An infant formula containing dairy lipids increased red blood cell membrane Omega 3 fatty acids in 4 month-old healthy newborns: a randomized controlled trial

Infant formula containing large, milk phospholipid-coated lipid droplets and dairy lipids affects cognitive performance at school age

Background

Breastfeeding has been positively associated with infant and child neurocognitive development and function. Contributing to this effect may be differences between human milk and infant formula in the milk lipid composition and milk fat globule structure.

Objective

To evaluate the effects of an infant formula mimicking human milk lipid composition and milk fat globule structure on childhood cognitive performance.

Methods

In a randomized, controlled trial, healthy term infants received until 4 months of age either a Standard infant formula (n = 108) or a Concept infant formula (n = 115) with large, milk phospholipid coated lipid droplets and containing dairy lipids. A breastfed reference group (n = 88) was included. Erythrocyte fatty acid composition was determined at 3 months of age. Neurocognitive function was assessed as exploratory follow-up outcome at 3, 4, and 5 years of age using the Flanker test, Dimensional Change Card Sort (DCCS) test and Picture Sequence Memory test from the National Institutes of Health Toolbox Cognition Battery. Mann-Whitney U test and Fisher exact test were used to compare groups.

Results

Erythrocyte omega-6 to -3 long-chain polyunsaturated fatty acid ratio appeared to be lower in the Concept compared to the Standard group (P = 0.025). At age 5, only the Concept group was comparable to the Breastfed group in the highest reached levels on the Flanker test, and the DCCS computed score was higher in the Concept compared to the Standard group (P = 0.021).

Conclusion

These outcomes suggest that exposure to an infant formula mimicking human milk lipid composition and milk fat globule structure positively affects child neurocognitive development. Underlying mechanisms may include a different omega-3 fatty acid status during the first months of life.

Clinical trial registration

https://onderzoekmetmensen.nl/en/trial/28614, identifier NTR3683 and NTR5538.

Predictors of Human Milk Fatty Acids and Associations with Infant Growth in a Norwegian Birth Cohort

Triglyceride-bound fatty acids constitute the majority of lipids in human milk and may affect infant growth. We describe the composition of fatty acids in human milk, identify predictors, and investigate associations between fatty acids and infant growth using data from the Norwegian Human Milk Study birth cohort. In a subset of participants (n = 789, 30% of cohort), oversampled for overweight and obesity, we analyzed milk concentrations of detectable fatty acids. We modelled percent composition of fatty acids in relation to maternal body mass index, pregnancy weight gain, parity, smoking, delivery mode, gestational age, fish intake, and cod liver oil intake. We assessed the relation between fatty acids and infant growth from 0 to 6 months. Of the factors tested, excess pregnancy weight gain was positively associated with monounsaturated fatty acids and inversely associated with stearic acid. Multiparity was negatively associated with monounsaturated fatty acids and n-3 fatty acids while positively associated with stearic acid. Gestational age was inversely associated with myristic acid. Medium-chain saturated fatty acids were inversely associated with infant growth, and mono-unsaturated fatty acids, particularly oleic acid, were associated with an increased odds of rapid growth. Notably, excessive maternal weight gain was associated with cis-vaccenic acid, which was further associated with a threefold increased risk of rapid infant growth (OR = 2.9, 95% CI 1.2–6.6), suggesting that monounsaturated fatty acids in milk may play a role in the intergenerational transmission of obesity.

Advances in analysis, metabolism and mimicking of human milk lipids

Human milk lipids differ from the milk lipids of other mammals in composition and positional distribution of fatty acids. Analysis and detection technology of lipids is key to understanding milk lipids, and thus the concentrations, compositions and distribution characteristics of milk lipids are discussed. Differences between human milk lipids and their substitutes in form, composition and structure affect their digestion, absorption and function in infants. Characteristics and mimicking of human milk lipids have been intensively studied with the objective of narrowing the gap between human milk and infant formulae. Based on the existing achievements, further progress may be made by improving detection techniques, deepening knowledge of metabolic pathways and perfecting fat substitutes. This review detailed the characteristics of human milk lipids and related detection technologies with a view towards providing a clear direction for research on mimicking human milk lipids in formulae to further improve infant nutrition.

Similarity Index for the Fat Fraction between Breast Milk and Infant Formulas

The similarity of the fat fraction in infant formulas rich in either bovine milk fat (MF) or vegetable oil (VO) to breast milk was evaluated by analyzing their lipid composition. Milk fat-rich formulas were highly similar (average similarity index 0.68) to breast milk compared to the VO-rich formulas (average similarity index 0.56). The highest difference in the indices was found in the contents of cholesterol (0.66 vs 0.28 in MF- and VO-rich formulas, respectively, on average) and polar lipids (0.84 vs 0.53), the positional distribution of fatty acids in the sn-2 position of triacylglycerols (0.53 vs 0.28), and fatty acid composition (0.72 vs 0.54). The VO-based formulas were superior in similarity in n - 6 PUFA. Thus, the addition of bovine MF fractions is an effective way to increase the similarity between the lipid composition of infant formulas and human milk.

Effect of Milk-Based Infant Formula Fortified with PUFAs on Lipid Profile, Growth and Micronutrient Status of Young Children: A Randomized Double-Blind Clinical Trial

BACKGROUND

Polyunsaturated fatty acids (PUFAs) are essential to child growth and development.

OBJECTIVE

To assess the effect of PUFAs-fortified infant formula on lipid profile, growth and micronutrient status in children 12 to 30 months old.

METHODS

This study is a double-blind randomized controlled clinical trial. Two study groups were assessed: (a) milk-based infant formula with micronutrients and PUFAs (PUFAs) and (b) milk-based infant formula with micronutrients, no PUFAs added (Non-PUFAs). Children received prepared formula (240 mL) twice a day, according to the color-code assigned to each infant. Anthropometric measurements and venous blood samples were taken at each day-care center at baseline, and again after four months. Total serum lipid extraction was 0.5 mL. Samples were treated and modified by the Folch method and analyzed with gas chromatography.

RESULTS

Changes in serum lipid profile (expressed as % FA) between baseline and four months showed a statistically significant increase in docosahexaenoic acid (DHA) (0.22 vs. -0.07, p < 0.05) and Alpha-Linoleic acid (0.08 vs. 0.02, p < 0.05) in infants who consumed PUFAs-fortified formula compared to Non-PUFAs-fortified formula. Infants increased their length/height-for-age Z-score: median change for the PUFAs group was 0.16 (95% CI = 0.08, 0.28) and 0.23 (95% CI = 0.14, 0.33) for Non-PUFAs, with no differences between groups. Median folate level was significantly higher among the PUFAs group compared to Non-PUFAs: -0.87 (95% CI = -1.38, -0.44) and -3.83 (95% CI = -4.65, -3.03) respectively. Consumption of both supplements was adequate and stable during the intervention.

CONCLUSION

A significant improvement was observed in the lipid profile of children who received the PUFAs-fortified milk-based formula.

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.

Neonatal diet impacts liver mitochondrial bioenergetics in piglets fed formula or human milk

BACKGROUND

Neonatal diet impacts many physiological systems and can modify risk for developing metabolic disease and obesity later in life. Less well studied is the effect of postnatal diet (e.g., comparing human milk (HM) or milk formula (MF) feeding) on mitochondrial bioenergetics. Such effects may be most profound in splanchnic tissues that would have early exposure to diet-associated or gut microbe-derived factors.

METHODS

To address this question, we measured ileal and liver mitochondrial bioenergetics phenotypes in male piglets fed with HM or MF from day 2 to day 21 age. Ileal and liver tissue were processed for mitochondrial respiration (substrate only [pyruvate, malate, glutamate], substrate + ADP, and proton "leak" post-oligomycin; measured by Oroboros methods), mitochondrial DNA (mtDNA) and metabolically-relevant gene expression analyses.

RESULTS

No differences between the diet groups were observed in mitochondrial bioenergetics indices in ileal tissue. In contrast, ADP-dependent liver Complex I-linked OXPHOS capacity and Complex I + II-linked OXPHOS capacity were significantly higher in MF animals relative to HM fed piglets. Interestingly, p53, Trap1, and Pparβ transcript abundances were higher in MF-fed relative to HM-fed piglets in the liver. Mitochondrial DNA copy numbers (normalized to nuclear DNA) were similar within-tissue regardless of postnatal diet, and were ~ 2-3 times higher in liver vs. ileal tissue.

CONCLUSION

While mechanisms remain to be identified, the data indicate that neonatal diet can significantly impact liver mitochondrial bioenergetics phenotypes, even in the absence of a change in mtDNA abundance. Since permeabilized liver mitochondrial respiration was increased in MF piglets only in the presence of ADP, it suggests that formula feeding led to a higher ATP turnover. Specific mechanisms and signals involved with neonatal diet-associated differences in liver bioenergetics remain to be elucidated.

The Lipid and Glyceride Profiles of Infant Formula Differ by Manufacturer, Region and Date Sold

We tested the hypothesis that the lipid composition of infant formula is consistent between manufacturers, countries and target demographic. We developed techniques to profile the lipid and glyceride fraction of milk and formula in a high throughput fashion. Formula from principal brands in the UK (2017-2019; bovine-, caprine-, soya-based), the Netherlands (2018; bovine-based) and South Africa (2018; bovine-based) were profiled along with fresh British animal and soya milk and skimmed milk powder. We found that the lipid and glyceride composition of infant formula differed by region, manufacturer and date of manufacture. The formulations within some brands, aimed at different target age ranges, differed considerably where others were similar across the range. Soya lecithin and milk lipids had characteristic phospholipid profiles. Particular sources of fat, such as coconut oil, were also easy to distinguish. Docosahexaenoic acid is typically found in triglycerides rather than phospholipids in formula. The variety by region, manufacturer, date of manufacture and sub-type for target demographics lead to an array of lipid profiles in formula. This makes it impossible to predict its molecular profile. Without detailed profile of the formula fed to infants, it is difficult to characterise the relationship between infant nutrition and their growth and development.

The Role of Lipids in Human Milk and Infant Formulae

The quantity and quality of dietary lipids in infant formulae have a significant impact on health outcomes, especially when fat storing and/or absorption are limited (e.g., preterm birth and short bowel disease) or when fat byproducts may help to prevent some pathologies (e.g., atopy). The lipid composition of infant formulae varies according to the different fat sources used, and the potential biological effects are related to the variety of saturated and unsaturated fatty acids. For example, since lipids are the main source of energy when the normal absorptive capacity of the digestive tract is compromised, medium-chain saturated fatty acids might cover this requirement. Instead, ruminant-derived trans fatty acids and metabolites of n-3 long-chain polyunsaturated fatty acids with their anti-inflammatory properties can modulate immune function. Furthermore, dietary fats may influence the nutrient profile of formulae, improving the acceptance of these products and the compliance with dietary schedules.