Search Results (58)

Background/Objectives: Preterm infants are at high risk of extrauterine growth restriction and suboptimal neurological development due to cumulative nutrient deficits. Standard fortification (SF) of human milk does not account for individual macronutrient variability, potentially leading to inadequate intake. Target fortification (TFO) adjusts supplementation based on the measured macronutrient content, aimed at providing macronutrient intake aligned with ESPGHAN (European Society for Paediatric Gastroenterology, Hepatology and Nutrition) recommendations and optimize growth and development. This study aims to evaluate the effects of TFO compared to SF on growth, body composition, and neurological outcomes at 18 months corrected age. Methods: In this double-blind, randomized controlled trial, preterm infants (<30 weeks gestation) received either SF or TFO for at least three weeks. Macronutrient levels in breast milk were analyzed three times per week, with modular adjustments in the TFO group. Growth parameters, body composition at 36 weeks postmenstrual age, and Bayley Scales of Infant and Toddler Development III (BSID-III) scores at 18 months corrected age were assessed (n = 69). Results: TFO significantly increased protein, fat, and carbohydrate intake compared to SF, leading to higher weight gain (2514 ± 289 g vs. 2283 ± 332 g, p < 0.01) and growth velocity (21.7 ± 2.3 g/kg/d vs. 19.2 ± 2.2 g/kg/d, p < 0.001). In infants whose mother’s milk had low protein levels, fat-free mass was significantly higher with TFO compared to SF. BSID-III scores were higher in the TFO group across cognitive, language, and motor domains, with significant improvements in expressive language scores in infants whose mother’s milk had high protein levels (p < 0.05). The number of preterm infants with a motor BSID-III score of ≤70 was significantly lower in the TFO group compared to the SF group (0 vs. 3, p < 0.05). Conclusions: TFO enhanced growth and body composition and may support better neurological outcomes in preterm infants. While most BSID-III differences were not statistically significant, the data suggest that TFO may reduce the risk of developmental delays. Larger, multicenter trials are needed to confirm these findings. Full article

Background/Objectives: Optimal feeding regimens for preterm neonates, including the role of multi-nutrient fortification, are unknown, leading to large practice variation in comparing different feeding regimens that include fortification and their impact on outcomes for preterm infants. Methods: Using a network meta-analyses design, two reviewers independently extracted data. A Cochrane CENTRAL, Medline, Embase, and CINAHL search was conducted for all studies published up to 27 June 2023. Randomized clinical trials of feeding regimens for preterm infants that included multi-nutrient fortification were included. Outcomes were mortality, necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), sepsis, periventricular leukomalacia (PVL), bronchopulmonary dysplasia (BPD), time to full enteral feeds, and the Bayley II MDI developmental score. Results: Fifty-nine studies were included. For mortality, NEC, and time to reach full enteral feeds, the top-ranked treatment class was the mother’s own milk with donor milk and a human-milk-based fortifier. For ROP and BPD, the top-ranked treatment class was mother’s own milk with a phosphorus fortifier. For sepsis, the top-ranked treatment class was mother’s own milk with formula. For PVL, the top-ranked treatment classes were mother’s own milk and mother’s own milk with donor milk and a bovine fortifier in the two disconnected networks. For the Bayley II MDI score, the top-ranked treatment class was mother’s own milk with formula and bovine fortification. Conclusions: Treatment rankings are consistent with the underlying hypothesis that increased mother’s own milk intake appears to be associated with better clinical outcomes. This review provides the first global view of interventions and highlights insufficient high-quality evidence to support or refute one fortification feeding regimen over another. Full article

The growing popularity of a diverse range of plant-based beverages is entrenched in promoting health functionality and addressing ethical and environmental concerns. These beverages offer similar physico-chemical attributes to animal milk and are prepared using plant-based ingredients, such as soy, oats, almonds, rice, chickpeas, sesame seeds, and coconut. These beverages have many nutritional benefits but are deficient in certain nutrients such as essential amino acids, minerals, vitamin B12, vitamin D, and omega-3 fatty acids. Fortifying these beverages with deficient nutrients could effectively provide comprehensive and nutritionally balanced product options. This approach could be useful in improving the nutritional profile of plant-based beverages to meet the expectations of health-conscious consumers. However, fortifying these products poses challenges related to taste, stability, and ingredient sourcing. Omega-3 fatty acids are crucial for human health and provide numerous health benefits, such as improved heart and vascular health, reduced inflammation, and the prevention of various health conditions. As plant-based diets gain popularity, the demand for nutritionally balanced products is growing, making omega-3 fortification a strategic approach for businesses to tap into an expanding market of health-conscious consumers. However, it is important to consider individual needs about health and ensure regulatory oversight to ensure the safety and effectiveness of fortified plant-based products. This article provides an overview of emerging plant-based beverages, their comparative nutritional profiles, the need to improve the nutritional value using omega-3 fatty acids as an example, and challenges in omega-3 fatty acid fortification. Full article

Background/Objectives: Very preterm body composition at term shows potential as a biomarker of later health outcomes, but effects from in-hospital formula versus human milk (HM) (maternal milk (MM) and/or pasteurised human donor milk (DM) supplement) intake studies are confounded by the effect from the fortifier. We investigated the impact of in-hospital unfortified HM (UHM), fortified HM (FHM), and preterm formula (PTF) intake on very preterm body composition at term. Methods: Preplanned analysis of the PREterM FOrmula or Donor milk (PREMFOOD) trial: Infants born at <32 weeks were randomised to either (i) UHM, (ii) FHM, or (iii) MM and/or PTF supplement. Main outcomes were assessed by anthropometry and magnetic resonance imaging of body composition at term. Secondary comparison between groups defined by proportion of milk intake from birth to 35 weeks postmenstrual age: The groups comprised exclusive UHM (ExUHM, proportion of UHM 99–100%, n = 23), predominantly UHM (PrUHM, UHM 50–98.9%, n = 15), predominantly FHM (PrFHM, FHM > 50%, n = 17), and predominantly PTF (PrPTF, PTF > 50%, n = 7). Results: At term, compared to the ExUHM group, the PrPTF group had 274.3 g (95% CI: 30.1 to 518.5) more Non-Adipose Tissue Mass (NATM) and a 1.11 times (95% CI: 0.38 to 1.84) greater increase in weight z score from birth, while both PrPTF and PrFHM had greater increases in length z scores from birth. Conclusions: High formula intake was associated with maximal gains in NATM at term, and these gains were not matched by the early fortification of HM. The alteration of body composition at term with prolonged or delayed HM fortification and its relation to later health outcomes are important research questions. Full article

Background: Zinc is an essential trace element that is crucial for numerous biological processes, including protein synthesis, antioxidant activity, and bone calcification. Preterm infants are at high risk of zinc deficiency owing to inadequate zinc stores at birth and the rapid decline in zinc concentration in breast milk. This study aimed to evaluate the relationship between zinc concentrations in breast milk and zinc supplementation in preterm infants. Methods: A prospective observational study was conducted at Showa University Hospital, enrolling preterm infants born at less than 32 weeks of gestation or with a birth weight of less than 1800 g. Serum zinc levels, breast milk zinc concentrations, and zinc acetate supplementation were analyzed. Results: The results indicated an inverse correlation between breast milk zinc concentration and the required zinc supplementation dose. Infants receiving high-dose zinc supplementation (≥3 mg/kg/day) had significantly lower breast milk zinc concentrations at 2, 4, and 5 weeks postpartum. Conclusions: These findings highlight the need for individualized zinc monitoring and supplementation strategies to prevent zinc deficiency in preterm infants. Considering the absence of zinc in human milk fortifiers in Japan, aggressive zinc supplementation may be necessary to ensure optimal growth and development. Full article

Fortified human milk is the first choice for preterm infants. Although individualized fortification is recommended, the optimal method for this population remains uncertain. We conducted a comparative study assessing the growth effects of adjusted (AF) and targeted fortification (TF) in extremely low birth weight (ELBW) infants. This single-center, randomized, controlled clinical trial was conducted at a tertiary neonatal unit in Spain. Eligible participants were premature infants with a birthweight of <1000 g exclusively fed with human milk. A total of 38 patients were enrolled, 15 of them randomized to AF group and 23 to TF group. AF was based on blood urea nitrogen (BUN) concentration and TF on human milk analysis. The primary outcome was weight gain velocity (g/kg/day). No significant differences were found in weight gain velocity at 28 days, at 36 weeks of postmenstrual age, at discharge, nor during the intervention. Protein intake was significantly higher in the AF group (5.02 g/kg/day vs. 4.48 g/kg/day, p = 0.001). No differences were found in the lipid, carbohydrate, and energy intake; in the weight z score change between the different time points; nor in the length and head circumference growth. Both AF and TF are comparable methods of fortification and provide the appropriate growth rate in ELBW infants. Full article

The milk fat globule membrane (MFGM) contains bioactive proteins, carbohydrates, and lipids. Polar lipids found in the MFGM play a critical role in maintaining cell membrane integrity and neuronal signalling capacity, thereby supporting brain health. This review summarises the literature on the MFGM and its phospholipid constituents for improvement of mental health across three key stages of the human lifespan, i.e., infancy, adulthood, and older age. MFGM supplementation may improve mental health by reducing neuroinflammation and supporting neurotransmitter synthesis through the gut–brain axis. Fortification of infant formula with MFGMs is designed to mimic the composition of breastmilk and optimise early gut and central nervous system development. Early behavioural and emotional development sets the stage for future mental health. In adults, promising results suggest that MFGMs can reduce the negative consequences of situational stress. Preclinical models of age-related cognitive decline suggest a role for the MFGM in supporting brain health in older age and reducing depressive symptoms. While there is preclinical and clinical evidence to support the use of MFGM supplementation for improved mental health, human studies with mental health as the primary target outcome are sparce. Further high-quality clinical trials examining the potential of the MFGM for psychological health improvement are important. Full article

This meta-analysis assessed short-term outcomes after using human milk-derived fortifiers (HMFs) compared with bovine milk fortifiers (BMFs) in preterm infants fed an exclusive human milk (HM) diet, either mother’s own milk (MOM) or donor human milk (DHM). We searched PubMed, Embase, Google Scholar, CENTRAL and CINHAL between January 2015 and August 2023 for studies reporting outcomes in infants with ≤28 weeks gestation and/or birthweight ≤ 1500 g on an exclusive human milk diet fortified with HMF versus BMF. The primary outcomes were death and NEC (stage ≥ 2). Four studies with a total of 681 infants were included. Mortality was significantly lower in infants fed with an HM-HMFs diet (four studies, 681 infants; RR = 0.50, 95% CI = 0.26–0.94; p = 0.03; I² = 0%), NEC was similar between the two groups (four studies, 681 infants; RR = 0.48, 95% CI = 0.20–1.17; p = 0.11; I²= 39%). BPD was higher in the HM-BMFs group (four studies, 663 infants; RR = 0.83, 95% CI = 0.69–1.000; p = 0.05, I² = 0%), although not statistically significant. No differences were found for sepsis (RR = 0.97, 95% CI = 0.66–1.42; p = 0.96; I² = 26%) or combined ROP (four studies, 671 infants; RR = 0.64, 95% CI = 0.53–1.07; p = 0.28; I² = 69%). An HM-HMFs diet could possibly be associated with decreased mortality with no association with NEC, BPD, sepsis, or ROP. This meta-analysis was limited by the small number of studies included. However, the results should not be refuted for this reason as they provide an impetus for subsequent clinical trials to assess the observed associations. Full article

Vitamin A is a fat-soluble micronutrient that is essential for human health. In this study, the daily vitamin A intake of Chinese residents was evaluated by investigating the vitamin A content of various foods. The results show that the dietary intake of vitamin A in common foods was 460.56 ugRAE/day, which is significantly lower than the recommended dietary reference intake of vitamin A (800 ugRAE/day for adult men and 700 ugRAE/day for adult women). Vegetables contributed the most to daily vitamin A dietary intake, accounting for 54.94% of vitamin A intake (253.03 ugRAE/day), followed by eggs, milk, aquatic products, meat, fruit, legumes, coarse cereals, and potatoes. Therefore, an increase in the vitamin A content of vegetables and the fortification of vegetable oils with vitamin A are effective ways to increase vitamin A intake to meet the recommended dietary guidelines in China. The assessment results support the design of fortified foods. Full article

Functional foods have recently generated a lot of attention among consumers looking for healthy options. Studies have examined yogurt with carao to increase health benefits and probiotic characteristics. It has been determined that carao fruit and camel milk have high phenolic compound and antioxidant activity concentrations. The objective of this study was to examine if carao (0, 1.3, 2.65, and 5.3 g/L) incorporated into yogurt enhances anti-inflammatory stimulus and antioxidant activity and impacts the physio-chemical and sensory properties of camel milk yogurt. HT-29 cells were used as a model of anti-inflammatory response, including cytokine responses of IL-8 and mRNA production of IL-1β and TNF-α in gastric digested isolated fraction. In addition, pH, titratable acidity, Streptococcus thermophilus counts and Lactobacillus bulgaricus counts of camel yogurts were examined during the fermentation process in 0, 2.5, 5, and 7 h whereas viscosity, syneresis, and radical scavenging assay evaluations were determined at hour 7. Furthermore, a consumer study was performed. Compared to control samples, the incorporation of carao into yogurts did not lead to a significant (ρ > 0.05) difference in the pH. In contrast, titratable acidity (TA), viscosity, syneresis, and antioxidant capacity significantly increased with the inclusion of 2.65 and 5.3 g/L carao, while 5.3 g/L carao significantly (ρ < 0.05) increased the counts of both bacteria. The inflammatory response of IL-8 and the level of mRNA production of IL-1β and TNF-α was significantly (ρ < 0.05) lower with 2.65 and 5.3 g/L carao yogurt compared to control camel yogurt. Sensory attributes were not impacted by the addition of 1.3 and 2.65 g/L carao. Carao could be a possible ingredient to consider when improving the nutrition value of yogurt. Full article

Human milk represents an optimal source of nutrition during infancy. Milk also serves as a vehicle for the transfer of growth factors, commensal microbes, and prebiotic compounds to the immature gastrointestinal tract. These immunomodulatory and prebiotic functions of milk are increasingly appreciated as critical factors in the development of the infant gut and its associated microbial community. Advances in infant formula composition have sought to recapitulate some of the prebiotic and immunomodulatory functions of milk through human milk oligosaccharide (HMO) fortification, with the aim of promoting healthy development both within the gastrointestinal tract and systemically. Our objective was to investigate the effects of feeding formulas supplemented with the HMO 2′-fucosyllactose (2′-FL) on serum metabolite levels relative to breastfed infants. A prospective, randomized, double-blinded, controlled study of infant formulas (64.3 kcal/dL) fortified with varying levels of 2′-FL and galactooligosaccharides (GOS) was conducted [0.2 g/L 2′-FL + 2.2 g/L GOS; 1.0 g/L 2′-FL + 1.4 g/L GOS]. Healthy singleton infants age 0–5 days and with birth weight > 2490 g were enrolled (n = 201). Mothers chose to either exclusively formula-feed or breastfeed their infant from birth to 4 months of age. Blood samples were drawn from a subset of infants at 6 weeks of age (n = 35–40 per group). Plasma was evaluated by global metabolic profiling and compared to a breastfed reference group (HM) and a control formula (2.4 g/L GOS). Fortification of control infant formula with the HMO 2′-FL resulted in significant increases in serum metabolites derived from microbial activity in the gastrointestinal tract. Most notably, secondary bile acid production was broadly increased in a dose-dependent manner among infants receiving 2′-FL supplemented formula relative to the control formula. 2′-FL supplementation increased secondary bile acid production to levels associated with breastfeeding. Our data indicate that supplementation of infant formula with 2′-FL supports the production of secondary microbial metabolites at levels comparable to breastfed infants. Thus, dietary supplementation of HMO may have broad implications for the function of the gut microbiome in systemic metabolism. This trial was registered at with the U.S. National library of Medicine as NCT01808105. Full article

Moderately preterm infants (32–36 weeks of gestational age) have an increased risk of worse health and developmental outcomes compared to infants born at term. Optimal nutrition may alter this risk. The aim of this study was to investigate the neurological, growth, and health outcomes up to six years of age in children born moderately preterm who receive either exclusive or fortified breast milk and/or formula in the neonatal unit. In this longitudinal cohort study, data were collected for 142 children. Data were collected up to six years of age via several questionnaires containing questions about demographics, growth, child health status, health care visits, and the Five to Fifteen Questionnaire. Data on the intake of breast milk, human milk fortification, formula, and growth during hospitalization were collected from the children’s medical records. No statistically significant differences in neurological outcomes, growth, or health at six years of age were found between the two groups (exclusive breast milk, n = 43 vs. fortified breast milk and/or formula, n = 99). There is a need for research in larger populations to further assess potential effects on health and developmental outcomes when comparing the use of exclusive versus fortified breast milk for moderately preterm infants during neonatal hospitalization. Full article

Fixed-dose fortification of human milk (HM) is insufficient to meet the nutrient requirements of preterm infants. Commercial human milk analyzers (HMA) to individually fortify HM are unavailable in most centers. We describe the development and validation of a bedside color-based tool called the ‘human milk calorie guide’(HMCG) for differentiating low-calorie HM using commercial HMA as the gold standard. Mothers of preterm babies (birth weight ≤ 1500 g or gestation ≤ 34 weeks) were enrolled. The final color tool had nine color shades arranged as three rows of three shades each (rows A, B, and C). We hypothesized that calorie values for HM samples would increase with increasing ‘yellowness’ predictably from row A to C. One hundred thirty-one mother’s own milk (MOM) and 136 donor human milk (DHM) samples (total n = 267) were color matched and analyzed for macronutrients. The HMCG tool performed best in DHM samples for predicting lower calories (<55 kcal/dL) (AUC 0.87 for category A DHM) with modest accuracy for >70 kcal/dL (AUC 0.77 for category C DHM). For MOM, its diagnostic performance was poor. The tool showed good inter-rater reliability (Krippendorff’s alpha = 0.80). The HMCG was reliable in predicting lower calorie ranges for DHM and has the potential for improving donor HM fortification practices. Full article

The optimal method for human milk (HM) fortification has not yet been determined. This study assessed whether fortification relying on measured HM macronutrient content (Miris AB analyzer, Upsala, Sweden) composition is superior to fortification based on assumed HM macronutrient content, to optimize the nutrition support, growth, and body composition in infants born at <33 weeks’ gestation. In a mixed-cohort study, 57 infants fed fortified HM based on its measured content were compared with 58 infants fed fortified HM based on its assumed content, for a median of 28 and 23 exposure days, respectively. The ESPGHAN 2010 guidelines for preterm enteral nutrition were followed. Growth assessment was based on body weight, length, and head circumference Δ z-scores, and the respective growth velocities until discharge. Body composition was assessed using air displacement plethysmography. Fortification based on measured HM content provided significantly higher energy, fat, and carbohydrate intakes, although with a lower protein intake in infants weighing ≥ 1 kg and lower protein-to-energy ratio in infants weighing < 1 kg. Infants fed fortified HM based on its measured content were discharged with significantly better weight gain, length, and head growth. These infants had significantly lower adiposity and greater lean mass near term-equivalent age, despite receiving higher in-hospital energy and fat intakes, with a mean fat intake higher than the maximum recommended and a median protein-to-energy ratio intake (in infants weighing < 1 kg) lower than the minimum recommended. Full article

Bifidobacteria, a major bacterial group, have several beneficial impacts on health, such as enhancing the intestinal flora by limiting the colonization of pathogenic microorganisms and stimulating the immune system. As a result, bifidobacteria have been extensively included in various food products. In this study, Bifidobacterium breve TISTR 2130 was microencapsulated using an emulsion technique with sodium alginate and calcium lactate in green soybean milk as wall materials. This study found that microbeads prepared with 2.0% (w/v) sodium alginate and 2.0% (w/v) calcium lactate had the highest microencapsulation efficiency (MEE) of 99.8% ± 0.07%. In addition, the viability of microencapsulated B. breve TISTR 2130 and free cells was evaluated following a simulated gastrointestinal treatment. Microencapsulated B. breve TISTR 2130 showed higher cell viability than free cells under the simulated gastrointestinal conditions. The viability reduction of free cells dropped substantially to zero after 1 h of incubation in simulated gastrointestinal juice (SIJ), while the viable cell count of microencapsulated B. breve TISTR 2130 remained greater than 5 log CFU/mL and the survival rate was greater than 64% at the end of the sequential digestion. During refrigerated storage of green soybean yogurt (GSY) fortified with microencapsulated B. breve, the viability of B. breve TISTR 2130, syneresis, and acidity decreased, while the pH and viscosity increased. Microencapsulated B. breve TISTR 2130 has the potential to be used as a probiotic fortification in GSY since the viability remained above the recommended minimal limit of 6 log CFU/mL for 10 days during refrigerated storage. The present study demonstrated that the optimized microencapsulated B. breve TISTR 2130 sodium alginate matrix could survive the human gastrointestinal tract to provide health benefits and the possibility of incorporation into functional foods. Full article