Fat digestion in very low-birth-weight infants: effect of addition of human milk to low-birth-weight formula.

The possible compensatory role of human milk lipase in the digestion of dietary fat was examined in a group of very low-birth-weight infants. Fat excretion was studied in 15 preterm infants of gestational age 26 to 33 weeks and birth weight 660 to 1,695 gm. The amount and composition of fecal fat were determined in stools collected for 72 hours. Eight infants were fed Similac 24 LBW exclusively and seven infants were fed a mixture of fresh human milk (40%) and formula (60%). Fat excretion was lower in infants fed a mixture of human milk and formula than in infants fed formula only (4.7% -+/- 0.50% vs 11.9% +/- 1.4% of intake, respectively). Excretion of calcium soaps, when expressed as percent of total fat, was higher in the group fed the human milk-containing diet (18.9% +/- 13.5%), than in the group fed formula only (6.8 +/- 2.5%); however, the absolute amounts excreted were similar in both groups (65 +/- 46 and 45 +/- 17 mg/kg/day, respectively). The lower fat excretion in infants fed a mixture of fresh human milk and formula could be related to the lipase present in human milk. These data suggest that human milk lipase probably contributes to the digestion and absorption of dietary fat in the "tiny premature" infant.