Infant Formula: Second Best but Good Enough

by Food and Drug Administration (FDA)

A century ago, babies who couldn't be breast-fed usually didn't survive. Today, although breast-feeding is still the best nourishment for infants, infant formula is a close enough second that babies not only survive but thrive.

Commercially prepared formulas are regulated by the Food and Drug Administration.

The safety of commercially prepared formula is also ensured by the agency's nutrient requirements and by strict quality control procedures that require manufacturers to analyze each batch of formula for required nutrients, to test samples for stability during the shelf life of the product, to code containers to identify the batch, and to make all records available to FDA investigators.

The composition of infant formula is similar to breast milk, but it isn't a perfect match, because the exact chemical makeup of breast milk is still unknown.

Human milk is very complex, and scientists are still trying to unravel and understand what makes it such a good source of nutrition for rapidly growing and developing infants. However, John C. Wallingford, Ph.D., an infant nutrition specialist with FDA's Center for Food Safety and Applied Nutrition, notes that "infant formula is increasingly close to breast milk."

More than half the calories in breast milk come from fat, and the same is true for today's infant formulas. This may be alarming to many American adults watching their intake of fat and cholesterol, especially when sources of saturated fats, such as coconut oil, are used in formulas. (In adults, high intakes of saturated fats tend to increase blood cholesterol levels more than other fats or oils.) But the low-fat diet recommended for adults doesn't apply to infants.

"Infants have a very high energy requirement, and they have a restricted volume of food that they can digest," says Wallingford. "The only way to get the energy density of a food up is to have a high amount of fat."

While greater knowledge about human milk has helped scientists improve infant formula, it has become "increasingly apparent that infant formula can never duplicate human milk," write John D. Benson, Ph.D, and Mark L. Masor, Ph.D., in the March 1994 issue of Endocrine Regulations. "Human milk contains living cells, hormones, active enzymes, immunoglobulins and compounds with unique structures that cannot be replicated in infant formula."

Benson and Masor, both of whom are pediatric nutrition researchers at infant formula manufacturer Abbott Laboratories, believe creating formula that duplicates human milk is impossible. "A better goal is to match the performance of the breastfed infant," they write. Performance is measured by the infant's growth, absorption of nutrients, gastrointestinal tolerance, and reactions in blood.

Wallingford agrees, explaining that while FDA's regulations on what goes into infant formula are to ensure there are enough nutrients, "that's just a starting point. What's really important is how infants thrive."

Cow's Milk or Soy?

Normal, full-term infants should get a conventional cow's-milk-based formula, says John N. Udall Jr., M.D., chief of nutrition and gastroenterology at Children's Hospital of New Orleans. However, adverse reactions to the protein in cow's milk formula or symptoms of lactose intolerance (lactose is the carbohydrate in cow's milk) may require switching to another type of formula, he says.

Symptoms that may indicate an adverse reaction to cow's milk protein include vomiting, diarrhea, abdominal pain, and rash. With lactose intolerance, the most common symptoms are excessive gas, abdominal distension and pain, and diarrhea. Since some of the symptoms overlap, a stool test may be necessary to determine the culprit. Usually, lactose intolerance will produce acidic stools that contain glucose. If the protein is the problem, stools will be nonacidic and have flecks of blood.

The main alternative to cow's milk formula is soy formula. About 20 percent of the formula sold in the United States is soy. "Lactose intolerance is probably the biggest reason to switch to soy formula," says William J. Klish, M.D., chairman of the American Academy of Pediatrics Committee on Nutrition.

The carbohydrates in most soy formulas are sucrose and corn syrup, which are easily digested and absorbed by infants. However, soy is not as good a protein source as cow's milk. Also, babies don't absorb some minerals, such as calcium, as efficiently from soy formulas. Therefore, according to the American Academy of Pediatrics, "Healthy full-term infants should be given soy formula only when medically necessary."

For a child who can't tolerate cow's milk protein, Klish recommends the use of hydrolyzed-protein formula. Although hydrolyzed-protein formulas are made from cow's milk, the protein has been broken up into its component parts. Essentially, it's been predigested, which decreases the likelihood of an allergic reaction.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.