PEDIATRICS Vol. 78 No. 2 August 1986, pp. 305-312
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Fecal agr1-Antitrypsin and Hemoglobin Excretion in Healthy Human Milk-, Formula-, or Cow's Milk-Fed Infants

Dan W. Thomas MD1, Kathryn M. McGilligan BS1, Michael Carlson MS1, Stanley P. Azen PhD1, Lawrence D. Eisenberg MD1, Harry M. Lieberman MD1, and Edward M. Rissman MD1

1 From the Division of Gastroenterology and Nutrition, Department of Pediatrics, Childrens Hospital of Los Angeles, and the Department of Preventive Medicine, University of Southern California School of Medicine, Los Angeles, and the Southern California Permanente Medical Group, Los Angeles, Panorama City, and Woodland Hills

There is concern that whole cow's milk feedings may be associated with intestinal abnormalities in infants. We studied this issue by measuring random fecal samples for agr1-antitrypsin (FA1AT) and hemoglobin (FH) concentrations in 820 healthy infants up to 12 months of age. Subjects were fed either human milk, formula, or fresh whole cow's milk. Solid foods were given ad libitum. Fecal samples were also tested for occult blood with Hematest reagent tablets. None of the infants younger than 6 months of age were receiving fresh whole cow's milk. We found small but statistically significant differences in mean FA1AT between the three feeding groups (P < .0001): human milk (n = 354) > formula (n = 320) > cow's milk (n = 146). The younger subjects fed either formula or human milk tended to have higher FA1AT concentrations than did the age-matched subjects who were not consuming solid foods (P le .005). Daily FA1AT excretion, FA1AT concentration, and daily stool output were subsequently determined on a separate group of 40 infants 8 to 12 months of age to ascertain whether differences in total daily FA1AT excretion occur in children fed different types of milk. Total daily FA1AT excretion was similar in the three milk feeding groups. An inverse correlation between FA1AT concentration and daily stool output was also found (P < .001). The overall rate of detectable FH in 792 stool smears was 2.1% and unrelated to type of milk feeding. Of 705 stool smears, 3.5% had positive Hematest reactions. Our results indicate that exudative protein loss or intestinal bleeding, as determined by FA1AT and FH, are uncommon in healthy cow's milk-fed infants older than 6 months of age. Dietary intake of solid foods and type of milk feeding should be considered when analyzing random stool samples for FA1AT concentration in young infants. Normal human milk-fed infants may have "high" FA1AT content because of reduced stool output.

Key Words: agr1-antitrypsin excretin • fecal hemoglobin • infant feeding • cow's milk

Submitted on July 29, 1985
Accepted on December 6, 1985