Abstract

Lipids are essential for healthy infant growth and development. The structural complexity of lipids in human milk is not present in infant milk formula (IF). A concept IF was developed mimicking more closely the structure and composition of human milk fat globules. The current study evaluates whether a concept IF with large, milk phospholipid-coated lipid droplets (mode diameter 3 to 5 μm) is equivalent to standard IF with regard to growth adequacy and safety in healthy, term Asian infants. In this randomized, double-blind, controlled trial, infants were randomized after parents decided to introduce formula. Infants received a standard IF with (Control) or without the specific prebiotic mixture scGOS/lcFOS (9:1 ratio; Control w/o prebiotics), or a Concept IF with large, milk phospholipid-coated lipid droplets and the prebiotic mixture. A group of 67 breastfed infants served as a reference. As a priori defined, only those infants who were fully intervention formula-fed ≤28 days of age were included in the equivalence analysis (Control n = 29; Control w/o prebiotics n = 28; Concept n = 35, per-protocol population). Primary outcome was daily weight gain during the first four months of life, with the difference between the Concept and Control as the key comparison of interest. Additionally, adverse events, growth and tolerance parameters were evaluated. Equivalence of daily weight gain was demonstrated between the Concept and Control group after additional correction for ethnicity and birthweight (difference in estimated means of 0.1 g/d, 90%CI [−2.30, 2.47]; equivalence margin +/− 3 g/d). No clinically relevant group differences were observed in secondary growth outcomes, tolerance outcomes or number, severity or relatedness of adverse events. This study corroborates that an infant formula with large, milk phospholipid-coated lipid droplets supports adequate growth and is well tolerated and safe for use in healthy infants.

Highlights

  • Human milk provides a complete supply of nutrients to optimally support infant growth and development in early life [1]

  • An independent data monitoring committee conducted an interim analysis to perform safety surveillance, which had been ongoing for one year, and the committee provided the advice to continue the study without modifications

  • 117 subjects were fully formula-fed by 28 days of age, which is a lower number than the original estimated required sample size of 249 infants for the equivalence analysis

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Summary

Introduction

Human milk provides a complete supply of nutrients to optimally support infant growth and development in early life [1]. In case breastfeeding is not possible, the provided infant formula (IF) must be safe and suitable to meet the nutritional requirements of infants, promoting their growth and development [3]. Lipids in human milk are present as lipid droplets with a volume-based mode diameter of 3–5 μm and are enveloped by a tri-layered membrane mainly consisting of phospholipids, membranespecific proteins and cholesterol [7,8,9]. Lipids in IF, in contrast, are present as lipid droplets with a volume-based mode diameter of ~0.5 μm with mainly proteins adhered to their outer surface area [9]

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