• Nutrition Research and Practice
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• v.16 no.3
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• pp.344-353
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• 2022

BACKGROUND/OBJECTIVES: Hydrolyzed formula is often fed to infants with gastrointestinal or immune issues, such as malabsorption or cow's milk allergy, because enzymatic treatment has rendered it more digestible and less allergenic than standard cow's milk formula (SF). Partially hydrolyzed formula (PHF) should be considered for those infants who are intolerant to extensively hydrolyzed formula. However, there are concerns about the nutritional insufficiencies of PHF. We aimed to evaluate the effects of PHF on the growth and health indicators in infants who were at high-risk of allergic disease and potential candidates for consuming PHF. SUBJECTS/METHODS: A total of 83 infants aged 0-2 mon with a family history of allergies were assigned to consume either PHF or SF until 24 weeks of age. Anthropometric measures were obtained at baseline, 12 weeks, and 24 weeks; blood samples were drawn and evaluated at the end of the study. RESULTS: No significant differences were observed in weight, height, and weight-for-height at any time point in each sex between the PHF and SF groups. At 24 weeks of age, the weight-for-age and height-for-age z-scores of the SF group were higher than those of the PHF group, but there was no significant difference in the weight-for-height z-score. There were no significant differences in levels of white blood cells, hemoglobin, ferritin, protein, albumin, aspartate aminotransferase, alanine aminotransferase, eosinophil cationic protein, and immunoglobulin E. CONCLUSIONS: In this study, there were no differences in growth and blood panels between the infants consuming PHF or SF. Therefore, infants who are unable to tolerate SF can be fed PHF without nutritional concerns about growth.

• Clinical and Experimental Pediatrics
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• v.62 no.5
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• pp.149-154
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• 2019

The World Health Organization recommends that infants should be exclusively breastfed for the first 6 months of life to provide optimal nutrition in this critical period of life. After this, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years of age or beyond. For nonbreastfed infants, infant formula is an available option to provide the nutrition needed. Infant formula is usually prepared from industrially modified cow's milk and processed to adjust for the nutritional needs of infants. However, cow's milk is one of the most common causes of food allergy, affecting 2%-5% of all formula-fed infants during their first year of life. One strategy to prevent cow's milk allergy in nonbreastfed infants is the use of partially hydrolyzed formula (pHF) in high-risk infants, which are infants born in families with atopic disease. However, based on an epidemiological study, approximately half of the infants who develop allergy are not part of the at-risk group. This is because the non-at-risk group is significantly larger than the at-risk group and the non-at-risk infants have approximately 15% risk of developing allergies. This study aimed to evaluate the effects of partially hydrolyzed whey formula (pHF-W) in nonbreastfed infants and determine whether pHF-W can prevent atopic disease in high-risk infants and can be used as routine starter formula regardless of the allergy risk status.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.17 no.2
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• pp.61-73
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• 2014

Presented are guidelines for the prevention, diagnosis, and treatment of cow's milk protein allergy (CMPA) which is the most common food allergy in infants. It manifests through a variety of symptoms that place a burden on both the infant and their caregivers. The guidelines were formulated by evaluation of existing evidence-based guidelines, literature evidence and expert clinical experience. The guidelines set out practical recommendations and include algorithms for the prevention and treatment of CMPA. For infants at risk of allergy, appropriate prevention diets are suggested. Breastfeeding is the best method for prevention; however, a partially hydrolyzed formula should be used in infants unable to be breastfed. In infants with suspected CMPA, guidelines are presented for the appropriate diagnostic workup and subsequent appropriate elimination diet for treatment. Exclusive breastfeeding and maternal dietary allergen avoidance are the best treatment. In infants not exclusively breastfed, an extensively hydrolyzed formula should be used with amino acid formula recommended if the symptoms are life-threatening or do not resolve after extensively hydrolyzed formula. Adherence to these guidelines should assist healthcare practitioners in optimizing their approach to the management of CMPA and decrease the burden on infants and their caregivers.

• Clinical and Experimental Pediatrics
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• v.62 no.9
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• pp.340-341
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• 2019

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.19 no.3
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• pp.153-161
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• 2016

This paper covers algorithms for the management of regurgitation, constipation and infantile colic in infants. Anti-regurgitation formula may be considered in infants with troublesome regurgitation, while diagnostic investigations or drug therapy are not indicated in the absence of warning signs. Although probiotics have shown some positive evidence for the management of functional gastrointestinal disorders (FGIDs), the evidence is not strong enough to make a recommendation. A partially hydrolyzed infant formula with prebiotics and ${\beta}$-palmitate may be considered as a dietary intervention for functional constipation in formula fed infants. Lactulose has been shown to be effective and safe in infants younger than 6 months that are constipated. Macrogol (polyethylene glycol, PEG) is not approved for use in infants less than 6 months of age. However, PEG is preferred over lactulose in infants >6 months of age. Limited data suggests that infant formula with a partial hydrolysate, galacto-oligosaccharides/fructo-oligosaccharides, added ${\beta}$-palmitate may be of benefit in reducing infantile colic in formula fed infants in cases where cow's milk protein allergy (CMPA) is not suspected. Evidence suggests that the use of extensively hydrolyzed infant formula for a formula-fed baby and a cow's milk free diet for a breastfeeding mother may be beneficial to decrease infantile colic if CMPA is suspected. None of the FGIDs is a reason to stop breastfeeding.

• Preventive Nutrition and Food Science
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• v.16 no.3
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• pp.248-252
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• 2011

Soy protein based formula (SPF) has been developed for infants who are at a high risk for atopic dermatitis (AD) and cow's milk protein allergy (CMA). We performed this study to evaluate the therapeutic efficacy and safety of SPF compared to conventional hydrolyzed cow's milk formula (hCMF) in the feeding of infants with AD and CMA. 38 infants (12 to 24 months of age) diagnosed with CMA and AD were randomized to receive either SPF or hCMF for 12 weeks. Follow-up was conducted at 4, 8 and 12 weeks. Growth parameters of the infants were evaluated during each visit. Clinical evaluations, including AD severity scores, pruritus, specific immunoglobulin E (IgE) (cow's milk protein and soy protein) levels of peripheral blood, were made at enrollment and week 12. Analysis was performed on the 32 infants (SPF: n=16, hCMF: n=16) who completed the 12-week intervention. Eczema area and severity index (EASI) scores, a measure of the severity of AD, and pruritus were significantly reduced after 12 weeks compared to enrollment in the both groups; however, the median changes for EASI scores and pruritus were not statistically different between the two groups. The growth parameters did not differ significantly between both groups at any assessed time point. This study suggests that SPF could be useful in decreasing the severity of AD without affecting infant growth status. Therefore SPF could provide an adequate and safe alternative to hCMF in treating infants with AD and CMA during the first 12 to 24 months of their life.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.sup1
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• pp.1-6
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• 2008

Previous infant feeding guidelines recommended a delayed introduction of solids to beyond 6 months of age to prevent atopic diseases. However, scientific evidence supporting a delayed introduction of solids for prevention of atopic diseases is scarce and inconsistent. Current evidence does not support a major role for maternal dietary restrictions during pregnancy or lactation in the prevention of atopic disease. In studies of infants at high risk of developing atopic disease, there is evidence that exclusive breastfeeding for at least 4 months compared with feeding intact cow milk protein decreases the incidence of atopic dermatitis, cow milk allergy, and wheezing in early childhood. For infants at high risk of developing atopic disease who are not breastfed exclusively for 4 to 6 months, there is modest evidence that atopic dermatitis may be delayed or prevented by the use of extensively or partially hydrolyzed formulas, compared with cow milk formula, in early childhood. There is no convincing evidence that a delayed introduction of solid foods beyond 4 to 6 months of age prevents the development of atopic disease. For infants after 4 to 6 months of age, there are insufficient data to support a protective effect of any dietary intervention for the development of atopic disease.

• Food Science of Animal Resources
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• v.31 no.1
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• pp.129-138
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• 2011

Hydrolyzed wheat gluten (HWG) and low glutamic acid (Glu) hydrolyzed wheat gluten with different quantities of NaCl were reacted with several precursors to develop natural meat flavor based on Maillard reaction products (MRP). The MRP based flavors were analyzed for their pH, browning index, DPPH radical scavenging effect, and sensory properties. Synthetic meat flavor from low Glu hydrolyzed wheat gluten with 7% NaCl and ribose, cysteine, methionine, thiamin, lecithin, and garlic powder reacted at $140^{\circ}C$ for 30 min and were most favorable for a roasted meat flavor. Based on an omission test, cysteine was selected as the most important precursor for producing meat flavor compared to methionine, thiamine, and lecithin. Natural precursors including mushroom powder and fat medium were applied to compensate for the synthetic precursors. The optimum formula for meat flavor was 5% ribose, 7.7% cysteine, 6.9% garlic juice powder, 2.1% Lentinusedodes powder digested with protease, and 1% lard. The sulfuric pungent, oily, and salty attributes of the formula decreased and a mild roasted meat flavor was expressed.

• Food Science and Biotechnology
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• v.16 no.4
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• pp.590-593
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• 2007

The textural properties of doughs mixed with L-ascorbic acid (AA), trypsin hydrolyzed gluten peptide (THGP), and a mixture of AA-THGP were investigated using texture analyzer under the fermentation of the full formula and the freezing process. The full formula dough (FFD) required a shorter mixing time than the flour and water formula dough (FWD). The maximum resistance (Rmax) values of both the unfrozen and frozen doughs were lower for the FFD. The effects of AA and THGP additions were not significant (p<0.01) in FFD, however, they were significant in FWD. The freezing effect was significant (p<0.0001) for FFD, indicating that yeast fermented dough was much more sensitive to damage from freezing, which subsequently affected dough strength. Additions of AA (p=0.0026) and THGP (p=0.0097) had a significant effect on the extensibility (E-value) of unfrozen FWD, where THGP increased and AA decreased the E-value. However, freezing did not significantly effect the extensibilities of FWD (p=0.64) or FFD (p=0.21). The area of FFD was lower than the area of FWD for both the unfrozen and frozen doughs. However, the frozen dough mixed with THGP alone had the largest area overall. The addition of additives did not result in significantly different (p<0.01) areas under the curve, except in the frozen FFD. Freezing caused a statistically significant difference in the area of FWD (p=0.0045).

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.26 no.5
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• pp.277-283
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• 2023

Purpose: Cow's milk protein allergy (CMPA) is a common condition in infants, but little is known about healthcare providers' clinical experience treating infants with CMPA. To address this gap, we analyzed prospectively collected data from healthcare providers (HCPs) who treated infants under six months old with suspected CMPA using hypoallergenic formulas. The study focused on a commercial extensively hydrolyzed formula containing Lactobacillus rhamnosus GG (ATCC53103) (eHF-LGG) or a commercial amino acid formula (AAF). Methods: In this secondary analysis of prospectively collected survey data, 52 HCPs treated 329 infants under six months old with suspected CMPA using hypoallergenic formulas. A series of two de-identified surveys per patient were collected by HCPs to assess short-term symptom relief in the patients and HCP's satisfaction with the management strategies. The initial survey was completed at the initiation of treatment of CMPA, and the second survey was completed at a follow-up visit. Results: The majority of HCPs (87%) in the study were general pediatricians, and most saw 2 to 10 CMPA patients weekly. Results showed that clinicians reported satisfaction with treatment in 95% of patients in the EHF cohort and 97% of patients in the AAF cohort and achieved expected clinical results in 93% and 97% of patients using eHF and AAF, respectively. Furthermore, few patients were switched from the hypoallergenic formula once initiated. Conclusion: The study provides new insights into HCP perspectives on treating infants with CMPA and supports using hypoallergenic formulas to manage this condition. However, additional prospective controlled studies are needed to confirm these initial findings.