Methods of modulating inflammation in preterm infants using carotenoids

TECHNICAL FIELD

The present disclosure relates to preterm infant formulas comprising lutein, lycopene, and beta-carotene, and the use of the preterm infant formulas to modulate inflammation, such as skin inflammation, in preterm infants.

BACKGROUND OF THE DISCLOSURE

Dietary carotenoids are lipid soluble compounds abundant in fruits and vegetables. Carotenoids are responsible the spectrum of color found in fruits and vegetables, and are also responsible for the coloring of some birds and shellfish. Hundreds of carotenoid compounds have been identified, and approximately 30 of these compounds have been detected in human serum, milk, and other tissues (Khachik, et al., "Chemistry, distribution, and metabolism of tomato carotenoids and their impact on human health," Exp. Biol. Med. 2002, Vol. 227:845-851).

Human milk provides a variety of antioxidants to the breastfed infant. In contrast, exclusively formula-fed infants do not receive the variety or the quantity of carotenoids that are ingested by breastfed infants until other complementary foods are introduced to the diet. The lack of carotenoids in the diets of formula fed infants may be particularly problematic in preterm infants.

Infants who are born prior to 37 weeks gestation often face complications resulting from their prematurity. For instance, preterm infants are more susceptible to increased morbidities that are not common in healthy term infants. Underdeveloped organs such as the lungs, eye, intestines, and brain can reveal conditions such as chronic lung disease, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), and intraventricular hemorrhage (IVH). Infants in the NICU often have increased inflammation and oxidative stress associated with common diseases of prematurity as well as the treatments used to combat these illnesses (Gitto, et al., Am. J. Perinatal. 2004, Vol. 21:209-216; Ochoa, et al., Free Rad. Res. 2003, Vol. 37:317-322; Saugstad, Sem. Neonatal. 2003, Vol. 3:39-49).

Preterm infants are also at a nutritional disadvantage at birth, as they have been deprived of the period of maximal transfer of nutrients during the last few weeks of pregnancy. Consequently, it would therefore be desirable to provide a preterm infant formula comprising sufficient levels of carotenoids, such as lutein, lycopene, and beta-carotene, to modulate inflammation in preterm infants, such as inflammation associated with common diseases of prematurity.

It has now been unexpectedly discovered that inflammation in preterm infants, particularly skin inflammation, can be modulated by administering to the preterm infant a preterm infant formula that has been supplemented with a mixture of lutein, lycopene, and beta-carotene. More particularly, it has been discovered that preterm infant formulas containing certain levels of beta-carotene, lutein, and lycopene, can be used to decrease plasma levels of the inflammation marker C-reactive protein, and consequently decrease inflammation in preterm infants.

SUMMARY OF THE DISCLOSURE

The present disclosure is directed to a method for modulating inflammation in preterm infants. The method comprises administering to the preterm infant a preterm infant formula comprising from about 75 .mu.g/L to about 500 .mu.g/L of lutein, from about 60 .mu.g/L to about 500 .mu.g/L of lycopene, and from about 85 .mu.g/L to about 500 .mu.g/L of beta-carotene.

In another aspect, the present disclosure is directed to a method for modulating levels of C-reactive protein in preterm infants. The method comprises administering to the preterm infant a preterm infant formula comprising from about 75 .mu.g/L to about 500 .mu.g/L of lutein, from about 60 .mu.g/L to about 500 .mu.g/L of lycopene, and from about 85 .mu.g/L to about 500 .mu.g/L of beta-carotene.

It has been discovered that administering a preterm infant formula containing certain levels of carotenoids, such as beta-carotene, lutein, and lycopene, to a preterm infant results in a decrease in the plasma concentration of C-reactive protein in the preterm infant. Since C-reactive protein is a well known marker for inflammatory conditions, by decreasing plasma concentrations of C-reactive protein in the preterm infant, the level of inflammation can also be modulated.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a graph showing the median plasma concentration of C-reactive protein at study day (SD) 1, hospital discharge, and 40 weeks PMA for infants in the control formula group (no added carotenoids), infants in the study formula group (added carotenoids), and infants in the human milk (HM) fed reference group, as discussed in Example 16.

FIG. 2 is a graph showing the relationship between the plasma concentration of C-reactive protein and the plasma concentration of lutein for evaluable infants in the study formula group (added carotenoids), as discussed in Example 16. Plasma concentration of lutein was inversely related to plasma concentration of C-reactive protein.

FIG. 3 is a graph showing the relationship between the plasma concentration of C-reactive protein and the plasma concentration of lycopene for evaluable infants in the study formula group (added carotenoids), as discussed in Example 16. Plasma concentration of lycopene was inversely related to plasma concentration of C-reactive protein.

FIG. 4 is a graph showing the relationship between the plasma concentration of C-reactive protein and the plasma concentration of beta-carotene for evaluable infants in the study formula group (added carotenoids), as discussed in Example 16. Plasma concentration of beta-carotene was inversely related to plasma concentration of C-reactive protein.

DETAILED DESCRIPTION OF THE DISCLOSURE

The present disclosure is directed to methods for modulating levels of C-reactive protein, and consequently inflammation, in preterm infants using a preterm infant formula comprising a select level of the carotenoids beta-carotene, lutein, and lycopene. More particularly, it has been discovered that when preterm infant formulas containing select levels of the carotenoids beta-carotene, lutein, and lycopene are administered to preterm infants, the plasma concentration of C-reactive protein in the infants is decreased. By decreasing plasma concentrations of C-reactive protein, the level of inflammation in preterm infants can be modulated. These and other essential or optional elements or limitations of the preterm infant formulas and methods of the present disclosure are described in detail hereafter.

The term "infant" as used herein, unless otherwise specified, refers to children not more than about one year of age, and includes infants from 0 to about 4 months of age, infants from about 4 to about 8 months of age, infants from about 8 to about 12 months of age, low birth weight infants at less than 2,500 grams at birth, and preterm infants.

The terms "preterm infant" or "premature infant," used interchangeably herein, unless otherwise specified, refer to infants born at less than about 37 weeks gestational age, typically from about 26 weeks to about 34 weeks gestational age. A "term" infant is an infant born at about 37 to about 42 weeks gestational age. While actual conception, and thus gestational age, may not be precisely determinable, it can be approximated based on last menstrual cycle and/or on other objective estimates, such as early ultrasound assessments or clinical neonatal assessments such as Ballard's. The choice of which method to use in the event of discrepant results is often a matter of physician or institution preference.

The term "corrected age" (CA) refers to a concept used to standardize preterm infants to their full term peers for purposes of comparing their growth and development. Corrected age represents the age of the child from the expected date of delivery. Corrected age is calculated by subtracting the number of weeks born before 40 weeks of gestation from the chronological age. For example, a preterm infant born 8 weeks prematurely reaches "term corrected age" at approximately 2 months chronological age, and at 6 months chronological age may developmentally be equivalent to a 4 month-old term infant.

The term "chronological age" (or "postnatal" age) is the time elapsed after birth (gestational age).

The term "post-menstrual age" (PMA) refers to the time elapsed between the first day of the last menstrual period and birth (gestational age) plus the time elapsed after birth (chronological age).

The term "preterm infant formula" as used herein, unless otherwise specified, refers to a nutritional formula designed for preterm infants that contains sufficient nutrients such as proteins, carbohydrates, lipids, vitamins, and minerals to potentially serve as a supplemental, primary, or sole source of nutrition.

The term "nutritional formula" as used herein, unless otherwise specified, refers to a nutritional composition designed for infants, toddlers, children, adults, or combinations thereof, that contains sufficient nutrients such as proteins, carbohydrates, lipids, vitamins, minerals, and electrolytes to potentially serve as a supplemental, primary, or sole source of nutrition.

The term "ready-to-feed" as used herein, unless otherwise specified, refers to nutritional formulas in liquid form suitable for administration, including reconstituted powders, diluted concentrates, and manufactured liquids.

All percentages, parts and ratios as used herein, are by weight of the total formula, unless otherwise specified. All such weights as they pertain to listed ingredients are based on the active level and, therefore, do not include solvents or by-products that may be included in commercially available materials, unless otherwise specified.

Numerical ranges as used herein are intended to include every number and subset of numbers within that range, whether specifically disclosed or not. Further, these numerical ranges should be construed as providing support for a claim directed to any number or subset of numbers in that range. For example, a disclosure of from 1 to 10 should be construed as supporting a range of from 2 to 8, from 3 to 7, from 5 to 6, from 1 to 9, from 3.6 to 4.6, from 3.5 to 9.9, and so forth.

All references to singular characteristics or limitations of the present disclosure shall include the corresponding plural characteristic or limitation, and vice versa, unless otherwise specified or clearly implied to the contrary by the context in which the reference is made.

All combinations of method or process steps as used herein can be performed in any order, unless otherwise specified or clearly implied to the contrary by the context in which the referenced combination is made.

The preterm infant formulas of the present disclosure may also be substantially free of any optional or selected essential ingredient or feature described herein, provided that the remaining formula still contains all of the required ingredients or features as described herein. In this context, and unless otherwise specified, the term "substantially free" means that the selected formula contains less than a functional amount of the optional ingredient, typically less than 0.1% by weight, and also including zero percent by weight of such optional or selected essential ingredient.

The preterm infant formulas and corresponding methods of use of the present disclosure can comprise, consist of, or consist essentially of the essential elements and limitations of the disclosure as described herein, as well as any additional or optional ingredients, components, or limitations described herein or otherwise useful in nutritional formula applications.

Carotenoids

The preterm infant formulas of the present disclosure comprise select combinations of the carotenoids lutein, lycopene, and beta-carotene. Preterm infant formulas containing these combinations, as selected and defined herein, can be used to modulate inflammation and/or levels of C-reactive protein in preterm infants.

It is generally preferable that the preterm infant formula comprise from about 75 .mu.g/L to about 500 .mu.g/L of lutein, including from about 100 .mu.g/L to about 350 .mu.g/L of lutein, and also including from about 200 .mu.g/L to about 250 .mu.g/L of lutein and from about 100 .mu.g/L to about 215 .mu.g/L of lutein. It is also generally preferable that preterm infant formula comprise from about 60 .mu.g/L to about 500 .mu.g/L of lycopene, including from about 90 .mu.g/L to about 350 .mu.g/L of lycopene, and also including from about 100 .mu.g/L to about 150 .mu.g/L of lycopene. It is also generally preferable that preterm infant formula comprise from about 85 .mu.g/L to about 500 .mu.g/L of beta-carotene, including from about 150 .mu.g/L to about 350 .mu.g/L of beta-carotene, and also including from about 200 .mu.g/L to about 250 .mu.g/L of beta-carotene and from about 150 .mu.g/L to about 200 .mu.g/L of beta-carotene. It should be understood that any combination of these amounts of beta-carotene, lutein, and lycopene can be included in the preterm infant formulas of the present disclosure. In one exemplary embodiment, the preterm infant formula of the present disclosure comprises about 211 .mu.g/L of lutein, about 143 .mu.g/L of lycopene, and about 219 .mu.g/L of beta-carotene. In another exemplary embodiment, the preterm infant formula of the present disclosure comprises about 120 .mu.g/L of lutein, about 100 .mu.g/L of lycopene, and about 180 .mu.g/L of beta-carotene. Other carotenoids may optionally be included in the preterm infant formulas as described herein. Any one or all of the carotenoids included in the preterm infant formulas described herein may be from a natural source, or artificially synthesized.

In one embodiment, the preterm infant formula may optionally further comprise the carotenoid zeaxanthin. The preterm infant formulas of the present disclosure may comprise zeaxanthin in amounts of from about 5 .mu.g/L to about 300 .mu.g/L, including from about 10 .mu.g/L to about 100 .mu.g/L or from about 5 .mu.g/L to about 50 .mu.g/L. As will be recognized by one skilled in the art based on the disclosure herein, if lutein is utilized from a naturally-occurring source, some zeaxanthin may also be included in the carotenoids.

Typically, the preterm infant formulas of the present disclosure will comprise lutein, lycopene, and beta-carotene in amounts sufficient to provide from about 22 .mu.g/kg/day to about 150 .mu.g/kg/day of lutein; from about 18 .mu.g/kg/day to about 150 .mu.g/kg/day of lycopene; and from about 26 .mu.g/kg/day to about 150 .mu.g/kg/day of beta-carotene. Optionally, the preterm infant formula may further comprise zeaxanthin in amounts sufficient to provide from about 1 .mu.g/kg/day to about 15 .mu.g/kg/day.

Each of the carotenoids in the selected combinations can be obtained from any known or otherwise suitable material source for use in nutritional formulas, and each can be provided individually, or all together, or in any combination and from any number of sources, including sources such as multivitamin premixes containing other vitamins or minerals in combination with one or more of the carotenoids as described herein. Non-limiting examples of some suitable sources of lutein, lycopene, beta-carotene, or combinations thereof include LycoVit.RTM. lycopene (available from BASF, Mount Olive, N.J.), Lyc-O-Mato.RTM. tomato extract in oil, powder, or bead form (available from LycoRed Corp., Orange, N.J.), beta-carotene, lutein, or lycopene available from DSM Nutritional Products, Parsippany, N.J.), FloraGLO.RTM. lutein (available from Kemin Health, Des Moines, Iowa), Xangold.RTM. Natural Lutein Esters (available from Cognis, Cincinnati, Ohio), and Lucarotin.RTM. beta-carotene (available from BASF, Mount Olive, N.J.).

Plasma carotenoid concentration can be measured using any suitable technique. For instance, plasma carotenoid concentration can be measured by subjecting a blood sample to high performance liquid chromatography (HPLC). Carotenoid concentration in the skin can be measured using any suitable technique, such as Raman spectroscopy. Raman spectroscopy involves exposing the skin to a laser light source and detecting the scattered light as a function of photon frequency.

Nutrients

The preterm infant formulas of the present disclosure can be incorporated into any food or beverage that can be consumed by human infants, particularly preterm infants, or adults or animals. Thus, in one aspect, the present disclosure is directed to a preterm infant formula. The preterm infant formulas of the present disclosure may comprise sufficient types and amounts of nutrients to meet the targeted dietary needs of the intended user. These preterm infant formulas may therefore comprise protein, carbohydrate, and a lipid component (all either organic or non-organic) in addition to the carotenoids discussed above. The preterm infant formulas may also include vitamins, minerals, or other ingredients suitable for use in preterm infant formulas.

For example, the preterm infant formula includes those embodiments in which the protein component may comprise from about 7.5% to about 25% of the caloric content of the formula; the carbohydrate component may comprise from about 35% to about 50% of the total caloric content of the formula; and the lipid component may comprise from about 30% to about 60% of the total caloric content of the formula. These ranges are provided as examples only, and are not intended to be limiting. Additional suitable ranges are noted in the following Table.

TABLE-US-00001 Nutrient* 1.sup.st Embodiment 2.sup.nd Embodiment 3.sup.rd Embodiment Carbohydrates: % 20-85 30-60 35-55 total calories Lipid: % total 5-70 20-60 25-50 calories Protein: % total 2-75 5-50 7-40 calories *all numerical values preceded by the term "about"

Many different sources and types of carbohydrates, lipids, proteins, minerals and vitamins are known and can be used in the preterm infant formulas of the present disclosure, provided that such nutrients are compatible with the added ingredients in the selected formula, are safe for their intended use, and do not otherwise unduly impair product performance.

Carbohydrates suitable for use in the preterm infant formulas of the present disclosure can be simple, complex, or variations or combinations thereof. Non-limiting examples of suitable carbohydrates include hydrolyzed, intact, naturally and/or chemically modified cornstarch, maltodextrin, glucose polymers, sucrose, corn syrup, corn syrup solids, rice or potato derived carbohydrate, glucose, fructose, lactose, high fructose corn syrup and indigestible oligosaccharides such as fructooligosaccharides (FOS), and combinations thereof.

Non-limiting examples of proteins suitable for use in the preterm infant formulas include extensively hydrolyzed, partially hydrolyzed or non-hydrolyzed proteins or protein sources, and can be derived from any known or otherwise suitable source such as milk (e.g., casein, whey), animal (e.g., meat, fish), cereal (e.g., rice, corn), vegetable (e.g., soy), or combinations thereof. The proteins for use herein can also include, or be entirely or partially replaced by, free amino acids known for use in infant formulas, non-limiting examples of which include tryptophan, glutamine, tyrosine, methionine, cysteine, arginine, and combinations thereof. Other (non-protein) amino acids typically added to infant formulas include carnitine and taurine. In some cases, the D-forms of the amino acids are considered as nutritionally equivalent to the L-forms, and isomer mixtures are used to lower cost (for example, D,L-methionine).

Non-limiting examples of lipids suitable for use in the preterm infant formulas include coconut oil, soy oil, corn oil, olive oil, safflower oil, high oleic safflower oil, MCT oil (medium chain triglycerides), sunflower oil, high oleic sunflower oil, palm and palm kernel oils, palm olein, canola oil, marine oils, cottonseed oils, long-chain polyunsaturated fatty acids such as arachidonic acid (ARA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA), and combinations thereof.

In addition to these food grade oils, structured lipids may be incorporated into the preterm infant formulas if desired. Structured lipids are known in the art, descriptions of which can be found in INFORM, Vol. 8, no. 10, page 1004, Structured lipids allow fat tailoring (October 1997). Structured lipids are predominantly triacylglycerols containing mixtures of medium and long chain fatty acids on the same glycerol nucleus. Structured lipids are also described in U.S. Pat. No. 6,160,007, which is also incorporated herein by reference.

The preterm infant formulas of the present disclosure may further comprise any of a variety of vitamins in addition to the components described above. Non-limiting examples of vitamins include vitamin A, vitamin D, vitamin E, vitamin K, thiamine, riboflavin, pyridoxine, vitamin B12, niacin, folic acid, pantothenic acid, biotin, vitamin C, choline, chromium, carnitine, inositol, salts and derivatives thereof, and combinations thereof.

The preterm infant formulas may further comprise any of a variety of minerals, non-limiting examples of which include calcium, phosphorus, magnesium, iron, zinc, manganese, copper, iodine, sodium, potassium, chloride, and combinations thereof.

The preterm infant formulas of the present disclosure preferably comprise nutrients in accordance with the relevant infant formula guidelines for the targeted consumer or user population, as example of which would be the Infant Formula Act, 21 U.S.C. Section 350(a).

The preterm infant formulas of the present disclosure include those embodiments containing the carbohydrate, lipid, and protein concentrations described in Table 1 (Nutritional Formula Macronutrients).

TABLE-US-00002 TABLE 1* g/100 g/100 g g/L Nutrient Embodiment kcal total solids (as fed) Carbohydrate 1.sup.st Embodiment 8-16 30-83 54-108 2.sup.nd Embodiment 9-13 45-60 57-79 3.sup.rd Embodiment 15-19 63-81 157-203 Lipid 1.sup.st Embodiment 3-8 15-42 20-54 2.sup.nd Embodiment 4-6.6 20-30 27-45 3.sup.rd Embodiment 2-5 8-21 20-53 Protein 1.sup.st Embodiment 1-3.9 5-20.5 7-24 2.sup.nd Embodiment 1.5-3.4 10-17 10-23 3.sup.rd Embodiment 3.5-6.0 14.8-25.3 37-63 *all numerical values preceded by the term "about"

The preterm infant formulas of the present disclosure include those embodiments that comprise per 100 kcal of reconstituted formula one or more of the following: vitamin A (from about 250 to about 1250 IU), vitamin D (from about 40 to about 150 IU), vitamin K (greater than about 4 mcg), vitamin E (at least about 0.3 IU), vitamin C (at least about 8 mg), thiamine (at least about 8 mcg), vitamin B12 (at least about 0.15 mcg), niacin (at least about 250 mcg), folic acid (at least about 4 mcg), pantothenic acid (at least about 300 mcg), biotin (at least about 1.5 mcg), choline (at least about 7 mg), and inositol (at least about 4 mg).

The preterm infant formulas of the present disclosure include those embodiments that comprise per 100 kcal of reconstituted formula one or more of the following: calcium (at least about 50 mg), phosphorus (at least about 25 mg), magnesium (at least about 6 mg), iron (at least about 0.15 mg), iodine (at least about 5 mcg), zinc (at least about 0.5 mg), copper (at least about 60 mcg), manganese (at least about 5 mcg), sodium (from about 20 to about 60 mg), potassium (from about 80 to about 200 mg), and chloride (from about 55 to about 150 mg).

Optional Ingredients

The preterm infant formulas of the present disclosure may further comprise other optional components that may modify the physical, chemical, aesthetic or processing characteristics of the formulas or serve as pharmaceutical or additional nutritional components when used in the targeted population. Many such optional ingredients are known or other suitable for use in food and nutritional products, including infant formulas, and may also be used in the preterm infant formulas of the present disclosure, provided that such optional materials are compatible with the essential materials described herein, are safe for their intended use, and do not otherwise unduly impair product performance.

Non-limiting examples of such optional ingredients include preservatives, anti-oxidants, emulsifying agents, buffers, colorants, flavors, nucleotides, and nucleosides, additional probiotics, additional prebiotics, lactoferrin, and related derivatives, thickening agents and stabilizers, and so forth.

Product Form

The preterm infant formulas of the present disclosure may be prepared as any product form suitable for use in humans, including liquid or powdered complete nutritionals, liquid or powdered supplements (such as a supplement that can be mixed with a drink), reconstitutable powders, ready-to-feed liquids, bars, and dilutable liquid concentrates, which product forms are all well known in the nutritional formula arts.

The preterm infant formulas of the present disclosure may have any caloric density suitable for the targeted or intended patient population, i.e., preterm infants, or provide such a density upon reconstitution of a powder embodiment or upon dilution of a liquid concentrate embodiment. Most common caloric densities for the formulas of the present disclosure are generally at least about 19 kcal/fl oz (660 kcal/liter), more typically from about 20 kcal/fl oz (675-680 kcal/liter) to about 31 kcal/fl oz, even more typically from about 20 kcal/fl oz (675-680 kcal/liter) to about 24 kcal/fl oz (800-810 kcal/liter). Generally, 22-24 kcal/fl oz formulas are more commonly used in preterm or low birth weight infants, and the 20-21 kcal/fl oz (675-680 to 700 kcal/liter) formulas are more often used in term infants.

For nutritional powder embodiments of the present disclosure, such powders are typically in the form of flowable or substantially flowable particulate compositions, or at least particulate compositions that can be easily scooped and measured with a spoon or similar other device, wherein the compositions can easily be reconstituted by the intended user with a suitable aqueous fluid, typically water, to form a liquid nutritional formula for immediate oral or enteral use. In this context, "immediate" use generally means within about 48 hours, most typically within about 24 hours, preferably right after reconstitution. These powder embodiments include spray dried, agglomerated, dry mixed or other known or otherwise effective particulate form. The quantity of a nutritional powder required to produce a volume suitable for one serving may vary.

The preterm infant formulas of the present disclosure may be packaged and sealed in single or multi-use containers, and then stored under ambient conditions for up to about 36 months or longer, more typically from about 12 to about 24 months. For multi-use containers, these packages can be opened and then covered for repeated use by the ultimate user, provided that the covered package is then stored under ambient conditions (e.g., avoid extreme temperatures) and the contents used within about one month or so.

Methods of Manufacture

The preterm infant formulas of the present disclosure may be prepared by any known or otherwise effective technique suitable for making and formulating a nutritional formula or similar other formula, variations of which may depend upon variables such as the selected product form, ingredient combination, packaging and container selection, and so forth, for the desired preterm infant formula. Such techniques and variations for any given formula are easily determined and applied by one of ordinary skill in the nutritional formulation or manufacturing arts.

The preterm infant formulas of the present disclosure, including the exemplified formulas described hereinafter, can therefore be prepared by any of a variety of known or otherwise effective formulation or manufacturing methods. These methods most typically involve the initial formation of an aqueous slurry containing carbohydrates, proteins, lipids, stabilizers or other formulation aids, vitamins, minerals, or combinations thereof. The slurry is emulsified, pasteurized, homogenized, and cooled. Various other solutions, mixtures, or other materials may be added to the resulting emulsion before, during, or after further processing. This emulsion can then be further diluted, heat-treated, and packaged to form a ready-to-feed or concentrated liquid, or it can be heat-treated and subsequently processed and packaged as a reconstitutable powder, e.g., spray dried, dry mixed, agglomerated.

Other suitable methods for making nutritional formulas are described, for example, in U.S. Pat. No. 6,365,218 (Borschel, et al.), U.S. Pat. No. 6,589,576 (Borschel, et al.), U.S. Pat. No. 6,306,908 (Carlson, et al.), U.S. Patent Application No. 20030118703 A1 (Nguyen, et al.), which descriptions are incorporated herein by reference.

Methods of Use

The preterm infant formulas of the present disclosure can be administered to any individual as a nutrition source, e.g., in the form of a nutritional formula, especially to infants, or more particularly to preterm infants.

The preterm infant formulas of the present disclosure may also be used for the purpose of modulating levels of C-reactive protein (CRP), and thus inflammation, in an individual, and particularly in preterm infants. Specifically, CRP has gained recognition as a marker for inflammatory conditions. In humans, CRP levels are elevated in response to infection, trauma, surgery, and tissue infarction. Preterm infants often have increased inflammation and oxidative stress associated with common diseases of prematurity, such as chronic lung disease, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), and intraventricular hemorrhage (IVH), among others. The skin of preterm infants is also immature and susceptible to inflammation. These common issues associated with prematurity may result in elevated levels of CRP in preterm infants.

It has now been discovered that administering a preterm infant formula containing the levels of beta-carotene, lutein, and lycopene set forth herein, to a preterm infant allows the levels of CRP in the preterm infants to be modulated. More specifically, the formulas of the present disclosure, when administered to a preterm infant, can decrease plasma concentrations of CRP in the preterm infant. Since CRP is a well known marker for inflammatory conditions, by decreasing plasma concentrations of CRP in the preterm infant, the level of inflammation can also be modulated (i.e., decreased).

Thus, in one aspect, the present disclosure is directed to a method for modulating inflammation in preterm infants. The method comprises administering to the preterm infant an effective amount of a preterm infant formula of the present disclosure. The modulation of inflammation may be, for example, a reduction in inflammation, preferably skin inflammation, such as is measured by a decrease in the plasma concentration of CRP in the preterm infant. Plasma concentration of CRP can be measured with a standard CRP test of the blood.

In another aspect, the present disclosure is directed to a method for modulating levels of CRP in a preterm infant. The method comprises administering to the preterm infant an effective amount of a preterm infant formula of the present disclosure. The modulation of CRP levels may be, for example, a decrease in the plasma concentration of CRP in the preterm infant. Preferably, the administration of the preterm infant formula also results in an increase in the levels of beta-carotene, lutein, and lycopene in the skin of the preterm infant.

An "effective amount" of the preterm infant formula is any amount effective to achieve the desired reduction in inflammation and/or CRP levels in the preterm infant. Typically, the preterm infant formula is administered to a preterm infant in amounts of from about 100 mL/day to about 1000 mL/day, more typically in amounts of from about 150 mL/day to about 700 mL/day. Preferably, the preterm infant formula is administered in sufficient amounts to provide from about 22 .mu.g/kg/day to about 150 .mu.g/kg/day of lutein; from about 18 .mu.g/kg/day to about 150 .mu.g/kg/day of lycopene; and from about 26 .mu.g/kg/day to about 150 .mu.g/kg/day of beta-carotene

In preterm infants, the formula may be administered at any time during which it is desirable to modulate inflammation and/or CRP levels in preterm infants. Typically, the formula is administered from start of enteral feeding until typically up to about 50 weeks post-menstrual age, or up to about 40 weeks post-menstrual age. Preferably, the preterm infant formula is administered at least until the plasma concentration of CRP in the preterm infant has decreased and/or until the levels of beta-carotene, lutein, and/or lycopene in the skin are increased.

EXAMPLES

The following examples further describe and demonstrate specific embodiments within the scope of the present disclosure. The examples are given solely for the purpose of illustration and are not to be construed as limitations of the present disclosure, as many variations thereof are possible without departing from the spirit and scope of the disclosure. All exemplified amounts are weight percentages based upon the total weight of the composition, unless otherwise specified.

Each of the exemplified formulas is fed to humans to provide sole, primary, or supplemental nutrition. Each formula contains carotenoids as described herein, and can be used to modulate inflammation and/or levels of C-reactive protein in preterm infants.

Examples 1-15

The following examples illustrate preterm infant formulas of the present disclosure, including methods of making and using the preterm infant formulas. Formula ingredients for each batch are listed in Table 2. Exemplary amounts of beta-carotene, lutein, and lycopene provided by each formula when prepared as a ready-to-feed (RTF) formula, which may be varied depending on the amount of water used to prepare the RTF formula, is set forth in Tables 3 and 4.

TABLE-US-00003 TABLE 2 Preterm Infant Formulas Comprising Carotenoids Example 1 Example 2 Example 3 Quantity Quantity Quantity per 1000 per 1000 per 1000 Ingredients kg kg kg Water (kg) 681.6 747 795 Non Fat Dry Milk (kg) 180.7 127.3 98.0 Corn syrup (kg) 38.39 38.8 35.19 Corn syrup solids (kg) 36.47 36.9 33.43 Medium chain triglycerides (kg) 31.60 20.8 15.42 Soy oil (kg) 18.96 12.4 9.25 Whey Protein Concentrate (kg) 14.11 16.6 12.69 Coconut oil (kg) 11.56 7.48 5.64 Lactose (kg) 7.13 16.3 17.23 5% KOH (kg) 6.37 5.10 4.86 Potassium hydroxide solids (kg) 0.319 0.255 0.243 Ultra-micronized tricalcium 2.81 2.41 2.56 phosphate (kg) Ascorbic acid (kg) 1.14 0.913 0.888 Vitamin/Mineral/Taurine Premix (g) 802.7 642 537 Calcium Carbonate (g) 680 476 98 Soy lecithin (g) 659 433 364 Monoglycerides (g) 659 433 364 Magnesium chloride (g) 554 424 404 ARASCO M. alpine oil (g) 541 433 364 Sodium citrate (g) 438.5 203 As needed Nucleotide/Choline Premix (g) 366.5 293 293 DHASCO C. cohnii oil (g) 339.0 272 229 Carotenoid premixed suspension Beta-carotene (mg) 100 226 280 Lutein (mg) 100 218 250 Lycopene (mg) 100 147 180 Vitamin A, D3, E, K1 (g) 123.6 98.9 82.39 Seakem RLC carrageenan (g) 120.0 150 299 Seakem GP-359 carrageenan (g) -- 150 -- Ferrous Sulfate (g) 72.97 58.4 48.83 Choline Chloride (g) 60.07 48.1 35.42 L-carnitine (g) 40.34 36.6 30.62 Potassium citrate (2) (g) 4.60 -- 3.080 Thiamine HCl (g) 4.34 -- -- Riboflavin (g) 1.8 -- -- Vitamin A (g) 0.463 1.25 1.606 Vitamin A palmitate (g) 0.254 0.685 0.880 Potassium citrate (1) As needed 261 335 Sodium Chloride -- As needed As needed Potassium Chloride (g) As needed 196 140 Potassium phosphate As needed As needed As needed

TABLE-US-00004 TABLE 3 Carotenoid Concentration in RTF Formula Example Example Example Example Example Example Carotenoid 4 5 6 7 8 9 Beta-carotene (.mu.g/L) 85 144 203 219 262 321 Lutein (.mu.g/L) 75 90 158 211 251 294 Lycopene (.mu.g/L) 60 78 129 143 198 257

TABLE-US-00005 TABLE 4 Carotenoid Concentration in RTF Formula Example Example Example Example Example Example Carotenoid 10 11 12 13 14 15 Beta-carotene (.mu.g/L) 380 439 500 180 295 260 Lutein (.mu.g/L) 362 430 500 120 265 202 Lycopene (.mu.g/L) 319 417 500 100 219 188

The exemplified formulas may be prepared as a powdered nutritional infant formula by making at least two separate slurries that are later blended together, heat treated, standardized, heat treated a second time, spray dried, agglomerated, dry blended, and packaged, or may be prepared as a liquid ready-to-feed infant nutritional formula by making at least two separate slurries that are later blended together, heat treated, standardized, diluted with an appropriate amount of water, packaged, and sterilized. Initially, a carbohydrate-mineral slurry is prepared by dissolving the carbohydrates in water at 60-71.degree. C., followed by the addition of magnesium chloride, choline chloride, sodium chloride, potassium chloride, and calcium carbonate. The resulting slurry is held under moderate agitation at 49-60.degree. C. until it is later blended with the other prepared slurries.

An oil slurry is prepared by combining the medium chain triglycerides, monoglycerides, soy oil, coconut oil, arachidonic acid, and docosahexaenoic acid (DHA) at 49-60.degree. C., followed by the addition of carotenoids (beta-carotene, lutein, lycopene), Vitamin A, vitamin ADEK premix, and lecithin. The resulting oil slurry is held under moderate agitation at 38-49.degree. C. until it is later blended with the other prepared slurries.

A protein slurry is prepared by dissolving non-fat dry milk and whey protein concentrate in water at approximately 5-30.degree. C. The resulting protein slurry is held under low agitation at 2-7.degree. C. until it is later blended with the other prepared slurries.

Water, the carbohydrate-mineral slurry, and the protein slurry are combined under adequate agitation. The oil slurry is then added. The pH of the resulting blend is adjusted with potassium hydroxide. This blend is held under moderate agitation at 49-60.degree. C.

The resulting blend is heated to 71-77.degree. C., emulsified to a maximum of 300 psig, and then homogenized at 2400-2600/400-600 psig. The blend is then heated to 144-146.degree. C. for about 5 seconds. The heated blend is then cooled to a temperature of about 4.degree. C. Samples are taken for microbiological and analytical testing. The mixture is held under agitation.

A vitamin/mineral/taurine premix solution and an ascorbic acid solution are prepared separately and added to the processed blended slurry. The vitamin/mineral/taurine premix solution is prepared by adding the following ingredients to water with agitation: potassium citrate, sodium citrate, potassium phosphate, ultra-micronized tricalcium phosphate, ferrous sulfate, vitamin/mineral/taurine premix, L-carnitine, and the nucleotide-choline premix. The ascorbic acid solution is prepared by adding potassium hydroxide and ascorbic acid to a sufficient amount of water to dissolve the ingredients. The ascorbic acid solution pH is then adjusted to 5-9 with potassium hydroxide.

To prepare a powdered nutritional infant formula, the blend pH may be adjusted with potassium hydroxide to achieve optimal product stability. The blend then receives a second heat treatment. The blend is originally heated to 71-77.degree. C., and then further heated to 144-146.degree. C. for about 5 seconds. The heated blend is then passed through a flash cooler to reduce the temperature to 71-82.degree. C. Following heat treatment, the blend is evaporated.

The evaporated blend is passed through a spray drier. The finished powder then undergoes agglomeration with water as the binder solution. The probiotic is dryblended into the product. The completed product is then packaged into suitable containers.

To prepare a ready-to-feed nutritional infant formula, based on the analytical results of the quality control tests, an appropriate amount of water is added to the batch with agitation to achieve the desired total solids. The product pH may be adjusted to achieve optimal product stability. The completed product is then placed in suitable containers and subjected to terminal sterilization.

The resulting formula is then used to provide a supplemental, primary, or sole source of nutrition to premature infants or other appropriate individuals.

Example 16

A study was conducted to evaluate and compare the plasma concentrations of beta-carotene, lutein, and lycopene in preterm infants fed a regimen of preterm infant formulas with mixed carotenoids to plasma concentrations in preterm infants fed a regimen of preterm infant formulas with no added carotenoids, and to a reference group of human milk (HM)-fed preterm infants. Skin carotenoid concentrations in preterm infants fed preterm infant formulas with mixed carotenoids were also compared to those in the preterm infants fed preterm infant formulas with no added carotenoids and to the reference group of HM-fed preterm infants.

The study was a randomized, controlled, double-blinded, parallel study. Two-hundred three preterm infants from birth to 21 days of age were enrolled. Formula fed infants were administered an in-hospital formula (Similac.RTM. Special Care.RTM. formula (SSC)) with (study formula) or without (control formula) added carotenoids from start of enteral feeding until 40 weeks post-menstrual age (PMA), unless the infant reached 3.5 kg of body weight earlier or until the in-hospital, higher caloric formula was no longer medically indicated. At that time, infants were switched to the corresponding post-discharge formula (Similac.RTM. NeoSure.RTM. formula), with (study formula) or without (control formula) added carotenoids, and were administered the post-discharge formula until 50 weeks PMA (10 weeks corrected age). Infants remained on the same feeding regimen throughout the study. Specifically, infants administered the in-hospital formula with added carotenoids were switched to the post-discharge formula with added carotenoids, while infants fed the in-hospital formula without added carotenoids were switched to the post-discharge formula without the added carotenoids. The compositions of the formulas used in this study are set forth in Table 5.

TABLE-US-00006 TABLE 5 Composition of Control and Study Formulas In-hospital RTF formulas Post-discharge RTF formulas (24 kcal/oz) (22 kcal/oz) SSC with added NeoSure .RTM. with Nutrient SSC carotenoids NeoSure .RTM. added carotenoids Protein, g 24.4 24.4 20.8 20.8 Source Nonfat milk, whey protein conc. Nonfat milk, whey protein conc. Fat, g 44.0 44.0 40.9 40.9 Source MCT, soy, coconut, M. alpina, soy, coconut, MCT, M. alpina, C. cohnii oils C. cohnii oils Oil Ratio (50:30:18.3) (44.7:29:24.9) % fatty acids 0.40% ARA, 0.25% DHA 0.40% ARA, 0.25% DHA Carbohydrate, g 83.6 83.6 75.1 75.1 Minerals Calcium, mg 1461 1461 781 781 Phosphorus, mg 812 812 464 464 Ca:P ratio 1.7 1.7 1.7 1.7 Magnesium, mg 97.4 97.4 67.0 67.0 Sodium, mg 349 349 245 245 Potassium, mg 1047 1047 1056 1056 Chloride, mg 657 657 558 558 Iron, mg 14.6 14.6 13.4 13.4 Zinc, mg 12.1 12.1 9.0 9.0 Copper, mg 2.0 2.0 0.9 0.9 Manganese, .mu.g 97 97 74 74 Selenium, .mu.g 14.6 14.6 15.7 15.7 Vitamins A, IU 10144 10144 3422 3422 Thiamin, mg 2.03 2.03 1.6 1.6 Riboflavin, mg 5.0 5.0 1.1 1.1 B.sub.6, mg 2.6 2.6 0.8 0.8 B.sub.12, .mu.g 4.5 4.5 3.0 3.0 Biotin, .mu.g 350 350 80 80 Pantothenic acid, mg 15.4 15.4 6.0 6.0 Folic acid, .mu.g 540 540 200 200 C, mg 300 300 112 112 D, IU 1217 1217 521 521 E, IU 32.5 32.5 26.8 26.8 K, .mu.g 97.4 97.4 81.8 81.8 Taurine, mg 60 60 50 50 Carnitine, mg 12 12 44 44 Inositol, mg 45 45 45 45 Choline, mg 18 18 119 119 Carotenoids* Beta-carotene, .mu.g/L 20.sup..dagger. 220 28.sup..dagger. 90 Lutein, .mu.g/L NA 212 NA 90 Lycopene, .mu.g/L NA 143 NA 59 .sup..dagger.Inherent levels of beta-carotene in the control product NA Concentrations were not measured *Average of five batches

The formula fed infants were randomized to receive control or study formula. Human milk fed infants were also randomized. If for some reason human milk became insufficient or the mother chose not to human milk feed her baby at any time during the study, the feedings were supplemented with the formula randomly assigned at enrollment (i.e., the control or study formula). If formula (i.e., the randomly assigned control or study formula) accounted for 60% or more of the total volume of enteral intake in-hospital, the originally assigned human milk fed infant was evaluated with the appropriate formula subjects.

Of the 203 randomized subjects, 143 completed the study. Of these subjects who completed the study, 108 completed the study on the assigned feeding. Subjects were considered to have completed the study if they followed the assigned study feeding until 50 weeks PMA.

The lutein, lycopene, and beta-carotene intake, calculated from the actual amount of formula consumed by the subject, for subjects receiving the formulas with added carotenoids (i.e., study formulas) is set forth in Table 6.

TABLE-US-00007 TABLE 6 Carotenoid Intake (.mu.g/kg/day) for Evaluable Subjects Fed Study Formulas Visit In Hospital 40 wks PMA 44 wks PMA 50 wks PMA Total lutein intake (.mu.g/kg/day) Mean .+-. SEM 23.7 .+-. 0.9 32.3 .+-. 3.8 14.7 .+-. 1.1 13.1 .+-. 0.6 Range 8.2-35.3 6.7-103.2 8.8-41.8 7.9-21.2 N 46 31 31 29 Total lycopene intake (.mu.g/kg/day) Mean .+-. SEM 16.1 .+-. 0.6 22.0 .+-. 2.5 10.6 .+-. 0.8 9.4 .+-. 0.4 Range 5.7-23.9 4.8-69.8 6.3-30.1 5.7-15.3 N 46 31 31 29 Total beta-carotene intake (.mu.g/kg/day) Mean .+-. SEM 24.6 .+-. 1.0 33.7 .+-. 3.9 16.1 .+-. 1.2 14.3 .+-. 0.7 Range 8.7-36.6 7.3-106.9 9.7-45.8 8.6-23.3 N 46 31 31 29

Blood samples (1.5 mL in-hospital and 0.5 mL post-discharge) were taken from the subjects at study day 1, at hospital discharge, at 40 weeks PMA, and at 50 weeks PMA. Blood samples were sent to Craft Technologies (Wilson, N.C.) for determination of plasma concentrations of lutein, lycoene, beta-carotene, and C-reactive protein. The plasma concentrations of lutein, lycopene, and beta-carotene in evaluable subjects at study day 1, at hospital discharge, and at 40 and 50 weeks PMA are shown in Tables 7-10. The plasma concentrations of C-reactive protein at study day 1, at hospital discharge, and at 40 and 50 weeks PMA are shown in Table 11. Growth, including weight gain, length gain, and head circumference, of the infants (study formula group, control formula group, and milk-fed group) was also determined in hospital and at 40 and 50 weeks PMA. Growth was not different between the control formula group and the study formula group at any time during the study, if human milk intake was controlled for in the analyses (data not shown).

Tables 7-11 set forth results for subjects classified as "evaluable." The evaluable analysis for a defined study outcome included data collected from a subject following the feeding protocol at the time of observation of the outcome. A subject's outcome data were classified as `evaluable` for the analysis until one or more of the exclusion events occurred during the study. Exclusion events included correct randomization but incorrect dispensing of assigned formula, refusal or unsuccessful blood draws, volume of formula intake accounting for less than 60% of total volume in-hospital, and days of formula intake accounting for less than 60% of study interval after hospital discharge. In addition, a subject was removed from the evaluable analysis if the subject received less than 7 days of study formula in-hospital, subject was NPO (i.e., nothing taken by mouth) all day for at least 10 days in-hospital, or at 50 weeks, subject exited study more than 7 days after last study formula was received. These criteria were established to ensure that infants were exposed to an acceptable amount of the assigned formula (control or study) during the in-hospital phase and post-discharge phase of the study.

TABLE-US-00008 TABLE 7 Plasma Concentrations of Lutein** (.mu.g/dL) in Evaluable Subjects Study Group HM Reference Groups Lutein (.mu.g/dL) Control Formula (CF) Study Formula (SF) Preterm Term* Study Day 1.sup..dagger. Mean .+-. SEM 1.71 .+-. 0.14 2.41 .+-. 0.19 2.44 .+-. 0.13 Median 1.40 2.10 2.30 Range 0.30-4.40 0.60-5.40 0.70-4.80 N 42 37 52 Hospital discharge.sup..dagger-dbl. Mean .+-. SEM 0.82 .+-. 0.08 6.96 .+-. 0.84 2.73 .+-. 0.44 Median 0.80 6.90 2.70 Range 0.20-2.30 0.70-21.20 0.30-8.40 N 31 30 23 40 wks PMA.sup..dagger-dbl. Mean .+-. SEM 0.92 .+-. 0.08 10.30 .+-. 0.95 3.83 .+-. 0.54 Median 0.90 10.90 3.00 Range 0.20-2.60 0.70-24.60 0.20-15.90 N 43 36 39 50 wks PMA.sup..dagger-dbl. Mean .+-. SEM 1.83 .+-. 0.40 7.68 .+-. 0.58 3.94 .+-. 0.60 5.88 .+-. 0.77 Median 1.40 7.60 3.10 4.72 Range 0.20-11.80 0.80-15.50 0.20-13.10 0.49-20.09 N 28 26 35 26 Abbreviations used: HM = human milk; PMA = post-menstrual age *Human milk reference group data adapted from Mackey, et al., "Relative bioavailability of carotenoids in infant formula and human milk," presented at Clinical Nutrition Week, Chicago, February 2008. Plasma lutein concentration values were obtained at 10-13 weeks of age from term infants fed HM. **Plasma concentrations for lutein include concentrations of the trans isomer. .sup..dagger.SF > CF; p < 0.01. .sup..dagger-dbl.SF > CF; p < 0.0001.

TABLE-US-00009 TABLE 8 Plasma Concentration of Lycopene** (.mu.g/dL) in Evaluable Subjects Study Group HM Reference Groups Total Lycopene (.mu.g/dL) Control Formula (CF) Study Formula (SF) Preterm Term* Study day 1 Mean .+-. SEM 1.07 .+-. 0.12 1.33 .+-. 0.15 1.43 .+-. 0.15 Median 0.90 1.30 1.10 Range 0.30-3.40 0.10-4.80 0.30-5.10 N 42 37 52 Hospital discharge.sup..dagger. Mean .+-. SEM 0.33 .+-. 0.01 4.41 0 .+-. 0.65 1.42 .+-. 0.23 Median 0.30 3.70 1.20 Range 0.30-0.60 0.30-15.90 0.30-3.60 N 31 30 23 40 wks PMA.sup..dagger. Mean .+-. SEM 0.31 .+-. 0.01 7.93 .+-. 0.86 2.17 .+-. 0.32 Median 0.30 7.30 1.50 Range 0.30-0.60 0.30-21.50 0.30-10.10 N 43 36 39 50 wks PMA.sup..dagger. Mean .+-. SEM 0.32 .+-. 0.01 10.78 .+-. 0.91 3.25 .+-. 0.62 10.85 .+-. 1.08 Median 0.30 10.70 1.90 11.21 Range 0.30-0.60 0.30-21.00 0.30-11.20 0.3-23.13 N 28 26 35 26 Abbreviations used: HM = human milk; PMA = post-menstrual age *Human milk reference group data adapted from Mackey, et al., "Relative bioavailability of carotenoids in infant formula and human milk," presented at Clinical Nutrition Week, Chicago, February 2008. Plasma lycopene concentration values were obtained at 10-13 weeks of age from term infants fed HM. **Plasma concentrations of lycopene include concentrations of the cis and trans isomers. .sup..dagger.SF > CF; p < 0.0001.

TABLE-US-00010 TABLE 9 Plasma Concentrations of Beta-Carotene** (.mu.g/dL) in Evaluable Subjects Total Beta-Carotene Study Group HM Reference Groups (.mu.g/dL) Control Formula (CF) Study Formula (SF) Preterm Term* Study day 1 Mean .+-. SEM 0.97 .+-. 0.14 1.21 .+-. 0.25 1.46 .+-. 0.22 Median 0.55 0.70 0.90 Range 0.30-4.10 0.30-8.20 0.30-7.40 N 42 37 52 Hospital discharge.sup..dagger. Mean .+-. SEM 0.74 .+-. 0.14 4.79 .+-. 0.64 3.42 .+-. 0.90 Median 0.40 4.15 2.20 Range 0.30-3.60 0.30-13.40 0.30-14.80 N 31 30 23 40 wks PMA.sup..dagger. Mean .+-. SEM 0.83 .+-. 0.09 7.22 .+-. 0.74 4.81 .+-. 0.98 Median 0.80 6.85 1.60 Range 0.30-3.60 0.50-16.10 0.30-24.30 N 43 36 39 50 wks PMA.sup..dagger. Mean .+-. SEM 4.52 .+-. 1.43 8.49 .+-. 1.26 9.37 .+-. 2.04 6.79 .+-. 1.51 Median 1.25 6.55 4.70 3.65 Range 0.50-34.80 3.60-35.40 0.30-48.00 0.40-29.89 N 28 26 35 26 Abbreviations used: HM = human milk; PMA = post-menstrual age *Human milk reference group data adapted from Mackey, et al., "Relative bioavailability of carotenoids in infant formula and human milk," presented at Clinical Nutrition Week, Chicago, February 2008. Plasma beta-carotene concentration values were obtained at 10-13 weeks of age from term infants fed HM. **Plasma concentrations of beta-carotene include concentrations of the cis and trans isomers. .sup..dagger.SF > CF; p < 0.0001.

TABLE-US-00011 TABLE 10 Plasma Concentrations of Total Lutein/Zeaxanthin* (.mu.g/dL) in Evaluable Subjects Treatment group including HM Total Lutein/Zeaxanthin Control Study (.mu.g/dL) Formula (CF) Formula (SF) HM Study day 1 Mean .+-. SEM 2.65 .+-. 0.22 3.74 .+-. 0.31 3.69 .+-. 0.18 Median 2.25 3.40 3.45 Min, Max 0.40, 6.90 0.70, 8.40 1.10, 6.60 N 42 37 52 Hosp. disc. Mean .+-. SEM 1.11 .+-. 0.10 8.45 .+-. 0.99 4.13 .+-. 0.65 Median 1.10 7.90 4.80 Min, Max 0.20, 2.70 0.90, 25.40 0.50, 12.60 N 31 30 23 40 wks PMA Mean .+-. SEM 1.15 .+-. 0.10 12.35 .+-. 1.12 5.69 .+-. 0.76 Median 1.10 12.80 4.60 Min, Max 0.20, 3.40 1.00, 29.80 0.20, 23.20 N 43 36 39 50 wks PMA Mean .+-. SEM 2.46 .+-. 0.44 9.25 .+-. 0.75 5.65 .+-. 0.84 Median 1.95 9.30 4.50 Min, Max 0.20, 13.00 0.90, 19.30 0.20, 16.30 N 28 26 35 Abbreviations used: HM = Human Milk; PMA = Post-menstrual age Statistical analysis was not done on plasma concentrations of total lutein/zeaxanthin. *Plasma concentrations of total lutein/zeaxanthin include concentrations of cis and trans isomers of lutein. The cis isomer of lutein can not be separated from the cis isomer of zeaxanthin. Plasma concentrations of total lutein/zeaxanthin were not included in the primary analyses but are shown because infants in the study formula group did receive some zeaxanthin during the study.

As can be seen from Tables 7-10, plasma lycopene and beta-carotene concentrations were not different at enrollment (study day 1), but plasma lutein concentrations were different between the study groups (SF>CF; p<0.01) at study day 1. At hospital discharge, plasma concentrations of lutein, lycopene, and beta-carotene were significantly higher in the study formula group (added carotenoids), compared to the control formula group (no added carotenoids). Infants in the study formula group had significantly higher mean plasma concentration of lutein than infants in the control group (6.96 vs. 0.82 .mu.g/dL; p<0.0001) at hospital discharge. Similarly, mean plasma lycopene concentration was significantly higher in the study formula group than in the control formula group (4.41 vs. 0.33 .mu.g/dL; p<0.0001) at hospital discharge. Mean plasma beta-carotene concentration was also significantly higher in the study formula group than in the control formula group (4.79 vs. 0.74 .mu.g/dL; p<0.0001).

The mean plasma lutein concentrations at 40 and 50 weeks PMA were also significantly higher in the study formula (SF) group compared to the control formula (CF) group in evaluable subjects (10.30 .mu.g/dL>0.93 .mu.g/dL, p<0.0001; 7.68 .mu.g/dL>1.83 .mu.g/dL, p<0.0001, respectively). The plasma lutein concentration in the study formula group was thus closer to the plasma lutein levels reported in term human milk fed infants (i.e., mean of 5.88 .mu.g/dL; range of 0.49-20.09 .mu.g/dL) at approximately 10-13 weeks of age than was the plasma concentrations of the control formula group.

Plasma lycopene and beta-carotene concentrations were significantly higher (p<0.0001) in the study formula group as compared to the control formula group at 40 weeks and 50 weeks PMA for evaluable subjects. Specifically, the mean plasma lycopene levels in the study formula group were 7.93 .mu.g/dL and 10.78 .mu.g/dL at 40 and 50 weeks PMA, respectively. In contrast, the mean lycopene plasma concentrations in the control formula group were only 0.31 .mu.g/dL and 0.32 .mu.g/dL (considered undetectable) at 40 and 50 weeks PMA, respectively. The plasma lycopene concentration in the study formula group was thus closer to the plasma lycopene levels reported in term human milk fed infants (i.e., mean of 10.85 .mu.g/dL; range of 0.3-23.13 .mu.g/dL) at approximately 10-13 weeks of age, than was the plasma concentrations of the control formula group.

The mean plasma beta-carotene levels in the study formula group were 7.22 .mu.g/dL and 8.49 .mu.g/dL at 40 and 50 weeks PMA, respectively, for evaluable subjects. In contrast, the mean beta-carotene plasma concentrations in the control formula group were 0.83 .mu.g/dL and 4.52 .mu.g/dL at 40 and 50 weeks PMA. The plasma beta-carotene concentration in the study formula group was thus closer to the plasma lycopene levels reported in term human milk fed infants (i.e., mean of 6.79 .mu.g/dL; range of 0.40-29.89 .mu.g/dL) at approximately 10-13 weeks of age, than was the plasma concentration of the control formula group.

The plasma concentrations of C-reactive protein (CRP) at study day 1, at hospital discharge, and at 40 and 50 weeks PMA in evaluable subjects that received the study formula (with added carotenoids) are shown in Table 11.

TABLE-US-00012 TABLE 11 Plasma Concentrations of C-Reactive Protein (.mu.g/mL) in Evaluable Subjects Study Group C-reactive protein Control Study (.mu.g/mL) Formula (CF) Formula (SF) HM * Study Day 1 Mean .+-. SEM 0.763 .+-. 0.167 0.853 .+-. 0.225 0.773 .+-. 0.319 Median 0.385 0.410 0.260 Range 0.020-5.570 0.020-7.320 0.020-16.550 N 42 37 52 Hospital discharge Mean .+-. SEM 0.827 .+-. 0.355 0.343 .+-. 0.079 0.343 .+-. 0.113 Median 0.400 0.200 0.120 Range 0.020-10.340 0.020-1.910 0.020-2.160 N 29 27 23 40 wks PMA .sup..dagger. Mean .+-. SEM 3.250 .+-. 1.017 0.536 .+-. 0.130 1.826 .+-. 0.610 Median 0.600 0.180 0.210 Range 0.020-26.580 0.020-3.240 0.020-17.400 N 38 36 38 50 wks PMA Mean .+-. SEM 1.644 .+-. 0.723 2.822 .+-. 0.927 0.423 .+-. 0.110 Median 0.220 0.360 0.290 Range 0.020-16.190 0.020-19.270 0.020-3.600 N 27 25 35 Abbreviations used: HM = human milk. * HM reference group only. These data were not included in the statistical analyses .sup..dagger. CF > SF; p < 0.001.

As can be seen from Table 11, CRP levels at 40 weeks PMA were significantly lower in the study formula group as compared to the control formula group (p<0.001). FIG. 1 is a graph showing the median CRP levels from study day 1 to 40 weeks PMA for the control formula group, study formula group, and the human milk fed reference group. As can be seen from FIG. 1, CRP levels decreased in the study formula group and the human milk fed group whereas they increased in the control formula group from study day 1 to 40 weeks PMA.

The results of the CRP evaluation suggest that carotenoids may play a role in modulating inflammation in preterm infants, and that this may be related to the amount of carotenoids administered to the infant. Specifically, the time period during which CRP levels decreased in the study formula group relative to control (i.e., study day 1 to 40 weeks PMA) is the time period during which the study formula infants were receiving the in-hospital formula study formula. As can be seen from Table 5 above, the in-hospital study formula (Similac.RTM. Special Care.RTM. formula with added carotenoids) contained higher concentrations of carotenoids than the post-discharge study formula (Neosure.RTM. formula with added carotenoids). The total carotenoid intake at 40 weeks PMA (i.e., at the time the study group infants were receiving the Similac.RTM. Special Care.RTM. study formula) was at least two times higher than the total carotenoid intake at 50 weeks PMA (i.e., at the time the study group infants were receiving the NeoSure.RTM. study formula) (see Table 6).

The plasma concentration of CRP for evaluable infants in the study formula group (see Table 11) was plotted verses the plasma concentration of lutein, lycopene, and beta-carotene. The results are shown in FIGS. 2-4. As can be seen from FIGS. 2-4, the plasma concentration of CRP decreases with increasing plasma concentrations of lutein (FIG. 2), lycopene (FIG. 3), and beta-carotene (FIG. 4), indicating that the plasma concentrations of lutein, lycopene, and beta-carotene are separately inversely related to the plasma concentrations of CRP.

CONCLUSION

There were consistent differences between the study formula and the control formula groups in regards to plasma concentrations of lutein, lycopene and beta-carotene. Specifically, plasma concentrations of lutein, lycopene and beta-carotene were consistently higher in the study formula group as compared to the control formula group at hospital discharge, and at 40 and 50 weeks PMA. The concentration of carotenoids in the plasma of the study formula group was closer to that observed in human milk fed term infants, than was the plasma concentration of the control group subjects. Infants in both the study formula and control formula groups had good growth, indicating that both formulas provided adequate nutrition to the infants and were well tolerated.

Plasma concentration of CRP at 40 weeks PMA was significantly lower in the study formula group as compared to the control formula group, but was not significantly different at 50 weeks PMA, suggesting that carotenoids may play a role in modulating inflammation. Since the total carotenoid intake at 40 weeks PMA (i.e., at the time the study group infants were receiving the Similac.RTM. Special Care.RTM. study formula supplemented with high levels of carotenoids) was at least two times higher than the total carotenoid intake at 50 weeks PMA (i.e., at the time the study group infants were receiving the NeoSure.RTM. study formula supplemented with lower levels of carotenoids), the role of carotenoids in modulating inflammation may be related to the amount of carotenoids administered to the infant.

The results also demonstrated that plasma concentrations of the carotenoids beta-carotene, lutein, and lycopene are inversely correlated with plasma concentrations of CRP. Plasma carotenoid levels were also significantly correlated with skin carotenoid levels, as determined by Raman spectroscopy (data not shown).