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. 2020 Sep 14:6:46.
doi: 10.1186/s40795-020-00365-4. eCollection 2020.

Effect of milk fat-based infant formulae on stool fatty acid soaps and calcium excretion in healthy term infants: two double-blind randomised cross-over trials

Yannis Manios  1 , Eva Karaglani  1 , Inge Thijs-Verhoeven  2 , Elpis Vlachopapadopoulou  3 , Anastasia Papazoglou  1 , Eleni Maragoudaki  1 , Zafeiris Manikas  1 , Tarek-Michail Kampani  1 , Iliana Christaki  1 , Marlotte M Vonk  2 , Rolf Bos  2 , Panam Parikh  2
Affiliations

Effect of milk fat-based infant formulae on stool fatty acid soaps and calcium excretion in healthy term infants: two double-blind randomised cross-over trials

Yannis Manios et al. BMC Nutr. .

Abstract

Background: Palmitic acid (PA) is predominantly esterified at the SN-2 position of triacylglycerols in human milk. PA at the SN-2 position is more efficiently absorbed and results in reduced formation of PA soaps, as well as reduced fatty acid (FA) and calcium malabsorption. Bovine milk fat (MF), a natural source of SN-2-palmitate, was used in the fat blend of infant formulae (IF) in the current study to investigate its effect on stool fatty acid soaps, calcium excretion and stool characteristics.

Methods: Two double-blind, randomised cross-over trials (CS1, CS2) were conducted in parallel with healthy term, formula-fed infants aged 9-14 weeks. After a two-week run-in period, infants in CS1 (n = 17) were randomly allocated to receive either a 50% MF-based formula (50MF) or a 100% vegetable fat (VF) formula; in CS2 (n = 18), infants received either a 20% MF-based formula (20MF) or the VF formula, in a 2 × 2-week cross-over design. At the end of each two-week intervention period, stool samples were collected for FA, FA soaps and calcium excretion analysis and stool consistency was assessed according to the Amsterdam Infant Stool Scale (AISS).

Results: MF-based groups showed no significant difference in PA in stools compared to VF group, although reduced stool PA soaps (CS1: 111.28 ± 18.33 vs. 220.25 ± 29.35 mg/g dry weight, p < 0.0001; CS2: 216.24 ± 25.16 vs. 233.94 ± 35.12 mg/g dry weight, p = 0.0023), total FA soaps and calcium excretion (CS1: 46.40 ± 5.27 vs. 49.88 ± 4.77 mg/g dry weight, p = 0.0041; CS2: 46.20 ± 4.26 vs. 50.47 ± 6.71 mg/g dry weight, p = 0.0067) were observed. Furthermore, the 50MF group showed a favourable lower mean stool consistency score compared to the VF group (1.64 ± 0.49 vs. 2.03 ± 0.19, p = 0.0008).

Conclusions: While the use of bovine MF in IF did not affect PA concentrations in stool, lower excretion of palmitate soaps, total FA soaps and calcium was seen in healthy term infants. 50MF formula also showed improved stool consistency. The use of MF in IF could be an interesting approach to improve gut comfort and stool characteristics in infants, warranting further research.

Trial registration: Netherlands Trial Registry Identifier: NTR6702. Date registered: December 01, 2017.

Keywords: Amsterdam infant stool scale; Calcium excretion; Milk fat; Palmitate soap; SN-2-palmitate; Stool consistency.

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Conflict of interest statement

Competing interestsITV, MMV, PP and RB are employees at FrieslandCampina. Any opinions, findings, conclusions or recommendations expressed in the current study are those of the authors and do not necessarily reflect the views of FrieslandCampina. The other authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
Study flowchart and subjects’ disposition CS1: cross-over study 1; CS2: cross-over study 2. MF: milk fat; VF: vegetable fat; 50MF: 50% MF formula; 20MF: 20% MF formula
Fig. 2
Fig. 2
Stool consistency scores according to feeding group Individual stool consistency scores were determined using the Amsterdam Infant Stool Scale (AISS) (categorization: 1 = watery, 2 = soft, 3 = formed, and 4 = hard). Comparisons between the formula groups were conducted using analysis of variance. Values are mean (SD) CS1: cross-over study 1; CS2: cross-over study 2. MF: milk fat; VF: vegetable fat; SD standard deviation. Significant difference between the 50MF and the VF group: ap = 0.0032; 50MF: 50% MF formula; 20MF: 20% MF formula
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