A review of recent developments in the use of moderately hydrolyzed whey formulae in infant nutrition

Abstract

The best nutritional option for newborn infants is mother’s milk. However, some infants may not be exclusively breastfed during the first months of life, potentially leading to a reduction in overall health status and the early onset of allergic diseases in some infants. Food allergies play a major role in the pathogenesis of atopic diseases, and therefore dietary intervention during early infancy is an important strategy in preventing such illnesses. An ideal prevention program should avoid food sensitization while inducing oral tolerance to food protein allergens during the first few months of life, provide adequate nutrition, be acceptable to both parent and infant, and cost effective. Infant formulae that contain unmodified cow’s milk proteins may produce sensitization, and there is now widespread agreement that cow’s milk formulae (CMF) should be avoided in infants with a presumed risk of atopic disease. If exclusive breastfeeding during the first months of life is not possible, mother’s milk must be replaced or supplemented by an infant formula during the first 4 to 6 months of life. Today, all nutritional bodies recommend a hypoallergenic hydrolyzed formula in non- or partially breastfed infants with an elevated allergic risk. Both extensively (eHF) and moderately (pHF) hydrolyzed formulae are used in allergy prevention nutrition. The pHF formulae, first introduced in 1985, are more palatable and less expensive than most eHF formulae, and their low residual content of allergens suggests that they may induce oral tolerance without sensitization. The recent literature on pHF demonstrates reductions in short- and long-term incidences of atopic diseases in high-risk infants fed pHF when compared with CMF, with no negative effects on infant growth. Recently published randomized studies comparing pHF with eHF produced no conclusive results to demonstrate a preference between pHF or eHF in early allergy prevention. In an unselected infant population, an allergen-reduced nutrition program resulted in improvements in overall health status during the intervention period, and fewer skin problems from birth to 2 years of age, when compared with controls.