There Is No Iron in Human Milk

Abstract

in children. Only 41% of the cohort were on daily preoperative narcotics, so this cohort had less opioid dependence than is seen in adolescent and adults (6). Despite this relatively low rate of daily narcotic use preoperatively, patients required a median of 2 months to wean off of narcotics. At our center, we have had similar experience that younger children, with shorter duration of disease, often wean off of narcotics more quickly and recover from their chronic pain more easily.Regardless of opioid dependence, all of these children suffer from chronic pain before TP-IAT. Chronic pancreatitis significantly impairs quality of life in pediatric patients and in their parents (6). In our experience, psychiatric issues including anxiety, depression, and conversion disorder are common in older children and teenagers experiencing chronic pancreatitis; whether early intervention might alleviate or even prevent these serious morbidities is not known. Close collaboration with pediatric pain specialists is crucial for postoperative pharmacologic and nonpharmacologic pain management, and coping skills. The long-term psychological impact of severe chronic pain, missed school days, disruption of family life has not been systematically studied but should be in the future for these children. Adult studies have shown significant improvements in quality of life after TP-IAT that are independent of insulin dependence; this balance will be important to investigate in children (7).Despite the severity of these children's pancreatitis, they had excellent islet yields-with almost all exceeding the 5000 islet equivalents per kilogram body mass that has been associated with high prevalence of insulin independence in previous reports (8). The relatively short duration of disease and Minnesota's decades of experience with islet isolation are both key components of these islet yields.Following with the high islet yields, insulin independence rates were high-and seemed to be sustained over the reported follow-up period. Reported postsurgical follow-up time was relatively short, with most less than 5 years. Longer-term follow-up of this and other pediatric TP-IAT cohorts will be crucial, particularly in evaluating the sustainability of islets and insulin independence. Even over the relatively short follow-up period, it appears that 3 of the 14 patients that attained temporary insulin independence had to resume insulin. Two of 7 patients that had more than 3 years of follow-up had to restart insulin, and 1 of those 7 never came off of insulin (1).Continued monitoring of glucose tolerance, even in those off of insulin, is key for children who undergo TP-IAT. In Bellin et al's cohort, hemoglobin A1c was elevated in 2 patients and borderline elevated in 75% of the cohort. Given their early onset of severe disease, these children would likely have progressed to insulindependent diabetes eventually without the TP-IAT. And even their insulin-dependent patients had some islet function, indicated by their C-peptide, which likely gave them some prot...

Longitudinal Effects of Iron Deficiency Anemia and Subsequent Repletion on Blood Parameters and the Rate and Composition of Growth in Pigs

“…The CONT treatment contained 21.3 mg/L (106.3 mg/kg), and the ID treatment contained 2.72 mg/L (13.6 mg/kg). The ID treatment closely resembled the average iron content of porcine milk ( n = 7; 1.06 mg/L) collected during a prior study [ 18 ], and is comparable to the iron concentration of human milk [ 7 , 19 ]. During phase 2, all pigs were fed a series of standard commercial starter diets (180–300 mg/kg).…”

Importance of Dietary Sources of Iron in Infants and Toddlers: Lessons from the FITS Study

“…This highlights the importance of education among caregivers of breast fed infants about the importance of dietary iron in reducing the risk of inadequate intake. Even though breastmilk was not a significant contributor to total dietary iron intake in any age group due to the low levels of iron in breastmilk (0.4 mg/L), it belies the well-known fact that the iron in breastmilk may be highly bioavailable [ 33 ]. Since more infants in the cereal-user group also consumed iron fortified infant formula, we analyzed the iron intake from complementary foods only (excluding breastmilk and infant formula) in order to eliminate the difference in iron contribution from formula versus breastmilk.…”

Breastfeeding, Mixed, or Formula Feeding at 9 Months of Age and the Prevalence of Iron Deficiency and Iron Deficiency Anemia in Two Cohorts of Infants in China

“…In an editorial accompanying the Cai et al paper, Friel challenges the rationale for exclusive breastfeeding for 6 months and argues cogently for providing external sources of iron earlier. 46 …”