Infant Formulas - An Update For all infants, human milk is the gold-standard in feeding the infant from a nutritional, social, economical and emotional basis. However, for those families where breastfeeding is terminated prematurely or is not chosen, parents and health professionals must then select a product designed to mimic breast milk as closely as possible. Since the last INI update on commercial infant formula was published in the spring of 1992, several new products have been introduced to the market while others have been discontinued. In addition, some products have new labels, scoop sizes, recommended uses and nutrient profiles. This article and a second item to be published in the next issue of In-Touch will identify those changes. While different products may be marketed under the same brand name in different countries, in Canada and the United States, most products have common formulations. Where differences exist, the Canadian and U.S. profiles of Mead Johnson products and Carnation formulas are identified in the tables. Ross formulas are the same in both countries, with two exceptions - the fat blend in Similac, and the presence of Similac Advancein the Canadian market only. As of January 1, 1996, Wyeth-Ayerst and Milupa products are only available in Canada. Cow’s Milk-Based Formulas: These products (Table 1) vary slightly in the whey-casein ratio, in the sources of fatty acids and in proportion of polyunsaturated, monounsaturated and saturated fatty acids they contain. All meet the infant’s nutritional needs. Because acceptable growth rates and metabolic status have been observed in infants fed whey dominant as well as casein-dominant formulas, the optimal whey casein ratio has yet to be clearly demonstrated. The protein in Carnation’s Good Start is partially hydrogenated whey to decrease allergenicity. However, it should not be given to infants who have demonstrated an allergy to cow’s milk protein because these infants may be sensitive to the protein in Good Startas well. Good Starthas a different flavor because it is sterilized and then packaged rather than being processed after packaging in cans. For several years, nucleotides have been added to SMAformula to enhance immune response. In 1996, another nucleotide fortified product called Similac Advancewas launched in Canada. (This is notthe same product as Similac Advance, a follow-on formula previously sold in the U.S.) At present, there is insufficient knowledge on the functional effects of dietary nucleotides during the early months of life to substantiate the clinical relevance of supplementation with such compounds. SMAalso contains beta carotene to match the levels in breast milk. However, once again, the clinical significance has yet to be shown. Fat sources include palm olein, soy, oleo, coconut, sunflower, and safflower in a variety of combinations. The proportions of fatty acids differ significantly. See Table 1. The introduction of a low-cost formula (Bonamil) has caused some confusion in the minds of consumers about whether a product that is approximately one dollar per litter less expensive, can be as healthy for their baby. Bonamil meets all the requirements of an infant formula in Canada. Availability in some parts of Canada may be a problem, and it is only sold in powdered form. Two other low-cost products, Vitalacfrom Bristol-Meyers, and Aptamil, by Milupa are no longer sold in Canada. Unilacis a Canadian product that has been sold at a lower price since it was introduced to the market 14 years ago. New scoop sizes can be found in Enfalac/ Enfamilpowdered containers. The new scoop is double the previous scoop size so that half the number of scoops is needed. One scoop is to be mixed with 60 mL of water. Health care workers encountering an infant who has recently failed to thrive should be alert to the possibility that the family may have continued to use their old scoop while following the instructions for the new scoops, resulting in diluted formula. Directions for preparing formula appear on the back of the Enfalac/ Enfamillabel while SMAmeasurements are now printed on the lid. When comparing prices, caregivers should be reminded to compare sizes of containers of the powdered formula (370, 400, 450, 550, or 600 gram containers). Labels have changed in 1995 and the three major companies boast that their color-coded labels reduce confusion. However, because of the many forms, brands and colors, parents may want to send a label with a baby-sitter or grandparent who runs to the store to pick up a can of formula. Lactose-Free Cow’s Milk-Based Formulas: There are two products available for infants who have demonstrated an intolerance to lactose (Table 2). EnfalacLactose-Free is the new name for Alactamil, a product that is lactose and sucrose free. Similac LFis lactose free and recommended for short-term treatment of lactose-intolerance. It is available only in Canada. A variety of products is also available for families who choose a soy protein-based product, protein hydrolysate formula or a follow-up formula. An examination of these products will be published in the next issue of In-Touch. Literature Reviewed 1 Atkinson, Stephanie, Feeding the normal term infant: human milk and formula. In: Effective Care of the Newborn Infant. (J.C.Sinclair & M.B.Bracken eds.) Oxford press, 1992, pages 83, 84.
* First figure is for formula with added iron, second figure is for formula without added iron. ** Similac U.S. contains a fat blend of coconut, corn and soy giving a fatty acid profile of 37% PUFA, 17% MONO and 46% saturated fatty acids.
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
