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Il latte nel divezzamento. Carlo Agostoni Dipartimento di Scienze Materno-Infantili IRCCS Policlinico Cà Granda Università degli Studi di Milano. Il latte nel divezzamento (e oltre) Quale latte?. Latte materno Formule Latte vaccino. Il latte materno.

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Il latte nel divezzamento

Il latte nel divezzamento

Carlo Agostoni

Dipartimento di Scienze

Materno-Infantili

IRCCS Policlinico Cà Granda

Università degli Studi di Milano


Il latte nel divezzamento e oltre quale latte
Il latte nel divezzamento (e oltre)Quale latte?

  • Latte materno

  • Formule

  • Latte vaccino


Il latte materno
Il latte materno

  • 1.   Basso apporto proteico (< 1 g / 100 ml; latte vaccino 3.5 g/100 ml, formule non meno di 1.2-1.4 g/100 ml)

  • 2. Ottimale rapporto energia/proteine

  • 3. Presenza di numerosi fattori anti-infettivi

  • 3. Grassi e carboidrati con valore funzionale (LCPUFA, oligosaccaridi)


Allattamento al seno e prevalenza di sovrappeso e obesità in 9357 bambini di età compresa tra 5 e 6 anni (Von Kries R et al, BMJ 1999; 319:147)

sovrappeso : BMI> 90o percentile per età e sesso

obesità: BMI>97o percentile per età e sesso


Breastfeeding and prevalence of overweight° in over 15000 adolescents aged 9-14 years. (adapted from Gillmann et al, JAMA 2001:285:2461-67)

°Overweight was BMI>95th percentile for age and sex


Hypothesis of Programming of IGF-I axis adolescents aged 9-14 years. (adapted from Gillmann et al, JAMA 2001:285:2461-67)

Breastfeeding versus formula feeding

During breastfeeding

________________

↓ Linear growth √

↓ IGF-I levels √

During childhood

and adulthood

_________________

↑ height – stature (√)

↑ IGF-I levels (√)


Taveras EM et al 2004; 114: e577 adolescents aged 9-14 years. (adapted from Gillmann et al, JAMA 2001:285:2461-67)


A high percentage of breastfeeds among all milk feeds accumulated

during the first 14 months was positively related with child mental

development (0.37 points/month of full breastfeeding [95% CI: 0.06–0.67])


Di soggetti con qi wais subottimale 90
% di soggetti con QI (WAIS) subottimale (<90) accumulated

p<0.001

JAMA 2002; 287:2365


n-3 PUFA, enhance hepatic fatty acid oxidation and inhibit accumulated

fatty acid synthesis and VLDL secretion by regulating gene expression

PUFA (DHA) contro of hepatic

metabolic processes

Chem Phys Lipids 2008;153:3    


1 accumulated) permanent structural changes in an organ

2) persistent alterations in epigenetic modifications (eg, DNA methylation and histone modifications) that lead to changes in gene expression (eg, several transcription factors are susceptible to programmed changes in gene expression through such mechanisms)

3) permanent effects on the regulation of cellular aging


The identification of primitive cell types within human breast milk may provide a non-invasive source of relevant mammary cells for a wide-range of applications; even the possibility of banking one’s own stem cell for everybreastfeeding woman.


Formule quali
Formule : quali breast milk may provide a non-invasive source of relevant mammary cells for a wide-range of applications; even the possibility of banking one’s own stem cell for

  • Formule standard

    fino a 6 o 12 mesi?

  • Formule di seguito 

    tra 6 e 12 mesi?

  • Formule di crescita 

    2 e 3 anni ?


Quale riferimento usare

GLOBAL STANDARD FOR THE COMPOSITION breast milk may provide a non-invasive source of relevant mammary cells for a wide-range of applications; even the possibility of banking one’s own stem cell for

OF INFANT FORMULAS

Quale “riferimento” usare?

JPGN 2005; 41: 584-99

Riferimento: non la composizione biochimica

del latte materno ma la crescita ed i marker biochimici

e funzionali dell’allattato al seno


Elementi chiave delle formule
Elementi chiave delle formule breast milk may provide a non-invasive source of relevant mammary cells for a wide-range of applications; even the possibility of banking one’s own stem cell for

  • Proteine (quantità e qualità)

  • Grassi (quantità e qualità acido linolenico, acido docosaesaenoico)

  • Minerali e micronutrienti (ferro, zinco, calcio, Vitamina D)


15% breast milk may provide a non-invasive source of relevant mammary cells for a wide-range of applications; even the possibility of banking one’s own stem cell for


Influence of protein intake on metabolic endocrine response in infants
Influence of Protein Intake on breast milk may provide a non-invasive source of relevant mammary cells for a wide-range of applications; even the possibility of banking one’s own stem cell for Metabolic-endocrine Response in Infants

Socha P, et al. Am J Clin Nutr. 2011.


DHA in forebrain breast milk may provide a non-invasive source of relevant mammary cells for a wide-range of applications; even the possibility of banking one’s own stem cell for

in 34 infants

up to 2 years

EPA


Lc pufa supply short term effects from trials in the complementary feeding period
LC-PUFA supply breast milk may provide a non-invasive source of relevant mammary cells for a wide-range of applications; even the possibility of banking one’s own stem cell for : short-term effects from trials in the complementary feeding period

 Visual acuity at 12

months:

positive effects

from 3 studies

enriched formulas

or eggs in previously

breastfed infants

Complementary

feeding

period

Limited sample size justified by the end-points 

DHA status, changes of VEP parameters

 Visual acuity at 12 months:

no direct effects,

visual acuity associated

with DHA status

irrespective of the type of diet

LC-PUFA in

PKU infants

through a specific

product


Cow s milk and iron deficiency anemia in infants
Cow’s milk and breast milk may provide a non-invasive source of relevant mammary cells for a wide-range of applications; even the possibility of banking one’s own stem cell for iron deficiency anemia in infants

  • Mechanisms: low iron content in WCM, occult intestinal blood loss in up to 40% infants fed WCM, the inhibiting effect of calcium and casein

  • Infants fed milk-based formulas from birth had a lower incidence of blood loss

  • Blood loss also with fermented milk

  • A low iron content is a concern only when milk as food is the predominant source of energy , as would be the case in a 6-month old infant fed cow’s milk

  • Signficant negative associations of iron status with cow’s milk consumption at 9 and 12 months of age when >460 ml/day

“antigenic” effect?

Ziegler EE, NNWS 60, 2007: 185-199

Thorsdottir I, Eur J ClinNutr 2003; 57:505


JPGN 2008; 46: 99-110 breast milk may provide a non-invasive source of relevant mammary cells for a wide-range of applications; even the possibility of banking one’s own stem cell for

Whole cow’s milk asmain source of milk :

notbefore 12 months

(limitedamountsfrom a cupstarting at 9 months)

topreventirondeficiency (ESPGHAN CoN, 2002)


Limited sample size! breast milk may provide a non-invasive source of relevant mammary cells for a wide-range of applications; even the possibility of banking one’s own stem cell for

Iron-sensitive

subjects

emerging in

smaller studies?


Ghisolfi et al, Public Health Nutr, accepted breast milk may provide a non-invasive source of relevant mammary cells for a wide-range of applications; even the possibility of banking one’s own stem cell for


Latte tra 6 e 12 mesi
LATTE TRA 6 E 12 MESI breast milk may provide a non-invasive source of relevant mammary cells for a wide-range of applications; even the possibility of banking one’s own stem cell for

  • Latte materno se possibile durante tutto il periodo del divezzamento

  • Se manca il latte materno una formula adattata “funzionalmente” (tipo 1 / tipo 2?)

  • NO latte vaccino come fonte principale di latte (piccole quantità tra 9 e 12 mesi?)

TRA 12 E 36 MESI AREA “GRIGIA”

LATTE VACCINO  può essere introdotto

LATTI DI CRESCITA  migliore equilibrio nutrienti

MANCANO evidenze “funzionali”


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