Whole Goat Milk as a Source of Fat and Milk Fat Globule Membrane in Infant Formula

Cow milk is the most common dairy milk and has been extensively researched for its functional, technological and nutritional properties for a wide range of products. One such product category is infant formula, which is the most suitable alternative to feed infants, when breastfeeding is not possible. Most infant formulas are based on cow milk protein ingredients. For several reasons, consumers now seek alternatives such as goat milk, which has increasingly been used to manufacture infant, follow-on and young child formulas over the last 30 years. While similar in many aspects, compositional and functional differences exist between cow and goat milk. This offers the opportunity to explore different formulations or manufacturing options for formulas based on goat milk. The use of whole goat milk as the only source of proteins in formulas allows levels of milk fat, short and medium chain fatty acids, sn-2 palmitic acid, and milk fat globule membrane (MFGM) to be maximised. These features improve the composition and microstructure of whole goat milk-based infant formula, providing similarities to the complex human milk fat globules, and have been shown to benefit digestion, and cognitive and immune development. Recent research indicates a role for milk fat and MFGM on digestive health, the gut–brain axis and the gut–skin axis. This review highlights the lipid composition of whole goat milk-based infant formula and its potential for infant nutrition to support healthy digestion, brain development and immunity. Further work is warranted on the role of these components in allergy development and the advantages of goat milk fat and MFGM for infant nutrition and health.     

A review of recent developments in the use of moderately hydrolyzed whey formulae in infant nutrition

The best nutritional option for newborn infants is mother’s milk. However, some infants may not be exclusively breastfed during the first months of life, potentially leading to a reduction in overall health status and the early onset of allergic diseases in some infants. Food allergies play a major role in the pathogenesis of atopic diseases, and therefore dietary intervention during early infancy is an important strategy in preventing such illnesses. An ideal prevention program should avoid food sensitization while inducing oral tolerance to food protein allergens during the first few months of life, provide adequate nutrition, be acceptable to both parent and infant, and cost effective. Infant formulae that contain unmodified cow’s milk proteins may produce sensitization, and there is now widespread agreement that cow’s milk formulae (CMF) should be avoided in infants with a presumed risk of atopic disease. If exclusive breastfeeding during the first months of life is not possible, mother’s milk must be replaced or supplemented by an infant formula during the first 4 to 6 months of life. Today, all nutritional bodies recommend a hypoallergenic hydrolyzed formula in non- or partially breastfed infants with an elevated allergic risk. Both extensively (eHF) and moderately (pHF) hydrolyzed formulae are used in allergy prevention nutrition. The pHF formulae, first introduced in 1985, are more palatable and less expensive than most eHF formulae, and their low residual content of allergens suggests that they may induce oral tolerance without sensitization. The recent literature on pHF demonstrates reductions in short- and long-term incidences of atopic diseases in high-risk infants fed pHF when compared with CMF, with no negative effects on infant growth. Recently published randomized studies comparing pHF with eHF produced no conclusive results to demonstrate a preference between pHF or eHF in early allergy prevention. In an unselected infant population, an allergen-reduced nutrition program resulted in improvements in overall health status during the intervention period, and fewer skin problems from birth to 2 years of age, when compared with controls.     

Concentrations of iron, copper and zinc in human milk and powdered infant formula

Concentrations of iron, copper and zinc were determined in 56 samples of mature human milk from Canarian women and 5 samples of powdered infant formula. According to the literature our data fall within the normal limits in each kind of milk. The mean concentration of Fe, Cu and Zn of powdered infant formula was significantly higher than those concentrations found in the human milks. Significant differences among the concentrations of the studied metals for the milks of considered mothers were observed. The Fe, Cu and Zn intakes of infants fed with human milk are lower than the requirements recommended by the Food and Nutrition Board (1989). However, the infants fed with powdered infant formula had consumed an adequate intake of Fe and Cu. A progressive decrease of the metal concentrations with the lactation stage was observed. The human milk obtained in spring presented Fe and Zn concentrations lower than in autumn, which could be due to changes in nutritional habits of the mothers. Age of mother and number of previous children seem to influence the Zn and Cu concentrations of human milk.     

Concentrations of iron,copper and zinc in human milk and powdered infant formula

Concentrations of iron, copper and zinc were determined in 56 samples of mature human milk from Canarian women and 5 samples of powdered infant formula. According to the literature our data fall within the normal limits in each kind of milk. The mean concentration of Fe, Cu and Zn of powdered infant formula was significantly higher than those concentrations found in the human milks. Significant differences among the concentrations of the studied metals for the milks of considered mothers were observed. The Fe, Cu and Zn intakes of infants fed with human milk are lower than the requirements recommended by the Food and Nutrition Board (1989). However, the infants fed with powdered infant formula had consumed an adequate intake of Fe and Cu. A progressive decrease of the metal concentrations with the lactation stage was observed. The human milk obtained in spring presented Fe and Zn concentrations lower than in autumn, which could be due to changes in nutritional habits of the mothers. Age of mother and number of previous children seem to influence the Zn and Cu concentrations of human milk.     

A critical review of methods for comparing estrogenic activity of endogenous and exogenous chemicals in human milk and infant formula

The two primary sources of nutrition for infants are human milk and infant formula. Both contain an array of endogenous and exogenous chemicals that may act through many separate hormonal mechanisms. The safety of infant nutrition sources has been questioned based on the possibility that exogenous chemicals may exert adverse effects on nursing or formula-fed infants through estrogen-mediated mechanisms. In response to these and other concerns, the National Research Council recommended assessing the estrogenic potency of natural and anthropogenic hormonally active agents. Furthermore, the Endocrine Disruptor Screening and Testing Advisory Committee of the U.S. Environmental Protection Agency specifically recommended testing chemicals present in human milk as a representative mixture to which large segments of the population are exposed. To date, no clinical or epidemiologic evidence demonstrates that levels of chemicals currently found in human milk or infant formulas cause adverse effects in infants. Nonetheless, the question is sufficiently important to warrant a consideration of how best to evaluate potential estrogenic risks. We reviewed the types of data available for measuring estrogenic potency as well as methods for estimating health risks from mixtures of chemicals in infant nutrition sources that act via estrogenic mechanisms. We conclude that the science is insufficiently developed at this time to allow a credible assessment of health risks to infants based on estimates of estrogenic potency or on an understanding of toxicologic effects mediated by estrogenic mechanisms. However, clinical and epidemiologic data for infant nutrition sources may provide insights about risks of such substances in human milk and infant formulas.     

Milks for infants and toddlers

Breast milk is by far the superior milk for infants, providing ideal nutrition and protection against infection. Exclusive breast-feeding up until weaning provides the healthiest start in life. Ideally it should continue during weaning and can continue as the main milk drink for as long as the mother chooses. Formula milks are the only suitable alternative from birth and during the first year of life. Compared with breast milk, some nutrients are less well absorbed and formula milks do not contain anti-infective agents to protect against infections. Cow's milk is not suitable as a drink before 12 months of age. Various formula milks are available in the United Kingdom and their content must comply with statutory regulations. Types include whey- and casein-dominant formulae, modified formulae for minor digestive disorders, follow-on milks for babies over six months of age, and milks designed for toddlers. Formulae are modified as new research becomes available and developments in recent years include nucleotides, long-chain polyunsaturated fatty acids, prebiotics and fresh thinking on protein content. Recent guidance on the safe preparation and storage of infant milks is outlined. Specialised formulae such as those for preterm infants or those with cow's milk protein allergy or inborn errors of metabolism are not included here but will be covered in a later article.     

Parental response to health risk information: experimental results on willingness-to-pay for safer infant milk formula

Enterobacter sakazakii, a pathogen that can be found in powdered infant milk formula, can cause adverse health effects on infants. Using Vickrey auction, this study examines parents' willingness to pay (WTP) for a quality assurance label on powdered infant milk formula. The influence of ambiguity with the incidence rate information and provision of safe-handling information on WTP are also evaluated using three experimental treatments. Our findings generally imply that parents significantly value a quality assurance label. The mean price premium parents are willing to pay for the safer and quality assurance labelled powdered infant milk formula ranges from 61 to 133 Eurocents per 100 grams (53-116% of the base price per 100 grams) depending on the treatment. While no ambiguity effects are generally found, provision of safe-handling information significantly reduced WTP to 39-69 Eurocents per 100 grams depending on the treatment.     

Fluoride content of powdered infant formula meets Australian Food Safety Standards

Objectives: To identify the fluoride content of powdered formula for infants 0‐12 months in products available from Brisbane stores in 2006/07 and compare this with the fluoride content of infant formula products available in Australia 10 years earlier. Methods: A range of available infant formula powders were collected from major supermarkets and chemists in Brisbane, Queensland. The fluoride levels in infant formula powder samples were determined using a modification of the micro‐diffusion method of Silva and Reynolds 1 utilising perchloric acid and silver sulphate and measured with an ion selective (fluoride) electrode/meter. Fluoride content both prior to and after reconstitution, as well as estimated daily intake according to age was calculated. Results: Formula samples contained an average of 0.49 μg F/g of powder (range 0.24–0.92 μg F/g). After reconstitution with water containing 0mg/L fluoride, the fluoride content averaged 7.09μg F/100mL (range 3.367–22.72 μg F/100mL). Estimated infant fluoride intakes ranged from 0.0039 mg/kg/day for a 6‐12 month old infant when reconstituting milk‐based formula with non‐fluoridated water (0 mg/L), to 0.1735 mg/kg/day for a 0‐3 month old infant when reconstituting soy‐based formula with fluoridated water (1.0 mg/L). Conclusions: Infant formula powders contain lower levels of fluoride than previously found in Australia in 1996. Implications: This confirms that infants consume only a small amount of fluoride from milk‐based powdered infant formula. Although soy‐based infant formulas contain more fluoride than milk‐based products, the levels still comply with national food standards.     

Isolation and identification of Enterobacter sakazakii in infant milk formulas

Enterobacter sakazakii is a pathogen of increasing medical concern, due to it being implicated in cases of meningitis, sepis, and necrotizing enterocolitis associated with the consumption of contaminated infant milk formula. At present, the method adopted by the Mexican food industry for the isolation and identification of E. sakazakii is based on the methodology of the United States Food and Drug Administration (FDA). However, this procedure is laborious and requires 7 days to obtain a confirmative result. The objective of this study was to determine the presence of E. sakazakii in two types of powdered infant milk formula, using an alternative method that requires less time and a smaller sample size than the FDA protocol. We adapted Leuschner's procedure by eliminating violet red bile glucose agar (VRBG) plates and instead adopting white light incubation to stimulate yellow pigment development. This allowed for isolation of E. sakazakii from powdered infant milk formula using a smaller sample and requiring only 5 days for analysis. Results showed that 92% of formula 1 and 32% of formula 2 was positive for E. sakazakii. The high contamination level of E. sakazakii suggests the need for monitoring hygienic conditions in the manufacturing plant and to assess the prevalence of E. sakazakii in powdered infant milk formulas sold in México.     

Role of Long-Chain Polyunsaturated Fatty Acids in Early Human Neurodevelopment

While breast-fed infants receive considerable amounts of preformed dietary arachidonic and docosahexaenoic acids in human milk, most of the currently available infant formulae are devoid of long-chain polyunsaturated fatty acids. Observational data obtained in preterm as well as in full-term infants indicate that breast feeding as compared to feeding formula is associated with better results in various tests on visual and cognitive development. In several randomised, placebo controlled, double-blind studies carried out in preterm infants, feeding formula with as compared to without long-chain polyunsaturated fatty acids resulted in improved maturation of visual functions. However, beneficial effects of providing dietary long-chain polyunsaturated fatty acids were seen only in some but not in all randomised studies on the development of visual functions in full-term infants. Data obtained in two recent randomised clinical trials on cognitive functions in full-term infants indicate that supplementation of formula with arachidonic and docosahexaenoic acids offers some neurodevelopmental benefits detectable at the ages of 4 and 10 months. Confirmation of shortterm results in longer follow-up studies appears desirable, but available evidence support the supplementation of both preterm and term infant formulae with arachidonic and docosahexaenoic acids in amounts and ratios characteristic to those found in mature human milk.     

早产儿营养干预方式的研究进展

近年来,由于医疗技术的发展及社会、经济环境的变化,早产儿出生率增加,为降低早产儿宫外生长发育迟缓和神经发育落后,临床上应充分重视对早产儿出生后的营养支持方式。目前对早产儿的营养干预主要采用肠内或肠外营养。其中,肠外营养的使用按照最新中国新生儿营养支持应用指南中的推荐量,并给予早产儿个体化支持。肠内营养常用母乳及母乳强化剂、早产儿配方乳、深度水解蛋白乳及出院后配方乳。本文主要阐述早产儿营养干预的临床应用状况。     

Health,Nutrition, and Cost Outcomes of Human Milk Feedings for Very Low Birthweight Infants

This symposium examined the impact of human milk (HM) from the infant’s own mother on health, nutrition, and cost outcomes in very low birthweight (VLBW; <1500 g birthweight) infants. The 4 symposium speakers presented original research and summarized existing evidence about these primary outcomes. The conclusions from the symposium suggest that: 1) HM feedings for VLBW infants in the neonatal intensive care unit (NICU) reduce the risks and the associated costs of late onset sepsis and necrotizing enterocolitis (NEC); 2) the gut microbiota of the VLBW infant is influenced by multiple factors, some of which are modifiable, and that the milk microbiota affects the developing gut microbiota in a positive manner; 3) the clinical realties of feeding HM in the NICU that compromise safety and efficacy of HM can be addressed with evidence-based clinical practices; and 4) piglets can serve as a model for the premature infant to assess the impact of HM and formula additives on intestinal development.     

Free Amino Acid Content in Standard Infant Formulas: Comparison with Human Milk

Objective: To compare the concentration of non-protein nitrogen (NPN) and free amino acids (FAA) in powdered and liquid commercial formulas with that in human milk.

Methods: The non-protein nitrogen and FAAs in pooled breast milk was compared with that in 11 protein-modified starting infant formulas (seven powdered, four liquid whey-predominant formulas) and one powdered soy-formula. Human milk was collected at the end of each feeding (hindmilk) over 24 hours in a group of 40 healthy lactating women after delivery of full-term infants at age one month.

Results: In human milk glutamic acid plus glutamine and taurine were the prevalent amino acids, accounting for around 50% total FAA. In the analysed formulas the total FAA fraction was 10% or even less than in human milk, mostly represented by taurine, while methionine was high in soy formula. The sum of glutamic acid and glutamine in all the formulas was much lower than in human milk.

Conclusions: Breastfed infants are supplied with FAA, mainly glutamic acid and glutamine, compared to formula-fed counterparts. The different FAA intake might be the origin of some functional differences at the enteral level between breast- and formula-fed infants.     

Aluminum and bone disorders: with specific reference to aluminum contamination of infant nutrients

Aluminum (Al) impairment of bone matrix formation and mineralization may be mediated by its direct effect on bone cells or indirectly by its effect on parathyroid hormone and calcium metabolism. Its toxic effects are proportional to tissue Al load. Al contamination of nutrients depends on the amount of Al present naturally in chemicals or from the manufacturing process. Intravenous calcium, phosphorus, and albumin solutions have high Al (greater than 500 micrograms/L), whereas crystalline amino acid, sterile water, and dextrose water have low Al (less than 50 micrograms/L) content. Enteral nutrients including human and whole cow milk have low Al, whereas highly processed infant formulas with multiple additives, such as soy formula, preterm infant formula, and formulas for specific disorders are heavily contaminated with Al. Healthy adults are in zero balance for Al. The gastrointestinal tract excludes greater than 95% of dietary Al, and kidney is the dominant organ for Al excretion. However, even with normal renal function, only 30-60% of an Al load from parenteral nutrition is excreted in the urine, resulting in tissue accumulation of Al. The risk for Al toxicity is greatest in infants with chronic renal insufficiency, recipients of long term parenteral nutrition, i.e., no gut barrier to Al loading, and preterm infants with low Al binding capacity. The rapid growth of the infant would theoretically potentiate Al toxicity in all infants, although the critical level of Al loading causing bone disorders is not known. To minimize tissue burden, Al content of infant nutrients should be similar to "background" levels, i.e., similar to whole milk (less than 50 micrograms/L).     

Low-Protein Infant Formula and Obesity Risk

Infant formulas have been designed to mimic human milk for infants who cannot be breastfed. The overall goal is to establish similar functional outcomes to assure optimal growth, development, maturation of the immune system, and programming of the metabolic system. However, after decades of improving infant formula, growth patterns and body composition development are still different in formula-fed infants compared to breastfed infants, which could contribute to an increased risk of obesity among formula-fed infants. It has been hypothesized that the lower protein concentration of breast milk compared to infant formula influences infants’ growth and body composition. Thus, several trials in formula-fed infants with different protein intake levels have been performed to test this hypothesis. In this review, we discuss the current evidence on low-protein infant formula and obesity risk, including future perspectives and implications.     

Bioavailability of calcium and zinc from cow's milk-based versus soya-based infant food

A modified continuous flow dialysis in vitro method was used to study the availability of calcium and zinc from cow's milk-based versus soya-based infant food. First and second age infant formulae, milk for pre-schoolers and cow's milk were studied. The elemental content of the samples and dialysate fractions was determined by flame atomic absorption spectrometry. The relative availability of calcium and zinc from the soya-based first age infant formula (calcium: 31.6 ± 0.5%, zinc: 17.8 ± 1.8%), from the soya-based second age infant formula (calcium: 46.1 ± 2.1%, zinc: 20.9 ± 1.4%) and from the soya milk for pre-schoolers (calcium: 32.6 ± 0.7%, zinc: 39.7 ± 2.1%) proved to be as good as or even better than from the first age infant formula (calcium: 21.9 ± 1.4%, zinc: 23.3 ± 4.1%), from the second age infant formula (calcium: 31.0 ± 2.5%, zinc: 14.6 ± 0.7%) and from the milk for pre-schoolers (calcium: 27.7 ± 0.6%, zinc: 23.7 ± 2.8%) based on cow's milk. A similar relative availability from semi-skimmed cow's milk and soya milk was reported for calcium (31.5 ± 0.8% and 31.2 ± 1.7% respectively), as well as a much higher availability of zinc from soya milk than from cow's milk (55.7 ± 5.3% and 20.6 ± 3.0% respectively). Enrichment of soya milk with calcium results in a higher calcium availability (46.4 ± 1.9%), but a lower zinc availability (38.5 ± 2.6%) in comparison with the availability from non-enriched soya milk. The apparent absence of inhibitory effects of soya on the availability of calcium and zinc from infant food certainly is a positive finding for the about 10% of Belgian infants which are currently nourished with infant food based on derivatives of soya. According to these results no impaired calcium or zinc status should be feared for in this group of infants.     

Multifunctional Benefits of Prevalent HMOs: Implications for Infant Health

Breastfeeding is the best source of nutrition during infancy and is associated with a broad range of health benefits. However, there remains a significant and persistent need for innovations in infant formula that will allow infants to access a wider spectrum of benefits available to breastfed infants. The addition of human milk oligosaccharides (HMOs) to infant formulas represents the most significant innovation in infant nutrition in recent years. Although not a direct source of calories in milk, HMOs serve as potent prebiotics, versatile anti-infective agents, and key support for neurocognitive development. Continuing improvements in food science will facilitate production of a wide range of HMO structures in the years to come. In this review, we evaluate the relationship between HMO structure and functional benefits. We propose that infant formula fortification strategies should aim to recapitulate a broad range of benefits to support digestive health, immunity, and cognitive development associated with HMOs in breastmilk. We conclude that acetylated, fucosylated, and sialylated HMOs likely confer important health benefits through multiple complementary mechanisms of action.     

Efficacy of Donated Milk in Early Nutrition of Preterm Infants: A Meta-Analysis

Background: Preterm birth is associated with an increased risk of many complications, which is a main public health problem worldwide with social and economic consequences. Human milk from breast feeding has been proved to be the optimal nutrition strategy for preterm infants when available. However, the lack of human milk from mothers makes formula widely used in clinical practice. In recent years, donated breast milk has gained popularity as an alternative choice which can provide human milk oligosaccharides and other bioactive substances. Objective: We aimed to conduct a systematic review and meta-analysis to evaluate the nutritional effects of donated breast milk on preterm infants compared with formula. Method: In the present study, we searched Medline, Web of Science, Embase, clinicaltrials.gov, the China national knowledge infrastructure, and the Cochrane central register of controlled trials for candidate randomized controlled trials (RCTs). Results: A total of 1390 patients were enrolled in 11 RCTs and meta-analysis results showed that donated breast milk is also more advantageous in reducing the incidence of necrotizing enterocolitis (NEC, RR = 0.67, 95% CI = 0.48 to 0.93, p = 0.02), reducing the duration of parenteral nutrition (MD = −2.39, 95% CI = −3.66 to −1.13, p = 0.0002) and the time of full enteral feeding (MD = −0.33, 95% CI = −3.23 to 2.57, p = 0.0002). In comparison, formula significantly promotes the growth of premature infants, including their weight gain (MD = −3.45, 95% CI = −3.68 to −3.21, p < 0.00001), head growth (MD = −0.07, 95% CI = −0.08 to −0.06, p < 0.00001) and body length (MD = −0.13, 95% CI = −0.15 to −0.11, p < 0.00001), and reduces the time it takes for premature infants to regain birth weight (MD = 6.60, 95% CI = 6.11 to 7.08, p < 0.00001. Conclusion: Compared with formula, donated breast milk could significantly reduce the incidence of NEC, the duration of parenteral nutrition, and the time of full enteral feeding. Adding fortifiers in donated milk could make it as effective as formula in promoting the physical growth of premature infants.     

Caregiver's Provision of Non-Recommended Commercially Prepared Milk-Based Drinks to Infants and Toddlers

ObjectiveAssess milk type provision (commercially prepared infant and toddler formula, cow's milk, and plant milk) to infants and toddlers, accounting for sociodemographic characteristics and marketing claims.ParticipantsCaregivers (N = 1,645) of children (aged 6–36 months) recruited through online panels in 2017.MethodsCross-sectional survey analysis (system of probit equations) estimated associations between sociodemographics and agreement with marketing claims (independent variables) with milk type provision in the past month (binary dependent variable).ResultsMost caregivers (63%) of infants (aged 6–11 months) provided only breastmilk and/or commercially prepared infant formula. Sixty-five percent of caregivers of 12-month-old infants provided commercially prepared infant formula, and 47% provided cow's milk. Most caregivers (64%) of toddlers (aged 13–36 months) provided cow's milk; some also provided other non-recommended milk types (51%).Associations between milk types suggested milk-based drink provision should be evaluated as a pattern and not as independent behaviors (all Ps < 0.048). Milk type provision was significantly associated with a child's age (months), household income, and race (all Ps < 0.049). Including agreement with marketing claims reduced the significance of associations between milk type provision and some sociodemographic characteristics.Conclusions and ImplicationsThese findings suggest the need for additional expert guidance to discourage inappropriate and unnecessary milk for young children, provide strategies to transition from breastmilk (or commercially prepared infant formula) to cow's milk, and conduct outreach to communities at risk for health disparities about the dangers of serving milk that is not recommended for their child's age. Research is needed to understand how diverse populations interpret product claims and how marketing may perpetuate health disparities.