Infant Formulas - An Update (part 2)Lynda Clark Lowry MS PHEcAs published in the last issue of In-Touch, parents who choose not to breast feed or terminate breastfeeding early will need to choose a product that most closely resembles human milk. The first article in this series included a discussion of cow’s milk-based formulas, with and without lactose. This article covers the recent changes in soy-protein, protein hydrolysate and follow-up formulas. Soy Protein - Based Products The effects on nutritional status and growth of infants receiving soy formula for long periods of time have not been adequately evaluated. Presently, soy formula is recommended for infants with galactosemia, primary and secondary lactase deficiency and for families who choose a vegetarian lifestyle. Even though some infants who are allergic to cow’s milk protein may also be sensitive to soy protein, soy protein-based formulas are less expensive and more palatable than hydrolysate formulas. While the protein and carbohydrate sources are different, soy formula is otherwise similar in composition to cow’s milk products. There are two new products available in Canada and the United States. (Table 1) In 1995 Carnation acquired the I-Soyalac and Soyalac brands. Soyalac was discontinued and I-Soyalac was renamed Alsoy and was reformulated to change the carbohydrate and fat blends. Enfalac Soy is a second soy formula from Mead Johnson, Canada. It contains sucrose while ProSobee does not. ProSobee is the only soy formula that is sucrose and lactose free. Isomil DF contains soy polysaccharide fibre but is identical to Isomil in all other constituents. Protein Hydrolysate Formulas An hydrolysate is recommended for infants who are unable to digest and absorb intact protein, lactose and/or fat. (Table 2) Whether these products can be used in the prevention of allergy or colic has not been shown. Enfalac Nutramigen in Canada and Nutramigen in the United States, are recommended for infants with a demonstrated allergy to intact protein. Pregestimil and Alimentum are given to infants with fat and/or protein malabsorption. Nutramigen is lactose and sucrose free while Alimentum is corn free and lactose free. These products are more expensive than other formulas and their taste is less acceptable. There are no long term trials of infants receiving these products. Follow-up Formulas Transitional or second stage formulas are marketed for infants who are over six months of age and are receiving at least 200 mL (12 tablespoons) of solid foods. Follow-up formulas are fortified with vitamins and minerals, as are the regular formulas. In the U.S., there are also two soy protein - based follow-up formulas. (Table 3) The most significant difference in this category of products is that they are lower in fat. Carnation Follow-up Formula contains 37% energy from fat, both soy formulas have 40%, Milumil has 41% energy from fat and Next Step contains 45%. (Note: Regular formulas contribute 48-50% energy from fat and breast milk provides 45-50%). Current recommendations advise against lowering the fat intake of infants and since there are few additional sources of fat in the first year of life, the decrease in fat that would result from the use of a lower fat formula cannot be supported. Conclusion As more is learned about infant nutrition, new products will be developed to fulfil any perceived or created needs. Nevertheless, breast milk will remain the reference standard for nutritional requirements and must be promoted as the preferred method of feeding. We must remain diligent in our support for breastfeeding. 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.
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