Chemistry Reference
In-Depth Information
in a decrease of the blood pH and acidosis, which has been reported by several
investigators for infants and children.
261-263
In the Codex Alimentarius (FAO/WHO
food standards) and the EU directive on Additives 95/2/EC, it is stated that only
L-lactic acid (E270) or bacteria that produce only L-lactic acid are allowed in infant
products.
264,265
In a toxicological evaluation of the FAO/WHO on D- and L-lactic
acid in adults and infants, it was concluded that neither D-lactic acid nor DL-lactic
acid should be used in infant foods.
266
Only one study was found with the primary
end point being the evaluation of D-lactic acid levels in infants administrated with
D-lactic acid producing microorganisms. No adverse effects were found from the
administration of
L. reuteri
ATCC 55730 regarding its D-lactic acid production in
a small subgroup of 24 infants.
267
It was shown that there was no elevation of D(-)-
lactic acid in the blood of infants given
L. reuteri
ATCC 55730 at a dose of 10
8
cfu/
day from birth daily for 12 months. Larger studies would be needed to confirm the
safety of using D-lactic acid producing bacteria in infant formula.
15.4.5 Current recommendations for starter and Follow-on Formulae
Addition of probiotic bacteria to infant formula has shown promising benefits in
treatment and prevention of allergy, prevention of NEC, and treatment and preven-
tion of acute infectious diarrhea. Effects are clearly strain specific, depending on
the dosage given, but also specific for a target group with a given clinical condition.
Therefore, probiotic bacteria should always be tested for safety and efficacy in the
target population of end use in its final product composition. Pediatricians should
choose bacterial preparations based on these effectiveness data. Illustrative is the
study of Canani in which five commercially available probiotic preparations were
tested to treat acute infectious diarrhea in infants of which only two preparations
were shown effective.
190
Adequate doses need to be defined for each strain and each
product independently. The importance of dose was emphasized by the FAO/WHO
committee, which recommended definition of probiotic bacteria as “live microor-
ganisms which when administrated in adequate amounts confer a health benefit on
the host.”
155-157
However, dose-response studies are lacking in infants. Furthermore,
safety of probiotic bacteria in pediatric critical care needs more attention. Finally,
good identification of the strains used in commercial products is highly desirable
since many cases of misidentification in commercial probiotic products have been
reported.
159
15.5 suMMAry AND FuTurE DEvEloPMENTs
The fact that diseases later in life can be influenced by nutrition during infancy
has raised a completely new perspective regarding the judgment of infant formulae.
The consequences of prebiotics or probiotics on the development of the immune
system are current examples, which have been extensively reviewed in this chapter.
However, the starting point of the development was the current requirements of the
infant rather than the prevention of later diseases. Therefore, the composition of
