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Effects of carob-bean gum thickened formulas on infants' reflux and tolerance indices
Miglena Georgieva1, Yannis Manios1, Niya Rasheva1
1Miglena Georgieva, Niya Rasheva, Elena Dimitrova, Second Pediatric Clinic, University Hospital "St. Marine", 9000 Varna, Bulgaria.
Insights
Carob-bean gum thickened infant formula effectively reduced gastro-esophageal reflux (GER) symptoms and improved weight gain in infants. Formula A (0.33 g/100 mL cold galactomannans) showed the best results for reflux reduction and tolerance.
Area of Science:
- Pediatrics
- Gastroenterology
- Nutritional Science
Background:
- Gastro-esophageal reflux (GER) is common in infants.
- Thickened formulas are used to manage GER.
- Carob-bean gum (CBG) is a potential thickening agent.
Purpose of the Study:
- To evaluate the efficacy of CBG-thickened formulas in managing GER in infants.
- To assess the impact of different CBG concentrations and types on reflux and tolerance indices.
- To compare the effects of CBG-thickened formulas on infant growth and tolerance.
Main Methods:
- A randomized trial involving 56 infants (1-6 months) with GER.
- Infants received formulas thickened with varying concentrations (0.33-0.45 g/100 mL) of cold or hot soluble CBG galactomannans for two weeks.
- Data collected included 24-hour esophageal pH monitoring, anthropometric measurements, and tolerance indices (colics, defecations).
Main Results:
- Formula A (0.33 g/100 mL cold CBG) significantly reduced esophageal acid exposure and reflux symptoms.
- Body weight increased significantly in infants receiving Formulas A and C.
- Formula B (0.45 g/100 mL cold CBG) led to increased diarrheic defecations, while colics decreased across all groups.
Conclusions:
- Formula A, with 0.33 g/100 mL cold CBG, effectively reduced GER indices and improved infant weight.
- CBG-thickened formulas, particularly Formula A, demonstrate good tolerance in infants with GER.
- The concentration and type of CBG influence the formula's effects on reflux, growth, and tolerance.
Aim:
To examine the effect of carob-bean gum (CBG) thickened-formulas on reflux and tolerance indices in infants with gastro-esophageal reflux (GER).
Methods:
Fifty-six eligible infants (1-6 mo old) were randomly allocated to receive for two weeks a formula with either 0.33 g/100 mL (Formula A) or 0.45 g/100 mL (Formula B) of cold soluble CBG galactomannans respectively, or a formula with 0.45 g/100 mL of hot soluble CBG galactomannans (Formula C). No control group receiving standard formula was included in the study. Data on the following indices were obtained both at baseline and follow-up from all study participants: 24 h esophageal pH monitoring indices, anthropometrical indices (i.e., body weight and length) and tolerance indices (i.e., frequency of colics; type and frequency of defecations). From the eligible infants, forty seven were included in an intention-to-treat analysis to examine the effects of the two-week trial on esophageal 24 h pH monitoring, growth and tolerance indices. Repeated Measures ANOVA was used to examine the research hypothesis.
Results:
Regarding changes in 24 h pH monitoring indices, significant decreases from baseline to follow-up were observed in the "Boix Ochoa Score" (i.e., an index of esophageal acid exposure), in the total number of visible refluxes and in all symptoms related indices due to acid reflux only for infants provided with Formula A, while no significant changes were observed for infants provided with Formulas B and C. In addition, the significant decreases observed in two symptoms related pH monitoring indices (i.e., "Symptom index for reflux" and "Percentage of all reflux") for infants provided with Formula A were also found to differentiate significantly compared to the changes observed in the other two groups (P = 0.048 and P = 0.014 respectively). Concerning changes in anthropometric indices, body weight significantly increased among infants provided with Formulas A and C, but not for infants provided with Formula B. As far as tolerance indices were concerned, the numbers of total and diarrheic defecations increased significantly only in infants provided with Formula B and these changes were significantly higher compared to the decreases observed in infants fed with Formulas A and C (P = 0.003 and P = 0.015 respectively. Lastly the number of colics significantly decreased in all infants, irrespective of the tested formula.
Conclusion:
Formula A (i.e., 0.33 g/100 mL of cold galactomannans) was effective in reducing certain pH-monitoring indices of uncomplicated GER, increased body weight and was well-tolerated by infants.
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