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Cow's milk protein allergy (CMPA) is the first allergy that affects infants. In this population, the incidence rate reaches 7.5%. The multiplicity and aspecificity of the symptoms makes its diagnosis sometimes complicated, especially in the delayed type (gastrointestinal, dermatological, and cutaneous). CMPA symptoms can develop in exclusively breastfed infants with an incidence rate of 0.5%. It, therefore, raises questions about sensitization to cow's milk proteins through breast milk. Transfer of native bovine proteins such as β-lactoglobulin into the breast milk is controversial: some authors have found bovine proteins in human milk but others point to cross-reactivity between human milk proteins and cow's milk proteins. However, it seems that a small percentage of dietary proteins can resist digestion and become potentially allergenic. Moreover, some authors suspect the transfer of some of these dietary proteins from the maternal bloodstream to breast milk, but the mechanisms governing sensitization are still being studied. Theoretically, CMPA diagnosis is based on clinical observations, prick-test or patch-test results, and cow's milk-specific IgE antibody concentration. A positive food challenge test usually confirms the diagnosis. No laboratory test is available to make a certain diagnosis, but the detection of eosinophil cationic protein (ECP) in the mother's milk, for example, seems to be advantageous since it is linked to CMA. Excluding cow's milk from the mother's diet is the only cure when she still wants to breastfeed. Usually, cow's milk proteins are reintroduced after 6 months of exclusion. Indeed, the prognosis for infants is very good: 80% acquire a tolerance before the age of 3 or 4 years. Mothers should not avoid dairy products during pregnancy and breastfeeding as preventive measures against allergy., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Despite the benefits of human milk fortification, nutrients of human milk are not sufficient to cover the greater needs of very low birth weight and to ensure a growth similar to that of premature infants fed with preterm formula. These differences could be related to the variation in the macronutrient composition of expressed breast milk with lower protein and energy content. Unfortunately there is unusually no information on macronutrients composition prior human milk fortification. With such data, it would be possible to individualize the fortification. In order to use adjustable fortification of human milk, we have assessed a rapid and simple method using full spectrum infrared laser technology (Milkoscan) to analyze human milk composition. We describe the variation in concentration of protein, lipid and energy in the human milk received in our neonatal unit. Then we evaluate the benefit of adjustable fortification of human milk compared with standard fortification. After standard fortification the variability of protein and lipid remains with a risk of protein deficiency or excess and a risk of energy deficiency. After adjustable human milk fortification based on human milk analysis using Milkoscan, we observe a more stable protein content and a lower amount of added fortifier decreasing the risk of hyperosmolarity. Furthermore, the energy content is higher following of the fat human milk adjusted content. Up to now, our preliminary results suggest that individualized fortification of human milk improves growth rate in preterm infants (21 g/kg/d) to a level close to formula fed infants.

All infant and follow-on formulae available on the market are of high quality. Nevertheless, they are not identical. Several formulae recently launched are characterized by innovations that may have interesting functional effects in some infants. The rising number of formulae and the uncertainty on the validity of the claims presented to justify these innovations make more and more difficult the prescription of a formula that has to be individually tailored for each child. A rational prescription should only be approached on the principle of evidence-based dietetics. Infant formulae satisfy by themselves the nutritional needs of infants up to 6 months of age whereas follow-on formulae should only be used after 6 months when complementary feeding has been introduced into the diet. None of these formulae can claim any nutritional superiority, in particular over breast feeding, which is the reference mode of feeding during the first 6 months of life. The nature of the protein source is the main criteria for choosing an infant formula. In the absence of breast feeding, cow's milk protein infant and follow-on formulae represent the first choice, with the exception of infants at risk for allergy, who should be exclusively fed a hypoallergenic formula during the first 6 months of life. The main interest of soy protein infant and follow-on formulae is feeding infants in vegan families. A functional benefit has only been shown for anti regurgitation formulae as well as for formulae that have the potential to soften stools. Except for the prevention of allergic disease in at-risk families with the use of hypoallergenic infant (and not follow-on) formulae, there is no convincing evidence supporting the prescription of specific formulae in a preventive approach.

The protein requirements during infancy and childhood are the sum of both maintenance nitrogen needs and the amount of nitrogen required for growth. Exclusive breast feeding entirely meets these requirements, at least until 6 months of age, and the different approaches for estimating protein needs provide consistent values, which are strikingly steady for the first 12 months. From the mean protein requirement, it is possible to calculate the safe protein intake, eg, the amount of protein which should meet the requirements of every infant and child from 4 months to 3 years of age. Several expert committees concluded that the safe intake amounts to 15 g/d, a figure which now seems overestimated. In any case, the average intake of infants and toddlers is two to three fold higher than the safe protein intake in most developed countries. This holds true during later childhood and adolescence, the intakes exceeding the needs so much as to render pointless any discussion about amino acid requirements. Although the information about the long term effects of protein intakes in excess of the needs is scanty, the tight relationship between protein and fat intakes, particularly saturated ones, should not be overlooked and should prompt some caution when providing mothers with recommendations about feeding their infant.

Epidemiological and experimental studies suggest that dietary milk products may exert an inhibitory effect on the development of several types of tumors. Some recent experiments in rodents indicate that the antitumor activity of the dairy product is in the protein fraction and more specifically in the whey protein component of milk. It has been demonstrated that whey protein diets result in increased glutathione (GSH) concentration in a number of tissues, and that some of the beneficial effects of whey protein intake are abrogated by inhibition of GSH synthesis. Whey protein is particularly rich in substrates for GSH synthesis. It has been suggested that whey protein may be exerting its effect on carcinogenesis and VIH infection by enhancing GSH concentration. Lactoferrin, one of the proteins contained in whey has aise been studied in this way. It has been suggested that lactoferrin binding may play an important role in maintaining, optimal mononuclear phagocyte function, thus protecting adjacent tissue against phagocyte derived radicals. Moreover it has been demonstrated by one of us that the level of plasma lactoferrin were decreased in HIV-1 infected patients in relation to the progression of the disease. The aim of the present study is to evaluate in rat the reactive oxygen species, scavenger activities (ROSSA) of red blood cells (RBCs) with a multifermented whey (SK 344), by repeated doses during 16 days. This study has permitted to demonstrate in vivo that the SK 344 has an excellent ROSSA corresponding to a limitation of the lipoperoxidation of RBCs membranes by singlet oxygen and nitric oxide. We can conclude that whey protein, lactoferrin and multifermented whey are good candidates as dietary inhibitors of the oxidative stress and should be considered as potential medicinal foods in various pathologies as HIV infection and cancer.

A prospective randomized study of growth and digestive tolerance in a cohort of 60 healthy infants with no history for allergic disease is reported. A milk-based formula and a formula of identical composition whose proteins had undergone hydrolysis were fed successively to the study infants according to a crossover design, for eight weeks. Intake, weight gain and length gain were comparable and satisfactory with both diets. With the hydrolyzed protein formula, stools were greener in color and significantly more numerous, although both parameters remained within normal limits. The most noteworthy result was the significantly greater rate of regurgitations in the group given the hydrolyzed protein formula, i.e., 26% versus 8% in the group fed a conventional modified milk formula. These results show that use of partial protein hydrolysate formulas is associated with minor digestive adverse effects.