medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-336medsovet-7832Research ArticleГАСТРОЭНТЕРОЛОГИЯGASTROENTEROLOGYСовременные адаптированные смеси для вскармливания младенцев: состояние проблемы и перспективы решенияModern adapted infant formulas: problem status and prospects for solvinghttps://orcid.org/0000-0002-8202-3876ДмитриевА. В.DmitrievA. V.

Дмитриев Андрей Владимирович, доктор медицинских наук, профессор, заведующий кафедрой детских болезней с курсом госпитальной педиатрии, Рязанский государственный медицинский университет имени академика И.П. Павлова; профессор кафедры неонатологии имени профессора В.В. Гаврюшова, Российская медицинская академия непрерывного профессионального образования

390023, Рязань, ул. Высоковольтная, д. 9,

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

SPIN-код: 9059-2164

Andrey V. Dmitriev, Dr. Sci. (Med.), Professor, Head of the Department of Childhood Diseases with the course of Hospital Pediatrics, Ryazan State Medical University named after Academician I.P. Pavlov; Professor of the Department of Neona- tology named after Professor V.V. Gavryushov, Russian Medical Academy of Continuous Professional Education

9, Vysokovoltnaya St., Ryazan, 390023,

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

aakavd@yandex.ruhttps://orcid.org/0000-0002-4060-9692ГудковР. А.GudkovR. A.

Гудков Роман Анатольевич, кандидат медицинских наук, доцент кафедры детских болезней с курсом госпитальной педиатрии

390023, Рязань, ул. Высоковольтная, д. 9

SPIN-код: 3065-4800

Roman A. Gudkov, Cand. Sci. (Med.), Associate Professor of the Department of Childhood Diseases with the course of Hospital Pediatrics

9, Vysokovoltnaya St., Ryazan, 390023

comancherro@mail.ruhttps://orcid.org/0000-0001-5205-0956ПетроваВ. И.PetrovaV. I.

Петрова Валерия Игоревна, кандидат медицинских наук, доцент кафедры детских болезней с курсом госпитальной педиатрии

390023, Рязань, ул. Высоковольтная, д. 9

SPIN-код: 2747-5836

Valeria I. Petrova, Cand. Sci. (Med.), Associate Professor of the Department of Childhood Diseases with the course of Hospital Pediatrics

9, Vysokovoltnaya St., Ryazan, 390023

gtpf17@gmail.comhttps://orcid.org/0000-0001-6307-7249ФединаН. В.FedinaN. V.

Федина Наталья Васильевна, кандидат медицинских наук, доцент кафедры детских болезней с курсом госпитальной педиатрии

390023, Рязань, ул. Высоковольтная, д. 9

SPIN-код: 2128-5240

Natalia V. Fedina, Cand. Sci. (Med.), Associate Professor of the Department of Childhood Diseases with the course of Hospital Pediatrics

9, Vysokovoltnaya St., Ryazan, 390023

k2ataka@mail.ruhttps://orcid.org/0000-0003-1303-8318ЗаплатниковА. Л.ZaplatnikovA. L.

Заплатников Андрей Леонидович, доктор медицинских наук, профессор, проректор по учебной работе, заведующий кафедрой неонатологии имени профессора В.В. Гаврюшова, профессор кафедры педиатрии имени академика Г.Н. Сперанского

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Andrey L. Zaplatnikov, Dr. Sci. (Med.), Professor, Pro-Vice-Chancellor for Academic Affairs, Head of the Department of Neonatology named after Professor V.V. Gavryushov, Professor of Academician G.N. Speransky Department of Pediatrics

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

zaplatnikov@mail.ruРязанский государственный медицинский университет имени академика И.П. Павлова; Российская медицинская академия непрерывного профессионального образованияРоссияRyazan State Medical University named after Academician I.P. Pavlov; Russian Medical Academy of Continuous Professional EducationRussian FederationРязанский государственный медицинский университет имени академика И.П. ПавловаРоссияRyazan State Medical University named after Academician I.P. PavlovRussian FederationРоссийская медицинская академия непрерывного профессионального образованияРоссияRussian Medical Academy of Continuous Professional EducationRussian Federation202331102023017Педиатрия133141Copyright © Дмитриев А.В., Гудков Р.А., Петрова В.И., Федина Н.В., Заплатников А.Л., 20232023Дмитриев А.В., Гудков Р.А., Петрова В.И., Федина Н.В., Заплатников А.Л.Dmitriev A.V., Gudkov R.A., Petrova V.I., Fedina N.V., Zaplatnikov A.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7832

По оценкам Всемирной организации здравоохранения, в 2019 г. 47 млн детей в возрасте до 5 лет имели дефицит массы тела, из которых у 14,3 млн наблюдалась тяжелая степень недостаточности питания. Главной причиной большинства случаев нутритивного дефицита в мире является низкая калорийность рациона ребенка, дефицит и неполноценность пищевого белка, а также отклонения в потреблении витаминов и микроэлементов. В статье представлен обзор современной литературы, посвященный основным проблемам в создании адаптированных смесей для младенцев, лишенных возможности вскармливания грудным молоком. Среди наиболее острых проблем можно выделить следующие: трудности в приведении общего содержания белка в смеси к уровню грудного молока при сохранении адекватного аминокислотного профиля, высокий риск развития аллергии у младенцев на белок молока животных, неоправдавшиеся надежды на профилактический эффект смесей на основе частичных гидролизатов в отношении развития аллергических заболеваний, а также высокая распространенность функциональных нарушений пищеварительного тракта у детей, находящихся на искусственном вскармливании. При этом отмечено, что использование козьего молока в качестве белковой основы базовых детских формул может в перспективе позволить решить некоторые из вышеперечисленных проблем. Белковый компонент козьего молока выгодно отличается от коровьего, а спектр аминокислот позволяет снизить содержание белка в готовой смеси, обогащенной сывороточной фракцией, до рекомендованного уровня. Подчеркивается, что для окончательного ответа на поставленные вопросы требуется продолжение исследований по изучению эффективности и безопасности адаптированных смесей на основе козьего молока у младенцев.

According to the World Health Organization report, in 2019 47 million children under 5 were wasted, of which 14.3 million were severely wasted. In most cases, the main reason for nutritional deficiencies in the world is a child’s diet low in calories, dietary protein deficiency and inferiority, as well as inadequate intake of vitamins and minerals. The article presents a modern literature review devoted to the main problems in creating adapted formulas for infants who are deprived of the opportunity of getting breastfeeding. Among the most pressing problems are: difficulties in bringing the total protein concentration in the formula to the breast milk level while keeping an adequate amino acid profile, the high risk of animal milk protein allergies in infants, unfulfilled hopes for the preventive effect of partially hydrolysed formulas in relation to the development of allergic diseases, as well as the high prevalence of functional gastrointestinal diseases in children who are formula-fed. At the same time, it was emphasized that the use of goat’s milk as a protein base for basic infant formulas may in the future help solve some of the above problems. The protein component of goat’s milk compares favourably with cow’s milk, and the amino acid composition helps reduce protein concentration in the finished formula enriched with whey fraction to the recommended level. The article stresses that there is a need to continue studies on the effectiveness and safety of adapted goat’s milk formulas in infants to give definite answers to the questions posed.

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The authors declare that there are no conflicts of interest present.