Enterokinase has a critical role in initiating proteolytic digestion by hydrolysing the conversion of pancreatic trypsinogen into trypsin. The enzyme is synthesised by enterocytes of the proximal small intestine and initially incorporated into the brush border from where it is released into the intestinal lumen by the action of pancreatic secretions. The aim of the study was to analyse enterokinase activity in the duodenal mucosa of infants with diarrhoeal disease including cow's milk protein-sensitive enteropathy. Our observations show that the mean depletion of enterokinase was only 17% compared to 60-80% for other brush border enzymes like disaccharidases, peptidases and alkaline phosphatases in infants with diarrhoea. This suggests that enterokinase activity in the small bowel enteropathies may be dependent not only on the degree of mucosal damage specifically but also on the extent of damage to the goblet cell population where the enzyme is synthesised. Thus the enterokinase activity was reduced in acute and chronic diarrhoea with marked mucosal damage where significant reduction of goblet cell population was evident but the enzyme was relatively little affected when the mucosa was damaged mildly.
The objective of this study was to assess the nutritional status of children in FELDA Sungai Koyan, Pahang. Anthropometric measurements were taken from 105 children comprising of 62 boys and 43 girls aged 12 to 72 months. Food intake records from 84 of these children aged 4-6.9 years were obtained. Socio-economic factors which may influence nutritional status were also studied. The anthropometric assessment showed that 14.3% (n=15) of the children were underweight, 10.5% (n=11) stunted and 2.9% (n=3) wasted when compared with the NCHS Reference. It was also found that 28.6% (n=30) of the children had low mid arm circumference for age according to the Frisancho reference, indicating a low protein calorie reserve. The result of the dietary study showed that the intake of calories, calcium, niacin and thiamine were below the recommended daily allowances (RDA) for Malaysia. However, the intake of protein, iron, vitamin A, riboflavin and vitamin C were above the RDA levels. Foods most frequently taken were rice, fish, milk and meat. Vegetables and fruits were also often consumed by the children. Based on the Pearson correlation test, a significant relationship was shown between the nutritional status of the children (weight for age and height for age) with the mother’s educational level, and the number of children in the family. There was also a significant relationship between mother’s nutrition knowledge and the nutritional status of the children (weight for age). Inadequate calorie intake is one of the important factors involved in the causation of protein energy malnutrition. This problem is influenced by socio-economic factor such as low educational level and nutrition knowledge of mothers and large family size. Parents should be encouraged to participate in activities that enhance nutrition knowledge and promote good nutritional practices. FELDA is encouraged to organize more such activities.
A survey of infant-feeding and weaning practices of 566 mothers, systematically sampled from 15 rural villages, randomly selected in the district of Tumpat, Kelantan was carried out. Almost all mothers (97.3%) breastfed their children, reinforcing the previously reported high incidence of breast-feeding among rural Malaysian mothers. One hundred and seventeen (21.3%) of the 551 children breastfed were also given mixed feeding with infant fomulae as well. Weaning started before 4 months of age in 28.3% of the children and after 6 months of age in 12.8% of the children. The 3 most common type of food used in weaning were Nestum (45.0%), rice porridge or paste (42.6%) and wheat porridge or cakes (11.5%). Forty eight children (12.1%) discontinued breastfeeding once weaning was initiated. The main reasons for initiating weaning was mothers' perception that there was insufficient milk and that the child was always hungry (55.7%). Most mothers were also given advice by the health clinic staff on weaning, including the timing and the suitable weaning foods to give. All of the mothers were able to name at least one commercial weaning food product available in their community.
Milk lipids play an important role in the early nutrition of an infant's life. A study was undertaken to investigate the total lipid content of milk obtained from urban, exclusively breastfeeding Malaysian mothers offill term infants. Results from approximately 600 samples analysed using a commercial kit [MerckotestO] , showed that the total lipid concentration was lowest in colostrum [1.9 + 0.1 g/dl J, however this value increased gradually with days of lactation and attained a maximum concentration of 3.1 ± 0.1 g/dl during the mature milk stage. This agrees with results from other studies that the total lipid content is indeed influenced by the stage of lactation. The effect of socioeconomic factors such as income and parity on the milk lipids was also investi-gated and the results revealed that the above factors had no significant influence on the total lipid content of Malaysian mother 's milk obtained during all three stages of lactation studied [colostrum, transitional and mature milk] . However; ethnicity showed significant influence during the mature but not in the early [colostrum and transitional] stage of lactation. This however, is not filly explained by this study. As a whole, this study suggests that the human breast, through a mechanism that is ill understood, maintains cm optimal level of total lipid in milk despite their differing cultural and genetic background. It is hoped that such scientific evidence will instil more confidence among breastfeeding mothers in this fast developing cosmopolitan nation.
Two active interventions were carried out in order to encourage breast feeding of low birth weight (LBW) neonates who were admitted to the neonatal intensive care unit (NICU), Universiti Sains Malaysia. These were the establishment of (a) an effective transport system for conveying expressed breast milk (EBM) from the motherk home to the neonatal intensive care unit and (b) providing rooming-infacilities in the neonatal ward. The EBM was transported by a male health assistant, by the parents themselves or by the local bus company. A total of 473 babies were admitted from April 1994 to September 1995. Thirty-three babies weighed between 540-1000g and 440 were between 1001-2000g. A total of 226 (47.8%) babies were given mixed formula (less than 20% of daily needs) and EBM feeds (Group A) and 247 (52.2%) were given only formula feeds (Group B). A total of 79 babies died of which 5 were in Group A and 74 were in group B. (P value is 0.00). In Group A, 45 babies had clinical sepsis, 9 of whom were blood culture positive. Four of these babies died. In group B, out of 108 babies with clinical sepsis 36 were blood culture positive. 29 died because of the sepsis This study shows that by providing an effective transport system for breast milk expressed at home and the availability of roomingfacilities in the neonatal ward a significant number of LBW babies admitted to the NICU continue to receive their mothers' milk. The incidence of nosocomial sepsis and the over all mortality due to sepsis was significantly higher in those on full formulafeeding compared to those given mixed formula and expressed breast milk.
Twelve premature infants were studied prospectively to determine the extent and pattern of bacterial contamination in nasogastric tube (NGT) milk residues. Of the 60 NGT milk residue samples cultured, 49 (82%) had bacterial isolates; 34 (69%) samples with multiple organisms. Gram negative organisms were the predominant species; Klebsiella spp. (32%), Pseudomonas spp. (16%), Acinetobacter spp. (14%), Enterobacter spp. (11%) and Escherichia coli (11%). The antibiograms of these organisms indicated the environment as the main source of bacteria for the NGT colonisation. However, the relation-ship of high rates of isolation of potentially pathogenic bacteria in NGT milk residues and the risks of infection to these infants is unclear and needs further evaluation.
Commercial samples of Malaysian cocoa butter (MCB), anhydrous milkfat (AMF), high melting fraction milkfat42 (HMF42) and cocoa butter equivalent (CBE) were blended in binary and ternary blends. All the fats were then evaluated for their solid fat content, thermal analyses and polymorphic stability. MCB possessed the highest solid followed by CBE, HMF42 and AMF. Data on thermal analyses showed that eutectic interaction was more noticeable when AMF and HMF42 were present in the MCB and CBE system. Moreover, X-ray diffraction patterns also showed that AMF and HMF42 exhibit the presence of beta' polymorph while MCB and CBE exhibit beta polymorph.
A cross-sectional study using structured questionnaires was conducted to determine the level of knowledge, attitude and practice on breast-feeding among working mothers. A total of 200 working mothers who attended the Child Health Clinics in Temerloh, for their chil-dren's third DPT/Polio vaccination were interviewed. Eighty-nine percent of the mothers successfully initiat-ed breast-feeding. However, there was a rapid decline in breast-feeding each month especially during the period when the mothers returned to work. Only 33.5% of the mothers had at least one experience in expressing and feeding expressed breast milk to their babies and only 47% reported that they had been taught by health work-ers. The mothers scored highest on the 'benefits of breast-feeding' with a mean knowledge score of 77.9% and lowest on "storage of expressed breast milk" (35.4%). Overall the mothers showed a positive attitude towards breast-feeding. The two main reasons given for stopping breast-feeding were "work" (61.4%) and "insufficient milk" (57.9%). In conclusion, other areas of breast-feeding besides benefits such as "expressing and storing breast milk" and "how" to practise breast-feeding while working away from home are also impor-tant for working mothers.
Quarter milk samples were taken from 150 cows from three dairy farms in south-east Queensland at drying off, two, four and six weeks after drying off, at calving, and one, two and three weeks after calving. In each of the herds, the cows were randomly allocated to three groups of approximately equal size. One group had all the quarters of all the cows treated at drying off with a dry cow antibiotic infusion containing cloxacillin; the second group was given no treatment, and the third group had selected quarters treated on the basis of their high activity of N-acetyl-beta-D-glucosaminidase at drying off. Dry cow treatment resulted in a marked reduction in the number of infected quarters at two and four weeks after drying off, so that the comprehensively treated group had significantly less infected quarters at these times (P<0.02). Twelve dinical cases of mastitis were detected two weeks after drying off in the untreated groups, 10 in the untreated quarters of the selectively treated groups, and no cases in the comprehensively treated groups. These cases were due mainly to Streptococcus uberis and Streptococcus dysgalactiae. The number of infected untreated quarters increased markedly between drying off and two weeks later, but in all three groups there was a marked decrease in the number of infected quarters between six weeks after drying off and calving, suggesting that the mammary glands were more able to overcome infections at this time.
Milk is a physiological fluid which has high nutritional value and soybean has strong antioxidant characteristics which is believed to inhibit carcinogenesis. The objective of this study was to investigate the effects of administration of soybean and goat's milk on hepatocarcinogenesis in rats (fed with diethylnitrosamine; DEN and acetylaminofluorene; AAF) by determining the activities of plasma gamma-glutamyl transpeptidase (GGT) and alkaline phosphatase (ALP). Thirty-six rats from the species Sprague-Dawley were divided into 6 groups : control, DEN/AAF, soybean, DEN/AAF with soybean treatment, goat's milk and DEN/AAF with goat's milk treatment. Soybean and goat's milk administrations were given 5 ml/day. The rats were sacrificed after 8 weeks and the blood was collected. Treatment with DEN/AAF caused an increase in ALP and GGT levels and a decrease in weight significantly (p<0.05). ALP and GGT activities decreased significantly after administration of soybean and goat's milk (p<0.05). Administration of goat's milk and soybean alone did not cause any changes in the enzyme activities. Comparison between the effect of soybean and goat's milk in reducing the enzyme activities (ALP and GGT) did not give significant values (p>0.05). However, a decrease in weight was observed in the rats given soybean as well as goat's milk. The results obtained suggested that soybean and goat's milk may work as anti cancer agents in hepatocarcinogenesis although further studies are required to further elucidate this aspect.
Milk producers in Malaysia make extensive use of crossbred Sahiwal Friesian dairy cattle. These animals have, however, been found susceptible to lactation failure. A survey of cows in an experimental herd of F1 Sahiwal Friesian animals indicated that, in 30% of animals, milk yield decreased to negligible levels within the first 8 weeks post partum. Lactation failure was associated with a progressive increase in the amount of residual milk left in the udder after normal milking. By week 3 of lactation, residual milk volume was significantly greater than that in animals that, based on previous lactation history were not susceptible to lactation failure, and accounted for up to 30% of milk available at the morning milking. The cellular consequences of residual milk accumulation were evident in the activities of acetyl-CoA carboxylase, fatty acid synthetase and galactosyltransferase, key enzyme markers of cellular differentiation, which decreased in glands undergoing lactation failure and were lower than values measured in tissue of control cows. Mammary cell number, estimated by tissue DNA content, was also reduced in animals undergoing lactation failure. These indices of mammary development indicate that lactation failure is the result of premature involution in susceptible animals. Premature involution is a predictable consequence of progressive milk stasis in failing lactation, and attributable to an increase in autocrine feedback by inhibitory milk constituents. The progressive increase in residual milk is, on the other hand, unlikely to be attributable to impaired mammary development. Measurements of milk storage during milk accumulation showed no differences between control and lactation failure cows in the distribution of milk between alveolar and cisternal storage compartments. We conclude that lactation failure in Sahiwal Friesian cows is due to a failure of milk removal, and probably the result of an impaired milk ejection reflex rather than to the glands' milk storage characteristics.
The objective of this study was to compare the rates of bacterial contamination of expressed breast milk (EBM) obtained by manual expression and breast pumps in mothers of very low birthweight (VLBW) infants (<1501 g). This was a randomized, controlled study carried out on 28 mothers of such babies and 92 specimens of EBM were collected: 41 specimens from 13 mothers assigned to the manual group and 51 specimens from 15 mothers in the breast-pump group. EBM was cultured quantitatively by the Miles and Misra method. Breast milk expressed by breast pumps (86.3% or 44/51 specimens) had a significantly higher rate of bacterial contamination than milk expressed by the manual method (61.0% or 25/41 specimens) (P= 0.005). When breast milk was expressed in the hospital, there was no significant difference in contamination rates between the two methods. When breast milk was expressed at home, the rates of bacterial contamination by staphylococci (P= 0.003) and Gram-negative bacilli (P= 0.002) were significantly higher in the breast-pump group than the manual group. In conclusion, the rate of bacterial contamination of EBM of mothers of VLBW infants was high, especially when EBM was obtained by the breast pump or when expression was carried out at home.
Anhydrous milkfat (AMF) was fractionated to obtain a series of high-melting milkfat fractions (HMF). Solid fat content (SFC) of HMF as determined by nuclear magnetic resonance (NMR) was in the range 37.6-43.6% and 21.2-27.5% measured at 20 and 30 degrees C, respectively. The HMF have a higher melting characteristic compared to AMF as analyzed by differential scanning calorimetry (DSC) with melting enthalpies of 92.2-105.0 J/g and melting peak temperatures of 39.3-41.5 degrees C. The AMF was also blended with soft palm stearin (SPOs and/or hard palm stearin (HPOs)) according to a three conventional component mixture design which providing suitable formulations for HMF. This represented three selected blends of AMF:SPOs:HPOs at three different proportions (70:15:15, 60:30:10 and 50:45:5), having SFC and DSC melting characteristics of HMF. The study revealed that higher-melting characteristics of AMF could be achieved equally well by using both fractionation and blending techniques.
The effects of dietary fat during pregnancy and lactation on growth performance of pups, milk composition and very low density lipoprotein composition in rats were studied. A total of 33 dams were used in this study and each litter was adjusted to 8 pups per dam. The dams were fed on high fat (150 g fat/kg diet, HF), medium fat (75 g fat/kg of diet, MF) and low fat (2.5 g fat/kg diet, LF) diets. The body weights of dams increased during pregnancy and decreased after pregnancy. The HF pups had a higher body weight and higher weight gain than those of LF pups. The amount of feed intake of HF dams was significantly higher than LF and MF dams. The HF dams had significantly higher milk fat and water concentrations than LF dams. The milk protein was not significantly different among the treatment groups. All dams showed hypertriacylglycerolaemia in their very low density lipoprotein (VLDL) in late pregnancy. The VLDL-protein concentrations increased during the first week after parturition. The HF dams showed a greater response to the dietary fat than that of LF and MF dams. The findings suggest that addition of fat in the diet during pregnancy and lactation may improve the milk quality through modifying the composition of VLDL contents, leading to better growth of pups.
Dietary studies often report low calcium intake amongst post-menopausal Malaysian women and calcium deficiency has been implicated as part of the etiology of age-related bone loss leading to osteoporosis. Therefore, the objective of this study was to examine the effectiveness of high calcium skimmed milk (Anlene Gold, New Zealand Milk, Wellington, New Zealand) to reduce bone loss in Chinese postmenopausal women. Two hundred subjects aged 55-65 years and who were more than 5 years postmenopausal were randomized to a milk group and control group. The milk group consumed 50 g of high calcium skimmed milk powder daily, which contained 1200 mg calcium (taken as two glasses of milk a day). The control group continued with their usual diet. Using repeated measures ANCOVA, the milk supplement was found to significantly reduce the percentage of bone loss at the total body compared to the control group at 24 months (control -1.04%, milk -0.13%; P<0.001). At the lumbar spine, the percentage of bone loss in the control group was significantly higher (-0.90%) when compared to the milk (-0.13%) supplemented group at 24 months (P<0.05). Similarly, milk supplementation reduced the percentage of bone loss at the femoral neck (control -1.21%, milk 0.51%) (P<0.01) and total hip (control -2.17%, milk -0.50%) (P<0.01). The supplemented group did not experience any significant weight gain over the 24 months. The serum 25-hydroxy vitamin D level improved significantly (P<0.01) from 69.1 +/- 16.1 nmol/l at baseline to 86.4 +/- 22.0 nmol/l at 24 months in the milk group. In conclusion, ingestion of high calcium skimmed milk was effective in reducing the rate of bone loss at clinically important lumbar spine and hip sites in postmenopausal Chinese women in Malaysia. Supplementing with milk had additional benefits of improving the serum 25-hydroxy vitamin D status of the subjects.
A diarrhoea outbreak had occurred among neonates delivered in a private hospital in Kedah from 15 August to 8 September 2002 involving 27 (55.1%) cases out of a total of 49 deliveries. Thirteen of them (48.1%) were admitted to either government or private hospitals for treatnzent while fourteen of them (51.9%) were managed at home. The main presenting feature was frequent yellowish to greenish watery stool not associated with vomitting. Investigations include active case finding, environmental inspection, sampling of stool specimens, identifying causative agents and identuying human carriers. All the diarrhoea eases (100%) were noted to have received infant formula feeding while in the private hospital. Staphylococcus aureus was isolated hom the milk scoop which was used for milk preparation. Nasal swabs of four (50%) nursing personnel were also positive for Staphylococcus aureus. One of them was positive for methycilline resistant Staphylococcus aureus (MRSA). The milk and water samples showed no signuicant bacterial contamination. Stool samples of these cases were negative for Rotavirus, Vibrio sp., Salmonella sp., Shigella sp. and Entamoeba coli. This outbreak of diarrhoea was noted to have a strong association with infant formula feeding in the hospital. Breastfeeding should be continuously promoted. Baby friendly hospital initiatives in private hospital settings need to be initiated.
Current understanding of the use of exclusion diets in the management of asthma in children is limited and controversial. The aim of this study was to examine the effects of excluding eggs and milk on the occurrence of symptoms in children with asthma and involved 22 children aged between three and 14 years clinically diagnosed as having mild to moderate disease. The investigation was single blind and prospective, and parents were given the option of volunteering to join the 'experiment' group, avoiding eggs, milk and their products for eight weeks, or the 'control' group, who consumed their customary food. Thirteen children were recruited to the experimental group and nine to the control group. A trained paediatrician at the beginning and end of the study period assessed the children. A seven-day assessment of food intake was made before, during and immediately after the period of dietary intervention in both groups. A blood sample was taken from each child for determination of food specific antibodies and in those children who could do so, the peak expiratory flow rate (PEFR) was measured. Based on the recommended nutrient intake (RNI), the mean percentage energy intake of the children in the experimental group was significantly lower (p < 0.05) in the experimental group. After the eight-week study period and compared with baseline values, the mean serum anti-ovalbumin IgG and anti-beta lactoglobulin IgG concentrations were statistically significantly reduced (p < 0.05) for both in the experimental group. In contrast, the values for anti-ovalbumin IgG in the control group were significantly increased and those for anti-beta lactoglobulin IgG were practically unchanged. The total IgE values were unchanged in both groups. Over the study period, the PEFR in those children in the experimental group able to perform the test was significantly increased, but no such change was noted in the children in the control group who could do the test. These results suggest that even over the short time period of eight weeks, an egg- and milk-free diet can reduce atopic symptoms and improve lung function in asthmatic children.
Study site: Outpatient Department, Royal County Hospital and the Frimley Children’s Centre, United Kingdom
Matched MeSH terms: Milk/adverse effects*; Milk Hypersensitivity/prevention & control
This study determined the concentrations of polychlorinated dibenzo-p-dioxins/dibenzofurans (PCDD/Fs), polychlorinated biphenyls (PCBs), organochlorine (OC) pesticides, and tris(4-chlorophenyl) methane (TCPMe) in human breast milk samples collected in 2003 from primipara mothers living in Penang, Malaysia. OCs were detected in all the samples analyzed with DDTs, hexachlorocyclohexane isomers (HCHs), and PCBs as the major contaminants followed by chlordane compounds (CHLs), hexachlorobenzene (HCB), and TCPMe. The residue levels of DDTs, HCHs, and CHLs were comparable to or higher than those in general populations of other countries, whereas PCBs and HCB were relatively low. In addition, dioxins and related compounds were also detected with a range of dioxin equivalent concentrations from 3.4 to 24 pg-TEQs/g lipid wt. Levels of toxic equivalents (TEQs) were slightly higher than those in other developing countries but still much lower than those of industrialized nations. One donor mother contained a high TEQs level, equal to the mean value in human breast milk from Japan, implying that some of the residents in Malaysia may be exposed to specific pollution sources of dioxins and related compounds. No association was observed between OCs concentrations and maternal characteristics, which might be related to a limited number of samples, narrow range of age of the donor mothers, and/or other external factors. The recently identified endocrine disrupter, TCPMe, was also detected in all human breast milk samples of this study. A significant positive correlation was observed between TCPMe and DDTs, suggesting that technical DDT might be a source of TCPMe in Malaysia. The present study provides a useful baseline for future studies on the accumulations of OCs in the general population of Malaysia.
Breast-feeding offers many benefits to the baby and the mother. For instance, breast milk provides the right balance of nutrients to help an infant grow into a strong and healthy toddler. Even though breastfeeding is a natural process, it is not always easy. In certain situations, some mothers are unable to breastfeed their babies or the babies are unable to adapt to breastfeeding. This will lead to the use of bottle-feeding. The effect of breast-feeding and bottle-feeding on physical growth has been well established but less has been concentrated on the craniofacial growth and dental development. This review reveals the effects of breast-feeding and bottle-feeding on craniofacial growth and dentoalveolar development based on the available literature.