Abstract:Folate losses during heat treatment of human milk were considered acceptable. Yet, native folate content of heat-treated, non-fortified breastmilk supplied only 25% of the recommended daily intake for preterm infants.
“…The use of prenatal folic acid supplements around the time of conception has been associated with a lower risk of autistic disorder [29]. Human milk provides sufficient folate intake, essential for normal growth and brain development; heat treatment in the breastmilk banks may critically reduce its amount [30]. Fig.…”
Section: –16: Many More Reasons For Considering Breastfeeding As mentioning
confidence: 99%
“…Formula acceptance and tolerance were both good [65]. Last, a prospective trial assessed clinical tolerance of eRHF [30]. Forty infants (mean age, 3.4 months; range, 1–6 months) with CMA confirmed by a food challenge tolerated the eRHF with a symptom score significantly decreased from the first month of intervention on.…”
BackgroundIn 2010, the diagnosis and treatment of IgE-mediated CMA were systematized in a GRADE guideline.Objectives & methodsAfter 6 years, the state of the knowledge in diagnosis and treatment of CMA has largely evolved. We summarize here the main advances, and exemplify indicating some specific points: studies aimed at better knowledge of the effects of breastfeeding and the production of new special formulae intended for the treatment of CMA. The literature (PubMed/MEDLINE) was searched using the following algorithms: (1) [milk allergy] AND diagnosis; (2) [milk allergy] AND [formul*] OR [breast*], setting the search engine [6-years] time and [human] limits. The authors drew on their collective clinical experience to restrict retrieved studies to those of relevance to a pediatric allergy practice.ResultsSeveral clinical studies did address the possibility to diagnose CMA using new tools in vitro and in vivo, or to diagnose it without any evaluation of sensitization. Some studies also addressed the clinical role of formulae based on milk hydrolysates, soy, or rice hydrolysates in the treatment of CMA. Many studies have elucidated the effects of selective nutrients in breastfed infants on their immunologic and neurologic characteristics.ConclusionsEvidence-based diagnostic criteria should be identified for non-IgE-mediated CMA. Debate is ongoing about the best substitute for infants with CMA. In particular, Hydrolyzed Rice Formulae have been widely assessed in the last six years. In the substitute choice, clinicians should be aware of recent studies that can modify the interpretation of the current recommendations. New systematic reviews and metanalyses are needed to confirm or modify the current DRACMA recommendations.
“…The use of prenatal folic acid supplements around the time of conception has been associated with a lower risk of autistic disorder [29]. Human milk provides sufficient folate intake, essential for normal growth and brain development; heat treatment in the breastmilk banks may critically reduce its amount [30]. Fig.…”
Section: –16: Many More Reasons For Considering Breastfeeding As mentioning
confidence: 99%
“…Formula acceptance and tolerance were both good [65]. Last, a prospective trial assessed clinical tolerance of eRHF [30]. Forty infants (mean age, 3.4 months; range, 1–6 months) with CMA confirmed by a food challenge tolerated the eRHF with a symptom score significantly decreased from the first month of intervention on.…”
BackgroundIn 2010, the diagnosis and treatment of IgE-mediated CMA were systematized in a GRADE guideline.Objectives & methodsAfter 6 years, the state of the knowledge in diagnosis and treatment of CMA has largely evolved. We summarize here the main advances, and exemplify indicating some specific points: studies aimed at better knowledge of the effects of breastfeeding and the production of new special formulae intended for the treatment of CMA. The literature (PubMed/MEDLINE) was searched using the following algorithms: (1) [milk allergy] AND diagnosis; (2) [milk allergy] AND [formul*] OR [breast*], setting the search engine [6-years] time and [human] limits. The authors drew on their collective clinical experience to restrict retrieved studies to those of relevance to a pediatric allergy practice.ResultsSeveral clinical studies did address the possibility to diagnose CMA using new tools in vitro and in vivo, or to diagnose it without any evaluation of sensitization. Some studies also addressed the clinical role of formulae based on milk hydrolysates, soy, or rice hydrolysates in the treatment of CMA. Many studies have elucidated the effects of selective nutrients in breastfed infants on their immunologic and neurologic characteristics.ConclusionsEvidence-based diagnostic criteria should be identified for non-IgE-mediated CMA. Debate is ongoing about the best substitute for infants with CMA. In particular, Hydrolyzed Rice Formulae have been widely assessed in the last six years. In the substitute choice, clinicians should be aware of recent studies that can modify the interpretation of the current recommendations. New systematic reviews and metanalyses are needed to confirm or modify the current DRACMA recommendations.
“…Folic acid is a synthetic form of folate which does not occur in nature and is rarely found in unfortified foods [2]. In breast milk, the predominant folate species is L-5-MTHF [6]. Unmetabolized folic acid is not detectable in breast milk unless there are high maternal intakes of folic acid supplements or of foods fortified with folic acid [6, 7].…”
L-5-methyltetrahydrofolate is the predominant folate form in human milk but is currently not approved as a folate source for infant and follow-on formula. We aimed to assess the suitability of L-5-methyltetrahydrofolate as a folate source for infants. Growth and tolerance in healthy term infants fed formulae containing equimolar doses of L-5-methyltetrahydrofolate (10.4 μg/ 100 ml, n = 120, intervention group) or folic acid (10.0 μg/ 100 ml, n = 120, control group) was assessed in a randomized, double-blind, parallel, controlled trial. A reference group of breastfed infants was followed. Both formulae were well accepted without differences in tolerance or occurrence of adverse events. The most common adverse events were common cold, poor weight gain or growth, rash, eczema, or dry skin and respiratory tract infection. Weight gain (the primary outcome) was equivalent in the two groups (95% CI -2.11; 1.68 g/d). In line with this, there was only a small difference in absolute body weight adjusted for birth weight and sex at visit 4 (95% CI -235; 135 g). Equivalence was also shown for gain in head circumference but not for recumbent length gain and increase in calorie intake. Given the nature of the test, this does not indicate an actual difference, and adjusted means at visit 4 were not significantly different for any of these parameters. Infants receiving formula containing L-5-methyltetrahydrofolate had lower mean plasma levels of unmetabolized folic acid (intervention: 0.73 nmol/L, control: 1.15 nmol/L,
p
<0.0001) and higher levels of red cell folate (intervention: 907.0 ±192.8 nmol/L, control: 839.4 ±142.4 nmol/L,
p
= 0.0095). We conclude that L-5-methyltetrahydrofolate is suitable for use in infant and follow-on formula, and there are no indications of untoward effects.
Trial registration:
This trial was registered at ClinicalTrials.gov (
NCT02437721
).
“…Following consumption of folate-containing food, several monoglutamate forms of folate cross the intestinal lining and are converted into L-5-MTHF which is normally the only form of folate to enter the human circulation [6]. The folate vitamer L-5-MTHF is the main storage form in the human body and it is also the predominant form of folate in breast milk [7,8].…”
HighlightsThe toxicity of calcium L-methylfolate was studied.No toxic, mutagenic, teratogenic nor embryogenic effects were observed.The NOAEL for calcium L-methylfolate was 400 mg/kg bw/day.
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