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      No effect of adding dairy lipids or long chain polyunsaturated fatty acids on formula tolerance and growth in full term infants: a randomized controlled trial

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          Abstract

          Background

          When breastfeeding is not possible, infants are fed formulas in which lipids are usually of plant origin. However, the use of dairy fat in combination with plant oils enables a lipid profile in formula closer to breast milk in terms of fatty acid composition, triglyceride structure and cholesterol content. The objectives of this study were to investigate the impact on growth and gastrointestinal tolerance of a formula containing a mix of dairy lipids and plant oils in healthy infants.

          Methods

          This study was a monocentric, double-blind, controlled, randomized trial. Healthy term infants aged less than 3 weeks whose mothers did not breastfeed were randomly allocated to formula containing either: a mix of plant oils and dairy fat (D), only plant oils (P) or plant oils supplemented with long-chain polyunsaturated fatty acids (PDHA). Breastfed infants were included in a reference group (BF). Anthropometric parameters and body composition were measured after 2 and 4 months. Gastrointestinal tolerance was evaluated during 2 day-periods after 1 and 3 months thanks to descriptive parameters reported by parents. Nonrandomized BF infants were not included in the statistical analysis.

          Results

          Eighty eight formula-fed and 29 BF infants were enrolled. Gains of weight, recumbent length, cranial circumference and fat mass were similar between the 3 formula-fed groups at 2 and 4 months and close to those of BF. Z-scores for weight, recumbent length and cranial circumference in all groups were within normal ranges for growth standards. No significant differences were noted among the 3 formula groups in gastrointestinal parameters (stool frequency/consistency/color), occurrence of gastrointestinal symptoms (abdominal pain, flatulence, regurgitation) or infant’s behavior.

          Conclusions

          A formula containing a mix of dairy lipids and plant oils enables a normal growth in healthy newborns. This formula is well tolerated and does not lead to abnormal gastrointestinal symptoms. Consequently, reintroduction of dairy lipids could represent an interesting strategy to improve lipid quality in infant formulas.

          Trial registration

          ClinicalTrials.gov Identifier NCT01611649, retrospectively registered on May 25, 2012.

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          Most cited references19

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          Paroxysmal fussing in infancy, sometimes called colic.

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            Lipid Quality in Infant Nutrition: Current Knowledge and Future Opportunities

            Abstract Dietary lipids are key for infants to not only meet their high energy needs but also fulfill numerous metabolic and physiological functions critical to their growth, development, and health. The lipid composition of breast milk varies during lactation and according to the mother's diet, whereas the lipid composition of infant formulae varies according to the blend of different fat sources. This report compares the compositions of lipids in breast milk and infant formulae, and highlights the roles of dietary lipids in term and preterm infants and their potential biological and health effects. The major differences between breast milk and formulae lie in a variety of saturated fatty acids (such as palmitic acid, including its structural position) and unsaturated fatty acids (including arachidonic acid and docosahexaenoic acid), cholesterol, and complex lipids. The functional outcomes of these differences during infancy and for later child and adult life are still largely unknown, and some of them are discussed, but there is consensus that opportunities exist for improvements in the qualitative lipid supply to infants through the mother's diet or infant formulae. Furthermore, research is required in several areas, including the needs of term and preterm infants for long-chain polyunsaturated fatty acids, the sites of action and clinical effects of lipid mediators on immunity and inflammation, the role of lipids on metabolic, neurological, and immunological outcomes, and the mechanisms by which lipids act on short- and long-term health.
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              Dietary triacylglycerol structure and its role in infant nutrition.

              Human milk TG are a remarkable example of stereo-specific positioning of fatty acids with structures that are highly conserved and unusual. Not only does human milk contain high amounts of fat and 16:0, but ~70% of the 16:0 is esterified at the TG stereo-specifically numbered (sn)-2 position, with preferential positioning of 18:1(n-9) and 18:2(n-6) at the TG sn-1,3 positions. The milk TG structures and digestive lipases combine to enable efficient digestion and absorption of 16:0 by conserving 16:0 in sn-2 monoacylglycerols, which are absorbed, reassembled, and secreted in plasma conserving the original milk TG configuration; these studies are reviewed in this article. The reason why the mammary gland invests in enzymes to provide the infant with 20-25% milk fatty acids as 16:0 rather than selecting against 16:0 is unknown, yet likely has a purpose given the mammary gland capacity for 10:0, 12:0, and 14:0 synthesis. Recent advances in the development-, tissue-, and species-specific activity of enzymes of TG synthesis and knowledge that dietary TG structures are maintained postabsorption suggest that the purpose of the milk TG structures is more sophisticated than simply avoiding 16:0 malabsorption. The overall aim is to expand consideration of fatty acids in the infant diet from a simple view of average fatty acid compositions to the complex lipids and molecular structures in which fatty acids are provided to tissues during early life and the biology through which the unique features of human milk enable the infant to grow and thrive on a high-fat, high-saturated-fat milk diet.
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                Author and article information

                Contributors
                maria.gianni@unimi.it
                paola.roggero@unimi.it
                charlotte.baudry@lactalis.fr
                catherine.fressange-mazda@lactalis.fr
                pascale.leruyet@lactalis.fr
                fabio.mosca@unimi.it
                Journal
                BMC Pediatr
                BMC Pediatr
                BMC Pediatrics
                BioMed Central (London )
                1471-2431
                22 January 2018
                22 January 2018
                2018
                : 18
                : 10
                Affiliations
                [1 ]ISNI 0000 0004 1757 2822, GRID grid.4708.b, Neonatal Intensive Care Unit (NICU), Department of Clinical Science and Community Health, Fondazione IRCCS “Ca’ Granda” Ospedale Maggiore Policlinico, , University of Milan, ; Milan, Italy
                [2 ]Nutrition Department, Lactalis R&D, Retiers, France
                [3 ]Lactalis Nutrition Europe, Torcé, France
                Article
                985
                10.1186/s12887-018-0985-2
                5776758
                29357820
                8e60659b-084b-40b5-8216-b607081b7c58
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 4 October 2016
                : 16 January 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Pediatrics
                infant formula,lipid quality,dairy lipids,dairy fat,fatty acids,growth,body composition,fat mass,gastrointestinal tolerance,regurgitation

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