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Cow’s Milk Substitutes for Children: Nutritional Aspects of Milk from Different Mammalian Species, Special Formula and Plant-Based Beverages
Cow’s milk and dairy are commonly consumed foods in the human diet and contribute to maintaining a healthy nutritional state, providing unique sources of energy, calcium, protein, and vitamins, especially during early childhood. Milk formula is usually made from cow’s milk and represents the first food introduced into an infant’s diet when breastfeeding is either not possible or insufficient to cover nutritional needs. Very recently, increased awareness of cow’s milk protein allergy and intolerance, and higher preference to vegan dietary habits have influenced parents towards frequently choosing cows’ milk substitutes for children, comprising other mammalian milk types and plant-based milk beverages. However, many of these milk alternatives do not necessarily address the nutritional requirements of infants and children. There is a strong need to promote awareness about qualitative and quantitative nutritional compositions of different milk formulas, in order to guide parents and medical providers selecting the best option for children. In this article, we sought to review the different compositions in terms of macronutrients and micronutrients of milk from different mammalian species, including special milk formulas indicated for cow’s milk allergy, and of plant-based milk alternatives.
Journal Article
Spoiled : the myth of milk as a superfood
\"Can any other food product be as staggeringly difficult and expensive as milk to get from source (in this case, a cow) to destination (milk glass on table) in something loosely approximating its original condition? Cow and goat milk was consumed only in fermented form for centuries (e.g., cheese, yogurt) until modern times. The rise of fresh milk drinking is unnecessary, expensive, bad for the environment, and nonsensical, and has grown into a huge industry only because in the early 20th century advertising campaigns convinced doctors and the rest of us that milk was an essential food. Mendelson's book is a history of the food she describes as \"drinking-milk,\" referring to dairy animals' milk that is consumed in fluid form rather than as some kind of fermented sour milk or cheese. Contrary to popular belief, it never figured prominently in human diets until very recently. Mendelson argues that milk's rise to the status of nutritional mainstay - the first scientifically anointed superfood of the modern industrialized world - was one of the great flukes of food history. The founders of Western medicine had no way of understanding the genetic anomaly that allowed them, unlike most of the world's peoples, to digest lactose from babyhood to old age. In other words, today's mega-industry stemmed from a lack of scientific perspective. Mendelson further argues that in the case of drinking-milk's merits or demerits, early modern medical authorities' unquestioning faith in their own advanced knowledge lured them into misguided teachings destined to form the flawed basis of a huge - and soon troubled - industry that is now on the thin edge of unsustainability. From the Enlightenment era on, the seeds of many future dairy-industry crises lurked in an unavoidable bit of historical mistiming: Medical authorities arrived at a supposedly up-to-the-minute belief that \"sweet\" (unfermented, and thus full-lactose) drinking-milk was purer and more healthful than sour milk, well before crucial scientific advances that might have triggered some doubts. The purpose of this book is not to portray drinking-milk from dairy animals as a dangerous poison but to explain how milk is produced, and to debunk the idea that milk in unfermented fluid form is a food of unique virtues whose use goes back to remote prehistory. Along the way, she provides an interesting look at the history of the raw-versus-pasteurized milk debate, and how it has developed into not only a public health debate but also a 'personal choice' question adopted by those on opposite sides of the political spectrum\"-- Provided by publisher.
Book
Growth, Tolerance, and Compliance of Infants Fed an Extensively Hydrolyzed Infant Formula with Added 2′-FL Fucosyllactose (2′-FL) Human Milk Oligosaccharide
Background: The purpose of this study was to evaluate the growth, tolerance and compliance effects of an extensively hydrolyzed formula with added 2′-FL in an intended use population of infants. Methods: A non-randomized, single-group, multicenter study was conducted. Infants (0–60 days of age) with suspected food protein allergy, persistent feeding intolerance, or presenting conditions where an extensively hydrolyzed formula (eHF) was deemed appropriate were enrolled in a 2-month feeding trial. The primary outcome was maintenance of weight for age z-score during the study. Weight, length, head circumference, formula intake, tolerance measures, clinical symptoms and questionnaires were collected. Forty-eight infants were enrolled and 36 completed the study. Results: Weight for age z-scores of infants showed a statistically significant improvement from study day 1 to study day 60 (0.32 ± 0.11, p = 0.0078). Conclusions: Overall, the results of the study demonstrate that the study formula was well tolerated, safe and supported growth in the intended population.
Journal Article
Belgian Case Series Identifies Non-Cow Mammalian Milk Allergy as a Rare, Severe, Selective, and Late-Onset Condition
Background: Cow’s milk allergy (CMA) is the most common food allergy in children, typically resolving by adolescence. In contrast, the clinical spectrum of allergies to non-cow mammalian milk and their patterns of IgE cross-reactivity are less well documented. Nutritional differences between various mammalian milks may also impact dietary management in milk-allergic patients. Objectives: To characterize clinical features, onset age, and IgE cross-reactivity patterns of non-cow mammalian milk allergies in adult patients seen at a tertiary allergy center, and to compare these findings with published cases. Methods: A retrospective analysis of patients included in the “Extended Laboratory Investigation for Rare Causes of Anaphylaxis study” with mammalian milk allergy was performed using clinical history, skin testing, and serum-specific IgE measurements. Cross-reactivity patterns were assessed in selected cases using immunoblotting, specific IgE inhibition, and basophil activation testing, and compared with published reports of non-cow mammalian milk allergy. Results: In our case series of 22 patients with mammalian milk allergy and 10 healthy control subjects, 3 patients were identified with isolated adult-onset non-cow mammalian milk allergy (n = 1 buffalo milk; n = 2 mare milk), confirmed via immunoblotting and basophil activation testing. Streptavidin-based specific IgE measurement for buffalo cheese was positive in the buffalo milk allergic patient. The literature review identified 82 cases of non-cow mammalian milk allergy. These cases typically showed late onset (mean age 8.6 years; range 1–70 years), severe reactions (CoFAR (Consortium for Food Allergy Research) grade 3 or 4 in 66%, and one fatality), and selective sensitization (affecting sheep and/or goat, camel, mare, buffalo, donkey, or combinations thereof in 56, 10, 5, 5, 4, and 2 cases, respectively). Conclusions: Non-cow mammalian milk allergies are rare but generally present later in life with selective IgE cross-reactivity, differing from the broader cross-reactivity observed in CMA. This selectivity may allow for safe dietary alternatives. These findings underscore the need for improved diagnostics and personalized dietary management in this patient population.
Journal Article
Breast Milk: A Source of Functional Compounds with Potential Application in Nutrition and Therapy
Breast milk is an unbeatable food that covers all the nutritional requirements of an infant in its different stages of growth up to six months after birth. In addition, breastfeeding benefits both maternal and child health. Increasing knowledge has been acquired regarding the composition of breast milk. Epidemiological studies and epigenetics allow us to understand the possible lifelong effects of breastfeeding. In this review we have compiled some of the components with clear functional activity that are present in human milk and the processes through which they promote infant development and maturation as well as modulate immunity. Milk fat globule membrane, proteins, oligosaccharides, growth factors, milk exosomes, or microorganisms are functional components to use in infant formulas, any other food products, nutritional supplements, nutraceuticals, or even for the development of new clinical therapies. The clinical evaluation of these compounds and their commercial exploitation are limited by the difficulty of isolating and producing them on an adequate scale. In this work we focus on the compounds produced using milk components from other species such as bovine, transgenic cattle capable of expressing components of human breast milk or microbial culture engineering.
Journal Article
Effectiveness and safety of the four-step versus six-step milk ladder in children with IgE-mediated cow’s milk protein allergy: protocol for an open-label randomised controlled trial
IntroductionIntroducing baked milk into the diet of children with cow’s milk protein allergy (CMPA) has been shown to potentially accelerate the development of tolerance to non-heated milk. However, there is no standardised milk ladder (ML) protocol, and different scientific societies across countries recommend varying versions. This study aims to assess the effectiveness and safety of the four-step ML (4-ML) compared with the six-step ML (6-ML) in children with IgE-mediated CMPA.Methods and analysisWe will perform an open-label randomised trial with two parallel arms in two departments of the same academic hospital. A total of 92 children with IgE-mediated CMPA will be allocated in a 1:1 ratio to introduce cow’s milk into their diet according to either 4-ML or 6-ML with a 4-week break period between subsequent steps. Oral food challenge (OFC) with tested products at each subsequent step of the ML will be conducted in hospital settings. The primary outcome will be the percentage of children with tolerance to non-heated cow’s milk proteins defined as no allergic reaction to raw cow’s milk (120–240 mL depending on the age of the patient) during the last OFC; measured at the end of the 12-week observation period for the 4-ML and 20-week observation period for the 6-ML. Secondary outcomes will include the percentage of children with a negative OFC to each ML step; the percentage of children with anaphylaxis (both those who were treated and those who were not treated with epinephrine); the percentage of children with exacerbation of atopic dermatitis; growth; compliance; and quality of life of the caregivers and parents’ anxiety about adverse events during their child’s OFC.Ethics and disseminationThe bioethics committee of the Medical University of Warsaw, Poland, approved this protocol (KB/107/2024). The findings will be published in a peer-reviewed journal and submitted to relevant conferences no later than 1 year after data collection.Trial registration numberNCT06664918.
Journal Article