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EFSA was asked by the European Commission to provide scientific and technical assistance on the evaluation of human‐identical milk oligosaccharides (HiMOs) as novel foods (NFs). In recent years, the number of authorisations of HiMOs as NFs has markedly increased, which may lead to situations of multiple concurrent uses. Since the safety assessment of HiMOs is based on the comparison with the 'natural' intake of human milk oligosaccharides (HMOs), i.e. the HMO intake from human milk in exclusively breastfed infants, a scoping literature review was outsourced to update the database of mean concentrations of single and total HMOs in human milk, and relevant HMO intakes were thus updated. It is noted that in infants up to 16 weeks of age exclusively fed with infant formula, when adding all the assessed HiMOs at their highest maximum use levels across production methods, the resulting highest daily intakes of single HiMOs and the sum of HiMOs are within the natural HMO intake range. These intakes were also estimated (DietEx) for the most exposed population groups (i.e., infants and young children) considering the highest maximum use levels in those food categories with the highest contribution to the overall HiMO intake (i.e., infant and follow‐on formulae, ready‐to‐eat meals, yoghurt and cow milk). The resulting highest P95 daily HiMO intakes were unlikely to be higher than the highest mean daily HMO intakes. However, any possible higher intake would not necessarily imply a safety concern since such natural intake estimates represent an upper end of average natural intakes. It can be concluded that currently there are no safety concerns resulting from the authorised or assessed HiMO intakes from their concurrent combined uses. Nonetheless, in consideration of the increased interest in the use of HiMOs as NFs, a simplified but realistic approach for the intake assessment is proposed in the case of new HiMOs or extensions of use of already authorised HiMOs. [ABSTRACT FROM AUTHOR]

EFSA was asked by the European Commission to provide scientific assistance with respect to the EFSA scientific opinion on "Safety of Lemna minor and Lemna gibba whole plant material as a novel food (NF) pursuant to Regulation (EU) 2015/2283", which was adopted in 2022. In that Scientific Opinion, the Panel concluded that the NF, considering its proposed uses and the content of manganese as compared to the content of manganese normally present in other leafy vegetables, may be of safety concern and, therefore, the safety of the NF could not be established. In the context of this mandate, EFSA was requested to evaluate whether the additional information provided by the applicant addresses the increase of manganese intake from the NF, which was considered substantial as compared to the background manganese dietary intake. The applicant provided new data showing that by reducing the manganese concentrations in the cultivation medium, the manganese content in Lemna gibba does not exceed the manganese content in spinach. EFSA emphasizes that the rest of the production process should not deviate from what was reported and assessed in the original NF opinion. Data assessed in 2022 along with data provided for the current assessment show that under the same cultivation conditions Lemna gibba and Lemna minor display similar manganese contents. EFSA acknowledges that the composition of the NF should adhere to the specification levels established in 2022. However, regarding manganese, given the contents observed following these latest production processes, EFSA considers that the maximum specification level for manganese in the NF should be set at 6 mg/kg fresh weight. Based on the additional data provided, EFSA concludes that the contents of manganese in the NF have been reduced to levels not exceeding those in other leafy vegetables. [ABSTRACT FROM AUTHOR]

Background: No consensus currently exists on tube-weaning practice worldwide. The aim of this study was to describe tube-weaning practice (indications and modalities) of a panel of pediatric gastroenterologists involved in the management of prolonged enteral nutrition (EN).Methods: A cross-sectional survey of pediatric gastroenterologists involved in the management of children receiving prolonged (>3 months) EN who were likely to be weaned was conducted. A questionnaire containing 24 questions was disseminated to the French Speaking Group of Paediatric Gastroenterology, Hepatology, and Nutrition members. The association between weaning practice and the experience of respondents was investigated.Results: In total, 311 professionals were approached, and 64 questionnaires were completed (response rate 21%). Nearly all respondents (n = 61, 95%) reported using individualized weaning programs. Weaning attempts were performed more frequently at home, and follow-up was performed in the outpatient clinic (97%) by progressive EN volume reduction (83%). Inpatient weaning was performed by only 28% of participants. The choice of the setting was predominantly (59%) based on parental request. Management and follow-up involved mainly the referring pediatric gastroenterologist and the dietitian. Fifty-one (80%) of the respondents experienced ≥1 weaning failure.Conclusions: This is one of only a few studies examining real-life pediatric tube-weaning practices. Considerable practice variation between centers was observed; some of the common practices included the setting of weaning (outpatient vs inpatient) and the eligibility criteria. Increasing knowledge about weaning modalities is the starting point for the design of consensual standardized programs. [ABSTRACT FROM AUTHOR]

Aim: Breastfed infants pass more stools and more liquid stools than formula fed infants and some have no bowel movements or infrequent stools for several days or weeks. We compared exclusively breastfed and exclusively formula fed infants for the first three months.Methods: This study of 118 infants was carried out in the maternity ward of the Lille University Jeanne de Flandre Hospital, France, in 2015. The outcomes were the number and consistency of stools and the prevalence of infrequent stools.Results: At three months, 84 infants remained and we compared 40 who were exclusively breastfed and 13 who were exclusively formula fed. Daily stool frequency was significantly higher in the breastfed than formula fed infants during the first (4.9 ± 1.7 vs. 2.3 ± 1.6, p < 0.001) and second (3.2 ± 1.6 vs. 1.6 ± 1.5, p = 0.003) months. Stools were more liquid in the breastfed infants during the first three months. Infrequent stools occurred in 28% of breastfed and 8% of formula fed infants at least once. (p = 0.25).Conclusion: Exclusively breastfed infants produced more stools than exclusively formula fed infants during the first two months and more liquid stools during the first three. Infrequent stools were 3.5 times more likely in the breastfed infants. [ABSTRACT FROM AUTHOR]

Aims: Primary Helicobacter pylori infection occurs predominantly in childhood. The aims of this study were to establish the rate of H. pylori reinfection after successful eradication in children and adolescents and to determine the risk factors associated with reinfection. Patients and Methods: This retrospective study involved 45 children (20 girls, 25 boys) who met the following criteria: eradication of H. pylori confirmed at least 4 weeks after the completion of therapy, and the search for reinfection at least one year after control of eradication of H. pylori. Demographic data, socioeconomic status and living conditions were recorded. Results: Forty-five children aged 1.2–17.6 years (median, 10.9 years) at the time of H. pylori treatment were reviewed 1 to 9 years after H. pylori eradication. Eight children (18%) had been reinfected (5.4% to 6% per patient-year). Six of 25 (24%) children older than 10 years at the time of diagnosis became reinfected. None of the studied risk factors was associated with reinfection. However, having a sibling younger than 5 years was found in four of seven (57%) reinfected children versus five of 24 (21%) nonreinfected children ( p = .08). Conclusion: Children become reinfected more frequently than adults. Adolescents become reinfected, whereas acquisition of primary H. pylori infection occurs predominantly in early childhood. Close contact with young children, especially siblings, younger than 5 years could be a more important risk factor than the age of the patient at the time of treatment for the high rate of reinfection in childhood. [ABSTRACT FROM AUTHOR]

The Codex Alimentarius Commission of the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) develops food standards, guidelines and related texts for protecting consumer health and ensuring fair trade practices globally. The major part of the world's population lives in more than 160 countries that are members of the Codex Alimentarius. The Codex Standard on Infant Formula was adopted in 1981 based on scientific knowledge available in the 1970s and is currently being revised. As part of this process, the Codex Committee on Nutrition and Foods for Special Dietary Uses asked the ESPGHAN Committee on Nutrition to initiate a consultation process with the international scientific community to provide a proposal on nutrient levels in infant formulae, based on scientific analysis and taking into account existing scientific reports on the subject. ESPGHAN accepted the request and, in collaboration with its sister societies in the Federation of International Societies on Pediatric Gastroenterology, Hepatology and Nutrition, invited highly qualified experts in the area of infant nutrition to form an International Expert Group (IEG) to review the issues raised. The group arrived at recommendations on the compositional requirements for a global infant formula standard which are reported here. [ABSTRACT FROM AUTHOR]

Objective: To assess the incidence and location at diagnosis of inflammatory bowel disease in children and adolescents in northern France between 1988 and 1999.Methods: A 12-year prospective population-based study was conducted by gastroenterologists and pediatric gastroenterologists of northern France (1,312,141 children <17 years of age).Results: From 1988 to 1999, 509 cases of childhood inflammatory bowel disease were recorded (7.2% of all inflammatory bowel disease cases in Northern France): 367 Crohn disease, 122 ulcerative colitis and 20 indeterminate colitis. The mean standardized incidence was 3.1/10(5) for inflammatory bowel disease as a whole (2.3 for Crohn disease, 0.8 for ulcerative colitis and 0.12 for indeterminate colitis). Crohn disease location at diagnosis was: small bowel and colon (71%), colon only (10%) and small bowel only (19%). Location of initial ulcerative colitis was: proctitis (11%), left colitis (57%) and pancolitis (32%). Although ulcerative colitis incidence remained stable (0.8), Crohn disease incidence increased from 2.1 in 1988 to 1990 to 2.6 in 1997 to 1999 (P = 0.2).Conclusions: The incidence of Crohn disease in the children of northern France showed an increasing trend (20%; not significant) during the 12-year period while the incidence of ulcerative colitis remained stable. In the entire population(children and adults)the incidence of Crohn disease increased significantly (+23%; P < 0.001), while the incidence of ulcerative colitis decreased (-17%; P < 0.0001). [ABSTRACT FROM AUTHOR]

Objective. Because in children Helicobacter pylori colonization could differ as compared to that in adults, gastric metabolism of urea and the reliability of the breath test must be evaluated. The aim of this study was to quantify the relationship between breath test and colonization. Methodology. We studied data from 50 endoscopies performed in 39 children and adolescents (20 girls, 19 boys, aged 3-18 years); 28 were infected with H. pylori. Biopsies were analyzed for histological and microbiological diagnosis of infection and for quantitative antral culture of H. pylori. A [SUP 13]C urea breath test was performed on the same day as that of endoscopy (n = 33) or delayed between 2 and 90 days (n = 17). Results. Using a cut-off value of 3 δ ‰, sensitivity was 96.5%, and specificity was 91.5%. The three children showing discrepancies between breath test and biopsy results had a δ ‰ value close to the cut-off. For the 26 cases with a positive culture, we noted a significant correlation (r = 0.63; p < .001) that was not affected by the delay between breath test and gastroscopy. Conclusion. This quantitative relation between bacterial density and δ ‰ permits increasing the reliability of the test by interpreting carefully those results that approach the cut-off value. [ABSTRACT FROM AUTHOR]