Child ; Child Nutrition Disorders ; therapy ; Child, Preschool ; Humans ; Infant ; Infant Food ; standards ; Infant Formula ; methods ; Infant, Newborn

Diarrheal disorders in childhood are the second most common cause of child deaths worldwide. Nutritional rehabilitation is the most important factor among treatments when diarrheal disorders develop and has a general beneficial effect on the patient's condition, intestinal function, and immune response. Breast milk is the most nutritious food for treating acute and chronic diarrhea in infants. Until now, many infant formulas have been developed, and particularly, special formulas for treating acute or chronic diarrhea are commonly used. Lactose-free formulas, soy based formulas, and hydrolyzed and amino acid-based formula are typical formulas. In general, replacement with specialized lactose-free formulations is unnecessary in children with persistent diarrhea, and it has been reported that infants that are not severely compromised have food allergy and intestinal failure. However, a general knowledge does not always applied to all populations because the genetic, economic or environmental factors are different. Physicians should know about the components and characteristics of special formulas in order to coach parents to use these formulas properly.
Child ; Diarrhea ; Food Hypersensitivity ; Humans ; Infant ; Infant Formula ; Milk, Human ; Parents

Objective: To assess the risk of foodborne diseases caused by Cronobacter sakazakii in infant formula powder from retail to feeding and provide formulate suggestions for safe feeding of infants at home. Methods: This study used the special monitoring and risk monitoring data of infant formula powder in Heilongjiang Province and combined data at home and abroad. The @RISK software was used to evaluate the disease risk caused by Cronobacter sakazakii in the process of infant formula powder from retail to feeding. Results: According to the results of this quantitative risk assessment, the risk of foodborne diseases caused by Cronobacter sakazakii at the current consumption pattern in Heilongjiang Province was 5.158×10^-5 persons/million (40.0 ℃ and 50.0 ℃), 1.072×10^-7 persons/million (60.0 ℃), 5.544×10^-14 persons/million (70.0 ℃). When the feeding time of infant formula powder was adjusted to 0-2 h and 2-3 h respectively, the above prediction results did not change. When it was adjusted to 3-4 h, the risk increased. If it was adjusted to 4-24 h, the number of Cronobacter sakazakii increased by 14-24 orders of magnitude at room temperature. If the initial pollution concentration (after flushing) was adjusted to 1 MPN/ml, the average disease risk per meal was 805.7 persons/million (40.0 ℃ and 50.0 ℃), 1.7 persons/million (60.0 ℃) and 9.1 × 10^-7 persons/million (70.0 ℃). The results of sensitivity analysis showed that the water temperature (70.0 ℃), initial pollution concentration, room storage time and temperature were important factors of risk. Conclusion: Controlling the contamination level of Cronobacter sakazakii in infant formula powder, controlling the feeding time within 3 h, storing in refrigerator and mixing with water with temperature not lower than 70.0 ℃ are effective measures to prevent infants from eating infant formula powder infected by Cronobacter sakazakii.
Infant ; Humans ; Cronobacter sakazakii ; Infant Formula ; Food Microbiology ; Powders ; Risk Assessment ; Foodborne Diseases

Female ; Food Contamination ; Humans ; Infant ; Infant Formula ; Kidney Calculi ; chemically induced ; diagnosis ; Male ; Triazines ; toxicity

Animals ; Cattle ; China ; Dairy Products ; Food Contamination ; Humans ; Infant ; Infant Formula ; chemistry ; Milk ; Triazines ; chemistry

OBJECTIVETo investigate the occurrence and concentrations of melamine and its analogues in tainted infant formula and to identify the etiologic factors for the urinary stones epidemic in infants and young children in China in 2008.

METHODSSanlu infant formula samples were collected from families of the affected children in Gansu province, and markets in Gansu and Hebei provinces and Beijing city. Melamine and its analogues, including cyanuric acid, ammeline, and ammelide were measured by gas chromatography/tandem mass spectrometry.

RESULTSHigh prevalence and concentrations of melamine were found in Sanlu infant formula samples, with low concentrations of cyanuric acid, ammeline and ammelide. Melamine were detected in 87 out of 111 Sanlu infant formula samples with a range of 118 to 4,700 mg/kg.

CONCLUSIONThe results provide strong evidence for melamine as the etiological factor for the urinary stones epidemic in infants and young children in China in 2008.

China ; Flame Retardants ; analysis ; Food Contamination ; Humans ; Infant ; Infant Formula ; chemistry ; Triazines ; chemistry

OBJECTIVETo establish a method for determination of fatty acid esters of chloropropanols (chloropropanols esters) in milk powder by isotope dilution-gas chromatography-mass spectrometry (GC-MS), and to acquire the pollution level of chloropropanols esters in infant formula and evaluate the dietary exposure risk of chloropropanols esters in infant formula for infants.

METHODSA total of 111 infant formula samples were collected from supermarkets in Beijing, and the infant formula with no chloropropanols esters detected was served as the blank sample. The samples were ultrasonically extracted with hexane, followed by ester-bond cleavage reaction with sodium methylate-methanol and purification by matrix solid-supported liquid-liquid extraction, then being derivatived with heptafluoro butyrylimidazol. After extracted by sodium chloride solution, the derivatives were determined by GC-MS. The concentration of chloropropanols esters were quantified using the deuterium chloropropanols esters as the internal standards. The accuracy of the method was assessed by the recoveries of the blank spiked samples, and the relative standard deviations (RSD) of the recoveries represent the precision of the method. The contamination level of chloropropanols esters and the intake amount of the infant formula of the 6-month infant were used to estimate the dietary exposure assessment, and x (95% CI) and P97.5 of the contamination level of chloropropanols esters were used to represent the average dietary exposure and the high-end dietary exposure.

RESULTSThe satisfied linear correlations in the range of 0.010-0.800 mg/L was acquired for 3-MCPD esters, 2-MCPD esters, 1,3-DCP esters and 2,3-DCP esters with coefficient correlations of 0.999 9, 0.999 8, 0.999 5 and 0.999 6, respectively. The limits of detection (LOD) and the limits of quantitation (LOQ) for 3-MCPD esters, 2-MCPD esters, 1,3-DCP esters and 2,3-DCP esters were 0.005, 0.005, 0.015, 0.015 mg/kg, and 0.015, 0.015, 0.045, 0.045 mg/kg. The average recoveries of the four chloropropanols esters spiked at 0.025, 0.050 and 0.100 mg/kg in blank matrix were in a range from 80.3% to 111.9%, with relative standard deviations (RSD) less than 11.4%. Of the 111 infant formula samples, the detection rates and the contamination levels of 3-MCPD esters and 2-MCPD esters were 77.5% (86/111), 11.7% (13/111) with the contamination levels in the range of ND-0.230 mg/kg and ND-0.039 mg/kg, respectively, and χ (95% CI) and P97.5 of 3-MCPD esters and 2-MCPD esters were 0.020 (0.003-0.113) and 0.006 (0.005-0.025) mg/kg, 0.113 and 0.025 mg/kg, respectively. 1,3-DCP esters and 2,3-DCP esters were not detected in the 111 samples. x (95% CI) and P75 of the six-month old infants to 3-MCPD esters were 0.304 (0.038-1.735) and 1.735 µg · kg⁻¹ · d⁻¹, respectively, which accounted for 15.2% and 86.7% of the PMTDI (2 µg · kg⁻¹ · d⁻¹) of 3-MCPD.

CONCLUSIONThis GC-MS method was accurate and rugged for the determination of chloropropanols esters in milk powder. Based on the exposure assessment results, the health risk of chloropropanols esters for infants caused by the intake of infant formula was acceptable.

Chlorohydrins ; Esters ; Fatty Acids ; Food Contamination ; Gas Chromatography-Mass Spectrometry ; Humans ; Infant ; Infant Formula ; alpha-Chlorohydrin

OBJECTIVETo estimate the dietary melamine exposure in Chinese infants and young children from the consumption of melamine adulterated Sanlu infant formula.

METHODSFour age groups of infants and young children (3, 6, 12, and 24 months) were chosen as the assessed subjects and the maximum amount of infant formula consumption was estimated based on the recommended usage level in the package insert of Sanlu infant formula and other brands. Melamine was analyzed in 111 Sanlu infant formula samples collected from the markets in Beijing and Gansu province using the LC-MS-MS with a limit of quantification of 0.05 mg/kg. Four levels of melamine concentration were chosen to estimate the dietary intakes, including the mean, median, 90th percentile, and maximum.

RESULTSThe infants of 3 months had the highest intake of melamine, and with the increase of the age (month), the intake decreased. Based on the median melamine concentration (1,000 mg/kg) as an example, the melamine intakes for the infants of 3, 6, 12, and 24 months were 23.4, 21.4, 15.0, and 8.6 mg/kg bw/d, respectively.

CONCLUSIONDietary melamine intakes from tainted Sanlu infant formula significantly exceeded the TDI level (0.2 mg/kg bw/d) recommended by the WHO Expert Meeting in 2008. However, the present assessment has some limitations including the poor representative samples, the varied melamine concentrations in the adulterated Sanlu infant formula, and other brand infant formula possibly consumed by these infants.

China ; Diet ; Eating ; Female ; Flame Retardants ; analysis ; metabolism ; Food Contamination ; Humans ; Infant ; Infant Formula ; chemistry ; Male ; Triazines ; chemistry ; metabolism

BACKGROUND: IgE-mediated cow's milk allergy (CMA) is one of the most common food allergies in infants. It is still controversial whether the early introduction of cow's milk formula (CMF) prevents the development of CMA. OBJECTIVE: We aimed to evaluate the duration and frequency of CMF ingestion as compere with exclusive breast-fed for preventing CMA in high-risk infants. METHODS: We enrolled the patients diagnosed with hen's egg allergy by an oral food challenge. A questionnaire was completed by the caregivers of the patients regarding the timing of introduction and discontinuation of CMF, and the frequency of CMF ingestion. Based on the information, we analyzed the relationship between the duration and frequency of CMF ingestion and the development of CMA at 3–24 months of age. RESULTS: Three hundred seventy-four patients were analyzed; 171 were diagnosed with CMA (45.7%). The analyzed patients (n = 374) were categorized into the following subgroups: exclusively breast-fed (breast-fed group, n = 75); discontinued ingestion of CMF before 3 months of age (temporary group, n = 177); continuous ingestion of CMF, but not daily, up to 3 months of age (nondaily group, n = 47); continuous ingestion of CMF at least once daily (daily group, n = 75). The incidence of developing CMA between the breast-fed group and temporary group did not show any statistical difference. Nondaily group and daily group had significantly lower incidence of developing CMA in comparison to the breast-fed group (nondaily group odds ratio 0.43; p = 0.02, daily group odds ratio 0.11; p < 0.001). CONCLUSION: Ingestion of CMF during the first 3 months of life might prevent the development of CMA in high-risk infants.
Breast Feeding ; Caregivers ; Eating ; Egg Hypersensitivity ; Food Hypersensitivity ; Humans ; Immunoglobulin E ; Incidence ; Infant ; Infant Formula ; Milk Hypersensitivity ; Milk ; Odds Ratio

Bread ; analysis ; Child, Preschool ; Dietary Exposure ; analysis ; Flour ; analysis ; Food Additives ; analysis ; Food Contamination ; analysis ; Food, Preserved ; analysis ; Humans ; Hydrocarbons ; analysis ; Infant ; Infant Formula ; analysis ; Infant, Newborn ; Risk Assessment