Quinlan P T, Lockton S, Irwin J, Lucas A L
Unilever Research Laboratory, Sharnbrook, Bedford, UK.
J Pediatr Gastroenterol Nutr. 1995 Jan;20(1):81-90. doi: 10.1097/00005176-199501000-00014.
"Constipation" and "hard stools" are associated with formula feeding of both term and preterm infants and, in the latter, can lead to life-threatening complications. This study tested the hypothesis that stool hardness is related to excretion of fatty acid (FA) soaps in term infants, and in the extreme to milk bolus obstruction in premature infants. Stools (n = 44) were collected from 20 formula-fed and 10 breast-fed infants aged 6 weeks and were classified using visual charts for stool hardness on a 5-point scale (1, watery; 5, hard). Stools were analysed for nitrogen, minerals, and lipid, the latter divided between the soap and nonsoap fractions. We explored the relationship between stool hardness or solids content and stool constituents, relative to both wet and dry weight. Calcium and FA soaps were the dominant factors significantly related to stool solids and hardness score across the breast- and formula-fed groups. An 8% increase in stool dry weight FA soap content corresponded to a 1-point change in stool hardness score. Stools from formula-fed infants had a higher solids content and were classified as significantly harder than those from breast-fed infants (hardness scores, 4.0 +/- 0.5 versus 2.6 +/- 0.7, mean +/- SD) and on both a wet- and dry-weight basis contained severalfold higher levels of minerals and lipid and considerably less carbohydrate. Differences in lipids between formula- and breast-fed infants' stools were due almost entirely to FAs (mainly C16:0 and C18:0) excreted as soaps (27.7 +/- 7.5% compared to 3.1 +/- 4.1% of dry weight), suggesting the groups differed markedly in their handling of saturated FAs. An inspissated stool sample from a premature infant requiring surgical disempaction of an obstructed small intestine was found to be enriched in FA and calcium relative to the preterm formula. FA soaps, predominantly saturated, accounted for one third of the stool dry weight. These data support the hypothesis that calcium FA soaps are positively related to stool hardness; we speculate that this may, at least in part, explain the greater stool hardness in formula- versus breast-fed infants and milk bolus obstruction in preterm infants. This conclusion is consistent with the physical properties of calcium FA soaps.
“便秘”和“硬便”与足月儿和早产儿的配方奶喂养有关，对于早产儿，这可能会导致危及生命的并发症。本研究检验了以下假设：粪便硬度与足月儿脂肪酸（FA）皂的排泄有关，而对于早产儿，极端情况下与奶块梗阻有关。从20名配方奶喂养和10名母乳喂养的6周龄婴儿中收集粪便（n = 44），并使用视觉图表按照5分制对粪便硬度进行分类（1分，水样便；5分，硬便）。对粪便进行氮、矿物质和脂质分析，脂质分为皂类和非皂类部分。我们探讨了粪便硬度或固体成分与粪便成分之间相对于湿重和干重的关系。钙和FA皂是与母乳喂养组和配方奶喂养组的粪便固体和硬度评分显著相关的主要因素。粪便干重中FA皂含量增加8%，对应粪便硬度评分变化1分。配方奶喂养婴儿的粪便固体含量更高，分类显示比母乳喂养婴儿的粪便明显更硬（硬度评分，4.0±0.5对2.6±0.7，平均值±标准差），并且在湿重和干重基础上，矿物质和脂质水平高出几倍，碳水化合物含量则少得多。配方奶喂养和母乳喂养婴儿粪便中的脂质差异几乎完全归因于以皂类形式排泄的脂肪酸（主要是C16:0和C18:0）（干重的27.7±7.5%与3.1±4.1%相比），这表明两组在饱和脂肪酸的处理上存在显著差异。发现一名需要手术解除小肠梗阻的早产儿的浓缩粪便样本相对于早产配方奶富含脂肪酸和钙。FA皂主要为饱和脂肪酸，占粪便干重的三分之一。这些数据支持了钙FA皂与粪便硬度呈正相关的假设；我们推测，这可能至少部分解释了配方奶喂养婴儿比母乳喂养婴儿粪便更硬以及早产儿奶块梗阻的原因。这一结论与钙FA皂的物理性质一致。
