Complementary Foods and the Development of Food Allergy

Berthold Koletzko, MD

PEDIATRICS Vol. 106 No. 5 Supplement November 2000, pp. 1285

Background

The prevalence of allergic diseases in children is increasing in Western Europe and other developed countries. Allergic reactions to food components are of particular concern in infants and young children. In prospective studies the incidence of cows’ milk protein allergy in infancy has been estimated at about 2% to 3%. Allergic reactions are also frequently observed against egg white, fish, cereals, nuts, peanuts, and soybean and thus against complementary food products. In infants with documented allergy against complementary foods, the basic treatment is complete avoidance of the causal protein.
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Gastrointestinal Digestive and Absorptive Function

From a nutritional perspective, the gastrointestinal tract may be viewed as an organ of digestion and absorption, and the principal functions of each part; pregastric, gastric, small intestinal, pancreatic, hepatobiliary, and colonic, together operate in an integrated manner to assimilate complementary foods and transport nutrients across the intestinal mucosa. Intestinal motility and epithelial defense systems also play a part in this coordinated process, and a full understanding of the gut during weaning is a major challenge that can be addressed at all levels from molecular control to dietary balance. However, the relative importance of the functions of each part of the gut during the transition from milk-feeding to complementary diet is poorly understood, particularly in relation to the introduction of “new” nutrients, such as complex carbohydrates and nonhuman food proteins.
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Development of Intestinal Transport Function in Mammals

Jirí Pácha
Physiological Reviews, Vol. 80, No. 4, October 2000, pp. 1633-1667

Abstract

Considerable progress has been made over the last decade in the understanding of mechanisms responsible for the ontogenetic changes of mammalian intestine. This review presents the current knowledge about the development of intestinal transport function in the context of intestinal mucosa ontogeny. The review predominantly focuses on signals that trigger and/or modulate the developmental changes of intestinal transport. After an overview of the proliferation and differentiation of intestinal mucosa, data about the bidirectional traffic (absorption and secretion) across the developing intestinal epithelium are presented. The largest part of the review is devoted to the description of developmental patterns concerning the absorption of nutrients, ions, water, vitamins, trace elements, and milk-borne biologically active substances.
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Prolactin: Structure, Function, and Regulation of Secretion

Marc E. Freeman, Béla Kanyicska, Anna Lerant, and György Nagy

Physiological Reviews, Vol. 80, No. 4, October 2000, pp. 1523-1631

Abstract

Prolactin is a protein hormone of the anterior pituitary gland that was originally named for its ability to promote lactation in response to the suckling stimulus of hungry young mammals. We now know that prolactin is not as simple as originally described. Indeed, chemically, prolactin appears in a multiplicity of posttranslational forms ranging from size variants to chemical modifications such as phosphorylation or glycosylation. It is not only synthesized in the pituitary gland, as originally described, but also within the central nervous system, the immune system, the uterus and its associated tissues of conception, and even the mammary gland itself.
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Pacifier as a Risk Factor for Acute Otitis Media: A Randomized, Controlled Trial of Parental Counseling

Marjo Niemelä, MD, PhD, Outi Pihakari, MB, Tytti Pokka, BSc, Marja Uhari, MScDagger , and Matti Uhari, MD, PhD

PEDIATRICS Vol. 106 No. 3 September 2000, pp. 483-488

Abstract

Objectives. To evaluate the association between pacifier use and the increased occurrence of acute otitis media (AOM) in an intervention trial.

Methods. Fourteen well-baby clinics were selected to participate in an open, controlled cohort study. These clinics were paired according to the number of children and the social classes of the parents they served. One clinic in each pair was randomly allocated for an intervention, while the other served as a control.
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Mastitis – Causes and Management

A mastitis a mell gyulladásos állapota, amelyhez fertőzés társulhat. Általában a laktációval összefüggésben lép fel, ezért laktációs vagy puerperális mastitisnek is nevezik. Esetenként fatális lehet, amennyiben nem megfelelően kezelik. A mastitis súlyos szövődménye a melltályog, amely lokalizált gennygyülem a mell állományán belül. Ezek az állapotok számottevő nehézséget jelentenek, és jelentős költséggel járnak. A legújabb kutatások kimutatták, hogy a mastitis megnöveli a HIV szoptatás útján való átvitelének kockázatát.

Egyre nyilvánvalóbb, hogy a mell nem elég hatékony kiürítése, ami a nem megfelelő szoptatási technika eredménye, fontos hajlamosító tényező, mégis, a mastitis még mindig a mell-fertőzés szinonímája az egészségügyi szakemberek fejében. Ezek a szakemberek gyakran képtelenek a mastitisben szenvedő nőknek olyan segítséget nyújtani, ami lehetővé teszi a szoptatás folytatását, és javasolják szükségtelenül a szoptatás abbahagyását.
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ILCA: Position Paper on Infant Feeding

The International Lactation Consultant Association(ILCA) affirms the right of all women to breastfeed their infants, of all infants to receive human milk, and of all men and women to assist mothers in protecting these rights. Many unnecessary obstacles stand in the way of women who wish to breastfeed. ILCA seeks to draw attention to key findings of recent research and the clinical implications of those findings. References noted below include research with a variety of methodologies ranging from carefully controlled clinical trials to small descriptive studies. ILCA’s recommendations are based on rigorous published research wherever possible and on collected experience and wisdom where gaps in research-based knowledge exist.
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ILCA: Position on Infant Feeding in Emergencies

Increasingly over the last several years, mothers and infants have been affected by a variety of emergency situations world-wide

  • Armed conflicts displace millions of families and cut them off from their usual food supplies. There are some 50 million refugees around the word. Eighty percent of them are women and children.
  • Natural disasters also create short or long-term refugees and make access to food very difficult for sufficient time to endanger the most vulnerable of those affected – the ill, the elderly and young children. Crop failures, earthquakes, floods, hurricanes, tidal waves, typhoons and volcanic eruptions can destroy a country’s infrastructure and the livelihoods of those who weren’t killed outright.

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Transport of Milk Constituents by the Mammary Gland

D. B. Shennan and M. Peaker

Physiological Reviews, Vol. 80, No. 3, July 2000, pp. 925-951

Abstract

This review deals with the cellular mechanisms that transport milk constituents or the precursors of milk constituents into, out of, and across the mammary secretory cell. The various milk constituents are secreted by different intracellular routes, and these are outlined, including the paracellular pathway between interstitial fluid and milk that is present in some physiological states and in some species throughout lactation. Also considered are the in vivo and in vitro methods used to study mammary transport and secretory mechanisms. The main part of the review addresses the mechanisms responsible for uptake across the basolateral cell membrane and, in some cases, for transport into the Golgi apparatus and for movement across the apical membrane of sodium, potassium, chloride, water, phosphate, calcium, citrate, iodide, choline, carnitine, glucose, amino acids and peptides, and fatty acids.
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Promoting and Supporting Breast-Feeding

Jay Moreland, Jennifer Coombs

Am Fam Physician 2000;61:2093-100,2103-4.

The family physician can significantly influence a mother’s decision to breast-feed. Prenatal support, hospital management and subsequent pediatric and maternal visits are all-important components of breast-feeding promotion. Prenatal encouragement increases breast-feeding rates and identifies potential problem areas. Hospital practices should focus on rooming-in, early and frequent breast-feeding, skilled support and avoidance of artificial nipples, pacifiers and formula. Infant follow-up should be two to four days postdischarge, with liberal use of referral and support groups, including lactation consultants and peer counselors.

Breast-feeding is the best form of nutrition for infants.1,2 Family physicians can have a significant impact on the initiation and maintenance of breast-feeding, if they have sufficient knowledge of breast-feeding benefits and the necessary clinical management skills or habits.
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