Lecture 9: Infant Formula Flashcards
If an infant is not BF, then an infant formula should be used until…
The infant is 1 year of age
What are the three types of infant formula products?
- Infant formula (0-12 months)
- Follow on formula (6-12 months)
- Special dietary formula
How is infant formula regulated in NZ?
HIGHLY regulated
What is standard 2.9.1?
Infant formula products
What is schedule 29?
Special purpose foods
What are some of the NZ formula regulations? (Standard 2.9.1 Schedule 29)
- Specifies mandatory nutrient content
- Labelling requirements
- Controls food additives
What is proposal P1028?
Looking at making changes to the current regulations
What are the key amendments of proposal P1028?
- Prohibiting cross-promotion
- Mandading NIP
- Restriction on the sale of special medical purpose products
Majority of infant formula health claims are…
poorly supported!!!
How many groups of ingredients have been tied to ‘claims’ in formula?
41 groups
How many claims have been made related to formula ingredients?
1884 claims
What percent of claims were not specific to an ingredient?
50%
What percent of claims were supported by evidence?
26%
What percent of ‘evidence’ relating to formula claims were funded by formula companies or had authors with industry connections?
88% - what influence did they have?
What are the 5 most common infant formula claims?
- Supports brain/eyes/nervous system
- Strengthens immune system
- Supports growth/development
- Easy to digest
- Management of allergies
What is paleo DIY infant formula?
Homemade formula recommended instead of commercially made; raised major safety concern
What was the Paleo DIY formula made of?
- Liver
- Cod liver oil
- Bone broth
What were the main paleo DIY formula safety concerns?
- Immature kidneys and GI tract
- UL for vitamin A, sodium, protein and iron
- Microbiological risks
What was the end result of Pete Evans DIY paleo formula?
- Book was shelved
- Accepted changes to recipe
- Rebranded “Happy Tummy Brew”
- Moved to 6-12 months
- Only once a day
What did Chelsea Winter do in 2020?
Posted a recipe for an unsafe “dairy-free toddler milk”
What is the issue with influential people posting their own formula recipes?
- Using the word “formula” is misleading
- Not regulated
- ‘no nasties’ creating false ideas about formula
- Dangerous advice
What alternatives are NOT recommended for infants <12 months?
- Cows milk as a drink
- Plant-based alternatives as a drink
- Condensed milk
- Evaporated milk
What are the two types of protein?
Casein and whey
Digestibility of Whey vs Casein
Whey is quicker whereas casein is slower
Why does casein have slower digestibility?
Casein forms curds that are more slowly digested, resulting in slower gastric emptying
What is the casein:whey ratio of BM?
40:60
What is the casein:whey ratio of whey dominant formula?
40:60 - trying to replicate breastmilk; higher cost as manipulation is required
What is the casein:whey ratio of casein dominant infant formula?
80:20 - similar to cows milk; found more in follow up formulas
What is the formula for when cow’s milk formula is not tolerated?
Soy formula - extensively hydrolysed, amino acid
What is the dominant whey protein in BM?
Alpha-lactoalbumin
Is there alpha-lactoalbumin in formula?
Low levels
What is the dominant whey protein in cows milk infant formula?
Beta lactoglobulin
Is beta-lactoglobulin found in BM?
No
What is the dominant casein in BM?
Beta-casein
What is the dominant casein in cows milk formula?
Alpha-casein
What is the dominant casein in goats milk formula?
Beta-casein
What is the general casein:whey ratio for 0-6 months formula from birth?
40:60
What is the general casein:whey ratio for follow on formula (6-12 months)?
80:20
Why does follow-up formula have more casein?
- GI tract and kidneys are now further developed
- same composition as cows milk
What do soy formulas NOT contain?
- No cows milk
- No casein
- No whey
What protein is used in soy-based infant formula?
Soy protein isolate
Why is soy protein isolate highly digestible?
Has high amounts of essential amino acids, it is supplemented with methionine, taurine and cartinine (EAAs)
How old are babies that soy-based infant formula recommended for?
over 6 months
Which has higher protein, BM or formula?
Formula
What is the protein content of BM?
1.5g/100 kcal
What is the protein content of formula?
2.2g/100 kcal
Formula-fed infants tend to have greater….
Weight gain compared to BF infants
Protein quality in infant formula is positively associated with…
Increased risks of overweight and obesity, and these effects may have a long-term impact beyond the first 2 years of life
What did nestle propose in 2019?
to drop the minimum requirement of protein from 0.45g/100kJ to 0.38g/100kJ for follow up formula
How did FSANZ respond to nestle proposing changes to protein content in follow-up formula?
Declined - more evidence is required
What is the major CHO in human BM, cows milk and milk-based formulas?
Lactose
Is lactose intolerance common in infants?
Very rare
What is the main cause of lactose intolerance in infants?
Lactase enzyme deficiency
What are the two types of lactase enzyme deficiency?
Primary and secondary
Is primary or secondary lactase enzyme deficiency more common?
Secondary; primary is uncommon before 2-3 years of age
What are the symptoms of primary lactase enzyme deficiency?
- Diarrhoea
- Cramps
- Bloating/gas
- Vomiting
What does secondary lactase enzyme deficiency result from?
Small bowel injury; non IgE mediated cows milk allergy or viral gastroenteritis
What do lactose free formulas generally contain rather than lactose?
Corn-syrup solids
What glucose polymers are the preferred CHO source in infant formula?
Lactose and glucose
What glucose polymers should be avoided as a CHO source in infant formula? (not mandatory)
Sucrose and fructose
What percent of the energy in formulas come from fat?
40-50% energy
What does the ratio of PUFA to saturated fat affect?
Digestibility and facilitates absorption of calcium and fat from the gut; there is a required ratio
What is the main source of fat in infant formulas?
Vegetable oils including:
- Corn
- Soy
- Safflower
- Coconut
What are rules for infant formula in relation to essential fatty acids in NZ?
Formula MUST contain linoleic and alpha-linoleic acid within a specific ratio and range
What are the rules in NZ for LCPUFA’s in infant formula?
Not required; added to formulas at a cost to the consumer (premium or “gold”)
Why are prebiotics sometimes added to infant formula?
Oligosaccharides which support growth and activity of beneficial bacteria in the GI tract; Immunity?
What are the adverse effects of adding prebiotics to infant formula?
Increased incidence of diarrhoea, eczema and irritability
Why are probiotics sometimes added to infant formula?
For the beneficial live microorganisms
Why are organic formulas so expensive?
They are required to meet formula regulations and organic regulations
What is the NZIFMA Code of Practice 2007?
Applies to the marketing of infant formula, CANNOT promote 0-6 months infant formula
How much did NZ make from infant formula exports?
exceeded 1.8 billion
How much is it predicted that NZ will make in 2025 from infant formula exports?
2.7 billion
What is a common thing that infant formula has been contaminated with?
Melamine; causing kidney stones and kidney damage
What is melamine?
Used in plastics, adhesives, countertops, dish ware - organic base chemical rich in nitrogen