Gastric emptying in formula-fed and breast-fed infants measured with the 13C-octanoic acid breath test

• Published in: Journal of pediatric gastroenterology and nutrition Vol. 29; no. 1; pp. 46 - 51
• Main Authors: Driessche, M. Van Den, Peeters, K, Marien, P, Ghoos, Y, Devlieger, H, Veereman-Wauters
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01.07.1999; Lippincott
• Subjects: Biological and medical sciences; Breast Feeding; breast milk; Breath Tests; Caprylates - metabolism; Carbon Isotopes; Female; Functional investigation of the digestive system; Gastric Emptying; Humans; Infant Food; infant formulas; Infant, Newborn; infants; Investigative techniques, diagnostic techniques (general aspects); isotope labeling; Male; Medical sciences; Milk, Human; octanoic acid; Radionuclide study; Human; Stomach; Nutrition; Digestive system; Gastric emptying; Octanoic acid; Feeding; Breath test; Humanized milk; Newborn; Non invasive method; Human milk; Biological effect; Comparative study
• ISSN: 0277-2116; 1536-4801
• DOI: 10.1097/00005176-199907000-00013

BACKGROUND:The C-octanoic acid breath test, a noninvasive method for measuring gastric emptying, was used to compare the gastric-emptying rate of formula-fed and breast-fed infants. Octanoic acid, a medium-chain fatty acid marked with the stable isotope C is immediately absorbed in the duodenum. Because gastric emptying is the rate-limiting step for the absorption of medium-chain fatty acids, the fraction of C expired in the breath indicates the rate of gastric emptying. METHODS:Twenty-nine newborn infants (16 boys, 13 girls) were investigated, with parental consent. The infants had a mean gestational age at birth of 34.5 weeks (range, 27-41 weeks) and a birth weight of 2148 g (range, 960-4100 g). Their mean weight on the day of the test was 2496 g (range, 1998-4140 g), and their mean age was 23 days (range, 7-74 days). Each infant received a test meal after a maximum fasting period of 3 hours. Fourteen infants were fed formula milk (Nutrilon Premium, NV Nutricia, Zoetermeer, The Netherlands) with C-octanoic acid and 15 infants received expressed mother's milk mixed with C-octanoic acid. After obtaining two basal breath samples and the feeding, breath samples were collected using a nasal prong, every 5 minutes during the first half hour and every 15 minutes during the next 3.5 hours. Analysis of the expired C fraction in the breath samples was performed using isotope-ratio mass spectrometry, and the gastric emptying curve and gastric emptying parameters were determined. RESULTS:The mean half-emptying time determined by the C-octanoic acid breath test was 65 minutes (range, 27-98 minutes) for the formula fed infants and 47 minutes (range, 16-86 minutes) for the breast-fed infants. The difference between the half-emptying times is significant (t-test, p < 0.05). CONCLUSIONS:The results of the C-octanoic acid breath test indicated faster gastric emptying of human milk than formula. Our findings are in accordance with those in earlier studies, using the invasive-dilution technique; noninvasive and detailed ultrasonography, which is not easily used because it is operator dependent and the observation time is short; or cineesophagogastroscintigraphy, which is less suitable for infants (because of the radiation involved). The C-octanoic acid breath test is a safe and noninvasive method for measuring gastric emptying in small infants and allows comparison of various feeding methods.