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Dear Healthcare Professional,
Welcome to the October edition of our newsletters aimed to keep you updated with the latest news in infant nutrition. This month we are highlighting the key points from the new revised Rome IV guidelines regarding colic in infancy. Our new helpsheet which can be shared with parents, reflects this updated criteria. We are also discussing prebiotics and the potential positive effect on stool consistency when they are added to infant formula. Finally, find out about the new publication in the American Journal of Clinical Nutrition that looks into the growth of infants on a lower protein formula.
Kind regards,
The SMA® Professional Team |
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| Colic can be described as repeated episodes of excessive and inconsolable crying in an infant that otherwise appears to be healthy and thriving. It is thought to affect up to one in five babies, although the condition is not well understood1. Until recently, it was advised to refer to the ‘rule of three’ (excessive crying lasting for 3 hours a day, for more than 3 days in a row for a period of 3 weeks) when identifying infants suffering from colic. However, in May, the Rome Foundation updated their criteria2 for diagnosing colic in infancy, as a result of new insights into the different functional gastrointestinal disorders in infancy in the past decade. We have summarised this new criteria in our feeding issues section on the website to support you in your conversations with parents. We have also updated our English colic helpsheet for parents to reflect this new guidance, which you can download here. |
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| Prebiotics and constipation |
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| Prebiotics are non-digestible food fibres which selectively stimulate growth and/or activity of ‘good’ bacteria in the colon. Breast milk is believed to promote a healthy gut bacteria ecosystem in infants as a result of the presence of over 130 oligosaccharides, which are prebiotics3. Non-human oligosaccharides such as Galacto-oligosaccharide (GOS) and Fructo-oligosaccharide (FOS) can be added to infant formula as a source of prebiotics. It has been found that supplementation of infant formula with GOS/FOS promotes preferable faecal bacteria, with levels of ‘good’ bacteria such as Lactobacilli and Bifidobacteria higher than found in the stools of infants receiving an unsupplemented formula4. This study also reported that the infants receiving GOS/FOS had an improved stool consistency compared to the control group, suggesting infant formulas supplemented with prebiotics may help promote softer stools. Visit our website to view more information on constipation and a summary of the NICE guidelines which may be helpful for conversations you have with parents who have babies experiencing constipation. |
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| Childhood obesity is a growing global health priority. Lowering the protein content of infant formula so that it is closer to the quantity found in breast milk may reduce long term risk of obesity/overweight in formula fed infants5. |
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In September, a pooled analysis of 11 clinical trials with lower protein infant formula, was published in the American Journal of Clinical Nutrition.
The Meta-analysis used individual participant data from 11 Randomised Controlled Trials (RCTs) carried out in 6 countries (Australia, France, Italy, Greece, China and South Africa) with a cohort of 1882 healthy term infants. Anthropometric data of infants who were fed a lower quantity, higher quality protein infant formula (1.25g/100ml, equivalent to 1.8g/100kcal) at the same levels as SMA PRO First Infant Milk, for the first 4 months of life were measured and compared with WHO growth standards.
The results provide further scientific evidence that lower protein infant formula with high quality protein supports healthy growth, comparable to WHO Growth Standards, and close to that of breastfed infants.
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® Registered Trademark.
IMPORTANT NOTICE: The World Health Organisation (WHO) has recommended that pregnant women and new mothers be informed on the benefits and superiority of breastfeeding – in particular the fact that it provides the best nutrition and protection from illness for babies. Mothers should be given guidance on the preparation for, and maintenance of, lactation, with special emphasis on the importance of a well-balanced diet both during pregnancy and after delivery. Unnecessary introduction of partial bottle-feeding or other foods and drinks should be discouraged since it will have a negative effect on breastfeeding. Similarly, mothers should be warned of the difficulty of reversing a decision not to breast-feed. Before advising a mother to use an infant formula, she should be advised of the social and financial implications of her decision: for example, if a baby is exclusively bottle-fed, more than one can (400 g) per week will be needed, so the family circumstances and costs should be kept in mind. Mothers should be reminded that breast milk is not only the best, but also the most economical food for babies. If a decision to use an infant formula is taken, it is important to give instructions on correct preparation methods, emphasising that unboiled water, unsterilised bottles or incorrect dilution can all lead to illness.
References: 1. NHS Choices. Colic. 2014. Available here. 2. Benninga, M and Nurko S, et al (2016). Childhood functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology;150:1443-1455. 3. German BJ, Freeman SL, Lebrilla CB and Mills DA., 2008. Human Milk Oligosaccharides: Evolution, Structures and Bioselectivity as Substrates for Intestinal Bacteria. Nestle Nutr Workshop Ser Pediatr Program. 62: 205–222 4. Moro G, Minoli I, Mosca M, Fanaro S, Jelinek J, Stahl B, Boehm G., 2002. Dosage-related bifidogenic effects of galacto- and fructooligosaccharides in formula-fed term infants. Journal of Pediatric Gastroenterology and Nutrition. 34: 291–295. 5. Alexander et al., 2016. Growth of infants consuming whey-predominant term infant formulas with a protein content of 1.8 g/100 kcal: a multicenter pooled analysis of individual participant data. Am J Clin Nutr doi: 10.3945/ajcn.116.130633 |
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