Considerable advances have occurred in recent years in the scientific knowledge of the benefits of breastfeeding, the mechanisms underlying these benefits, and in the clinical management of breastfeeding. This policy statement on breastfeeding replaces the 1997 policy statement of the American Academy of Pediatrics and reflects this newer knowledge and the supporting publications. The benefits of breastfeeding for the infant, the mother, and the community are summarized, and recommendations to guide the pediatrician and other health care professionals in assisting mothers in the initiation and maintenance of breastfeeding for healthy term infants and high-risk infants are presented. The policy statement delineates various ways in which pediatricians can promote, protect, and support breastfeeding not only in their individual practices but also in the hospital, medical school, community, and nation.

/pdf/breastfeeding-and-the-use-of-human-milk-2m74a0njro.pdf

Breastfeeding and the Use of Human Milk

Prospective Cohort Study

With the continued interest in the role of the gut microbiota in health, attention has now turned to how to harness the microbiota for the benefit of the host. This Consensus Statement outlines the definition and scope of the term 'prebiotic' as determined by an expert panel convened by the International Scientific Association for Probiotics and Prebiotics in December 2016. In December 2016, a panel of experts in microbiology, nutrition and clinical research was convened by the International Scientific Association for Probiotics and Prebiotics to review the definition and scope of prebiotics. Consistent with the original embodiment of prebiotics, but aware of the latest scientific and clinical developments, the panel updated the definition of a prebiotic: a substrate that is selectively utilized by host microorganisms conferring a health benefit. This definition expands the concept of prebiotics to possibly include non-carbohydrate substances, applications to body sites other than the gastrointestinal tract, and diverse categories other than food. The requirement for selective microbiota-mediated mechanisms was retained. Beneficial health effects must be documented for a substance to be considered a prebiotic. The consensus definition applies also to prebiotics for use by animals, in which microbiota-focused strategies to maintain health and prevent disease is as relevant as for humans. Ultimately, the goal of this Consensus Statement is to engender appropriate use of the term 'prebiotic' by relevant stakeholders so that consistency and clarity can be achieved in research reports, product marketing and regulatory oversight of the category. To this end, we have reviewed several aspects of prebiotic science including its development, health benefits and legislation.

/pdf/expert-consensus-document-the-international-scientific-304wp8k7i9.pdf

Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics

Prebiotics are non-digestible (by the host) food ingredients that have a beneficial effect through their selective metabolism in the intestinal tract. Key to this is the specificity of microbial changes. The present paper reviews the concept in terms of three criteria: (a) resistance to gastric acidity, hydrolysis by mammalian enzymes and gastrointestinal absorption; (b) fermentation by intestinal microflora; (c) selective stimulation of the growth and/or activity of intestinal bacteria associated with health and wellbeing. The conclusion is that prebiotics that currently fulfil these three criteria are fructo-oligosaccharides, galacto-oligosaccharides and lactulose, although promise does exist with several other dietary carbohydrates. Given the range of food vehicles that may be fortified by prebiotics, their ability to confer positive microflora changes and the health aspects that may accrue, it is important that robust technologies to assay functionality are used. This would include a molecular-based approach to determine flora changes. The future use of prebiotics may allow species-level changes in the microbiota, an extrapolation into genera other than the bifidobacteria and lactobacilli, and allow preferential use in disease-prone areas of the body.

/pdf/dietary-modulation-of-the-human-colonic-microbiota-updating-tz2ksl8b3e.pdf

Dietary modulation of the human colonic microbiota: updating the concept of prebiotics

The different compartments of the gastrointestinal tract are inhabited by populations of micro-organisms. By far the most important predominant populations are in the colon where a true symbiosis with the host exists that is a key for well-being and health. For such a microbiota, 'normobiosis' characterises a composition of the gut 'ecosystem' in which micro-organisms with potential health benefits predominate in number over potentially harmful ones, in contrast to 'dysbiosis', in which one or a few potentially harmful micro-organisms are dominant, thus creating a disease-prone situation. The present document has been written by a group of both academic and industry experts (in the ILSI Europe Prebiotic Expert Group and Prebiotic Task Force, respectively). It does not aim to propose a new definition of a prebiotic nor to identify which food products are classified as prebiotic but rather to validate and expand the original idea of the prebiotic concept (that can be translated in 'prebiotic effects'), defined as: 'The selective stimulation of growth and/or activity(ies) of one or a limited number of microbial genus(era)/species in the gut microbiota that confer(s) health benefits to the host.' Thanks to the methodological and fundamental research of microbiologists, immense progress has very recently been made in our understanding of the gut microbiota. A large number of human intervention studies have been performed that have demonstrated that dietary consumption of certain food products can result in statistically significant changes in the composition of the gut microbiota in line with the prebiotic concept. Thus the prebiotic effect is now a well-established scientific fact. The more data are accumulating, the more it will be recognised that such changes in the microbiota's composition, especially increase in bifidobacteria, can be regarded as a marker of intestinal health. The review is divided in chapters that cover the major areas of nutrition research where a prebiotic effect has tentatively been investigated for potential health benefits. The prebiotic effect has been shown to associate with modulation of biomarkers and activity(ies) of the immune system. Confirming the studies in adults, it has been demonstrated that, in infant nutrition, the prebiotic effect includes a significant change of gut microbiota composition, especially an increase of faecal concentrations of bifidobacteria. This concomitantly improves stool quality (pH, SCFA, frequency and consistency), reduces the risk of gastroenteritis and infections, improves general well-being and reduces the incidence of allergic symptoms such as atopic eczema. Changes in the gut microbiota composition are classically considered as one of the many factors involved in the pathogenesis of either inflammatory bowel disease or irritable bowel syndrome. The use of particular food products with a prebiotic effect has thus been tested in clinical trials with the objective to improve the clinical activity and well-being of patients with such disorders. Promising beneficial effects have been demonstrated in some preliminary studies, including changes in gut microbiota composition (especially increase in bifidobacteria concentration). Often associated with toxic load and/or miscellaneous risk factors, colon cancer is another pathology for which a possible role of gut microbiota composition has been hypothesised. Numerous experimental studies have reported reduction in incidence of tumours and cancers after feeding specific food products with a prebiotic effect. Some of these studies (including one human trial) have also reported that, in such conditions, gut microbiota composition was modified (especially due to increased concentration of bifidobacteria). Dietary intake of particular food products with a prebiotic effect has been shown, especially in adolescents, but also tentatively in postmenopausal women, to increase Ca absorption as well as bone Ca accretion and bone mineral density. Recent data, both from experimental models and from human studies, support the beneficial effects of particular food products with prebiotic properties on energy homaeostasis, satiety regulation and body weight gain. Together, with data in obese animals and patients, these studies support the hypothesis that gut microbiota composition (especially the number of bifidobacteria) may contribute to modulate metabolic processes associated with syndrome X, especially obesity and diabetes type 2. It is plausible, even though not exclusive, that these effects are linked to the microbiota-induced changes and it is feasible to conclude that their mechanisms fit into the prebiotic effect. However, the role of such changes in these health benefits remains to be definitively proven. As a result of the research activity that followed the publication of the prebiotic concept 15 years ago, it has become clear that products that cause a selective modification in the gut microbiota's composition and/or activity(ies) and thus strengthens normobiosis could either induce beneficial physiological effects in the colon and also in extra-intestinal compartments or contribute towards reducing the risk of dysbiosis and associated intestinal and systemic pathologies.

/pdf/prebiotic-effects-metabolic-and-health-benefits-3ioljfudp0.pdf

Prebiotic effects: metabolic and health benefits.

Absorption of calcium from the carbonated dairy soft drink is greater than that from fat-free milk and calcium-fortified orange juice in women

Calculation of weight gain velocity is used to guide nutrition and fluid management practices in neonatal intensive care units. Calculations over short time periods may be more responsive to management changes, but less precise. Weight gain velocity calculated over 5 to 7+ days have lower variability and less noise than shorter periods.

https://fn.bmj.com/content/fetalneonatal/104/2/F218.full.pdf

Time interval for preterm infant weight gain velocity calculation precision

Infants less than 1 500 g birth weight (very low birth weight, VLBW) are at risk for significant nutritional deficiencies. Enhancing nutritional care of these infants during their first months of life may have important short and long-term benefits. In this article we will consider several areas of recent research in the nutritional management of VLBW infants. In particular we will focus on issues related to the introduction and use of enteral nutrition. These issues include avoiding mineral deficiencies, early (minimal) enteral nutrition, human milk fortification, and postdischarge nutrition. Transitioning VLBW infants successfully to enteral nutrition is a key to their achieving adequate growth and development without the long-term risks related to parenteral nutrition. Human milk is a key component of any strategy for enteral nutrition of all infants. Its introduction in the first days of life leads to improved growth and better health outcomes for infants. However, although some nutrients are initially increased in the milk of mothers delivering prematurely, there are inadequate amounts of calcium, phosphorus, zinc and other nutrients to meet the needs of the VLBW infant during growth. Therefore, safe and effective means of fortifying human milk are essential to the care of VLBW infants. The optimal approaches for this fortification and the potential risks related to human milk fortification remain controversial. Limited data are available for the optimal content, initiation and methods for mixing fortifier with human milk.

Current issues in nutritional management of very low birth weight infants.

The Thriposha programme is a community-level nutrition intervention in Sri Lanka that provides a combination of energy, protein and micronu-trients as a ‘ready-to-eat’ cereal-based food. We measured the bioavailability of Fe and Zn from Thriposha formula at two different molar ratios ofZn:Fe in order to determine the effect on Fe and Zn absorption. Children 4–7 years (n 53) were given a meal prepared with 50g Thriposha con-taining 1·5mg Zn as zinc sulphate and either 9mg (high Fe concentration (HiFe)) or 4·5mg (low Fe concentration (LoFe)) Fe as ferrous fumarate.Zn and Fe percent absorption were measured using stable isotopes by tracer:tracee ratio and by incorporation of erythrocytes, respectively. PercentFe absorption from the two meals was similar (6·6% (4·8) v. 4·8% (2·6); P¼0·15), but total Fe absorption was signiﬁcantly higher from the HiFemeal (0·59 (0·43)mg) than the LoFe meal (0·20 (0·12)mg; P¼0·01). There was no signiﬁcant difference between the two groups in Zn absorption(10·7% (0·9) v. 8·8% (1·4), P¼0·13, respectively). Decreasing the amount of Fe in Thriposha did not cause a signiﬁcant change in the percentabsorption of Fe and Zn, but signiﬁcantly lowered the total amount of absorbed Fe. These results demonstrate the utility of maintaining ahigher Fe content in this supplement. Further studies to increase Zn content are warranted while maintaining a HiFe.Iron absorption: Zinc absorption: Ready-to-eat cereals

/pdf/changing-the-zinc-iron-ratio-in-a-cereal-based-nutritional-zze4exf1l7.pdf

Changing the zinc:iron ratio in a cereal-based nutritional supplement has no effect on percent absorption of iron and zinc in Sri Lankan children.

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Ian J. Griffin

Papers

Absorption of calcium from the carbonated dairy soft drink is greater than that from fat-free milk and calcium-fortified orange juice in women

Time interval for preterm infant weight gain velocity calculation precision

Current issues in nutritional management of very low birth weight infants.

Changing the zinc:iron ratio in a cereal-based nutritional supplement has no effect on percent absorption of iron and zinc in Sri Lankan children.

Perinatal Growth and Nutrition