Effect of Soy Protein on the Small Bowel Mucosa of Young Infants Recovering from Acute Gastroenteritis

Iyngkaran, N; Yadav, M; Looi, Lai‐Meng; Cg, Boey; Kl, Lam; Balabaskaran, S; Sd, Puthucheary

doi:10.1097/00005176-198801000-00014

Cited by 26 publications

(14 citation statements)

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“…Small-bowel injury, a reversible celiac-like villus injury that produces an enteropathy with malabsorption, hypoalbuminemia, and failure to thrive, has been documented in at least 4 studies. [70][71][72][73] In case series of infantile food protein-induced enterocolitis caused by cow milk protein, 30% to 64% of infants had concomitant soy-induced enterocolitis, [74][75][76][77] with enterocolitis manifested by bloody diarrhea, ulcerations, and histologic features of acute and chronic inflammatory bowel disease. 69,75,[78][79][80] Afflicted infants have responded to replacing the soy protein-based formula with a hydrolyzed protein formula.…”

Section: Severe Gastrointestinal Reactions To Soy Formulamentioning

confidence: 99%

Use of Soy Protein-Based Formulas in Infant Feeding

Bhatia¹,

Greer²

2008

Pediatrics

321

333

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Soy protein-based formulas have been available for almost 100 years. Since the first use of soy formula as a milk substitute for an infant unable to tolerate a cow milk protein-based formula, the formulation has changed to the current soy protein isolate. Despite very limited indications for its use, soy protein-based formulas in the United States may account for nearly 25% of the formula market. This report reviews the limited indications and contraindications of soy formulas. It will also review the potential harmful effects of soy protein-based formulas and the phytoestrogens contained in these formulas.T HE AMERICAN ACADEMY of Pediatrics (AAP) is committed to the use of human milk as the ideal source of nutrition for infant feeding. However, by 2 months of age, the majority of infants in North America are receiving at least some formula. Soy-based infant formulas have been available for almost 100 years. 1 Despite limited indications, soy protein-based formula accounts for approximately 20% of the formula market in the United States. Because an infant formula provides a source of nutrition for an extended interval, its nutritional adequacy must be proven, and the indications for its use must be substantiated and well understood. This statement updates the 1998 AAP review of soy protein-based formulas and addresses the ongoing concern of phytoestrogens in soy formulas. COMPOSITIONIsolated soy protein-based formulas currently on the market are all free of cow milk protein and lactose and provide 67 kcal/dL. All are iron-fortified and meet the vitamin, mineral, and electrolyte specifications addressed in the 2004 guidelines from the AAP for feeding term infants 2 and established by the US Food and Drug Administration. 3 The protein is a soy isolate supplemented with L-methionine, L-carnitine, and taurine to provide a protein content of 2.45 to 2.8 g per 100 kcal or 1.65 to 1.9 g/dL. The fat content of soy protein-based formulas is derived primarily from vegetable oils. The quantity of specific fats varies by manufacturer and is usually similar to those in the manufacturer's corresponding cow milk-based formula. The fat content ranges from 5.02 to 5.46 g per 100 kcal or 3.4 to 3.6 g/dL. The oils used include soy, palm, sunflower, olein, safflower, and coconut. Docosahexaenoic and arachidonic acids now are added routinely.In formulas, carbohydrate sources are corn maltodextrin, corn syrup solids, and sucrose, with content ranging from 10.26 to 10.95 g per 100 kcal or 6.9 to 7.4 g/dL. Until 1980, mineral absorption from soy formulas was erratic because of poor stability of the suspensions and the presence of excessive soy phytates. 4 Because soy protein isolate formulas still contain 1.5% phytates, and up to 30% of the total phosphorus is phytate bound, they contain 20% more calcium and phosphorus than cow milk-based formulas and maintain the ratio of calcium to available phosphorus of 1.1 to 2.0:1. With the current formulations, bone mineralization, serum concentrations of calcium and phosphorus, and alka...

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Section: Severe Gastrointestinal Reactions To Soy Formulamentioning

confidence: 99%

Use of Soy Protein-Based Formulas in Infant Feeding

Bhatia¹,

Greer²

2008

Pediatrics

321

333

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“…The infants were readmitted six weeks later for challenge studies as previously described.4 8 The infant was offered 5 ml of the low lactose cows' milk (AL 110) and if no reaction occurred the volume was doubled hourly for the first four hours, then three hourly until the total fluid requirements had been met. If the infants developed symptoms the challenge was stopped and the infants were given an oral rehydrating solution after which they were given a protein hydrolysate formula.…”

Section: Methodsmentioning

confidence: 99%

“…The biopsy specimens were taken through the mouth just distal to the duodenojejunal flexure with the Watson paediatric capsule immediately before the challenge with cows' milk protein and then 20-24 hours later whether or not symptoms developed. The morphological changes in the mucosa were scored as previously described.4 8 Infants who had histological reactions but no symptoms (group 2), and infants without clinical and histological reactions to the challenge (group 3) were studied further. They were maintained on cows' milk (for example, S-26 (Wyeth)) and two to six weeks later were readmitted for complete clinical assessment and a third biopsy.…”

Section: Methodsmentioning

confidence: 99%

Effect of continued feeding of cows' milk on asymptomatic infants with milk protein sensitive enteropathy.

Iyngkaran

Yadav

Boey

et al. 1988

Archives of Disease in Childhood

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SUMMARYThe clinical response and the histological changes in the mucosa of the small bowel in response to continued feeding with cows' milk protein were assessed over a period of 2-6 weeks in 24 infants who had shown histological changes without immediate clinical symptoms after challenge with a diet containing cows' milk protein. Twenty of the 24 infants (83%) thrived well on cows' milk protein. Jejunal biopsy specimens taken six to eight weeks after the initial biopsy showed histological improvement in all 20 infants compared with biopsy specimens taken soon after the challenge, which had shown mucosal damage. The mucosa had returned to normal in 12, was mildly abnormal in seven, and moderately abnormal in one. Corresponding improvements in the activities of mucosal enzymes were seen. In four of the 24 infants (17%) symptoms developed between three and six weeks. Histological examination of the jejunal biopsy specimens showed that mucosal damage had progressed in two, and remained the same in two; moreover, the disaccharidase activities remained depressed. The present study shows that most infants with enteropathy caused by sensitivity to cows' milk protein but without clinical symptoms develop tolerance to the protein and the mucosa returns to normal despite continued feeding with cows' milk protein.

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“…In post-infectious dietary protein sensitive enteropathy, the most common symptom is diarrhea with or without vomiting (10)(11)(12)(13)(14)(15). Weight loss, anemia, and protein losing enteropathy have also been described, although colitis has not been frequently reported ( I 0-15).…”

Section: Pathophysiologymentioning

confidence: 99%

“…The signs and symptoms related to the gastrointestinal tract of patients with food allergy can include diarrhea with vomiting and weight loss associated with protein losing enteropathy, malabsorption, colitis, enterocolitis, and post-infectious dietary protein sensitive enteropathy (3,22). In post-infectious dietary protein sensitive enteropathy, the most common symptom is diarrhea with or without vomiting (10)(11)(12)(13)(14)(15). Weight loss, anemia, and protein losing enteropathy have also been described, although colitis has not been frequently reported ( I 0-15).…”

Section: Clinical Gastrointestinal Features Of Postinfectious Dietarymentioning

confidence: 99%

Dietary protein sensitivity: is it an important risk factor for persistent diarrhea?

Snyder

1992

Acta Paediatrica

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Although the causes of persistent diarrhea are largely unknown, dietary protein sensitivity has been identified as one possible mechanism. Since nutritional therapy appears to be an essential component of treatment for persistent diarrhea, a clearer understanding of the importance of dietary protein allergy is needed to provide optimal dietary recommendations. This paper reviews the current concepts of the pathophysiology, clinical features and criteria for diagnosis of dietary protein sensitivity. Evaluation of the results of several clinical studies indicates that dietary protein sensitivity does occur especially in young infants fed cows’milk but that it is an uncommon event, especially in older infants and children.

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Effect of Soy Protein on the Small Bowel Mucosa of Young Infants Recovering from Acute Gastroenteritis

Cited by 26 publications

References 0 publications

Use of Soy Protein-Based Formulas in Infant Feeding

Use of Soy Protein-Based Formulas in Infant Feeding

Effect of continued feeding of cows' milk on asymptomatic infants with milk protein sensitive enteropathy.

Dietary protein sensitivity: is it an important risk factor for persistent diarrhea?

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