August Issue by nutritioninsights

-BreastFeeding

AUGUST ISSUE 2020

EDITORIAL BANSARI RAO Editor-In-Chief

SONU MISHRA DVIJ MEHTA Managing Editors

WELCOME Cool to see you again in this issue.

According to WHO, Globally 3 in 5 are not breastfed in the first hour of life, whereas Breastmilk is the ideal food for infants. It is safe, clean and contains antibodies which help protect against many common childhood illnesses. Breastmilk provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one third during the second year of life. This issue IS DEDICATED TO celebrating the "WORLD BREAST FEEDING WEEK" where we would be discussing the imporatnce,benefits, nutritional composition and almost everything about breastmilk, inorder to create more awareness and knowledge among people.

Hope you have a great time reading this issue!

WEBSITE SOFTSIMPLICITY

ARTIST MANSI GORADIA

PUBLISHER

BANSARI RAO

CONTRIBUTORS Dr. Meena Gdhia Dr. Rupal Dalal Priya Karkera Dr. Lakshmi Menon Carlyne Remedios Nandita Dhanaki Paulomi Desai Ayesha Kherani Asma Tinwala Darshini Savla

SUBSCRIPTIONS SUBSCRIBE ONLINE www.nutritioninsights.in

BANSARI RAO Editor-In-Chief

In this Issue... 12 05

FEEDING THE FIRST 1000 DATS OF LIFE In the first 1000 days, this is the most important transition of the baby from being exclusively breast fed to family foods. By- Priya Karkera

HMO Human milk serves to facilitate organ maturation, provides development of immunity thereby protecting the infant from infection and inflammation By- Meena Godhia

IN CONVERSATION about breastfeeding and its techniques with Dr. Rupal Dalal

FEEDING DISORDERS Feeding is a complex physiologic process coupled with the progression of behaviours By- Lakshmi Menon

RECIPES ByPaulomi Desai Ayesha Kherani Asma Tinwala Darshini Savla

WHAT IS COLOSTRUM & ITS BENEFITS... BY - CARLYNE REMEDIOS, APD Team Lead: Nutrition and Clinical Practices Digestive Health Institute – Mumbai WHO and UNICEF both recommend: Breastfeeding within the hour of birth Exclusive breastfeeding for upto 6 months of life and Continued breastfeeding for upto 2 years of life with introduction of foods from 6 months onwards.

ammals are unique in a way that they possess this characteristic to breastfeed and this milk is the best milk for the infant in the initial stages of life. Breast milk possesses both preventive and therapeutic properties which are vital for the newborn Colostrum however which is secreted via the mammary glands within the first 24hours of birth up to 2-3 days after is called the ‘exilir of life’ .It is a yellowish sticky thick fluid that lays the foundation of life long immunity for the newborn. Colostrum is richer in growth factors and antibodies, it contains more protein, Immunoglobulins,lactoferrin ,vitamins, and minerals than milk. Because some vitamins do not cross the placental barrier, colostrum is the primary source of these nutrients for the newborn after birth.(1)(2)(3).

"File:Bovine colostrum and spray-dried colostrum powder.jpg" by Marguerita Briana Cattell is licensed under CC BY-SA 4.0

Colostrum also has a laxative effect and therefore assists in delivering the initial stools or meconium in the newborn. It also helps in the excretion of bilirubin and reduction of neonatal jaundice(2). Colostrum is the most potent natural immune booster known to science. Though all mammals produce colostrum, Human and Bovine colostrum are the most widely studied. Bovine colostrum is very similar to human colostrum in terms of macronutrients, growth factors and antimicrobial and immunological factors. (4) Because of its potency there is a lot of interest in bovine colostrum as a functional food.Healthy cows and buffalos generally produce colostrum in large amounts much more than are needed for its offspring.

Bovine colostrum is therefore being used as an ingredient in infantformulas,supplements, drugs for senior citizens with autoimmune disease,and gastrointestinal disease.(4) The Immunoglobulins from bovine colostrum is specifically being used for passive immunity , for protection against rotavirus (diarrhoea), Escherichia coli (diarrhoea), Candida albicans (candidiasis), Clostridium difficile (colitis, fever), Shigellaflexneri (shigellosis), Streptococcus mutans (dental caries), Cryptosporidium parvum (diarrhoea) and Helicobacter pylori (peptic ulcer). (1)(4)

World breastfeeding week is celebrated in the 1st week of august and the slogan for year 2020 is Breastfeeding: Foundation of Life! WWW.NUTRITIONINSIGHTS.IN | 4

Besides providing immune support, colostrum has remarkable muscular-skeletal repair and growth capabilities. Studies have shown that colostrum is the only natural source of two major growth factors namely, transforming growth factors alpha and beta, and insulin-like growth factors 1 and 2. These growth factors have significant muscle and cartilage repair characteristics. They promote wound healing with practical implications for trauma and surgical patients.(1) Because of this characteristic there is a lot of ongoing research

in the field of using colostrum for athletes to treat chronic fatigue syndrome to increase lean mass and assist in would healing and injury.(2). Another important component in colostrum is lactoferrin, which is an iron – binding protein. It is involved in several physiological and protective functions, including regulation of iron absorption in the bowel, antioxidant, anticancer, anti-inflammatory, and antimicrobial and antibacterial activities.(2) A limited number of human and animal studies done with colostrum itself or its

supplements are indicative of future prospects for helping in curing diseases like AIDS, cardiovascular disorders, diabetes, IBD, leaky gut syndrome, infectious diseases, wound healing, and certain cancers. The biologically active molecules and compounds isolated from colostrum or milk may serve as an adjunct or alternative therapy for the treatment of cancer. To fully explore the benefits of colostrum more long term, RCTs are required to unleash the full potential of this naturally occurring elixir of life.

References: 1.Uruakpa FO, Ismond MAH, Akobundu ENT. Colostrum and its benefits: A review. Nutr Res. 2002;22(6):755–67. 2.Buttar HS, Bagwe SM, Bhullar SK, Kaur G. Health Benefits of Bovine Colostrum in Children and Adults [Internet]. Dairy in Human Health and Disease across the Lifespan. Elsevier Inc.; 2017. 3–20 p. Available from: http://dx.doi.org/10.1016/B978-0-12-809868-4.00001-7 3. Godhia ML, Patel N. Colostrum - Its composition, benefits as a nutraceutical : A review. Curr Res Nutr Food Sci. 2013;1(1):37–47. 4. Borad SG, Singh AK. Colostrum immunoglobulins: Processing, preservation and application aspects. Int Dairy J [Internet]. 2018;85:201–10. Available from:https://doi.org/10.1016/j.idairyj.2018.05.016

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<a href='https://www.freepik.com/photos/food'>Food photo created by prostooleh - www.freepik.com</a>

https://www.aappublications.org/news/2016/02/29/Cleft022916

https://teisinc.com/blog/caring-baby-cerebral-palsy/

PEDIATRIC FEEDING DISORDERS DR. LAKSHMI MENON, PHD Feeding is a complex physiologic process

PaediatricFeeding

coupled with the progression of behaviours

broad term given to conditions involving

based

development.

eating in children who may or may not have

Problems in feeding are prevalent in the

difficulty with swallowing food and liquid.

paediatric population amongst both typically

Goday et al (2019) defined PFD as â&#x20AC;&#x153;impaired

developing

oral intake that is not age-appropriate, and

sensory

children

motor

and

children

with

range from mild problems like picky eating to

feeding

severe problems like refusal to eat and

dysfunction.â&#x20AC;? These disorders can either be

assisted feeding. Disruptions in development

feeding or swallowing disorders.

and

The skill deficits caused by feeding or

gastro-

swallowing disorders are multifactorial and

intestinal, and musculo-skeletal can place a

can be resultant of structural abnormalities,

child at a risk of feeding disorders.

medical complications, genetic disorders,

Understanding theaetiologies can help to

neuromuscular & developmental delays as

identify

and

well as environmental factors. This article

interventions. The common feeding problems

will feature PFD associated with feeding

can be related to feeding delays & deficits or

difficulties due to structural abnormalities

disruptive mealtime behaviours.

and neurodevelopmental disabilities.

oropharyngeal

the

systems

such

cardio-pulmonary,

feeding

disorders

medical,

skill,

with

(PFD)is

disabilities. The spectrum of problems can

coordination

associated

Disorders

and/or

nutritional, psychosocial

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Feeding children with structural abnormalities Children with congenital structural abnormalities are caregiver, Some intervention strategies include the said to have obstructions in the naso-oropharynx, following: larynx and trachea or the oesophagus. Conditions Placing the infant in an upright position to avoid such as cleft lip &palate, or asymmetrical facial nasal regurgitation features are categorised under this. Using an appropriate nipple size Positioning the nipple away from the side of the cleft (in unilateral clefts) Craniofacial conditions such as cleft lip and palate Burping the infant to reduce air intake are because of abnormal embryonic development. It Limiting feeding time to avoid feed fatigue can be categorised based on the structure involved Providing feeds based on the baby’s cues such (lip, hard palate, soft palate) or laterality (unilateral, as facial reactions or body movements bilateral) or severity (complete, incomplete). They Nasoalveolar Moulding Appliances provided as a can occur isolated or in combination. support prior to surgical intervention, was found to Depending on the type of the clefting, feeding facilitate better feeding as it can function as a palate. problems can vary. Infants with cleft lip only have Similarly, nipple size, shape and pliability used for little difficulty. In these infants, placement of the bottle feeding can also be modified for nipple is important. Once it is placed, the infant can use. For example, some modifications that are use compression with the intact palate to suckle. routinely used are: However, preterm and term infants with cleft palate Nipples with enlarged holes to allow the milk to with or without cleft lip may face more difficulty. They flow into the infant’s mouth. Caution must be are unable to create a space between the nasal and exercised by the feeder to avoid any oral cavity to compress the nipple and suckle. complications in the feeding pattern and Feeding difficulties cause potential problems such as coordination. fatigue while feeding, poor weight gain, inadequate Nipples with a one-way valve to permit one-way nutritional intake, excessive air intake, and flow of feed out of the bottle and not back in. With regurgitation. Preterm infantsnare also at high risk of each compression the milk or feed flows well into aspiration during feeding in addition to the above the mouth of the infant. problems. Noticing feeding cues and signals can help Soft squeezable bottles can help the feeder to parents or caregivers understand feeding and gently compress the bottle to coordinate with the swallowing difficulties in these infants. suckling motion of the infant. Inability to establish the sequence of suck, A mother can also be encouraged and guided to swallow, and breath breastfeed her infant based on the severity and type Refusal of the nipple or arching the back during a of cleft. Also, when the infant is unable to completely feed breastfeed, the milk can be expressed and stored for Coughing, choking, or gagging during a feed a later feeding. Increased respiration rate Some infants and children have cleft conditions Feeding interventions for these infants are always along-with other genetic syndromes which can also with an objective to ensure adequate intake, present with structural and/or neurological hydration and nutrition for growth and development. disabilities. A thorough assessment is necessary to also focuses on the need to ensure that feeding is a identify the need for alternate feeding strategies such ‘low stress’ experience for the infant as well as the as tube feeding in such infants.

Cleft lip and palate

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Feeding children with neurological disabilities Neuro-disabilities affect the functioning of the brain and central nervous system. In addition to problems in learning and coping, children with neurodisabilities have difficulties in eating and drinking which result in nutritional concerns.

Cerebral Palsy (CP) This condition is frequently associated with feeding disorders and swallowing problems (dysphagia). They are at a risk of aspiration when fed orally and can develop pulmonary issues. The nutritional risks are resultant of reduced intake, poor hydration status and stressful prolonged mealtimes. Increased severity of swallowing issues is seen with greater motor impairment. Interventions that are pleasurable and less stressful are devised for such cases keeping in mind a stable airway with adequate nutrition and hydration. Dysphagia, specifically, oropharyngeal dysphagia is characterized by difficulties in one or all phases of swallowing. A reduced lip closure, poor tongue functions, exaggerated bite, tongue thrusts and drooling are some of the oropharyngeal problems. Postural and positioning techniques of the infant or child with CP, along with dietary modifications play an important role in feeding. Modifications are made with respect to the viscosity, temperature, texture, portion size and choice of solid or liquid. The taste and temperature also help in sensory acceptance of the food while texture modifications such as softening, cutting, or pureeing is done to ease the process of swallowing. Feeding adaptation in terms of the utensils used for feeds are used. The equipment includes modified nipples, sectioned plates, non-tip bowls, weighted and angled cutlery. Under supervision, children with CP can be taught certain manoeuvres to strengthen the process of swallowing. For e.g the Masako or tongue hold is a manoeuvre done to help the child hold the tongue against the teeth while swallowing.

These strategies might not be suitable for children with cognitive impairments. The consequences of PFD are many based on the aetiology of the disorder. The following are some common consequences that are observed in PFD : Growth failure or faltering growth such as a low weight for height Susceptibility to acute / chronic illness Over nutrition Social or developmental risks Cognitive impairment Nutritional deficiencies such as osteopenia Digestive disorders Nutritional management of PFD is mostly individualized rather than based on set guidelines. While prescribing oral nutrition to these infants and children, fortification and supplementation can be considered owing to their susceptibility to nutrient deficiencies and inadequacies. Inadequate or excessing fluid consumption can raise a red flag, so assessment of fluid intake should be prioritized. The fibre content of foods for children with feeding disabilities must be considered to avoid gastrointestinal disturbances like constipation or diarrhea. Communication, positive reinforcement, prompts and assistance with feeding will make the experience of feeding less stressful on the infant or child and the caregiver. Appropriate use of special feeding equipment and aids can help to establish a sense of independence in an infant with PFD. Planning interventions for PFDis by a multidisciplinary team including clinicians, nursing professionals, dietitians, other healthcare staff and caregivers. It combines a flexible and functional approach that aligns with the developmental stage of the child. The recommendations by dietetic professionals must be based on the nutrient requirements, hydration status, growth patterns, food allergies and food sensitivities with the underlying consideration of the aetiology of the feeding disorder.

Bibliography 1) Matson, J. L. (2018). Handbook of Childhood Psychopathology and Developmental Disabilities Assessment. Springer International Publishing. 2) Bernard-Bonnin A. C. (2006). Feeding problems of infants and toddlers. Canadian family physician Medecin de famillecanadien, 52(10), 1247â&#x20AC;&#x201C;1251. 3)American Speech Language and Hearing Association Accessed on 27th July 2020, https://www.asha.org/PRPSpecificTopic.aspx? folderid=8589942918&section=Treatment 4) Pediatric Feeding Disorders â&#x20AC;&#x201C; Accessed on 27th July 2020 -http://rwjms.umdnj.edu/pediatric/residency/documents/PEDIATRICFEEDINGDISORDERS.pdf

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IN CONVERSATION WITH...

YEARS MD, FAAP, IBCLC PAEDIATRICIAN

ADJUNCT PROFESSOR, DEPT OF CTARA,Â IIT BOMBAY, DIRECTOR SMDT, MEMBER- WHO

DR. RUPAL DALAL WRITTEN BY SONU MISHRA

EXPERIENCED PEDIATRIC CARE PROVIDER WITH A DEMONSTRATED HISTORY OF WORKING IN THE HOSPITAL & NON PROFIT ORGANISATION. SKILLED IN 1ST 1000 DAYS HEALTH & NUTRITION OF THE CHILD, LACTATION EDUCATION, PEDIATRIC MEDICINE SPECIFICALLY IN URGENT CARE ISSUE. STRONG COMMUNITY AND SOCIAL SERVICES PROFESSIONAL WITH A MD FOCUSED ON PEDIATRIC NUTRITION AND URGENT CARE ISSUES.

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Why Conventional breast-feeding techniques are not working nowadays? Dr.RupalDala started with an example of a study conducted and published in UC. In that study, 600 lactating mothers participated where it was seen that almost 90-92 % mothers gave up on breastfeeding due to one or the other issues. This shows that conventional breastfeeding technique is not working. One needs to improvise on the Traditional Cradel Hold. The study which Dr RupalDalals team conducted identified various causes which suggested improvisation on the Traditional Cradel Hold. Dr.Dalal wanted the mother to focus on these small details which were then neglected. Babies had flexed neck due to which babies had difficulty to swallow. The whole body of the baby was not supported, only the head and the trunk are supported, the legs are kind of hanging in the air. The tummy to tummy touch (baby and mothers tummy) was absent in Cradel hold method of breastfeeding. Since the holding of the baby was little higher, more of the upper part of the mothers areola was coming in the mouth while breastfeeding whereas normally it should be the lower part of the areola which baby needs to suck milk from. Some other points which Dr Dalal mentioned were, nowadays mothers wait for babies to cry and then breastfeed them, and mothers were unaware of the hind milk concept, where hind milk contains more fat which was important for babies IQ and weight gain. Mothers focused more on fore milk due to which the baby was supposedly not gaining weight. Dr Dalal further mentioned points on latching concept, where she explained how mothers

were putting the both upper and lower part of the aerola, rather than the lower aerola in the baby’s mouth. It was important for mothers to understand that lower aerola latch is important. When all these points were corrected, it was seen that babies gained almost 40-50 grams of weight in a day in first 3 months, also some babies were successful in having catch up growth due to perfect latching. Dr RupalDalal and her team can also be connected through “Maashisu helpline number’ where one of them will be always there to provide assistance to breastfeeding mothers. They have this facility in 6 different languages such as Hindi, Marathi, English, Gujarati, Telgu and Tamil. One can connect to doctor’s nutritionist for respective assistance. Dr RuplaDalal has also provided content for right breastfeeding techniques which are prepared by IIT Bombay in the form of small ‘Health spoken tutorials’ videos. Dr Dalal also suggested few points for mothers, where she focused mothers should look at baby’s lips and their fingers should be parallel to their baby’s lips. See that baby presses on lower aerola and not on the nipples as collecting duct are present in the aerola. Lower lip has to be located at the aerola and breast border. Once the baby latches, mother has to see the latch, lip has to be at lower border, upper aerola should be seen and not lower one as lower one should be in the mouth of the baby. Once the latch is right, mother can push the baby furthermore into the breast, so that the baby’s mouth is embedded into the breast. Two point latches is important. First is lower lip latch, second is upper lip latch. Upper lip should beat upper border of the nipple, lower lip should be at aerola border.

Dr.RupalDalal wanted us to spread this awareness amongst the mothers. I am sure these points will help the breastfeeding mothers. We at Nutrition Insights thank Dr Dalal to share her expertise with us.

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FEEDING THE FIRST 1000 DAYS OF LIFE BY- Priya Karkera PediatricNutritionis , CNO Fitterfly Technologies Complementary feeding is defined as the process starting

when

sufficient

breast

meet

milk

the

alone

nutritional

longer

requirements

infants, and therefore other foods and liquids are needed, WHO).

along

important

the

with first

transition

breast 1000 of

milk.

days, the

(as

this

baby

defined is

the

from

most being

exclusively breast fed to family foods. However, the baby must be strictly exclusively breast fed for the first 6 months.

Practice good hygiene and proper food handling as suggested per WHO guidelines There

are

number

guidelines

and

initiatives

help mother start the right foods at the right time for

washing caregivers’ hands before food preparation and feeding the child

infants and overcome daily difficulties. There

increasing

recognition

that

optimal

complementary feeding depends not only on what is fed, but also on how, when, where, and by whom the child is fed

storing foods safely and serving foods immediately after preparation

FOOD DIVERSITY Cereal

pulse

seasonal

combinations,

vegetable

and

roots

fruits,

and

milk

tubers,

and

milk

products, eggs, fish meat etc can be initiated slowly Soaking

using clean utensils to prepare and serve food & avoiding the use of feeding bottles

and

malting

grains

will

increase

digestibility and vitamin content. Sprouting or germination will enhance vitamin content and make it amylase rich food. Including

maximum

food

diversity

(All

food

groups) is essential for optimum growth of the child.

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WHAT FOODS TO GIVE AND WHY

Examples:

groundnut

soaked

germinated

BREAST MILK: continues to provide energy and high

HOW TO GIVE THE FOODS

quality nutrients up to 23 months

STAPLE FOODS:

provide

energy,

some

protein

(cereals only) and vitamins

Examples:

cereals (rice, wheat, maize,millet), roots

ANIMAL-SOURCE FOODS: provide liver, red meat, chicken, fish, eggs (not

provide

protein,

energy,

Examples: milk, cheese, paneer and curds GREEN LEAFY AND ORANGE-COLOURED VEGETABLES: provide vitamins A, C, folate Examples: spinach, carrots, pumpkins,

most

sweet

Continue breastfeeding

pureed

potatoes, (maize

foods

millet)

made rice

out

add

green

Give

nutritious

snacks:

egg,

banana,

bread,

papaya, avocado, mango, other fruits, curd, milk

Continue breastfeeding Give adequate servings of:

protein

(of

medium

quality),

Mixtures

pureed

foods

made

of potatoes, (maize or millet) or rice add green

chickpeas, lentils, cowpeas, black-eyed

vegetables, fruits Give

peas, kidney beans, sprouts provide energy and essential fatty

nutritious

snacks:

egg,

banana,

bread,

papaya, avocado, mango, other fruits, curd, milk or chapati with ghee, idli, dosas, cheela

acids

Examples:

Infants 6–11 months

Children 12–23 months

energy, iron (not well absorbed)

OILS AND FATS:

pastes,

pumpkin,

or chapati with ghee, idli, dosas, cheela

potatoes, capsicum

Examples:

nut as

vegetables, fruits.

vitamins (especially vitamin A and folate), calcium

provide

other such

sunflower, melon, sesame

Mixtures

good source of iron)

PULSES:

seeds

Thick porridge made out of millet

high quality protein, haem iron, zinc and vitamins

MILK PRODUCTS:

paste

Give adequate servings of:

(yam and potatoes) and starchy fruits (plantain)

Examples:

oils

(preferably

margarine, butter or lard

SEEDS: provide energy

soy

rapeseed

oil),

The

child

must

start

consuming

normal

home

cooked food as the rest of the family ensuring including all food groups adequately.

Ref: IYCN Guidelines 2010

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NUTRIENT COMPOSITION OF BREASTMILK BY- NANDITA S DHANAKI (RD) PEDIATRIC ONCOLOGY NUTRITIONIST It is nearly three decades that India will be celebrating World Breastfeeding Week’, after being originally launched by UNICEF (United Nations Children’s Fund). Breastfeeding is birth-right of a new born; they must be put into mother’s breast within half an hour after delivery and within four hours after cesarean section. Breastmilk is a dynamic fluid which changes in composition during the course of lactation and varies within and between feeds. Mother’s body stores, diet impacts the composition of breastmilk.. The approximate composition of breast milk is 87% water, 7% lactose, 4% fat, and 1% protein.

“

The fat and lactose provide most of the energy in breast milk.. The protein content gradually increases. The approximate energy content of breastmilk is 70 kcal/dL and is significantly associated with the fatcontent of breastmilk. For Ne born Breastmilk protects against variety of disease and conditions like bacteremia, diarrhea, respiratory tract infection, neutropenic enterocolitis, otitis media, urinary tract infection, sepsis, type 1 and type 2 diabetes, malignancies (lymphoma, leukemia, Hodgkin’s lymphoma), childhood obesity, celiac disease, allergic disease like asthma, eczema.

Breast milk composition changes to match the age and various nutritional requirements of the child as they grow and develop. COLOSTRUM (THE FIRST FEW DAYS) Thick and sticky yellow milk. It’s low in volume. Colostrum’s role is more immune related than nutritious as it is rich in immunoglobulins. Colostrum provides antibodies, good bacteria, human milk oligosaccharides (HMOs), and other protective cells, essential micronutrients.

TRANSITIONAL MILK (THE FIRST FEW WEEKS) After colostrum comes transitional milk. Milk volume also increases. The milk becomes creamier due to higher fat and lactose content.

MATURE MILK (AFTER THE FIRST MONTH) After approximately 4 weeks, the breastmilk is a mature. Although mature milk is stable, breast milk will still vary feed-to-feed, and as infant grows.

<a href='https://www.freepik.com/photos/people'>People photo created by freepik - www.freepik.com</a>

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LACTOSE

PROTEIN

is the main carbohydrate in breastmilk and promotes healthy intestinal flora. Human milk lactose is tolerated in new born infants not cow’s milk lactose. Breast milk contains a category of carbohydrate called “human milk oligosaccharides” (HMOs). For example, in comparison to mature breast milk, HMO content is almost twice as high in colostrum. Infants can’t digest HMOs, instead they function as prebiotics. HMOs promote the growth of beneficial gut bacteria (i.e. Bifidobacteriuminfantis).

composition of human breastmilk is 80% whey and 20% casein,they are easily digestible. Breastmilk consists amino acids specific for brain development. There islactalbumin which has high amount of tryptophan, a precursor of neurotransmitter serotonin. Lactoferrinis bacteriostatic and ensures absorption of iron and zinc.

IMMUNE AGENTS The colostrum is a rich source of immune protective factors like secretory IgA,lactoferrin, white blood cells and developmental factors like epidermal growth factor. Secretory Ig A antibodies specifically protect mucosal surfaces.Lactoferrin provides protection against infections. Breastmilk is not sterile but rather contains its own microbial community. This likely helps to shape the development of a breastfed infant’s gut microbiome.

HORMONES & ENZYMES Breastmilk also contains enzymes like amylase, lipoprotein lipase, oxidases, lactoperoxidases, leucocyte myeloperoxidases. These enzymes increase digestibility and also acts as defense against microbes. It also consists of growth regulating factors, growth promoting factors and growth modulators. Hormones thyroxine, thyroid stimulating hormone, insulin, prolactin ad many more.

MINERALS The calcium-phosphorus ratio of breastmilk is suchthat it ensures calcium absorption. Iron content is breastmilk is low as well as body stores of infants. Pediatrician should be consulted for recommendation of iron supplementation. Breastmilk has trace elements like copper, magnesium, cobalt, selenium in bioavailable form.

VITAMINS

FATS are in the form of long chain polyunsaturated fatty acids (LCPUFA also consists DHA and EPA) suitable for the infants and evidences shows they promote cognitive development. Breastmilk also consists phospholipids and prostaglandin precursor for cell integrity.Human milk also has carnitine which ensure fatty acid metabolism.

Majority infants are born with low stores of Vitamin A. Mother’s body stores and diet influences the vitamin A content of breastmilk. Colostrum consists highest amount of vitamin A, Breastmilk is good source of all vitamins except vitamin D and vitamin K. If Mother is vitamin D deficient and receive too little sunlight, she may require may require vitamin D supplementation. Vitamin K rich foods should be consumed by mother.Breastfeeding mothers who are vegetarian may be deficient in vitamin B 12

References: 1. Benefits of Breastfeeding, American Academy of Paediatrics - https://www.aap.org/en-us/advocacy-and-policy/aap health-initiatives/Breastfeeding/Pages/Benefitsof-Breastfeeding.aspx 2. Breast feeding, WHO - https://www.who.int/health-topics/breastfeeding 3. https://familyandconutrition.com/breastmilk/ 4. Australian breastfeeding association, 2017 https://www.breastfeeding.asn.au/bfinfo/breastmilk-composition 5. Nutrition and Child development, K. E. Elizabeth, 4th Edition. ISBN: 978-81-8191-311-1.

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HMO

HUMAN MILK OLIGOSACCHARIDES-AN ESSENTIAL FUNCTIONAL CONSTITUENT OF BREAST MILK By- Dr. Meena L Godhia Former Associate Professor, SNDT, Juhu Mumbai & Rashi Nandwani, Msc. Symbiosis Institue of health Sciences, Pune Dr Meena L Godhia completed her doctorate in Food Science and Nutrition from SNDT Womenâ&#x20AC;&#x2122;s University in the year 1996 in the area of micro nutrient deficiency and supplementation of iron and iodine among adolescents. She has been teaching at SVT College of Home Science, Food and Nutrition department since 1991 and has administrative experience as well. Currently is guiding two PhD research scholars, besides other post graduate program students. She participated in the panel to evaluate the Midday meal program of school children for the state government of Maharashtra in the year 2013. She is reviewer for various journals and works closely with NGOs for community work.

reast milk provides the ideal nutrition for infants and the WHO has recommended exclusive breast feeding . for the first 6 months of life of the infantThe composition of human milk is unique, adapted for the infantâ&#x20AC;&#x2122;s immature digestive and immune system. Human milk serves to facilitate organ maturation, provides development of immunity thereby protecting the infant from infection and inflammation. Hence to achieve these important role newer and newer constituents are constantly being discovered and studied, helping us understand the importance of composition human breast milk. Human breast milk is a nutrient-filled biological fluid required for the complete development of the baby. As we know lactose is the milk sugar and Human Milk oligosaccharides (HMO) have a lactose core, attached to other simple sugars, which is holding interest of researchers. Though undigested, it reaches infants large intestines

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and provides nutrition to the gut friendly microorganism-Bifido bacteria. HMO is unique to human milk. This compound has hardly any nutritive function but is associated with tons of beneficial mechanisms that support the healthy baby. These unique and diverse structures can be called as an essential functional constituent of breastmilk. Currently researchers have found more than 200 different HMOs and each one of them is structurally and functionally distinct from each other with, 2’ Fucosyllactose (2’FL) being most abundant HMO, having average concentration of 2.4g/L, being more in early lactation and decreases later in lactation. They can be called an essential functional constituent of breastmilk and have an important determinant for the health of a neonate. An HMO is composed of - d-glucose (Glc), dgalactose (Gal), N-acetyl-d-glucosamine (GlcNAc), l-fucose (Fuc), and Nacetylneuraminic acid (Neu5Ac). They contain linear or branched bonds. The three major types of HMOs in human milk are the neutral (Fucosylated HMOs), neutral N containing non fucosylated and acidic containing sialic acid. Research studies have shown that only one percent of HMOs is metabolized in the gut. The rest is eliminated from the body as feces. The unique structure of human milk oligosaccharides is responsible for the benefits like providing immunity, prebiotic effect, and much more. The type and quantity of HMOs are influenced by mother’s genetic make up, stages of lactation, maternal BMI, gestation period and geographical region. Human milk oligosaccharides increase the survival chances of infants.

Prevention of infant mortality can also be associated with the presence of human milk oligosaccharides in breast milk.. The beneficial effects/ proposed role of human milk oligosaccharides as indicated by research are discussed belowAntimicrobial effect and protection against infection thereby offering defense mechanism against pathogens Prebiotics that increase colonization of favorable bacteria Anti-inflammatory and immune modulators Essential nutrient for the brain development of the baby All pathogens like bacteria, viruses, and protozoans work by adhering themselves to the mucosal wall. After successful adhesion, they penetrate and invade the host cells and thereby causing disease. The human milk oligosaccharides have an anti-adhesive property. These molecules resemble mucosal cell surface molecules and bind to the pathogens and act as a soluble decoy, thereby helping in removal of pathogens. This is important as it reduces the risk of infections. The structure of human milk oligosaccharides is homologous to the mucosal wall cell structure, and it mimics its action and prevents invasion of pathogens. It stops the binding to Escherichia coli, Streptococcus pneumonia, Campylobacter jejuni and such infective microorganisms. All this helps in preventing diarrhea and other infections. It plays a role in decreasing fetal mortality. Thus breastfeeding is very important for thecomplete development and protection of the baby against infections. These are soluble ligand analogs and prevent pathogen adhesion. This can be called a clickbait

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effect where Human milk oligosaccharides, as glycan structures seem to attract more pathogens and prevent it from causing disease. Another study has found that Human milk oligosaccharides have a glycomic modifying effect and change glycan expression to prevent adhesion by pathogens. They keep the pathogens in check and reduce risk of all kinds of microbial infection. The mimicking of glycan structure will block adherence to cells and thus prevent infection. The composition of human milk oligosaccharides also prevent invasion by human immunodeficiency virus. They modulate the gut microbiome and protect against infections. A healthy gut contains a good microbiome. The composition of microbiome is altered by the nutrients the infant is consuming. A healthy gut microbiome is the source of fighting infections and other deadly diseases. HMOs has an essential role in maintaining a good gut microbiome. HMOs increases the gut bifodo bacterium colonies. Bifidobacterium helps in blocking viral and bacterial pathogens. They also reduce the susceptibility of infection. Ingested human milk oligosaccharides reach the lower intestinal tract and promote the growth of favorable bacterial strains. Prebiotics are substrates that have the capacity to alter the composition of gut microbiota. They are also resistant to stomach acid and hydrolysis by enzymes. Thus all the prebiotic characteristics have been found in human milk oligosaccharides. Many studies have shown the growth of bifidobacterium on

the human body. These are responsible for giving immunity and prevention of infection In infants. Thus beneficial growth of bacterial strain has been attributed to the consumption of human milk oligosaccharides. The increased utilization of human milk oligosaccharides is very important. A bifidobacterium laid gut microbiota is essential for good neonatal health. Bifidobacterium that grows with increased human oligosaccharides consumption are responsible for preventing diarrhea, inflammatory bowel diseases, enterocolitis and much more. Human milk oligosaccharides reduce the platelet neutrophil complex production. They inhibit leukocyte rolling and prevent adhesion to endothelial cells. Human milk oligosaccharides also affect cytokine production and cause activation of T cells. It creates a well-balanced Th1/ Th2 response in the body. The immunomodulatory effect of human milk oligosaccharides. They show an independentmicrobiota effect by directly altering the immune response. It thus acts as a stimulator for the innate immune system. IMPORTANT NUTRIENT FOR BRAIN DEVELOPMENT The human breast milk is an important source of nutrients. It has been shown that breastfeed infants live longer, healthier life and have higher IQ. Studies have reported that componentsof human milk oligosaccharides serve as essential brain nutrients for infant development. The Important nutrients for brain health found in human breast milk are sialic acid. Human milk oligosaccharides have a component of this sialic acid and are a significant contributor to the sialic acid required

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required for the brain development of the infant. Sialic acid has been associated with improved intelligence quotient and cognition. Thus the human milk oligosaccharides serve various important functions thereby reducing infant mortality and nourishing the brain, both of which will help in developing healthy adults who contribute to the country’s human resources. required for the brain development of the infant. Sialic acid has been associated with improved intelligence quotient and cognition. Thus the human milk oligosaccharides serve various important functions thereby reducing infant mortality and nourishing the brain, both of which will help in developing healthy adults who contribute to the country’s human resources.

REFERENCESBallard O., Morrow A.L. Human milk composition: Nutrients and bioactive factors. Pediatr. Clin. N. Am. 2013;60:49–74. doi: 10.1016/j.pcl.2012.10.002. [PMC free article] [PubMed] [CrossRef] [Google Scholar] Morozov V., Hansman G., Hanisch F.-G.,Schroten H., Kunz C. Human milk oligosaccharides as promising antivirals. Mol. Nutr. Food Res. 2018;62:1700679. doi: 10.1002/mnfr.201700679. [PubMed] [CrossRef] [Google Scholar] Bode L. Human milk oligosaccharides: Every baby needs a sugar mama. Glycobiology. 2012;22:1147–1162. doi: 10.1093/glycob/cws074. [PMC free article] [PubMed][CrossRef] [Google Scholar] Bode L. The functional biology of human milk oligosaccharides. Early Hum. Dev. 2015;91:619–622. doi: 10.1016/j.earlhumdev.2015.09.001. [PubMed] [CrossRef] [Google Scholar] Plaza-Díaz J., Fontana L., Gil A. Human Milk Oligosaccharides and Immune System Development. Nutrients. 2018;10:1038. doi: 10.3390/nu10081038. [PMC free article] [PubMed][CrossRef] [Google Scholar] Hegar B., Wibowo Y., Basrowi R.W., Ranuh R.G., Sudarmo S.M., Munasir Z., Vandenplas Y. The Role of Two Human Milk Oligosaccharides, 2′Fucosyllactose and Lacto-N-Neotetraose, in Infant Nutrition. Pediatr. Gastroenterol. Hepatol. Nutr. 2019;22:330–340. doi: 10.5223/pghn.2019.22.4.330. [PMC free article] [PubMed] [CrossRef] [Google Scholar] milowitz J., Lebrilla C., Mills D., German J., Freeman S. Breast milk oligosaccharides: Structure-function relationships in the neonate. Annu. Rev. Nutr. 2014;34:143–169. doi: 10.1146/annurev-nutr-071813-105721. [PMC free article] [PubMed] [CrossRef] [Google Scholar] Steenhout P., Sperisen P., Martin F.-P., Sprenger N., Wernimont S., Pecquet S., Berger B. Term infant formula supplemented with human milk oligosaccharides (2′fucosyllactose and lacto-N-neotetraose) shifts stool microbiota and metabolic signatures closer to that of breastfed infants. J. Pediatr. Gastroenterol. Nutr. 2016;63:S55. [Google Scholar] Donovan S.M., Comstock S.S. Human Milk Oligosaccharides Influence Neonatal Mucosal and Systemic Immunity. Ann. Nutr. Metab. 2016;69:42–51. doi: 10.1159/000452818. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

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INGREDIENTS:

NUTRIVEG CREPES By- Ms Paulomi Desai MSc. DFSM, PG Dietetics, BSc. FSN . Senior Lecturer at Dr. B.M.N.College of Home Science Freelance Dietitian

1/2 cup maize flour (makkai atta) 1/3rd cup rice flour (chaval atta) 1/3rd cup besan (gram flour) 1/3rd cup wheat flour (gehu atta) ½ cup spinach (finely chopped) ¼ cup cauliflower(finely chopped) ¼ cup capsicum(finely chopped) ¼ cup tomatoes (finely chopped) ¼ cup carrots (finely grated) ¼ cup coriander leaves (finely chopped) 1 Tbsp. green chillies paste 1Tbsp. ginger paste Salt to taste Oil for shallow frying

METHOD: 1. In a big bowl mix all the flours and add all the finely chopped vegetables. Add ginger chilli paste and salt to taste and mix well. 2. Add water little by little to the above mixture and make soft dough. Cover and keep it aside for 10-15 min. 3. Knead the dough and make equal size balls (approx. 8) and roll them into crepes (like thin parathas ). 4. Heat tawa and shallow fry them with little oil. 5. Serve hot with grated cucumber raita.

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INGREDIENTS:

BANANA WHEAT PANCAKES By- AyeshaÂ Ashraf Kherani (M.Sc. Foods, Nutrition & Dietetics); Ph.D. Scholar

Eggwhole-1 Ripe bananas- 2 Wheat flour- 1 cup (200g) Jaggery-1 Tbsp Salt- 1/4th tsp Baking soda- 1/4th tsp Vanilla essence- 1/4th tsp Milk- 2 cups Butter- 3-4 tsp

METHOD: 1. Take an egg in a container and beat it nicely. In another container, mash two bananas. Keep aside. 2. In a mixing bowl, take wheat flour. To it, add sugar, salt and baking soda. Then, add vanilla essence and mix well. 3. Add two cups of milk and beaten egg to this mixture. Mix well using a whisk until a fluffy batter is obtained. 4. Now, add in the mashed bananas and mix lightly. 5. In a non-stick pan, take 1 tsp butter. Once it melts, pour the prepared batter and spread. Cook on a low flame. 6. Flip over and cook well on both sides until goldenbrown. 7. Enjoy.

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INGREDIENTS:

BLISS BALLS By- Asma Tinwala (Master’s in Foods, Nutrition and Dietetics)

Dates- 2 cups Raw almonds- 1 cup Walnuts- 1 cup Unsweetened raw cocoa powder- 1 Tbsp Vanilla essence- ½ tsp Salt- ¼ tsp Milk- 1-2 Tbsp

METHOD: 1. Grind the almonds and walnuts together. Keep it aside. 2. Grind together pitted dates, cocoa powder, vanilla essence, salt and milk. 3. Mix half of the ground almonds and walnuts in the ground dates mixture and make small balls of it. 4. Coat the balls in the remaining almonds and walnuts mixture. 5. Relish the guilt free and healthy date andnut balls..!

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INGREDIENTS:

FRESHO IMMUNE By -Darshni Savla MSc CND, Clinical Dietician

Red pumpkin – 1 small piece (25gms) Watermelon– 3 medium sized piece Mint leaves – 8-10 (finely chopped) Water– 1 cup (200ml) Fennel seeds (saunf) – 1 tsp Gardencress seeds – ½ tsp Rock salt – 2 pinch Lemon– 1 No.

METHOD: 1. Grind pumpkin and watermelon to thick fluid paste (add little water if required) 2. Add mint leaves and rock salt to it. 3. Set the mixture in the ice tray. 4. Soak fennel seeds in water for 1 hour, add gardencress seeds and let it soak for 10 mins. 5. Squeeze fresh lemon juice and 2 cubes of above prepared mixture and a pinch of rock salt. 6. Garnish with mint leaves and watermelon cube and serve immediately. (Tip cubes can be prepared in advance in bulk and store in freezer)

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COVID-19 & NUTRITION -MEHTA Balanced nutrition which can help in maintaining

lymphocytes (warrior cells)way of killing using

immunity

oxygen. Its additional antioxidant properties make

essential

for

prevention

and

management of viral infections. A healthy immune

it extremely beneficial to clearing harmful reactive

system is a strong arsenal.

oxygen species (ROS) used by immune cells to

There are several vitamins and trace elements which

deactivate viruses.ROS are especially critical in

are essential for the normal functioning of the

patients with respiratory disease as they cause

immune system. Supplementation of these have shown positive impact on enhancing immunity in viral infections and overall well-being. Several agents intended to supplement dietary intake or endogenous molecules may have a theoretical role in preventing or treating COVID-19. Herein we review three major vitamins and how these individually work on augmenting our immune system.

damage to the lungs. This could contribute to the inflammatory crisis that affects patients with severe COVID-19. Having a powerful antioxidant to clear the ROS may be helpful in symptomatic COVID-19 patients.Vitamin C could be one of the effective choices for the treatment of COVID‐19. Studies also show that vitamin Chas known to cause a reduction in a phenomenon called cytokine storm, which is a

VITAMIN C

fearfully

fatal

outcome

Vitamin C also known as ascorbic acid is a water-

preventing

soluble vitamin.Vitamin C is best known for its role in

Syndrome) and lung damage.

the synthesis of collagen in connective tissues and and

significantly

concentrates

patient’s

Respiratory

Distress

ZINC

acts as an antioxidant with immunomodulatory properties

ARDS(Acute

covid19

As an essential micronutrient for human health, zinc

important immune cells. Vitamin C may also

plays a key role in the immune system. It is

function as a weak antihistamine agent to provide

associated with many biological functions in the

relief from flu‐like symptoms such as sneezing, a

human body and involves in multiple cellular

running or stuffy nose, and swollen sinuses .It also

processes. Zinc is vital for more than 300 enzymes in

has roles in several aspects of immunity, including

the body, and also plays a role in protein synthesis,

leucocyte migration, bacterial killing, natural killer

wound healing, DNA synthesis, cell division and is

cell activity, and antibody production. It supports the

required for proper sense of taste and smell(which

function and proliferation of

are lost or

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impaired with covid19 infection). The adult body

their intake of animal products may be at greater risk

contains 2-3 grams of zinc. A daily intake of up to 11-

of vitamin D deficiency, because foods providing the

15 mg of zinc is needed to maintain a steady state as

highest amount of vitamin D per gram naturally are

there is no specific zinc storage system in the body.

all from animal sources.

Several studies in the past have stated that zinc has

Vitamin

a broad-spectrum antiviral activity against a variety

antiproliferative

viruses.

has

effects

cells,

RNA-dependent

RNA

signaling expressions (IL-6 and TNF alpha) of which

polymerase and other proteins essential for the

IL-6 is known to cause the fatal cytokine storm.

completion of different phases of the virus life

Vitamin D also enhances epithelial integrity and

cycle.It is well known that zinc possesses a variety of

induces antimicrobial protein synthesis in epithelial

direct and indirect antiviral properties, which are

cells and scavenger cells, directly enhancing host

realized

defense.

different

mechanisms.

modulating

expression

through

inhibition

effects,

zinc

inhibit

and

immunomodulatory

intracellular

concentrations

Increased

proinflammatory

Administration of Zinc supplement has a potential to enhance antiviral immunity, and to restore

A new link has been established between low levels

depleted immune cell function or to improve

of vitamin D in blood plasma and the likelihood of a

normal immune cell function, in particular in

COVID-19

immunocompromised or elderly patients. Zinc may

researchers

also protect or stabilize the cell membrane which

that analyzed vitamin D levels of 7,807 people, out of

could contribute to blocking of the virus entry into

which 782 were COVID-19 patients, found real-world

the cell. It was demonstrated that Zn may inhibit

data that those who had tested positive for COVID-19

viral replication by alteration of the viral machinery

had mean plasma vitamin D level significantly lower

in rhinoviruses, HCV, and influenza virus, and

among those who tested positive than negative for

diminish

RNA-synthesizing

published

study in

done

the

FEBS

Israeli journal

COVID-19. The researchers had concluded that “low plasma 25(OH)D level appears to be an independent

zinc

immune

risk factor for COVID‐19 infection and hospitalization.

responses by producing immune signals and by

Another study on the role of vitamin D in the

modulation of immune cell activity and, it may be

prevention of acute respiratory infections, which

hypothesized that Zn supplementation may be of

included 39 studies noted that observational studies

potential benefit for prophylaxis and treatment of

reported

COVID-19.

between low vitamin D and increased risk of both

helps

maintain

activity

nidoviruses, for which SARS-CoV-2 belongs. Further, also

the

infection.

robust

consequential

statistical

associations

upper and lower respiratory tract infections.

VITAMIN D

Because of their potential to influence immune

Vitamin D is fat-soluble vitamin found in foods such

response, reactive oxygen and nitrogen species,

as dairy products, cereals, and oily fish. It is converted

strengthening immunity and directly or indirectly

to its biologically active form 25-hydroxyvitamin D in

preventing fatal side effects of Covid19, ascorbic acid

the

(vitamin C), zinc, vitamin D, have been hypothesized

skin

through

the

effect

ultraviolet

radiation. Vegans and other vegetarians who limit

to be useful for prevention or treatment of COVID-19.

Colunga Biancatelli RML, Berrill M, Marik PE. The antiviral properties of vitamin C. Expert Rev Anti Infect Ther. 2020 Feb;18(2):99-101. doi: 10.1080/14787210.2020.1706483. Epub 2019 Dec 23. Marik PE. Hydrocortisone, Ascorbic Acid and Thiamine (HAT Therapy) for the Treatment of Sepsis. Focus on Ascorbic Acid. Nutrients. 2018 Nov 14;10(11):1762. doi: 10.3390/nu10111762. Hemila H. Vitamin C and SARS coronavirus. J Antimicrob Chemother. 2003; 52:1049‐ 1050. https://doi.org/10.1093/jac/dkh002 Crossref PubMed Web of Science®Google Scholar Atherton JG, Kratzing CC, Fisher A. The effect of ascorbic acid on infection chick‐embryo ciliated tracheal organ cultures by coronavirus. Arch Virol. 1978; 56: 195‐ 199. https://doi.org/10.1007/bf01317848 Crossref CAS PubMed Web of Science®Google Scholar Field CJ, Johnson IR, Schley PD. Nutrients and their role in host resistance to infection. J Leukoc Biol. 2002; 71: 16‐ 32. The vitamin D-antimicrobial peptide pathway and its role in protection against infection. Future Microbiol 2009;4:1151–65.doi:10.2217/fmb.09.87 pmid:http://www.ncbi.nlm.nih.gov/pubmed/19895218 CrossRefPubMedWeb of ScienceGoogle Scholar Cutting Edge: 1,25-Dihydroxyvitamin D 3 Is a Direct Inducer of Antimicrobial Peptide Gene Expression. J Immunol 2004;173:2909–12.doi:10.4049/jimmunol.173.5.2909 https://timesofindia.indiatimes.com/life-style/health-fitness/health-news/coronavirus- vaccine-frontrunner-oxford-astrazeneca-vaccine-phase-3-trials-to-begin-in-india-vaccine-may-reach-indiasooner/photostory/77214371.cms?picid=77214425 https://febs.onlinelibrary.wiley.com/doi/10.1111/febs.15495

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Prevent the spread of COVID-19 in

7 STEPS 01

Wash your hands frequently

Avoid touching your eyes, nose and mouth

Cover your cough using the bend of your elbow or a tissue

Avoid crowded places and close contact with anyone that has fever or cough

Stay at home if you feel unwell

If you have a fever, cough and difficulty breathing, seek medical care early â&#x20AC;&#x201D; but call first

Get information from trusted sources

SOURCE: WORLD HEALTH ORGANIZATION

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