for better utilization of fats.

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Breast milk substitutes

Some mothers cannot nurse. For their infants, substitutes nust be found. Trends in the area of formula development are varied.

Formulas have traditionally been based on the milk of some other mammal. In the United States, the milk most commonly use is that of the cow. Empirically, formulas were developed using whole or evaporated milk, sugar,and water. Even affter sterility, e.g.  boiling, evaporated, condense ,or acidified, was achieved problems became obvious. The high phosphorus content of such formulas led to seizures (4). Factors in the milk,including is low iron content, led to anemia. The high protein content was associated with azotemia (5). The high electrolyte content led to dehydration or hyperelectrolytemia. Its butterfat was rather poorly absorbed (6), and frequently led to diarrhea. The carbohydrate that was added was usually not lactose, and this led to decreases in absorption of some nutrients (7). In order to preserve sterility, excess sugar was added in condensed milk, and led to protein deficiency, or lactic acid (8) was added and was associated with infantile acidosis.

At the same time that these changes were occurring, the importance of vitamins was recognized and vitamins C and D were  added, resulting in elimination of rickets and scurvy. More recenty, the importance of iron and zinc were recognized, and the addition of these has led to a decrease in incidence of deficiency of these elements.

In the past 30 years, formulas which more closely approximate the composition of human milk. The protein content has been decreased to about 1.5g/dl. The butterfat has been removed and vegetable oils added. These not only supply essential fatty acids, but also improve fat absorption. Casein, Which is low in sulfur- containing amino acids, has been reduced and whey proteins increased in ratio similar to that in human milk. Lactose has been added as the only supplemental carbohydrate. Formulas are fortified with iron, zinc, and multiple vitamins.

Futher changes in formulas can be expected as analyses of breast milk and breast fed infants continue. Recent studies indicate that the caloric consumption of many breastfed infants is considerable less than previously documented (9). The factors responsible for the metabolic efficiency of the breastfed infants if found should lead to applicability not only to infants but to others.

Supplemental food

With the wider use of formulas in past, supplemental foods were introduced at younger and younger ages. Part of this practice was due to the recognition formulas then available were probably deficient in trace nutrients. Part was akso due to a developing fad. The early introduction of supplemental foods is frequently associated with discontinuance of breast or formula feeding. Whole cow’s milk is then substituted. Because of its ease of administion, it may be offered as a beverage without realization that it is a food. It then is consumed in excessive amounts leading to deficiencies of certain nutrients like iron and zinc, and in some children anemias may be responsible for learning difficulties and irritbility (10).

With better studies of neurophysiological development,(Table 1) the trend at present is to withold supplements in either the breast- or bottle-fed infant until 4-6 months (11). Not only is the swallowing mechanism better developed, but in the allergic reactions infant, breastfeeding benefits are prolonged

Posted 30 August 2009 † admin § Infant Food Intake ‡ Comments (0) ° Tagged:

Trends in infant feed in U.S.

ABSTRACT  Infant feeding practices in the United States , as elsewhere, continually undergo re-evaluation, to improve the health and well being of infants and to aviod,if possible, deleterious habits in later life. 15 years ago. It was estimated that 15-25% of infants were breastfed compare with 60-80% now. Formula-fed infants are fed almost entirely a cow’s-milk based iron fortified formula, which similates as closely as possible the composition of human milk, until about one year of age unless they have varied diet, limited whole milk, and liberal amounts of iron-containing foods.Breast milk composition is being studied vigorously. Low birth weight infants are fed their mothers milk. Soybased firmulas have wide use in the US.It is recognized that allergies are almost as common with this thus producing renewd interest infurther processing. Supplemental foods are first given at 4-6 months. As more is learned about human milk, it is expected that formulas will be made with other changes to accommodate those infants of mothers who cannot nurse.

Introduction

Infant feeding practices, like nutritional practices in adults, constantly change. Some of the changes are based on newly abtained properly controlled scientific information. Some of the changes are dictated by economic constrains, availability of foods, social conditions, and time available to harvest and prepare foods. Many of the changes are fads based on skimpy or non-existent information.Everyone eats and everyone can be a self-appointed nutrition expert, in areas where time and food availability are lesser problems. Giving nutritional advice, particularly as a treatment for serious illnesses, has become a very lucrative though frequently unjustified, feld of endeavor.

Changes have occurred in infant feeding practices in the US, and many of these  appear based on sound statistical principles.

The most striking chang is the gradual return to breasfeeding at least for yhe early months. 15 years ago it was estimate that 15-25% of infants were breastfed, even for short periods. Today, this number approaches 75% (1) The advantages of breastfeeding to the intant include a decreased incidence of infections, and particularly of the mother is healthly and well fed, assurance that almost all nutrients will be supplied to the infant (2). Allergies appear to be decrease or ameliorated (3).

Posted 29 August 2009 † admin § Infant Food Intake ‡ Comments (0) ° Tagged:

energy untake

To answer this question, 37 children of 2-3 year old in nursery B were studied for 10 months on the effect of supplementation of protein upon the changes of their physical measurement, urine creatinine excretion, blood hemoglobin as well as N-balance(only 10 children, 6 experimental and 4 control, took part in the N-balance test). All children were given the same basic diet of the nursery. A high protein food in the form of biscuit, containing 10 g of protein, was given to one half of the children, while the other half was supplied with a starchy biscuit, which gave the same amount of energy with very low protein content. The average daily energy and protein intake of the experimental group were 1200 kcal (84kcal/kg)and 40.0g (2.8g/kg)per child respectively, while that of the control group were 1196 kcal (83 kcal/kg) and 32.7 g protein(2.2g/kg)per child.The energy intake of both groups were about 93% of the RDA and the protein intake of the experimental and control group were 96% and 78% of the RDA respectively. In order to avoid the influence of other nutrients, Calcium, vitamin A,D,B2 and C were supplemented to the amount of that of the RDA . The results showed: 1) the gain of weight and height, skinfold thickness,midupper arm cirumference and bone age had no significant difference between the two groups (Table 4) ,2) at the end of the study, the out put of urinary creatinine of the expermental and control group in 4 hours were 39.8+- 11.5 and 38.9+- 8.6mg, respectively.The difference was not significant, 3) the average value of blood hemoglobin of the two groups were practically the same. The experimental and control group were 12.5g/dll and 12.2g/dll,respectively,4 )N-balance study showed that average N intake per child per day in the experimental group was 434+- 34.2 mg and that of the control group was 342+-22.7mg (Table 5). The difference was highly significant.The avervge daily N retention of the intake were 7.8% and 4.9% of the intake in the experimental and control group, respectively. The difference was not significant.

It is interesting to note that the energy untake pf both groups go up from the orginal level 81% to 93% of the RDA. Since protein in not the limiting factor, the supplemention of other nutrients may be responsible for the increase in energy intake. In order to make sure of this , more observations on the energy intake of these children were carried out.

18 children of 2-3 years old of nursery B were selected for the observation in 16 weeks . All children were supplemented with calcium, vitamin A,D, B2 And C to the amount of the RDA. By introduction of sme hight energy foods such as butter, sugar, jam etc, or some protein rich foods such as egg and soybean products to the diet, to see the changes in energy intake if the children.

The results showed that there was no significant changes in energy intake by introduction of these high density foods. The energy from protein varies from 10.5% to 13.5% of the total energy. The experimental children took about 991-1245 kcal per day, with an average of 1154 kcal per day. It ia about 90% of that of the RDA, same as that taken by the children in nursery A, and was higher than that of the other children in the same nursery, who were not supplemented withcalcium and vitamins During these period of observation, the growth rate of these children were withih normal range.

Conclusion

So the conclusion may be that the amount of energy intake of the nursery children, up to the level of 90% of that of the RDA is adequate. The less intake of energy of children in nursery B, and also the failure in growth of the children is the result of inadequate amount of intake of many other nutrients, except protein. As far as the food patten in concerned, the lack of milk in the diet may be the main cause . So, to provide a balanced diet to the children is of prime importance for children in the nursery.

Now in Bejing, a reference figyre of the amount of different kinds of foods which should provide to the nursery children have been worked out, and have been worked out, and have been recommended to the nurseries by the Department of Woman and Child Health of the Bureau of Public Health of  Bejing.

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Result and discussion

Nursery A

The nutrient supply nursery A seems quite good, for the weight and height of the children of this nursery gradually rose from a lower level to that of the average value, that is about 100% of the average value (Table 1) The energy and protein intake of the children were quite constant. This means that this amount of energy and protein taken were sufficient for the children to follow the lower value of the weight and height at the beginning and gradually rose to the higher level at the end, while the energy and protein intake were almost the same , was considered to be due to the unfavorable background in their health and nytritional status, and a change of food pattern during the experimental period. For instance, the animal food intake had raised from 20g per day in the first year to 33g and 44g day in the second and third year, respectively (Table 2). The animal protein intake as its percentage of the total protein intake had also raised from 24 to 36 and 40, respectively (Table 3). So the diet in the later part of the experimental period is presumably adequate fr these children.

Nursery B

On the other hand, the diet in nursery B was apparently not adequate for the children to follow the normal growth curves, because at the end of the experimental period, the body weight and height of the children were still far below that of average value.As still far below that of the average value.As stated above, there was some some improvement in body weight and height, but it still could not attain the average value at the end.

The dietary surveys showed that the average energy and protein intake of the children of nursery A were about 90% of that of the RDA, that is near 90 kcal and 2.8g protein per kg of body weight (Table 3).That of the nursery B were about 83% and 75% of the RDA, respectively. Children in these nurseries were encourage to eat as much as they can , so the amount of foods intake is not a man made effect, at least the main reason is not due to the restriction of the foods. The protein score of the diet of nursery A and B were 76 and 60, respectively. The intake of all the nutrients, except ascorbic acid, by the children of nursery B as calculated were lower than those of the nursery A (Table 3). The main difference of the foods taken by the children of the two nurseries was that in nursery A, the diet contained about ¼ kg milk per child per day (Table 2), while in nursery B there was no milk at all.

Additional informations have been obtained from some other short term nutritional surveys, In nursery C, D and E (3), the nutrients intake that of nursery A, but the body weight and height of the children of these nurseries were no better than that of the nursery A. So the conclusion must be that the diet pattern abd the amount of nutrients provided by nursery A are adequate for normal growth, and the increase in nutrients intake do not further improve the growth of the children.

Are the lower intake of protein responsible for the low body weight and height of the children in nursery B ?

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Future in infant feeding

Breasfeeding, however,is not completely instinctive in human. To a great extent it has to be learned and for its successful continuation most breastfeeding mothers also need encouragement and active  support. In all Asian Countries, breastfeeding is still common, especially in rural areas. Nevertheless, the signs of a decline and short duration have been observed. Malnutrition is today the most widespread and serious problem affecting young children. The first year of life is ceucial in laying the foundation of good health.

It is a campaign on the promotion of breastfeeding to which WHO,UNICEF and all Asian countries are now commited. Many nations have now adopted measures based on the 1981 Would Health Assembly’s International Code on the Marketing of Breas Milk Subtitutes and many manufactures of infant formula have begun to change their marketing practices towards an accordance with the Code.

Food supplement, the intervention to get more food to undernourished is almost certainly the cost-effective single point at which to reduce the incidence of low birth weight and infant deaths.

Ensuring that the breast fed infant recives nutritous multimixed from the age of 4 months onward which should consist of locally available, culturally acceptable,inexpensive dishs, suitable for the feeding of young infants,with an adequate blend of protein of good quality and sufficient calories,as well as needed vitamins and minerals.All countires in the region have their own reseach and implement on Home Based Supplementary Food. In some countries,They have used food subsidies as one of the mean doing so.

Finally I would like to end my presentaion with the theme of the Fourth Asian Congress of Nutrition Better Nutrition Better Life and infant feeding is starting point.

The adequate level of energy and protein intake of the children in nurseries(2-3 years)

ABSTRACT  Observations on the nutrient intake and physical growth of the children in 2 nurseries A and B had been conducted for 3 years. The results showd that when the energy and protein intake of the children in nursery A were about 90% and 80% respectively of the RDA, i.e., about 90kcal and 2.8 g protein per kg body weight per day, the body weight and height reached the normal average value.When the energy and protein intake of the children in nursery B were 83% and 75% respectively of the RDA, the body weight and height were lower than normal. The intake of other nutrients, except ascorbic acid, were lower in nursery B than A. Supplementation of a protein rich food to the children in nursery B showed that low  energy intake and delaved growth, and the lack of other minor nutrients may be the real cause.

Introduction

Most of the young mothers in our country have work to do, so they have to send their babies to the nurseies. Factories, educational or other institutions or people’s commune have their own  nurseries.Babies from 6 months to 3 years old are admitted by the child institutions.

Children affer one year old usually take 3 meals and one snack a day in the nursery, so the quantity and quality of the foods afforded by the nurseries are of first importance for the normal growth and good health of the children. Investigation on the composition of the diet and nutrients intake was made for the purpose of establishing a reference standard.

Method

The relationship between nutrients intake and body weight and height

After a number of nutritional surveys conducted in many nurseries in Bejing, two were selected for the observation of the relationship between nutrients intake and the health of children, as reflected by the growth rate. Nursery A represented those nurseries where the children have comparatively higher level of nutrient intake,and nursery B represented those  nurseries where the children have lower level of nutreint take due to lower boarding expense. The children in these nurseries were 2-3 years old. Dietary surveys in these two nurseries were conducted for three years, and body weight and height of the children were recorded at three minth interval.

The levels of nutrients intake were expressed as the percentage of the amount of recommended dietary aloowance (RDA)(1) of every particular nutrient. The results of the body weight and height of the children were expressed as the percentage of the average values from a survey conducted by Professor Chin of Bejing Medical College in 1956(2) on selected children of good nutrtional status.

Posted 26 August 2009 † admin § Infant Food Intake ‡ Comments (0) ° Tagged:

Bottle feeding

Among yhe poor urban and unskilled working mother, economically, it is impossible for them to properly manage bottle feeding. Sweetened condensed milk has been wiedly used instead of infant formula. If the infant formula is used it is prepared too dilute.

Supplementation and weaning

The introduction of food other-than breast milk reflects both cultural and economic differences. Early introduction of semi-sold food is very common among rural families in Thailand, Indonesia, China and Burma. Chewed rice,rice paste or gruel or banana are usually given to the baby. It is customary in Thailand to give the baby thick, sold feeda as a supplement to breast milk at an early age.If supplemental feeding is started within the first three months of life almost invariably consists of a mixture of mashed a chewed boiled rice and banana, especially the cheap and easy to get banana of kleuy namwa(Musa sapientum) variety is used for this purpose. When supplemental feeding is begun at a leter age there is more choice; vetetable soup, egg yolk, meat broth and the like; these are given together with the rice, and other fruits are offered in combination with banana. At the age of about one year,the supplement will consist of the family food, but for the baby it is always wellminced and left unseasoned.

In the Northern and Northeastern part of the country, the rice consumed is glutinous rice(Oryza glutinosa), in the Central and Southern part it is Oryza sativa (Table3). In the Southern part the first solids introduced sometimes consists of a thick cornflour porridge, called sojee, but with this too, banana is also given. Over all about 40% of the babies receive solid foods at the age of one month and about 60% at three months. In the Northern and Northestern part supplemental feeding with solids is frequently introduced early as the first week.

Supplemental feeding in the first week of life stands more chance of doing harm than of serving any useful purpose, and therefore it should be avoided. In general, amylase activity in the duodenal fluid of young infants during the first one or two months of life, is so low that it is almost unmeasurable, however it gradually increases as the child grows older. The study of the glucose level in the blood of infants, aged one to three months, whose regular food intake includes rice and banana, evidently increases after rice soup is given instead of milk. The result indirectly indicates that amylase activity in the intestines of those children increases in reponse to the stimulus of the early introduction of rice or banana(6). A study of the composition of carbohydrate in the ripe banana (Musca sapienta) shows more mono and disaccharide than starch (Table 4). The amount of starch in rice that is converted to sugar after being chewed for 5 minutes is 12.82% in the case of plain rice and 19.2% for glutinous rice (Table 5). The study of showed that the introduction of rice and banana at the age of one month did not do any harm from a digestive point of view. However, food supplement should not be given to the very young infant because it would reduce the sucking activity of the infant and this would lead to a decrease in the secretory function of mother’s breast. Beri-beri is common among pregnant and lactating women in the North and Northeastern part due to the fact that fresh food is taboo and the basic, common food: fermented fish contains thiaminase. The amount of banana which is given to the young infant varies from about 50-100 g. its universal use as a food in early infancy may well furnish the explanation why, in a country where beri-beri is so common, clinical infantile beri-beri is  fairly rare(7).

WHO collaborative study on breastfeeding in India and Sri Lanka showed that complementary feeding occurred as late as one year. In Sri Lanka, the delay is often due to a ritual rice eating ceremony which is traditionally arranged around the eleventh month. There is therefore reluctant to offer rice earlier(8).

When the child approaches the weaning age (from the age of 4 months onward),  the infant receives the local weaning foods vary from country to country. Almost of the traditional weaning foods are insufficent calories and inadequate essential nutrients, especially protein and fat as well as needed vitamins and minerals.This is the cornerstone for preschool malnutrition in Asia.

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Cultural food restriction

During pregnancy and lactation food restriction is common in various parts of Asia.The malnourished mother shows lack of knowledge on how to breastfeed ger infant which could lead to an inadequate supply of breast milk.

Malnutrition in infants and young children cannot be separeted from malnutrition and poor health in women. The mother and her infant form a biological unit; they share also the problem of malnutrition and ill health, and whatever is done to solve these problems must concern them both together.

Infant feeding

Breastfeeding

In general, breastfeeding is still traditionally practised in all Asian countries although it varies from country to country. The majority of mothers in rural areas nurse their babies until 1-2 years. In ueban areas, the breastfeeding practice is decreasing. Different studies have all documented a decline in breastfeeding as a resolt of urbanization. Breastfeeding duration has been shown to be short among educated mothers and those who work.

Weaning from the breast is as early as two weeks or as late as 1.5 years. From the studues of weaning practices, the reasons for weaning are inadequate milk flow or not suitable, doctor’s advice to bottle feed, social activities, and the marketing of infant formula. Other factors also mention the lack of transport for the mother to the day care center or no day care center in the factory,tradition use of prelacteal feeds(honey,mashed banana, chewed rice), prelacteal feeds(infant formula) given in hospital, separation of mother-child contact after delivery, indifference of hospital staff who unawere of the importance of early mother-child contact(5).

Despite the fact that breastfeeding practice is high among rural population, the nutritional status and food intake of lactating mother was not well enough to produce adequate  milk for the growing infant. However the amount of breast milk secreted is about 2/3 of normal amount in most mother (500-600ml).

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Protein-energy malnutrition(PEM)

About 60 to 70% of deaths in infant and children under the age of 5 are caused by diarrhea, pneumonia and immunizable diseases. Contributing to and underlying all of them is malnutrition. The magnitude of malnutrition in Asia and Middle East is shown inTable1 (2). Severe and moderate froms of PEM ranged from 20 to 80 percent of preschool children.

A recent surveillance data in Thailand by the Ministry of Public Health of preschool childern all over the country is shown in Table 2(3). The prevalence of PEM is strikingly high.

The report of United Nations; Economic and Social Commission for Asia and the Pacific (ESCAP) on review and Appraisal of Environmental Situation in the ESCAP Region (4) stated : impairment of human health is a widespread and common problem which occurs owing to both lack of development and development process itselt. Lack of basic community facilities, including sanitation, drinking water supply and primary health care as well environmental pollution (of air, water and soil) due to municipal, industrial and agriculture activities, are the major causes of the problem. Mortality and morbidity rates due to water and soilborne diseases are significant higher in many developing countries of the region such as Bangladesh, India, Pakistan, Sri Lanka and Viey Nam. In addition, debility due to malnutrition and continuous scikness is also causing a severe lack of human efficiency, although it is very difficult to quantify this problem.

Other nutrient deficiency

Though  PEM is considered the most important nutritional problem in Asia, other major nutrient deficiences can not be disregarded. The impairment of health status or even disability and death may occur as a result of such preventable cause. These include iron deficiency anemia, vitamin A deficiency, beri-beri, iodine deficiency goiter, bladder stone disease and riboflavin deficiency.

Pregnant and lactating women

Twenty to thirty percent of pregnant women are estimated to be anemic, an anemic in pregnant women is related to low birth weight and preterm infant. A 1975 national survey by the Ministry of Public Health, Thailand showned in fact the food intake of protein in compare with the recommendation of 2,100 calories and 67 grams of protein for pregnant women and 2,100 calories and 87 grams of protein for lactating women.

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Health status

Nowadays, the nutrition of infant and children is assumed a new significance with the realization that the feeding of this age group may have a marked influence on its health as adults. The long-term consequences of nutrition in early life may derive from both the quantity and Quality of the various nutrients. The oung cinsumers, as well as from the attitude and behaviors, engendered by their parents and process of eating and constituent of diet.

For generations,malnutrition was the common nutritional problem in very country. In reent years, food has become relatively abundant in the economically developed countries; obesity has become much more prominent. In 1979, some 15 million children around the world were expected to die of causes related to defective nutrition. Malnutrition is probably one of the most important health problems in developing countries.

Asia, the greatest land on earth, has been the center of the most ancient civilizations and the great religions of the world. In it, there is over half of the world population. The children in Asia, under 15 years of age, I shall omit any reference to Japan and Singapore, ehose disease patterns and mortality statistic now resemble those of Western Countries, constituted 40-45 percent of total population and those under 5 years constitute 15-17 percent of population. It is interesting to know that 70-80 percent of  population live in rural area. Although developing countries are still predominantly rural, the urban sector enlarges fast; slums and shanty town are still growing faster than the cities which they are linked, and usually consisted of young population. Slum clearance is not proved to be a practical and successful solution, pratly because of the high cost and partly because of inability to meet the needs of slum people or significantly control the spread of slums.

Health status

For infant and young children, the health status is very closely related to the environment in  which they live. The 1982-83 State of World’s Children report by James P Grant, Executive Director of the United Nation Children’s Fund (UNCEP)(1) state; “Today, an invisible malnutrition touches the lives of approximatedly one quarter of quietly steals away their energy; it gently restrains their growth; it is gradually lower their resistance. And in both cause and consequence it is inextricable interlocked with the illnesses and infections with both sharpen, and are sharpened by, malnutrition itself.”

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