Alternativen zu Säuglingsnahrungen auf Kuhmilchproteinbasis

Die natürliche Ernährung eines gesunden Säuglings ist das Stillen. Ist Stillen oder die Fütterung von Muttermilch nicht möglich, kann Frauenmilch für die Ernährung des Säuglings erwogen werden, sofern diese aus einer qualifizierten Humanmilchbank stammt. Vom Kauf von Frauenmilch aus dem Internet wird wegen Risiken einer Infektionsübertragung und einer unzureichenden Milchqualität strikt abgeraten. Aufgrund der geringen Verfügbarkeit, der hohen Kosten sowie möglicher Nachteile der Ernährung mit Spendermilch im Vergleich zum Stillen sind industriell gefertigte Säuglingsnahrungen das Mittel der Wahl zur Ernährung des gesunden, reifgeborenen Säuglings, wenn Stillen nicht oder nur partiell möglich ist. Kuhmilchprotein ist die am häufigsten verwendete Eiweißkomponente. Die Nachfrage nach anderen auf Tiermilchen basierten sowie vegetarischen bzw. veganen Alternativen steigt. Im Folgenden werden verschiedene Alternativen bezüglich ihrer Eignung betrachtet. Säuglingsnahrungen auf Basis von Ziegenmilchprotein stellen für gesunde, reifgeborene Säuglinge eine zugelassene und geeignete Alternative zu kuhmilchproteinbasierten Säuglingsnahrungen dar. Für Säuglingsnahrungen aus anderen Tiermilchen (z. B. Kamel‑, Schaf‑, Pferde- oder Büffelmilch) sind keine belastbaren Daten zu Eignung und Sicherheit bekannt, und sie sind in der Europäischen Union nicht zugelassen. Säuglingsnahrungen auf der Grundlage von Sojaproteinisolaten sind in der Europäischen Union zugelassen. Sie werden für die allgemeine Verwendung im 1. Lebenshalbjahr durch die Ernährungskommission nicht empfohlen, insbesondere weil potenziell nachteilige Effekte von enthaltenen Isoflavonen nicht ausgeschlossen werden können. Ab der Geburt und in den ersten Lebensmonaten sollte die Gabe von Sojanahrungen auf Indikationen wie eine bestehende Galaktosämie, die sehr seltene kongenitale Laktoseintoleranz sowie bei familiärem Wunsch nach veganer Ernährungsweise und aus anderen weltanschaulichen Gründen begrenzt werden. Im 2. Lebenshalbjahr ist die Zufuhrmenge pro Kilogramm Körpergewicht deutlich niedriger, sodass das Risiko unerwünschter Wirkungen als wesentlich geringer eingeschätzt wird. Zu neuerdings angebotenen Nahrungen auf der Grundlage einer Mischung aus Soja- und Kuhmilchprotein sind keine Daten zur Prüfung von Sicherheit und Eignung bekannt, sodass hierzu keine Empfehlung ausgesprochen werden kann. Von der Verwendung von Säuglingsnahrung auf der Grundlage von hydrolysiertem Reisprotein wird auch aufgrund hoher berichteter Arsengehalte abgeraten. Auch von einer häuslichen Selbstherstellung von Säuglingsnahrungen wird aufgrund eines erhöhten Risikos für eine nichtbedarfsgerechte Nährstoffzufuhr und für Infektionen abgeraten. // The natural nutrition of a healthy infant is breastfeeding. If breastfeeding or feeding of breast milk is not possible, feeding of donor human milk may be considered. The safety of donor milk can only be ensured if it is provided by a qualified human milk bank. The use of informally shared donor milk or the use of human milk purchased through the internet is strongly discouraged because of the risk of transmitting infections and of insufficient milk quality. Due to low availability, high costs and concerns about poorer nutritional quality of donor milk compared to breastfeeding, industrially manufactured infant formula is the preferred alternative for feeding healthy full-term infants that cannot or cannot be fully breastfed. Milk-based infant formula is most frequently made from cow’s milk protein; however, there is an increasing popularity of vegetarian or vegan formulas and of formulas based on different animal milks other than cow’s milk. Goat’s milk-based infant formulas represent an approved and suitable alternative to cow’s milk for healthy, full-term infants. Reliable data on the suitability and safety are unavailable for formulas based on other animal milks (e.g., camel, horse, sheep or buffalo milk), and these are not approved for infant feeding in the European Union. Infant formulas based on soybean protein isolates are approved in the European Union. They are not generally recommended by the Nutrition Committee for infant feeding in the first half year of life because potentially harmful effects of isoflavones derived from soybeans cannot be excluded; however, soybean protein isolate-based formulas may be reservedly used after birth and in the first months of life for infants affected by galactosemia, the very rare hereditary lactose intolerance manifest at birth, a vegan family lifestyle or other familial convictions. In the second half year of life the intake amount per kilogram body weight is much less so that the risk of undesired effects is estimated to be much lower. For the recently provided nutrition based on a mixture of soybean and cow’s milk proteins, no data on testing of the safety and suitability are known, so that no recommendations can be made on this. The use of infant formula based on hydrolyzed rice protein is not recommended because of concerns about possible high arsenic contamination. The use of homemade infant formulas is discouraged due to the high risk of introducing infections and of possible nutritional imbalances of macronutrients and micronutrients

Factors associated with diversity, quantity and zoonotic potential of ectoparasites on urban mice and voles

Wild rodents are important hosts for tick larvae but co-infestations with other mites and insects are largely neglected. Small rodents were trapped at four study sites in Berlin, Germany, to quantify their ectoparasite diversity. Host-specific, spatial and temporal occurrence of ectoparasites was determined to assess their influence on direct and indirect zoonotic risk due to mice and voles in an urban agglomeration. Rodent-associated arthropods were diverse, including 63 species observed on six host species with an overall prevalence of 99%. The tick Ixodes ricinus was the most prevalent species, found on 56% of the rodents. The trapping location clearly affected the presence of different rodent species and, therefore, the occurrence of particular host-specific parasites. In Berlin, fewer temporary and periodic parasite species as well as non-parasitic species (fleas, chiggers and nidicolous Gamasina) were detected than reported from rural areas. In addition, abundance of parasites with low host-specificity (ticks, fleas and chiggers) apparently decreased with increasing landscape fragmentation associated with a gradient of urbanisation. In contrast, stationary ectoparasites, closely adapted to the rodent host, such as the fur mites Myobiidae and Listrophoridae, were most abundant at the two urban sites. A direct zoonotic risk of infection for people may only be posed by Nosopsyllus fasciatus fleas, which were prevalent even in the city centre. More importantly, peridomestic rodents clearly supported the life cycle of ticks in the city as hosts for their subadult stages. In addition to trapping location, season, host species, body condition and host sex, infestation with fleas, gamasid Laelapidae mites and prostigmatic Myobiidae mites were associated with significantly altered abundance of I. ricinus larvae on mice and voles. Whether this is caused by predation, grooming behaviour or interaction with the host immune system is unclear. The present study constitutes a basis to identify interactions and vector function of rodent-associated arthropods and their potential impact on zoonotic diseases

Impact of infection on proteome-wide glycosylation revealed by distinct signatures for bacterial and viral pathogens

Mechanisms of infection and pathogenesis have predominantly been studied based on differential gene or protein expression. Less is known about posttranslational modifications, which are essential for protein functional diversity. We applied an innovative glycoproteomics method to study the systemic proteome-wide glycosylation in response to infection. The protein site-specific glycosylation was characterized in plasma derived from well-defined controls and patients. We found 3862 unique features, of which we identified 463 distinct intact glycopeptides, that could be mapped to more than 30 different proteins. Statistical analyses were used to derive a glycopeptide signature that enabled significant differentiation between patients with a bacterial or viral infection. Furthermore, supported by a machine learning algorithm, we demonstrated the ability to identify the causative pathogens based on the distinctive host blood plasma glycopeptide signatures. These results illustrate that glycoproteomics holds enormous potential as an innovative approach to improve the interpretation of relevant biological changes in response to infection

Relationship between molecular pathogen detection and clinical disease in febrile children across Europe: a multicentre, prospective observational study

BackgroundThe PERFORM study aimed to understand causes of febrile childhood illness by comparing molecular pathogen detection with current clinical practice.MethodsFebrile children and controls were recruited on presentation to hospital in 9 European countries 2016-2020. Each child was assigned a standardized diagnostic category based on retrospective review of local clinical and microbiological data. Subsequently, centralised molecular tests (CMTs) for 19 respiratory and 27 blood pathogens were performed.FindingsOf 4611 febrile children, 643 (14%) were classified as definite bacterial infection (DB), 491 (11%) as definite viral infection (DV), and 3477 (75%) had uncertain aetiology. 1061 controls without infection were recruited. CMTs detected blood bacteria more frequently in DB than DV cases for N. meningitidis (OR: 3.37, 95% CI: 1.92-5.99), S. pneumoniae (OR: 3.89, 95% CI: 2.07-7.59), Group A streptococcus (OR 2.73, 95% CI 1.13-6.09) and E. coli (OR 2.7, 95% CI 1.02-6.71). Respiratory viruses were more common in febrile children than controls, but only influenza A (OR 0.24, 95% CI 0.11-0.46), influenza B (OR 0.12, 95% CI 0.02-0.37) and RSV (OR 0.16, 95% CI: 0.06-0.36) were less common in DB than DV cases. Of 16 blood viruses, enterovirus (OR 0.43, 95% CI 0.23-0.72) and EBV (OR 0.71, 95% CI 0.56-0.90) were detected less often in DB than DV cases. Combined local diagnostics and CMTs respectively detected blood viruses and respiratory viruses in 360 (56%) and 161 (25%) of DB cases, and virus detection ruled-out bacterial infection poorly, with predictive values of 0.64 and 0.68 respectively.InterpretationMost febrile children cannot be conclusively defined as having bacterial or viral infection when molecular tests supplement conventional approaches. Viruses are detected in most patients with bacterial infections, and the clinical value of individual pathogen detection in determining treatment is low. New approaches are needed to help determine which febrile children require antibiotics.FundingEU Horizon 2020 grant 668303

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Fostering authentic inquiry at multiple levels through participatory action research

Dieser Artikel erforscht, wie ein Forschender Lernansatz auf mehreren Ebenen als Prozess von partizipativer Aktionsforschung in der Schulentwicklung genutzt werden kann. Der Lernprozess findet im Klassenzimmer mit Schülerinnen und Schülern statt, aber auch bei den Lehrkräften selbst sowie, nicht zuletzt, beim unterstützenden außerschulischen Forschungsteam. Bei diesem Prozess sollen auf all diesen Ebenen gewisse Kriterien zur Entfaltung gebracht werden, die für forschende, partizipative Lernarrangements typisch sind. Das Ziel der Studie ist es, jene Parameter zu finden, die forschendes, partizipatives Lernen begünstigen, sowie spezifische Methoden zu identifizieren, die Lehrkräfte in ihren Unterrichtsstunden dafür tatsächlich einsetzen. Dies wird einerseits durch die quantitative Analyse von Daten untersucht, die die Lehrkräfte in ihren Klassen bei ihren Schülerinnen und Schülern sammelten, und andererseits durch die qualitative Analyse von Leitfadeninterviews des unterstützenden Forschungsteams mit acht Lehrkräften. Die Analysen der Daten zeigen, dass eine fundierte Kenntnis der Theorie zum Forschenden Lernen, die Unterstützung des Forschungsteams, die Teilnahme der Lehrkräfte an schulinternen Lerngemeinschaften und vor allem auch das Vertrauen, das Lehrkräfte in die Fähigkeiten ihrer Schülerinnen und Schüler haben, eine zentrale Rolle bei der Effektivität des forschenden, partizipativen Unterrichtsansatzes spielen. Es zeigt sich, dass professionelle Refexion und Analyse der Aktivitäten im Unterricht schließlich neue, vertiefende Zyklen von Aktionsforschung auslösen, den Prozess der partizipativen Aktionsforschung dadurch vorantreiben und letztlich in einen Schulentwicklungsprozess münden