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Effect of Added Calcium, Phosphorus, and Infant Formula on Calcium and Phosphorus Dialyzability in Preterm Donor Human Milk

Fogleman, April D.*; Cohen, Ronald S.; Sakamoto, Pauline; Allen, Jonathan C.§

Journal of Pediatric Gastroenterology & Nutrition: October 2012 - Volume 55 - Issue 4 - p 390–397
doi: 10.1097/MPG.0b013e318254ec07
Hepatology and Nutrition

Objectives: We studied the effect of preparing donor human milk (DHM) with commonly used nutritional additives on the dialyzability of calcium and phosphate. We hypothesized that the additives to DHM would decrease the dialyzability of calcium and phosphate when prepared according to hospital protocols.

Methods: An in vitro system simulating premature infant digestion was developed to measure dialyzability of calcium and phosphate in DHM. Dialyzable calcium and phosphate were measured after in vitro digestion in DHM before and after preparation of DHM with the following additives according to hospital protocols: calcium glubionate, sodium potassium phosphate, calcium glubionate and sodium potassium phosphate added together, Similac human milk fortifier, Similac NeoSure, or Enfamil Enfacare.

Results: The percentage of dialyzable calcium in DHM with added calcium and calcium and phosphate together was greater than the percentage of dialyzable calcium in DHM with added powdered infant formulas (P < 0.0001). Dialyzable calcium was greater in DHM with added calcium and with added calcium and phosphate than in all other treatment groups (P < 0.0001). Dialyzable calcium in DHM without additives was not different from dialyzable calcium in DHM with added phosphate or with added powdered infant formulas. Dialyzable phosphate did not differ between the treatment groups.

Conclusions: The addition of calcium alone or calcium and phosphate together increased calcium dialyzability in DHM significantly, whereas the addition of powdered human milk fortifier or formulas did not. The addition of calcium or calcium with phosphate together to DHM may provide the most dialyzable calcium.

*North Carolina State University, Raleigh, NC

Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA

Mothers’ Milk Bank, San Jose, CA

§North Carolina State University, Raleigh, NC.

Address correspondence and reprint requests to April D. Fogleman, PhD, IBCLC, RD, Assistant Professor of Nutrition, North Carolina State University, Schaub Food Science Building 218-B, Box 7624, NCSU Campus, Raleigh, NC 27695 (e-mail:

Received 14 November, 2011

Accepted 9 March, 2012

Funding for this research was provided by the Mothers’ Milk Bank of San Jose, CA.

The authors are not affiliated with the manufacturers of the nutritional additives studied in this article.

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN