The development of suitable substitutes for human milk took place in the USA in 1915, when Gerstenberger and colleagues developed a revolutionary artificial milk based on the general composition of the breast milk model and containing various animal and vegetable oils blended together to mimic the lipid content of human milk. The new mixture, named “synthetic milk adapted”, was the first suitable alternative to human milk. This product was the forerunner of modern infant formulas and initiated the modern era of infant nutrition. For the first time, an artificial milk, well tolerated by the infant, was able to offer adequate amounts of nutrients to meet the demands of the growing organism. This innovative formula as well as other new and adequate human milk substitutes contributed in reducing infant morbidity and mortality, which were high in bottle-fed infants because of nutritional inadequacies and infectious diseases. However, for several years, in the mid-20th century, interest in infant nutrition gradually declined and no substantial improvement in the composition of infant formulas was recorded. Unfortunately, in those years, breastfeeding also declined dramatically in industrialized countries in favour of infant formulas or even pasteurized or evaporated milk. In the following years, a better understanding of the nutritional requirements of the infant and substantial scientific advances led to a resurgence in enthusiasm for breast milk. In addition, paediatricians became fully aware that the formulas so far employed, which had been regulated in their composition by the ESPGAN recommendations of 1977, promoted growth and development equivalent to that of healthy infants fed human milk, but did not produce similar clinical outcomes, also because, among other things, bottle-fed infants were not well protected from infections. In fact, formulas employed at the time, prepared from non-human milk components, were still substantially different in composition from the complex mixture of nutrients of human milk. The bioavailability, the digestibility and the biological value of the nutrients employed in the manufacturing of these human milk substitutes remained quite different to those found in human milk. The composition of human milk, which serves as a valuable reference for improving milk formulas, cannot be exactly replicated because it contains hormones, immune factors, active enzymes, growth factors and viable cells, whose precise functions and interactions are still poorly understood, so that at present their addition to formulas is not possible. Notwithstanding these limitations, which are often also connected to problems of economic feasibility, in the last two decades, and especially over the last few years, research in infant nutrition has led to important scientific advances and has greatly improved the quality of human milk substitutes, which continually change with new nutritional knowledge. New, improved formulas are already available. They are quite different and a great improvement on those prepared according to the dated ESPGAN recommendations of 1977. These products are aimed at obtaining a demonstrable advantage with the achievement of clinical outcomes similar to those of breastfed infants. This has been possible through closer adherence in composition to the human milk model (e.g. the addition of polyunsaturated fatty acids, oligosaccharides, nucleotides, lactoferrin or the manipulation of specific milk protein fractions, etc.), but also through dissimilarities and differences in composition from human milk (e.g. the addition of probiotics, fermented proteins, active metabolites, etc.). These new formulas are now closer to the human milk model, though more in the results obtained than in their actual composition, and they represent living proof that infant formulas are certainly not “all the same”. These new, advanced human milk substitutes clearly underline the importance of research for the constant improvement of infant formulas. On the other hand, scientific evidence so far acquired indicates the need for further improvements and adjustments. To reduce or to stop research altogether, in order to lower the cost of the formulas, so that they remain at the level of the ESPGAN recommendations of 1977, would be a great disservice to all infants who cannot be fed at the breast. The symposium “Mamma e Neonato” was planned to address some of the most relevant issues relative to infant nutrition. The papers presented illustrate several relevant topics in this field. Particular attention was paid to advances in the modulation of infant flora and to the use of prebiotics, because there is now general agreement that a favourable gut microbial ecosystem is an important advantage obtained by the infant fed at the breast, so that every effort should be made to replicate it in the bottle-fed infant. Another aspect of modern nutrition, which is currently the subject of intensive research and which was discussed at length during the meeting, pertains to the nutritional needs of preterm infants, particularly very preterm ones. The achievement of appropriate growth and nutrition accretion depends on the availability and on the correct use of appropriate infant formulas consistent with current scientific knowledge. Their safety and nutritional quality must be assured because they will represent the sole source of enteral nutrition for the preterm infant for a long period of time. In addition to the main topics of the symposium, other relevant issues of modern nutrition, such as the correct approach to the allergic infant, were presented. Finally, we wish to gratefully acknowledge the important and intelligent support of Royal Numico, whose commitment to qualified research in infant nutrition is well known and appreciated.

FOREWORD

FANARO, Silvia;VIGI, Vittorio
2005

Abstract

The development of suitable substitutes for human milk took place in the USA in 1915, when Gerstenberger and colleagues developed a revolutionary artificial milk based on the general composition of the breast milk model and containing various animal and vegetable oils blended together to mimic the lipid content of human milk. The new mixture, named “synthetic milk adapted”, was the first suitable alternative to human milk. This product was the forerunner of modern infant formulas and initiated the modern era of infant nutrition. For the first time, an artificial milk, well tolerated by the infant, was able to offer adequate amounts of nutrients to meet the demands of the growing organism. This innovative formula as well as other new and adequate human milk substitutes contributed in reducing infant morbidity and mortality, which were high in bottle-fed infants because of nutritional inadequacies and infectious diseases. However, for several years, in the mid-20th century, interest in infant nutrition gradually declined and no substantial improvement in the composition of infant formulas was recorded. Unfortunately, in those years, breastfeeding also declined dramatically in industrialized countries in favour of infant formulas or even pasteurized or evaporated milk. In the following years, a better understanding of the nutritional requirements of the infant and substantial scientific advances led to a resurgence in enthusiasm for breast milk. In addition, paediatricians became fully aware that the formulas so far employed, which had been regulated in their composition by the ESPGAN recommendations of 1977, promoted growth and development equivalent to that of healthy infants fed human milk, but did not produce similar clinical outcomes, also because, among other things, bottle-fed infants were not well protected from infections. In fact, formulas employed at the time, prepared from non-human milk components, were still substantially different in composition from the complex mixture of nutrients of human milk. The bioavailability, the digestibility and the biological value of the nutrients employed in the manufacturing of these human milk substitutes remained quite different to those found in human milk. The composition of human milk, which serves as a valuable reference for improving milk formulas, cannot be exactly replicated because it contains hormones, immune factors, active enzymes, growth factors and viable cells, whose precise functions and interactions are still poorly understood, so that at present their addition to formulas is not possible. Notwithstanding these limitations, which are often also connected to problems of economic feasibility, in the last two decades, and especially over the last few years, research in infant nutrition has led to important scientific advances and has greatly improved the quality of human milk substitutes, which continually change with new nutritional knowledge. New, improved formulas are already available. They are quite different and a great improvement on those prepared according to the dated ESPGAN recommendations of 1977. These products are aimed at obtaining a demonstrable advantage with the achievement of clinical outcomes similar to those of breastfed infants. This has been possible through closer adherence in composition to the human milk model (e.g. the addition of polyunsaturated fatty acids, oligosaccharides, nucleotides, lactoferrin or the manipulation of specific milk protein fractions, etc.), but also through dissimilarities and differences in composition from human milk (e.g. the addition of probiotics, fermented proteins, active metabolites, etc.). These new formulas are now closer to the human milk model, though more in the results obtained than in their actual composition, and they represent living proof that infant formulas are certainly not “all the same”. These new, advanced human milk substitutes clearly underline the importance of research for the constant improvement of infant formulas. On the other hand, scientific evidence so far acquired indicates the need for further improvements and adjustments. To reduce or to stop research altogether, in order to lower the cost of the formulas, so that they remain at the level of the ESPGAN recommendations of 1977, would be a great disservice to all infants who cannot be fed at the breast. The symposium “Mamma e Neonato” was planned to address some of the most relevant issues relative to infant nutrition. The papers presented illustrate several relevant topics in this field. Particular attention was paid to advances in the modulation of infant flora and to the use of prebiotics, because there is now general agreement that a favourable gut microbial ecosystem is an important advantage obtained by the infant fed at the breast, so that every effort should be made to replicate it in the bottle-fed infant. Another aspect of modern nutrition, which is currently the subject of intensive research and which was discussed at length during the meeting, pertains to the nutritional needs of preterm infants, particularly very preterm ones. The achievement of appropriate growth and nutrition accretion depends on the availability and on the correct use of appropriate infant formulas consistent with current scientific knowledge. Their safety and nutritional quality must be assured because they will represent the sole source of enteral nutrition for the preterm infant for a long period of time. In addition to the main topics of the symposium, other relevant issues of modern nutrition, such as the correct approach to the allergic infant, were presented. Finally, we wish to gratefully acknowledge the important and intelligent support of Royal Numico, whose commitment to qualified research in infant nutrition is well known and appreciated.
2005
Mosca, F; Fanaro, Silvia; Vigi, Vittorio
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/516503
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