Laurent Béghin1, Xavier Marchandise2, Eric Lien3, Myriam Bricout4, Jean-Paul Bernet4, Jean-François Lienhardt4, Françoise Jeannerot4, Vincent Menet4, Jean-Christophe Requillart4, Jacques Marx4, Nanda De Groot5, Jonathan Jaeger6, Philippe Steenhout7, Dominique Turck8. 1. Univ. Lille, Inserm, CHU Lille, CIC 1403 - Centre d'investigation clinique, F-59000 Lille, France; Univ. Lille, Inserm, CHU Lille, U995 - LIRIC - Lille Inflammation Research International Center, F-59000 Lille, France. Electronic address: laurent.beghin@chru-lille.fr. 2. Department of Nuclear Medicine, Lille University Hospital, Lille Hauts de France University, F-59000 Lille, France. 3. Department of Food Science and Human Nutrition, University of Illinois, Urbana, USA. 4. Ambulatory Paediatrician from the GREPA-Nord (Groupe de Recherche et d'Etudes en Pédiatrie Ambulatoire-Research and Study Group in Ambulatory Paediatrics from the North of France), French Association of Ambulatory Paediatrics, F-59000 Lille, France(1). 5. Nestlé Nutrition, Nestec Ltd, Vevey, Switzerland. 6. Nestlé Research Center, Lausanne, Switzerland. 7. Nestlé Health Science, Vevey, Switzerland. 8. Univ. Lille, Inserm, CHU Lille, U995 - LIRIC - Lille Inflammation Research International Center, F-59000 Lille, France; Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Lille University Children's Hospital and Lille University Faculty of Medicine, F-59000 Lille, France.
Abstract
BACKGROUND:Palmitate in breast milk is predominantly located in the triacylglycerol sn-2 position, while infant formulae contain palmitate predominantly in the sn-1 and sn-3 positions. During digestion, palmitate in the sn-1 and sn-3 positions is hydrolyzed to free palmitic acid that can subsequently complex with calcium to form insoluble soaps; this may partially explain why formula-fed infants have harder stools than breast-fed infants. METHODS: This large (n = 488) randomized, double-blind, multicentre trial investigated whether increasing the sn-2 palmitate content of infant formula improves stool consistency and bone mineral content (measured by dual-energy x-ray absorptiometry), without affecting growth or health. From ∼1 week to 4 months of age, infants were exclusively fed one of three formulae: i) control formula (CF; 16% of total palmitate at sn-2; n = 162), (ii) experimental formula 1 (EF1; 43% of total palmitate at sn-2; n = 166) or (iii) experimental formula 2 (EF2; 51% of total palmitate at sn-2; n = 160). RESULTS: Intention-to-treat analysis showed softer stools in both EF groups (vs. CF) at ages 2 weeks and 1 and 2 months (p ≤ 0.01), but not 3 and 4 months. At 4 months, all groups had similar growth outcomes while bone mineral content was significantly higher in EF1 (p = 0.0012) and EF2 (p = 0.0002) compared with CF. Comparison of reported adverse events up to 12 months revealed no differences among groups. All 3 infant formulae exhibited equally good digestive tolerance. CONCLUSIONS: Formulae enriched in sn-2 palmitate fed in early infancy are safe, improve stool consistency (from 2 weeks to 2 months) and increase bone mineral content (at 4 months).
RCT Entities:
BACKGROUND:Palmitate in breast milk is predominantly located in the triacylglycerolsn-2 position, while infant formulae contain palmitate predominantly in the sn-1 and sn-3 positions. During digestion, palmitate in the sn-1 and sn-3 positions is hydrolyzed to free palmitic acid that can subsequently complex with calcium to form insoluble soaps; this may partially explain why formula-fed infants have harder stools than breast-fed infants. METHODS: This large (n = 488) randomized, double-blind, multicentre trial investigated whether increasing the sn-2 palmitate content of infant formula improves stool consistency and bone mineral content (measured by dual-energy x-ray absorptiometry), without affecting growth or health. From ∼1 week to 4 months of age, infants were exclusively fed one of three formulae: i) control formula (CF; 16% of total palmitate at sn-2; n = 162), (ii) experimental formula 1 (EF1; 43% of total palmitate at sn-2; n = 166) or (iii) experimental formula 2 (EF2; 51% of total palmitate at sn-2; n = 160). RESULTS: Intention-to-treat analysis showed softer stools in both EF groups (vs. CF) at ages 2 weeks and 1 and 2 months (p ≤ 0.01), but not 3 and 4 months. At 4 months, all groups had similar growth outcomes while bone mineral content was significantly higher in EF1 (p = 0.0012) and EF2 (p = 0.0002) compared with CF. Comparison of reported adverse events up to 12 months revealed no differences among groups. All 3 infant formulae exhibited equally good digestive tolerance. CONCLUSIONS: Formulae enriched in sn-2 palmitate fed in early infancy are safe, improve stool consistency (from 2 weeks to 2 months) and increase bone mineral content (at 4 months).
Authors: Harrie van Erp; Fiona M Bryant; Jose Martin-Moreno; Louise V Michaelson; Govindprasad Bhutada; Peter J Eastmond Journal: Proc Natl Acad Sci U S A Date: 2019-09-30 Impact factor: 11.205
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