Soy formula can help manage cow's milk allergy in infants and children in 3 ways:
1) Soy formula is a hypoallergenic alternative to cow's milk formula for infants and children with cow's milk allergy.
2) Soy formula has positive effects on immunity and may help prevent the development of additional food allergies.
3) Adding supplements like vitamins, minerals, fatty acids and antioxidants to soy formula can further support immunity and development.
The Sorrows of Vegetarian — A survey of meat diet risk and vegetarian nutrition tips. Private sharing on 18 March 2013.
討論肉食的健康風險, 素食營養的基本知識. 2013-03-18 私人吹水會.
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Are you about to plan your holiday in Bali and looking for nice and cheap or exclusive Hotels, Villas or Resorts? You need to find out more about different areas to find you the most suitable place to stay? Are you already in Bali and want to know where to eat, spa and shop or which activities you can do? Or are you more interested in Bali’s unique culture and want to explore attractions all over Bali?
It doesn’t finally matter what you are looking for in Bali, with travelling BALI – the eBook, you simply get all information you are looking for. Even more information you can get on our homepage to make you Bali Holiday simply perfect!
www.travellingbali.com
The Sorrows of Vegetarian — A survey of meat diet risk and vegetarian nutrition tips. Private sharing on 18 March 2013.
討論肉食的健康風險, 素食營養的基本知識. 2013-03-18 私人吹水會.
BALI, Indonesia
Are you about to plan your holiday in Bali and looking for nice and cheap or exclusive Hotels, Villas or Resorts? You need to find out more about different areas to find you the most suitable place to stay? Are you already in Bali and want to know where to eat, spa and shop or which activities you can do? Or are you more interested in Bali’s unique culture and want to explore attractions all over Bali?
It doesn’t finally matter what you are looking for in Bali, with travelling BALI – the eBook, you simply get all information you are looking for. Even more information you can get on our homepage to make you Bali Holiday simply perfect!
www.travellingbali.com
Achieve Closing the Expectations Gap, 2010 Achieve, Inc.
Each year, on the anniversary of the 2005 National Education Summit on High Schools, Achieve releases a 50-state progress report on the alignment of high school policies with the demands of college and careers. Closing the Expectations Gap, 2010 is the fifth annual report in this series. The report details state progress implementing the American Diploma Project policy agenda. Visit http://www.achieve.org for more.
Di Board (Distribution Board) Load Centres have been Designed as per Customer Expectation by Considering International and Local Standards for Safe and Reliable Distribution and Control of Electrical Power for residential and commercial applications as Load Centers.
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Each year, on the anniversary of the 2005 National Education Summit on High Schools, Achieve releases a 50-state progress report on the alignment of high school policies with the demands of college and careers. Closing the Expectations Gap, 2010 is the fifth annual report in this series. The report details state progress implementing the American Diploma Project policy agenda. Visit http://www.achieve.org for more.
Di Board (Distribution Board) Load Centres have been Designed as per Customer Expectation by Considering International and Local Standards for Safe and Reliable Distribution and Control of Electrical Power for residential and commercial applications as Load Centers.
Yogurt and fermented milks in daily nutrition: from science to the guidelines...Yogurt in Nutrition #YINI
That yogurt might have a beneficial effect on consumers’ health is a generally held assumption. Now recent epidemiological studies reported that yogurt consumption has positive effects on public health diseases such as obesity or type 2-diabetes. But how exactly is this impact to be defined? Which conditions does yogurt help to prevent? What are the underlying mechanisms?
YOGURT: A DAILY PARTNER FOR HEALTH” is the title of an international symposium, where experts have provided answers to these questions by presenting data from a broad range of recent studies, that show the importance of this research field for health care.
Prof. Seppo Salminen (University of Turku / Finland) unveiled dietary guidelines for dairy and yogurt consumption and the growing interest in evidence-based recommendations by government bodies.
The symposium, which was organized by the Yogurt in Nutrition Initiative for a Balanced Diet (YINI) will be held Monday, November 10, 2014 (5-7 pm) as part of the III World Congress of Public Health Nutrition in Las Palmas de Grand Canarias (9-12 November 2014).
More info on www.yogurtinnutrition.com
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The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
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Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
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The benefits of soy formmula in the management of cma
1. THE BENEFITS OF SOY
FORMULA IN THE
MANAGEMENT of COW’S MILK
ALLERGY
Prof. Ariyanto Harsono MD PhD SpAK
1
2. Pendahuluan
The process will continue in the lives of babies
Sensitization to another food proteins would
otherwise occur
Prof DR Dr Ariyanto Harsono SpA(K)
Cow's milk is generally the first
allergen in infants
once responses to cow's milk IgE occurs
3. Prevention is very important
Allergy Prevention:
Primary
Secondary
Tertiary
3
Adjusting Solid Foods to Milk formula used
Other Suplement yang: LCP, vitamines, micronutrient
Soy Formula has a positive effect on immunity and
Allergy
4. Aktivasi
sel-sel
Imuno-
kompeten
•Sel T
•Sel B
•Sel Mast
•Sel
Langer-
hans
Aktivasi
sel-sel
struk-
tural
•Sel
endotel
•Sel
epitel
Aktivasi dan
Rekruitmen
•Sel Mast
•Eosinofil
•Basofil
Pelepasan
mediator
Kerusakan
epitel
Stimulasi
neural
Dilatasi &
peningkatan
permeabilitas
vaskulerl
Bronkokonstriksi
Perbaikan
epitel
•Proliferasi
fibroblast
•Deposisi
kolagen
•Hipertropi/hiper
plasia otot polos
•Ekspansi
vaskuler
Penyempitan
saluran nafas
bawah
Symptom
alergi
Bronkus
hiper-reaktif
A
L
E
R
G
E
N
A B C D E
Airway
remodelling
Primary Prevention Secondary Prevention
Tertiary Prevention
J Allergy Clin Immunol 2005;116:3-14
Prof DR Dr Ariyanto Harsono SpA(K)
4
Imunopathology of allergy
5. Ag
APC MHC-II Th0
IL-12/ IL-1
Th-2
Th.1
IL-1 IL-2, IFN-γ
B-Cell
IL-4
IL-5
SEL PLASMASEL MEMORI
IL-6
IL-10
A
AKTIVAtion of IMMUNOCOMPETENce CELLS by
ANTIGEN
Memory Cells
Prof DR Dr Ariyanto Harsono SpA(K) 5
12. Primary prevention with Milk
Formula
Partially hydrolyzed
formulas:
pHF FORMULA
Prof DR Dr Ariyanto Harsono SpA(K) 12
13. Target
Organ
IgE-mediated disorder Non IgE-mediated
disorder
Skin
Gastro-
intestinal
Respiratory
Tract
Multi-
system
Urticaria and angioedema
Atopic Dermatitis
Oral Allergy Syndrome
Gastrointestinal anaphylaxis
Allergic eosinophilic
gastroenteritis
Asthma; Allergic Rhinitis
Food-induced anaphylaxis
Food associated, exercise-
induced anaphylaxis
Atopic Drmatitis
Dermatitis Herpetiformis
Proctocolitis
Enterocolitis
Allergic eosinophilic-GE
Enteropathy syndrome
Celiac Disease
GI Haemorrhage
Heiner Syndrome
Clinical ManifestationE Symptoms
Prof DR Dr Ariyanto Harsono SpA(K)
13
14. VACCINATION
ACTIVATION
ANTIGEN
SPECIFIC
B CELL
GENERATION OF
MEMORY
ACTIVATED
CD4
+
Th-2 CELL IL-4
DIFFERENTIATION
& AFFINITY
MATURATION
ANTIBODY SECRETING
PLASMA CELLS
ANTIGEN
PROCESSING &
PRESENTATION
MHC Class II B CELL IMMUNOGLOBULINE
T CELL RECEPTOR ANTIGEN
B CELL
IL-5,IL-13
Cow’s Milk Protein
Cow’s Milk epitope
Prof DR Dr Ariyanto Harsono SpA(K) 14
29. History
• Early 1900 preparation based on “soy-protein”
for treatment of CMPA (in USA)
• Since1960 :composition better adapted to infan
t nutritional needs
• 2000 : infant formula based on soy fulfills
European Directives and legislation for
infant feeding
Prof DR Dr Ariyanto Harsono SpA(K) 29
30. Soy protein isolate instead of soy-cereal
• Previously: soy concentrate (protein content 70 %)
Now : isolate (95% protein) Dupuy et al,1994
• Addition of + methionine, + carnitine, + taurine,
+Fe, +Zn, +Ca, + P Heating to destroy « anti--
protease activity » for over 90 %
Prof DR Dr Ariyanto Harsono SpA(K) 30
31. WHO Committee on Nutrition / AAP:
Indications of Soy Infant Formula
Cow's milk allergy (CMA)
• For ages 6-12 months->
• For ages 0-6 months (necessary doctor
decisions in accordance with ESPGHAN
2010 Guideline)
Lactose intolerance
galactosemia
family Vegetarian
Prof DR Dr Ariyanto Harsono
SpA(K)
31
32. Other indications for soy infant
formula
• Cultural: traditional dietary habits
• Economic
• Religious (sometimes pork enzymes used
to hydrolyse in eHF?)
• Philosophical
Prof DR Dr Ariyanto Harsono SpA(K) 32
33. Phytoestrogen
Biological consequences of soy-rich diets
have been attributed to the presence of
soy isoflavones, which are members of the
phytoestrogen family.
Phytoestrogens are plant-derived,
estrogen-like compounds capable of
interacting with the estrogen receptors ER
and ERβ because their structure
resembles that of the endogenous
hormone 17β-estradiol.
J. Clin. Invest. 2006 116:16-19
Prof DR Dr Ariyanto Harsono SpA(K) 33
34. Phytoestrogen...
Four groups of phenolic compounds are classified
as phytoestrogens:
isoflavones,
stilbenes,
coumestans, and
lignans.
The main isoflavones, found mostly in soybeans,
are:
genistein,
daidzein, and
glycitein.
J. Clin. Invest. 2006 116:16-19
Prof DR Dr Ariyanto Harsono SpA(K)
34
35. Phytoestrogen...
Several epidemiological studies have
concluded that phytoestrogens confer:
cardioprotection by downregulating
cardiovascular disease risk markers,
consistent improvement in endothelial
function
antioxidant activity. J. Clin. Invest. 2006 116:16-19
Prof DR Dr Ariyanto Harsono SpA(K) 35
37. Phytoestrogen...
Soy product consumption has been
associated with the following:
reduced serum cholesterol levels via
reductions in total and low-density
lipoprotein levels;
vasodilatory activity under certain
conditions
enhanced activity of certain antioxidant
enzymes to increase antioxidant activities.
J. Clin. Invest. 2006 116:16-19
Prof DR Dr Ariyanto Harsono
SpA(K) 37
38. • symptoms of menopause
• Prevention of obesity
• Soy intake is related to a lower body mass
index in adult women
Maskarinec G. Eur J Nutr 2008;;47:138-
ˇ44
Prof DR Dr Ariyanto Harsono SpA(K) 38
40. A high intake of Soy and Isoflavones may
be associated with a reduced prevalence
of allergic Rhinitis
J Allergy Clin Immunol 2005;115:1176-83
Prof DR Dr Ariyanto Harsono SpA(K) 40
41. Prof DR Dr Ariyanto Harsono SpA(K) 41
Soy protein formulas in children: no hormonal effects in long-term feeding.
48 children (mean age 37 months (range 7--96 months) 27
boys, 21 girls) soy > 6 months 18 controls
bone age, urinary markers of bone metabolism, ␣
serum levels of bone alkaline phosphatase, osteocalcin
17beta--oestradiol, intact parathyroid hormone
girls: no signs/symptoms of precocious puberty
boys: no gynecomastia
bone age within the normal range bone alkaline
phosphatase, osteocalcin, 17beta--oestradiol, intact
parathyroid hormone, urinary levels of the markers of bone
metabolism all within normal values.
Giampietro PG;; J Pediatr Endocrinol Metab. 2004
;;17:191--6
42. Prof DR Dr Ariyanto Harsono SpA(K) 42
Soy protein infant formulae and follow-ˇon formulae:
a commentary by the ESPGHAN Committee on Nutrition.
Before 6 months
Soy not recommended
Extensive protein hydrolysates recommended
if eHF not tolerated: amino-ˇacid based formula
After 6 months
Soy can be used if tolerance first established
Benefit: acceptability, cost…..
Giampietro PG;; J Pediatr Endocrinol Metab. 2004 ;17:191--6
J Pediatr Gastroenterol Nutr. 2006;;42:352-ˇ61
44. Goal of Secondary Prevention
Prof DR Dr Ariyanto Harsono SpA(K) 44
1. Morbidity
2. Quality of life
45. Other Milk supplement
* Lipid-soluble vitamin E has a capacity of
defense against oxidant-induced
membrane injury. Studies have
consistently demonstrated beneficial
associations between dietary vitamin E
and ventilatory function, and few have
demonstrated beneficial association with
asthma and atopy.
Prof DR Dr Ariyanto Harsono SpA(K) 45
J Allergy Clin Immunol 2005;115:1109-17.
46. Water-soluble vitamin C provides anti-oxidant
capacity primarily by scavenging oxygen free
radicals and suppressing macrophage secretion
of super oxide anions, therefore play a role in
preventing mucosal shedding caused by
mediators released from eosinophils and
oxydants.
n-3 polyunsaturated fatty acid (Omega-3),
eicosapantaenoic acid, and docahexaenoic acid
might have contributed to the decrease in
asthma and atopic disease morbidity.
Micronutrents: Fe, Zn, Se
Prof DR Dr Ariyanto Harsono SpA(K) 46
J Allergy Clin Immunol 2005;115:1109-17.
Eur Respir J 1997;10:6-12.
47. Arachidonic Acid (ARA)
Phospholiphase A
Cyccloxygenase Lipoxygenase
Prostaglandine
TXA
Prostacyclin
Leukotriene A
Leukotriene B
Leukotriene C
Omega-3, DHA
ecosapantaenoic
acid
HETE,5-HETE, PAF
PGD2/E2
PGD3 LTC4
LTC5
47
48. Prof DR Dr Ariyanto Harsono SpA(K) 48
IMMUNOMODULATORY AND
IMMUNOSUPRESSIVE EFFECTS OF PUFAs
PUFAs modulate :
1. Cytokine production
2. Lymphocyte proliferation
3. Surface molecule expression
4. Phagocytosis and apoptosis
5. Inhibit natural killer (NK)cell activity
49. Prof DR Dr Ariyanto Harsono SpA(K) 49
N-3 PUFA are better than n-6 PUFA
The ratio of n-3 to n-6 may be an
important factor in modulating
inflammation
Increasing the ratio of n-3 to n-6
antiinflammatory effect especially with
atopic disease
50. Prof DR Dr Ariyanto Harsono
SpA(K)
50
LC-PUFA and immune response
ARA DHA
Prostaglandine D2/E2
LtC4
Push B cells to produce IgE
Th1 Response
pro-inflammatory anti-inflammatory
Antagonizes ARA
LTC5/PGD3/Prostacycline
Prostaglandine E2
51. Prof DR Dr Ariyanto Harsono
SpA(K)
51
Selenium
Essential trace mineral that plays a role in the body's
defense as an anti-oxidant and helps scavenge free
radicals that can cause tissue damage
Selenium concentrations in breast milk during
lactation and decreased greatly influenced by maternal
diet.
Infants who received soy formula with added selenium
may benefit from the addition of selenium to maintain
optimum levels of selenium.
52. Prof DR Dr Ariyanto Harsono
SpA(K)
52
Vitamin D
Vitamin D helps build and maintain bone
Vitamin D is a fat soluble vitamin serves as an important
biological regulator of calcium and phosphorus
metabolism
Vit D deficiency can cause rickets
AAP Recommendations whole milk infant formula must
meet IU/100 Vit D 40 kcal (258 IU / L)
53. Prof DR Dr Ariyanto Harsono
SpA(K)
53
Calcium and Phosphorus
–Has an important function collectively they build bones and teeth.
–Promotes nerve function and muscle
–activation of the enzyme helps convert food into energy
–Up until 1980 because of erratic absorption of minerals stabilita
suspension and the presence of excessive soy phytates
Consequently several studies have shown that poor bone
mineralization between infants who received cow's milk formula
compared to infants receiving soy formula
–Formulations of soy formula has been improved, so that the
concentration of calcium and phosphorus in serum and bone
mineralization in infants who receive formula milk formula milk
cows and donkeys
–The ratio of calcium and phosphorus in the latest standard is 1.3:
1 (ESPGHAN 2010)
54. Prof DR Dr Ariyanto Harsono
SpA(K) 54
Iron
Has an important role for the development of the
brain in the early stages of life.
Iron deficiency can cause anemia , can harm brain
tissue.
The AAP recommends that infant formulas
fortified with iron 4 mg - 12 mg / L
55. Prof DR Dr Ariyanto Harsono
SpA(K) 55
• Zinc
• Plays an important role in growth, brain and immunity
development
• Zinc plays an important role in normal growth,
neurotransmitter in motor function
• Zinc supplementation in infant formula may help
reduce the duration and severity of diarrhea.
• Mild zinc deficiency has a characteristic growth is
slower than normal.
56. The health implications of soy
infant formula
• Soy formula composition meets US Food and Drug Administration
and AAP guidelines for vitamin, mineral, and electrolyte content and
provides 67 kcal/dL:Soy isolate protein plus L-methionine, L-
carnitine, and taurine provide 2.45 to 2.8 grams per 100 kilocalories.
• Fat consisting mostly of vegetable oils provides 5.02 to 5.46 grams
per 100 kilocalories.
• Carbohydrate, consisting of corn maltodextrin, corn syrup solids,
and sucrose, provides 10.26 to 10.95 grams per 100 kilocalories.
• Soy formulas contain 20% more calcium and phosphorus than cow's
milk formulas and are fortified with iron and zinc because of
phosphorus, iron, and zinc binding.
Prof DR Dr Ariyanto Harsono
SpA(K) 56
Pediatrics: 1998 :101(1) : 148 -153
57. Prof DR Dr Ariyanto Harsono
SpA(K) 57
Numerous studies have documented normal growth
and development in term neonates fed methionine-
supplemented isolated soy protein-based formulas.
Average energy intakes in infants receiving soy
protein formulas also are equivalent to those
achieved with cow milk formula.
The serum albumin concentration, as a marker of
nutritional adequacy is normal,
Bone mineralization also is equivalent to that
documented with cow milk-based formula.
Additional studies confirm that soy protein formulas
do not interfere with the normal immune responses to
oral immunization with polio vaccine.Pediatrics: 1998 :101(1) : 148 -153
58. Growth in Infants Fed Soy Formulas
Prof DR Dr Ariyanto Harsono SpA(K) 58
59. From the nutritional point of view, formulas
based on soy-protein have in comparison
with cow milk based formula (eHF):
•no advantages
•no disadvantages
Prof DR Dr Ariyanto Harsono SpA(K) 59
60. Conclusion
Primary prevention with hypo-allergenic formula
should be started from the first trimester of life, do
not wait for the symptoms of allergy. Food additives
should also hypo-allergenic
Secondary prevention using advanced hydrolyzed
formula or formula Soy Isolate
Other nutritional supplements: omega-3,
ecosapentaenoic acid, DHA plays a role in immune
modulation of inflammatory mediators
Anti-oxidants: Vitamin A, C, E
Vit D
Micronutrients: Fe, Zn, Se
In the full-term infants fed on Soy Formula going
good growth
Prof DR Dr Ariyanto Harsono SpA(K)
60
61. Prof Dr Ariyanto Harsono dr SpAK
CURICULUM VITAE
Tempat /tgl lahir : Kediri, 3- Juli
Agama : Islam
Status Perkawinan: Menikah
Pendidikan
S-1: Lulus Dokter : FK UNAIR, 1972
S-2: Spesialis Anak : FK UNAIR, 1982
S-3: Program Pascasarjana UNAIR, 2004
Pendidikan tambahan : Sertifikat “Fellowship on Food Allergy”,
Academisch Ziekenhuis Utrecht, Nederland, 1990-1991
Jabatan sekarang : Guru Besar Ilmu Kesehatan Anak,
Dep IKA FK UNAIR/RSU Dr.Soetomo, Surabaya.
Konsultan Alergi/Imunologi: 1992
61