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Background: Constipation is a common problem in children. As first-line treatment, increased dietary fiber is often advocated. To our knowledge. however, no large Studies evaluating the effect of dietary fibers in childhood constipation have been published. Patients and Methods: A randomized, double-blind, prospective controlled Study was performed. Patients received either a fiber mixture or lactulose in a yogurt drink. After a baseline period of a week, patients were treated for 8 weeks followed by 4 weeks of weaning. Polyethylene glycol 3350 was added if no clinical improvement was observed after 3 weeks. Using a standardized bowel diary. parents recorded defecation frequency during the treatment period. In addition, incontinence frequency. stool consistency. presence of abdominal pain and flatulence. necessity for step-up medication, and dry weight of feces were recorded, as were adverse effects. Results: A total of 147 children were eligible 12 children wished not to participate. Of the remaining children, 65 were randomized to treatment with fiber Mixture and 70 to treatment with lactulose. In ally 97 children completed the study. No difference was found between the groups after the treatment period concerning defecation frequency (P=0.481) and fecal incontinence frequency (P=0.084). However, consistency of stools was softer in the lactulose group (P = 0.01). Abdominal pain and flatulence scores were comparable (P=0.395 and P = 0.739. respectively). The necessity of step-up medication during the treatment period was comparable (P=0.996), as were taste scores (P=0.657). No serious adverse effects were registered. Conclusions: A fluid fiber mixture and lactulose give Comparable results in the treatment of childhood constipation. JPGN 47:592-597, 2008

In this double-blind, randomized, placebo-controlled study, we investigated the effect of an infant milk formula with 6 g/L short-chain galacto- and long-chain fructo-oligosaccharides [(scGOS/lcFOS) ratio 9:1] on the development of the fecal secretory immunoglobulin A (sIgA) response and on the composition of the intestinal microbiota in 215 healthy infants during the first 26 wk of life. The infants received breast milk or were randomized to receive an infant milk formula with or without scGOS/lcFOS. Stool samples were collected after 8 and 26 wk of intervention. The concentration of fecal sIgA was determined by ELISA, and the composition of the intestinal microbiota was determined by quantitative fluorescent in situ hybridization. The scGOS/lcFOS group and the control group were compared in the statistical analysis. A breast fed group was included as a reference. In total, 187 infants completed the study. After 26 wk of intervention, in infants that were exclusively formula fed, the concentration of sIgA was higher (P < 0.001) in the scGOS/lcFOS group (719 microg/g) than in the control group (263 microg/g). In addition, the percentages of bifidobacteria were higher in the scGOS/lcFOS group (60.4%) than in the control group (52.6%, P = 0.04). The percentages of Clostridium spp. were 0.0 and 3.27%, respectively (P = 0.006). In conclusion, an infant milk formula with 6 g/L scGOS/lcFOS results in higher concentrations of fecal sIgA, suggesting a positive effect on mucosal immunity.

Objectives Breast-fed infants have relatively high proportions of faecal bifidobacteria. This bifidogenic microbiota is at least partly explained by the high levels of prebiotic oligosaccharides in human milk. The present study aimed at testing the effect of solid foods with added prebiotic galacto- and fructo-oligosaccharides (GOS/FOS) on the composition of the intestinal microbiota of fully formula-fed infants during the weaning period. Methods The study was a double-blind, randomised trial with an intervention period of 6 weeks. Infants aged 4 to 6 months who were about to start consuming solid foods were randomised to receive either weaning products with a mixture of GOS/FOS or control weaning products with maltodextrin. After an adjustment period, the presented daily dose of GOS/FOS was 4.5 g. Total numbers of bacteria and bifidobacteria in faecal samples were analysed with fluorescent in situ hybridization. Results Thirty-five infants were included in the study, and 20 infants were included in a per-protocol analysis. In the GOS/FOS group, the faecal percentage of bifidobacteria significantly increased from 43% to 57% (P = 0.031) from week 0 to week 6, but did not significantly change in the control group (36% and 32%, respectively; P = 0.387). The change in the percentage of bifidobacteria between week 0 and week 6 in the GOS/FOS was significantly different from this change in the control group (P = 0.026). Conclusions We conclude that addition of GOS/FOS to solid foods induces an increase in the faecal proportion of bifidobacteria in the intestinal microbiota of fully formula-fed infants with an established, mixed-type microbiota in the weaning period.

Secretory immunoglobulin A (SIgA) plays an important role in the defence of the gastrointestinal tract. The level of faecal SIgA antibody is associated with increased neutralization and clearance of viruses. Formula-fed infants who lack the transfer of protective maternal SIgA from breast milk may benefit from strategies to support maturation of humoral immunity and endogenous production of SIgA. We aimed at studying the effects of standard, prebiotic and probiotic infant formulas on the faecal SIgA levels. At birth, infants of whom the mother had decided not to breastfeed were allocated to one of three formula groups in a randomized, double-blind fashion. Nineteen infants received standard infant formula; 19 received prebiotic formula containing a specific mixture of 0.6 g galacto-oligosaccharides (GOS)/fructo-oligosaccharides (FOS)/100 ml formula and 19 received probiotic formula containing 6.0 × 109 cfu Bifidobacterium animalis/100 ml formula. Faecal samples were taken on postnatal day 5, day 10, wk 4 and every 4 wk thereafter until wk 32. SIgA in faeces was determined by an enzyme-linked immunosorbent assay. During the intervention, infants fed on prebiotic formula showed a trend towards higher faecal SIgA levels compared with the standard formula-fed infants reaching statistical significance at the age of 16 wk. In contrast, infants fed on the probiotic formula showed a highly variable faecal SIgA concentration with no statistically significant differences compared with the standard formula group. Formula-fed infants may benefit from infant formulas containing a prebiotic mixture of GOS and FOS because of the observed clear tendency to increase faecal SIgA secretion. Adding viable B. animalis strain Bb-12 to infant formula did not reveal any sign for such a trend. Secretory immunoglobulin A (SIgA) is one of the most abundant immunoglobulin in the human body and is the predominant immunoglobulin in mucosal surfaces. SIgA plays a key role in the gastrointestinal defence mechanism against dietary and microbial antigens. It inhibits adherence and invasion of potentially harmful antigens into mucosal tissues and neutralizing toxins and virulence factors from microbial pathogens (1). It is well established that the level of faecal SIgA antibody correlates with higher virus-neutralizing capacity and increased viral clearance (2). IgA deficiency in humans is one of the most common immunodeficiencies and is associated with frequent gastrointestinal infections (3). There is accumulating evidence that the intestinal SIgA production is highly influenced by the intestinal microflora. Indeed, the development of the IgA-producing plasmablasts (intermediate stage of the development of a B-lymphocyte into IgA-producing plasma cell) in the intestinal mucosa seems to be affected by components of the intestinal microflora (4). During the first few weeks after birth, the mucosal humoral immunity is not in a mature state. Passive immunity in this phase is provided by breast milk, which contains high levels of SIgA and antimicrobial peptides. SIgA in breast milk are mainly directed against the mother's previous and current gut microflora (5). Breast milk SIgA protects the maternal mammary gland against mastitis, protects the neonatal mucosa against early exposure to microbes and limits bacterial translocation. In breast milk, SIgA levels are highest during the first days after birth (human colostrum contains 2¿5 mg SIgA/ml) and then gradually decrease to 0.5¿1 mg/ml (6). Although many factors may influence SIgA survival in the large intestine, measuring SIgA levels in faeces gives a good representation of the amount available in the colon (7). In the first 2¿4 wk of life, the concentration of IgA in faeces of breast-fed infants is substantially higher compared to that found in formula-fed infants in whom SIgA is basically undetectable (8). Between 4 wk and 6 months of life, faecal IgA concentrations in both breast-fed and formula-fed infants converge towards similar levels. At age 1¿2 yr, when weaning is completed, the production of SIgA reaches adult levels (9). It is generally recognized that intestinal microflora may play an active role in the ontogeny of the newborn's immune response. Studies performed in germ-free animals showed that colonization leads to the development of the gut-associated lymphoid tissue, including SIgA secretion in the intestine (10, 11). Moreau and Baforiau-Routhiau have shown that in particular bifidobacteria in the infant's intestine are important for the synthesis of IgA against viral enteropathogens. Therefore, they suggested that foods promoting bifidobacteria in the intestine could be instrumental in stimulating endogenous SIgA production and hence promote resistance in infants (12). Although the mechanism of immune stimulation by bifidobacteria is largely unknown, it is thought that the cell walls of Gram-positive bacteria, which are rich in peptidoglycans, may play a role. Both prebiotics and probiotics change the intestinal microflora by increasing the numbers of bifidobacteria and lactobacilli. Bifidobacteria and lactobacilli have various beneficial effects in health and disease, including maintenance of intestinal barrier integrity and mucoprotection, stimulation of protective immune responses and protection against harmful pathogens. During the last decade, interest on the immune effects of probiotics has increased markedly. Experimental studies showed that probiotics have strain-specific effects on immunity, for instance in the prevention or treatment of allergic disease. The reported effects of probiotics include enhancement of gut barrier function and induction of regulatory and pro-inflammatory immune responses (13). Additionally, several studies reported that supplementation of food with prebiotics or probiotics can increase SIgA response to viruses and bacteria. However, most of these studies were performed in animals or in vitro and the mechanisms for this immune stimulation are largely unknown (14¿18). As infants not receiving breast milk have lower SIgA levels during the first months of life, they would potentially benefit from strategies to support maturation and production of mucosal SIgA. Therefore, we studied the effects of infant formula with added probiotics or prebiotics on the faecal SIgA levels in infants. We hypothesized that infants on probiotics or prebiotics will have higher levels of total faecal SIgA compared with infants fed on a standard, unsupplemented infant formula

Adding prebiotics or probiotics to infant formula to improve the intestinal flora of formula-fed infants is considered to be a major innovation. Several companies have brought relevant formulations onto the market. However, comparative data on the effects of pre- and probiotics on the intestinal microflora of infants are not available. The present study aimed to compare the effects of infant formula containing a mixture of galacto- and fructo-oligosaccharides or viableBifidobacterium animalison the composition and metabolic activity of the intestinal microflora. Before birth, infants were randomised and double blindly allocated to one of three formulas. The prebiotic (GOS/FOS) group (n19) received regular infant formula supplemented with a mixture of galacto-oligosaccharides and fructo-oligosaccharides (6g/l). The probiotic (Bb-12) group (n19) received the same formula supplemented with 6·0×1010viable cells ofB. animalisper litre. The standard group (n19) received non-supplemented regular formula. A group of sixty-three breast-fed infants was included as a reference group. Faecal samples were taken at postnatal day 5 and 10, and week 4, 8, 12 and 16. Compared with the groups fed Bb-12 and standard formula, the GOS/FOS formula group showed higher faecal acetate ratio (69·7% (sem 2·7), 69·9% (sem 3·9) and 82·2% (sem 5·3);PP

The early years of life are a period of very rapid growth and development. In this critical phase, food preferences are formed which carry over into childhood and beyond and foundations are laid for a healthy adult life. Excess energy, imbalances in macronutrient quality, and nutritional deficiencies may form inappropriate nutritional signals, leading to metabolic disturbances and affecting the obesity risk. For instance, the intake of protein and sugar-sweetened beverages in young children has been associated with an increased risk of overweight and obesity. In reality, scientific reports have shown that the dietary intakes of vegetables, α-linolenic acid, docosahexaenoic acid, iron, vitamin D, and iodine are low and the intakes of protein, saturated fatty acids, and added sugar are high in young children living in Europe. A focus on improving feeding habits and approaches to support more balanced nutritional intakes early in life may have significant public health benefits.

Background: Iron deficiency is the most common nutritional disorder in the world. Young children are particularly vulnerable to the consequences of iron deficiency because of their rapidly developing brain. This review evaluates the prevalence of inadequate iron intake and iron deficiency (anaemia) in European children aged 6-36 months. Summary: Computerized searches for relevant articles were performed in November 2013. A total of 7,297 citations were screened and 44 studies conducted in 19 European countries were included in this review. In both infants (6-12 months) and young children (12-36 months), the mean value of iron intakes in most countries was close to the RDA. Nevertheless, proportions of inadequate intakes were considerable, ranging from about 10% in the Netherlands up to 50% in Austria, Finland and the United Kingdom. The prevalence of iron deficiency varied between studies and was influenced by children's characteristics. Two to 25% of infants aged 6-12 months were found to be iron deficient, with a higher prevalence in those who were socially vulnerable and those who were drinking cow's milk as a main type of drink in their first year of life. In children aged 12-36 months, prevalence rates of iron deficiency varied between 3 and 48%. Prevalence of iron deficiency anaemia in both age groups was high in Eastern Europe, as high as 50%, whereas the prevalence in Western Europe was generally below 5%. Key Messages: In most European countries, mean iron intakes of infants and children aged 6 to 36 months were found to be close to the RDA. Nevertheless, high proportions of inadequate intakes and high prevalence rates of iron deficiency were observed. Health programs should (keep) focus(ing) on iron malnutrition by educating parents on food choices for their children with iron-rich and iron-fortified foods, and encourage iron supplementation programmes where iron intakes are the lowest.

Background The poor feeding practices of pregnant women, infants, and young children contribute to the burden of malnutrition and subsequently to childhood morbidity and mortality in sub-Saharan Africa. Gaining insight into the nutritional and health status of infants and young children will help to focus future nutrition programs and actions. Objective To assess the nutrition and health status of infants and young children in five sub-Saharan African countries: Ivory Coast, Senegal, Cameroon, Kenya, and Nigeria. Methods Published and gray literature was critically reviewed and enriched with the views of local experts from academia, hospitals, and institutions to assess infants' and children's diet and health in the five sub-Saharan African countries. Subsequently, the Africa Nutriday Conference was held in Senegal in November 2011 to further discuss key challenges, action plans, and recommendations for future research. Results This review highlighted the need for education of parents and healthcare professionals in order to increase their knowledge of breastfeeding, vaccination programs, and over- and undernutrition. An integrated health and nutrition surveillance is needed both to identify micronutrient deficiencies and to recognize early signs of overweight. These data will help to adapt nutrition education and food fortification programs to the target populations. Conclusions Different countries in sub-Saharan Africa face similar nutrition and health issues and are currently not sharing best practices, nutrition programs, and scientific studies optimally. There is a need for closer collaboration among scientists within and between countries.

Digestible carbohydrates are one of the main sources of dietary energy in infancy and childhood and are essential for growth and development. The aim of this narrative review is to outline the intakes of digestible carbohydrates and their role in health and disease, including the development of food preferences, as well the consequences of excess carbohydrate. Key experts in these fields provided up-to-date reviews of the literature. A search of available information on dietary intakes of children below the age of 4 years was conducted from 1985 up to 2010. Articles and reports including information about sugars and/or starch intakes were selected. A number of factors limit the ability to obtain an overall picture of carbohydrate intakes and food sources in this age group. These include small numbers of intake studies, differing approaches to analysing carbohydrate, a variety of terms used to describe sugars intakes and a dearth of information about starch intakes. Data suggest that sweet taste is preferred in infancy and later food choices. There are few established adverse consequences of high intakes of digestible carbohydrate for young children. The greatest evidence is for dental caries, although this is influenced by high intake frequency and poor oral hygiene. Evidence for detrimental effects on nutrient dilution, obesity, diabetes or cognition is limited. In infants, minimum carbohydrate (mainly lactose) intake should be 40% of total energy, gradually increasing to 55% energy by the age of 2 years.European Journal of Clinical Nutrition advance online publication, 4 April 2012; doi:10.1038/ejcn.2012.27. ispartof: European Journal of Clinical Nutrition vol:66 issue:7 pages:765-779 ispartof: location:England status: published

Fructo-oligosaccharides (FOS) are widely used in commercial food products. Most studies on FOS concern the health benefits, but some negative effects were recently reported concerning thefaecal cytotoxicity and excretion of mucin-type oligosaccharides in combination with a Ca-restricted diet. The present study was performed to investigate whether these effects of FOS are observed in adults consuming a regular diet unrestricted in Ca. The study was a randomised, double-blind, placebo-controlled crossover trial, involving eleven healthy adults, who consumed 25–30g FOS or maltodextrin (control) in a random order for 2 weeks in addition to their regular diet. Stools were collected for analysis of pH and SCFA (as markers of fermentation), for the assessment of faecal water cytotoxicity, and for the analysis of alkaline phosphataseactivity (as a marker of epithelial cell turnover) andO-linked oligosaccharides (to estimate the excretion of mucin-type oligosaccharides). FOS consumption significantly altered bacterial fermentation (increased percentage of acetate, decreased percentage of butyrate) and tended to decrease stool pH. Furthermore, FOS consumption resulted in a significantly higher stool frequency and in significantly more complaints of flatulence. No significant differences between the control and FOS period were observed in the mean cytotoxicity of faecal water (37·5 (sem 6·9) % v. 18·5 (sem 6·9) % P=0·084), in mean alkaline phosphatase activity (27·7 (sem 2·9) v. 24·6 (sem 3·2) U/g dry faeces; P=0·496) or in the mean excretion of mucin-type oligosaccharides (49·9 (sem 4·0)v. 53·5 (sem 4·3) mg/g dry faeces; P=0·553). We conclude that dietary FOS in a dose up to 25–30g/d altered the bacterial fermentation pattern but did not affect faecal cytotoxicity or the faecal concentration of mucin-type oligosaccharides in human adults consuming a regular diet.

Brain serotonin influences food intake and mood. It is synthesised from tryptophan (Trp) of which uptake in the brain is dependent on plasma ratio of tryptophan to the sum of other large neutral amino acids (Trp-LNAA). A carbohydrate-rich diet increases this ratio, whereas a protein-rich diet decreases it. Yet, if the protein source is alpha-lactalbumin the ratio increases. It is, however, unknown whether this also happens in the context of a regular diet (15% protein). We studied the effect of an alpha-lactalbumin supplement combined with regular diet on plasma Trp-LNAA ratio, serum prolactin (marker of serotonin synthesis), food intake, appetite, macronutrient preference and mood. Eighteen healthy males participated in a double-blind, randomised, placebo-controlled, crossover study. One hour after breakfast they received a drink containing alpha-lactalbumin and carbohydrates (AS) or carbohydrates (PS) only. Plasma Trp-LNAA ratio, serum prolactin, food intake, appetite, macronutrient preference and mood were assessed before and 90 min after consumption of the supplement. Changes of plasma Trp-LNAA ratio differed (P