A non-hydrolyzed, fermented milk formula reduces digestive and respiratory events in infants at high risk of allergy Safety and efficacy of omega-3 fatty acids in the nutrition of very low birth weight infants: soy oil and marine oil supplementation of formula. Soy allergy following early soy feeding in neonates. An extensively hydrolysed casein-based formula for infants with cows' milk protein allergy: tolerance/hypo-allergenicity and growth catch-up. Comparison of yogurt, soybean, casein, and amino acid-based diets in children with persistent diarrhea. Improved general health status in an unselected infant population following an allergen-reduced dietary intervention programme: the ZUFF-STUDY-PROGRAMME
Part II: infant growth and health status to age 6 months Retinal development in very-low-birth-weight infants fed diets differing in omega-3 fatty acids.
Background / Objectives : To determine the impact of a not hydrolyzed fermented infant formula containing heat-killed Bifidobacterium breve C50 and Streptococcus thermophilus 065 ( HKBBST ) on the incidence of allergy-like events during the first 2 years of life in children at high risk of atopy . Subjects/ Methods : This multicenter , r and omized , double-blind , controlled study included infants at high risk of atopy . Infants used HKBBST or a st and ard infant formula ( SIF ) since birth until 1 year of age , and were followed at 4 , 12 and 24 months after birth .  Skin prick tests ( SPTs ) for six foods and six aeroallergens were systematic ally performed and adverse events ( AEs ) were recorded . In case of potentially allergic AE ( PAAE ) , allergy could be further tested by SPT , patch tests and quantification of specific IgEs . If cow 's milk allergy ( CMA ) was suspected , an oral challenge could also be performed . Results : The study included 129 children , 63 were r and omized to SIF , 66 to HKBBST . The use of HKBBST milk did not alter the proportion of CMA but decreased the proportion of positive SPT to cow 's milk ( 1.7 vs 12.5 % , P=0.03 ) , and the incidence of digestive ( 39 vs 63 % , P=0.01 ) and respiratory potentially allergic AEs ( 7 vs 21 % , P=0.03 ) at 12 months , and that of respiratory PAAEs at 24 months ( 13 vs 35 % , P=0.01 ) . Conclusions : HKBBST decreased the incidence of PAAEs in children with family history of atopy , during the first months of life and after the formula was stopped . Oral tolerance to cow 's milk in infants at high risk of atopy may therefore be improved using not hydrolyzed fermented formulae Because formula-fed preterm infants may be at risk of omega 3 essential fatty acid deficiency , we tested experimental formulas supplemented with soy oil to provide alpha-linolenic acid or marine oil to provide preformed omega 3 long-chain polyunsaturated fatty acids at a level comparable to that of human milk . This report addresses the effect of feeding formula supplemented with soy oil or with soy and marine oils on growth , clinical tolerance , coagulation test results , changes in erythrocyte membrane fluidity , and plasma concentrations of vitamins A and E in very low birth weight infants from 30 to 57 weeks of postconceptional age . " Healthy " preterm infants were maternally selected to receive human milk or selected at r and om to receive commercial ready-to-feed  liquid formula  , which provided limited omega 3 fatty acid , or experimental formulas supplemented with soy oil or soy and marine oils . Results of this study indicate that formula enriched with soy oil or soy and marine oils containing preformed omega 3 long-chain polyunsaturated fatty acids does not induce abnormalities in growth , clotting function , erythrocyte membrane fluidity , or vitamin A or E levels in healthy very low birth weight preterm infants . Additional studies to evaluate safety in a representative preterm population are required UNLABELLED B ACKGROUND : Feeding neonates with humanized milk formula in maternity hospitals may increase the prevalence of  milk allergy in infants . However , prospect i ve studies of the possible allergenic effect of very early soy-based formula feeding are lacking . OBJECTIVES To assess the prevalence of soy allergy in infants fed soy-based formula in the first 3 days of life . METHODS The study group included 982 healthy full-term infants born within a 7 month period at a hospital that routinely uses soy-based formula to supplement breastfeeding .  In-hospital feeding was recorded and the parents were interviewed once monthly over the next 6 months regarding feeding practice s and clinical symptoms suggesting soy allergy in the infant . RESULTS Ninety-nine percent of the infants received soy-based formula supplement in hospital , and 33%-42 % at home . No cases of immediate allergic reaction to soy or soy-induced enterocolitis were reported . CONCLUSIONS The use of soy-based formula in the early neonatal period does not apparently increase the prevalence of soy allergy in infants followed for the next 6 months Children with cows ' milk protein allergy ( CMPA ) are at risk of insufficient length and weight gain , and the nutritional efficacy of hypo-allergenic formulas should be carefully assessed . In 2008 , a trial assessed the impact of probiotic supplementation of an extensively hydrolysed casein-based formula ( eHCF ) on acquisition of tolerance in 119 infants with CMPA . First analysis of the study results showed that the studied formula allowed improvement of food-related symptoms . The scoring of atopic dermatitis ( SCORAD ) index was assessed at r and omisation and after 6 months of feeding . A post hoc analysis was performed using WHO growth software 's nutritional survey module ( WHO Anthro version 3.2.2 ) . All infants who were fed the study formula tolerated it well . The SCORAD index significantly improved from r and omisation to 6 months of feeding with the study formula . Anthropometric data indicated a significant improvement in the weight-for-age , length-for-age and weight-for-length z scores , as well as in the restoration of normal BMI . The probiotic supplementation did not show any impact on these parameters . The present data showed that this eHCF was clinical ly tolerated and significantly improved the SCORAD index and growth indices Although previous studies have shown successful treatment of  persistent diarrhea ( PD ) with the use of yogurt-based diets , some recent ones speculate the need of special formulas for the nutritional management of PD complicated cases . In the present study , we tested the hypothesis that the consumption of 3 lactose-free diets , with different degrees of complexity , is associated with lower stool output and shorter duration of diarrhea when compared with the use of a yogurt-based one on the nutritional management of PD . A total of 154 male infants , aged between 1 and 30 months , with PD and with or without dehydration , were r and omly assigned to 1 of 4 treatment groups . Throughout the study , the patients were placed in a metabolic unit ; their body weights and intakes of oral rehydration solution , water , and formula diets , in addition to outputs of stool , urine , and vomit , were measured and recorded at 24-hour intervals . Four different diets were used in this study : diet 1 , yogurt-based formula ; diet 2 , soy-based formula ; diet 3 , hydrolyzed protein-based formula ; and diet 4 , amino acid-based formula . Throughout the study , only these formula diets were fed to the children . The data showed that children fed the yogurt-based diet ( diet 1 ) or the amino acid-based diet ( diet 4 ) had a significant reduction in stool output and in the duration of diarrhea . The use of an inexpensive and worldwide-available yogurt-based diet is recommended as the first choice for the nutritional management of mild to moderate PD . For the few complicated PD cases , when available , a more complex amino acid-based diet should be reserved for the nutritional management of these unresponsive and severe presentations . Soy-based or casein-based diets do not offer any specific advantage or benefits and do not seem to have a place in the management of PD Summary Aim of the study . An allergen-reduced dietary intervention programme with strict dietary requirements was implemented over the first four months of life in an unselected population -based infant cohort and compared to a non-intervention cohort ( the ZUFF study ) . Recommendations for the dietary programme in the intervention cohort were extended , but not strictly implemented , until the end of month six . The intervention was based on breastfeeding , a moderate whey hydrolysate formula ( pHF ) , and delayed introduction of weaning foods with a high allergenicity . This study was a prospect i ve , controlled , and unblinded study , the first to assess the effects of an allergen-reduced , pHF-based early nutritional programme in a broad unselected infant population . Because overall healthy development of the infant is a major objective of any nutritional programme , the study evaluated the effects of the dietary intervention on infant growth and general health status rather than specific allergic manifestations . Part I of this paper gave results for nutritional behaviour only , and Part II gives results for growth and general health status during the intervention period through the sixth month of life . Methods . Assignment of study infants was to demographically comparable intervention ( Z ) or control ( FF ) cohorts according to place of birth . In the intervention cohort ( Z=564 ) , the recommended dietary regimen was breastfeeding and – if exclusive breastfeeding was not possible – supplementation with a moderately hydrolysed , allergen-reduced infant formula ( pHF ) . Weaning foods were delayed until four months of age or later in case of weaning foods with high allergenicity . In the control cohort ( FF=566 ) , there was no specific intervention . Imbalances between cohorts in confounding ( adjuvant ) factors that could influence health related outcomes were integrated as covariates into the logistic regression of the main analyses . Growth parameters included weight , length , head circumference , BMI , and Z scores ( SDS ) . General health status was assessed by clinical ly significant findings in gastrointestinal , respiratory , or skin symptoms . Results . Growth at 6 weeks and at 3 and 6 months was similar for Z and FF . Significantly fewer Z than FF infants had clinical ly noteworthy health findings at 3 months ( Z=27 % versus FF=37 % , odds ratio=0.63 , CI=0.48–0.82 ) and 6 months ( Z=33 % versus FF=49 % , odds ratio=0.51 , CI=0.40–0.66 ) . This corresponds to a 30 % reduction in overall health concerns at 6 months for the intervention cohort . At 3 and 6 months , differences between cohorts in most measures of general health status were strongly influenced by a lower incidence of skin symptoms in the Z cohort . Within FF , there were fewer exclusively breastfed ( eBF ) infants with health problems at 3 months compared with those who were partially ( pBF ) or non-breastfed ( nBF ) ( eBF=31 % , pBF=40 % , nBF=39 % , p<0.05 ) . In contrast , in the Z intervention cohort , the number of infants with health concerns was similar for exclusively breastfed infants and for those in whom mother 's milk was supplemented or replaced by pHF ( eBF=29 % , pBF=25 % , nBF=26 % , ns ) . In a sub analysis of overall health findings in infants without a family risk of allergies , there were again significantly fewer Z than FF infants with any health or any skin problem . Conclusion .An allergen-reduced dietary recommendation that includes a moderate whey hydrolysate infant formula ( pHF ) has no negative effects on growth parameters up to 6 months of life in an infant population unselected for atopic risk . The dietary intervention produced improvements in general health status when compared with a control cohort that received infant formula with unhydrolysed proteins ( IF ) , and high allergenic weaning foods at an earlier age . The difference between cohorts was principally due to fewer adverse skin findings . In infants following our allergen-reduced feeding recommendation , 3-month general health status was comparable between those who were exclusively breastfed and those in whom breastfeeding was supplemented or replaced by pHF . Our results demonstrate that a pHF feeding recommendation during the first 4 to 6 months of life – when exclusive breestfeeding is not possible – is a safe and feasible regimen not only in high-allergic risk population s but in general unselected infant population . The general use of pHF formula in non- or partly breastfed infants could therefore be considered an important contribution to optimised infant nutrition Full-field electroretinograms ( ERGs ) were obtained from very-low-birth-weight ( VLBW ) neonates to determine whether omega-3 ( omega-3 ) fatty acids are essential for normal human retinal development . Eighty-one infants born at 30.4 ( st and ard deviation , + /- 1.5 ) wk gestation were , within 10 d of birth , either enrolled to receive mother 's milk ( naturally containing both omega-6 and omega-3 essential fatty acids ) or  r and omized to receive one of the infant formulas . Corn oil-based Formula A contained mainly linoleic acid ( 18:2 omega-6 ) and was low in all omega-3 fatty acids . Soy oil-based Formula B contained ample alpha-linolenic acid ( 18:3 omega-3 ) but no long-chain omega-3 . Formula C , supplemented with both alpha-linolenic acid and marine oils , was comparable to human milk in long-chain omega-3 . Full-field ERGs were obtained in the special care nursery from infants aged 36 and 57 wk postconception . Ten healthy preterm infants born at 35 wk gestation were tested at 36 wk postconception . Significant differences were found among groups in rod ERG function . Post hoc comparisons showed that infants fed Formula A had significantly higher rod thresholds than infants receiving long-chain omega-3 ( human milk , Formula C , and intrauterine ) . Infants receiving Formula B had intermediate thresholds that were significantly higher than those of infants receiving intrauterine nutrition . Analysis of the leading edge of the a-wave showed that b-wave differences originated at the photoreceptor level . Differences were not present in infants at 57 wk postconception . No significant differences among groups were found in cone b-waves at 36 or 57 wk postconception . Oscillatory potentials had significantly longer implicit times at 57 wk postconception in infants fed Formula A than in infants receiving human milk . These findings suggest that retinal function varies with the dietary supply of omega-3 fatty acids in VLBW infants
They support SIF 's  efficacy in the management of cow 's milk allergy and infant 's digestive tolerance , as well as its low cross allergy compared to cow 's milk and other formulas .
There is also evidence that demonstrates that SIFs have important advantages in terms of cost-benefit , palatability and effects on the intestinal microbiota , compared to other formulas .
Conclusions Although evidence to recommend its use in functional digestive disorders is limited , SIFs have an adequate safety profile and are still a valid option for infant feeding
Background Soy infant formulas ( SIF ) have long been used as an alternative for infants with special nutritional requirements .
However , the medical indications for their use , their allergenicity , safety and efficacy are still controversial .
Objective To present recommendations for the use of SIF based on the existing literature .