The Influence of Diet on the Ascorbic Acid Requirement of Premature Infants

Abstract

The purpose of this report is to present data, obtained on premature infants, demonstrating that one of the factors determining the need for ascorbic acid is the level of protein intake. It is proposed that this factor plays a role in the greater requirement of artificially fed babies, as compared to breast-fed infants, for supplements containing this vitamin.Long before actual data were available as to the daily total ascorbic acid requirement of the newborn infant, or as to the amount of the vitamin present in human and other milks, it was the common clinical observation that when scurvy occurred in infancy it was in the artificially fed baby. It was assumed that the protection of the breastfed infant against the disease could be attributed to the antiscorbutic activity of breast milk. This opinion was confirmed by experimental evidence, which has been well summarized in a recent review by Smith (1). The evidence includes the important findings of Selleg and King (2) who showed that the actual amount of ascorbic acid received by an infant ingesting an adequate volume of breast milk from a mother whose diet is adequate in this factor closely approaches the amount which other observers have determined to be the approximate daily requirement of the newborn infant. Determinations of blood plasma ascorbic acid levels by Braestrup (3), Mindlin (4, 5), Snelling (6) and others in babies of various ages, but particularly in the first weeks of life, reveal that these levels are on the average much lower in formula-fed than in breast-fed infants. Moreover, Mindlin (5) demonstrated a definite relationship between the plasma ascorbic acid level of the infant and the amount shown to be present in the mother's milk. However, Mindlin also found (4, 7) that even with supplements of 20 to 75 mgm. of ascorbic acid daily, formula-fed infants had lower levels, determined 16 hours after the last vitamin C dose, than did breast-fed infants receiving no supplements, and Braestrup (3) observed that daily dosages of 20 mgm. of ascorbic acid had a slow effect in raising the plasma levels in babies given boiled cow's milk. These observations are only partially explained on the assumption that the ascorbic acid requirement of the breast-fed and the formula-fed infant is the same, and that the former receives all or part of it in milk whereas the latter, whose feeding is prepared by heating in the presence of air, receives practically none. The supposition that the total daily requirement of infants receiving cow's milk is actually higher than that of infants receiving human milk is more completely consistent with the findings of the authors cited.The suggestion that the daily protein intake, which is usually at least twice as high with cow's milk formulas as with human milk, might play a role was made by Levine, Gordon, and Marples (8) as a result of observations on the amino acid metabolism of infants. They demonstrated the excretion of incompletely oxidized derivatives of phenylalanine and tyrosine in the urine of premature infants who...

Nutrient Requirements For Preterm Infant Formulas

“…They found five preterm infants who excreted hydroxphenyl compounds. The urinary levels of these compounds were markedly reduced by large doses (25-200 mg) of parenterally administered vitamin C. In an unpublished survey of 15,000 infants referred to by Avery et al (1967), tyrosinemia and tyrosyluria were more prevalent in preterm infants (30%) than in term infants (10%), and diets high in protein were associated with an increased incidence (Dann, 1942;Levine et al, 1941;Woolf & Edmunds, 1950). In addition, smaller preterm infants were reported to have a higher incidence of tyrosinemia than larger ones (Light et al, 1966), 41% compared with 22%.…”

“…There are conflicting reports, especially in the earlier literature, concerning the need for higher vitamin C intakes to prevent or alleviate tyrosinemia of prematurity (Avery et al, 1967;Dann, 1942;Levine et al, 1939;Light et al, 1966;Mathews & Partington, 1964;Woolf & Edmunds, 1950). Levine et al (1939) reported that high doses of parenteral vitamin C, up to 200 mg/single dose, in a total of 525 mg during a 4-day period, given to five premature infants fed dried cow milk without added vitamins C or B, resulted in a rapid decline in urinary tyrosine as measured by the Millon reaction.…”

Protein Allowances for Premature Infants

“…She found that infants on high protein diets developed lower plasma concentrations of ascorbic acid. 13 Premature infants particularly are prone to develop rickets. Customary explanations include initially low body stores of calcium and phosphorus, rapid rate of growth, faulty absorption of fat-soluble vitamin D, and prolonged shelter from exposure to sunlight.…”

Diseases of Nutrition

“…The ascorbic acid requirements of premature infants 77 and school children 7S have been reported, and it has been shown rather definitely that children who receive 3 ounces (90 cc.) or more of orange juice daily or an equivalent amount of ascorbic acid in citrus fruits and tomatoes maintain a liberal level of ascorbic acid in the plasma.79…”