Special Infant Formulas Research Articles

Cow's milk allergy immunoglobulin E-mediated: intake of proteins and amino acids.

SUMMARYOBJECTIVE:Children with cow’s milk allergy may be at nutritional risk due to the lower intake of nutrients, such as protein, calcium, and vitamin A, which are present in cow’s milk. The objective was to evaluate children’s diets with Children with cow’s milk allergy compared with healthy controls as well as to compare the intake of proteins and amino acids from the diet followed by Children with cow’s milk allergy who consume special infant formula or plant-based dairy alternatives with Children with cow’s milk allergy who do not consume special infant formula or plant-based dairy alternatives.METHODS:Through a cross-sectional controlled study, the dietary intake of 57 children (27 with immunoglobulin E-mediated Children with cow’s milk allergy and 30 healthy controls) was evaluated. Using 24-h nutritional recalls, the total energy intake value, macronutrients, and amino acids were calculated.RESULTS:No statistically significant difference was found between the Children with cow’s milk allergy group and healthy controls for the intake of proteins and amino acids. However, the Children with cow’s milk allergy do not consume special infant formula or plant-based dairy alternatives group had a lower protein (g/kg) and branched-chain amino acid (mg/kg) intake than the Children with cow’s milk allergy consume special infant formula or plant-based dairy alternatives group.CONCLUSIONS:The Children with cow’s milk allergy group achieved the recommendations for the intake of proteins and amino acids compared to the healthy control group. However, the Children with cow’s milk allergy do not consume special infant formula or plant-based dairy alternatives group had a lower intake of protein (g/kg) and branched-chain amino acid (mg/kg) than the Children with cow’s milk allergy consume special infant formula or plant-based dairy alternatives group.

LETHARGY AND HYPOTONIA IN A PRETERM NEONATE – USUAL SYMPTOM WITH UNUSUAL DIAGNOSIS OF MITOCHONDRIAL TRIFUNCTIONAL PROTEIN DEFICIENCY

Background: Methodical evaluation of a neonate with common clinical findings (hypotonia and lethargy) is important whenever it cannot be attributed to the frequent causes. This case report is on a preterm neonate with persistent hypotonia and metabolic acidosis was evaluated and diagnosed with mitochondrial trifunctional protein deficiency. Report: A preterm male baby second born to second degree consanguineous parents was found to have profound lethargy and hypotonia with severe metabolic acidosis despite the shock being corrected. Management: In spite of negative reports of first tier investigations for inborn errors of metabolism (IEM), baby was started on carnitine and biotin with strong clinical suspicion for IEM. Whole exome sequencing in the baby and Sanger sequencing in mother showed same gene mutation in HADHA gene suggesting mitochondrial trifunctional protein (MTFP) deficiency. He was started on special infant formula containing medium chain triglycerides along with breastfeeding. Conclusion: Early diagnosis and initiation of fat modified diet, avoiding catabolic stress situation and aggressive treatment during intercurrent illness can have satisfactory growth and development in the child.

Development of the digestive system in early infancy and nutritional management of digestive problems in breastfed and formula-fed infants.

Food digestion and absorption in infants are closely related to early growth and long-term health. Human milk and infant formula are the main food sources for 0-6 month-old infants. Due to the immature gastrointestinal tract of newborns, mild digestive problems, such as inefficient digestion and impaired absorption of proteins, lipids and lactose, and gut dysbiosis, are often seen in infancy. The differences in composition between infant formula and human milk make mild digestive problems more likely to occur in formula-fed infants. In recent years, several types of infant formulas have been developed to treat or reduce gastrointestinal digestive problems in infants. This review summarizes the gastrointestinal environment of infants and the digestion of human milk and different infant formulas. We particularly focus on the common digestive problems and appropriate nutritional solutions that may occur in healthy term infants during the first six months of life.

Cow's milk allergy in infancy and later development of type 1 diabetes-nationwide case-cohort study.

It is suggested that early intake of cow's milk could be a risk factor for type 1 diabetes (T1DM). Further, the different immunological background, gives a suggestion of an inverse relationship for the occurrence of these diseases. The aim of this study was to explore the association between cow's milk allergy (CMA) and the risk of T1DM in a register-based case-cohort study. Data were obtained from Finnish nationwide health registers. The study included all children born in Finland between January 01, 1986 and December 31, 2008 and diagnosed with T1DM before the age of 16 years (n = 7754). A 10% random sample from each birth year cohort was selected as a reference cohort (n = 137,798). T1DM, CMA, and asthma were defined based on valid special reimbursements for the costs of drugs/special formulas needed in the treatment of the diseases. Child's sex, birth decade, asthma, maternal diabetes and asthma, smoking during pregnancy, and previous deliveries were considered as confounding factors. Time-dependent, weighted Cox regression was applied for statistical analyses. Children with CMA had an increased risk of developing T1DM in fully adjusted model (HR = 1.17; 95% CI 1.02-1.34), but the association was no longer observed when including the use of special infant formulas in the definition of CMA in the sensitivity analysis (HR = 1.11; 95% CI 0.92-1.32). CMA was associated with an increased risk of T1DM in children without asthma (HR = 1.27; 95%CI 1.10-1.47), but not in children with asthma (HR = 0.80; 95% CI 0.92-1.27). Children with CMA may have an increased risk of T1DM.

Effciency of a rehabilitation training method by means of special infant formulas in patients with ischemic stroke and neurogenic dysphagia as part of combined therapy

Objective: to evaluate the efficiency of a training method using special infant formulas as part of combined rehabilitation for patients with ischemic stroke and neurogenic dysphagia.Patients and methods. The investigation enrolled 55 patients (30 men and 25 women) aged 45–80 years with dysphagia during the acute period of ischemic stroke. Thirty patients used special astringent formulas as part of combined therapy and 25 patients did not. The investigators studied the time of course of changes in the restoration of swallowing function, by using the Penetration-Aspiration Scale (PAS) and the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), as well as the transition from probe feeding to independent one.Results and discussion. The best restoration of swallowing function was shown to be achieved through training using formulas with different astringency. Stronger astringent formulas, like solid foods, stimulate better the pharyngeal receptor apparatus; the most active restoration of a dynamic swallowing stereotype occurs. The gradual transition to a milder astringent formula allows restoration of the skill to swallow thinner liquid foods. It takes 10 days to achieve a significant clinical effect in most patients, mainly in those with pseudobulbar disorders. Training may be prolonged to 2 weeks or more in severe cases, in bulbar dysfunctions.Conclusion. The training rehabilitation method using special infant formulas in combination with electrical stimulation in patients with ischemic stroke and neurogenic dysphagia allows achieving the significantly better indicators of restoration of swallowing function in accordance with the PAS scale. The application of the method contributes to the significantly better transition from probe feeding to independent one.

Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants.

AimRegurgitation, infantile colic and functional constipation are common functional gastrointestinal disorders (FGIDs) during infancy. Our aim was to carry out a concise review of the literature, evaluate the impact of these common FGIDs on infants and their families, and provide an overview of national and international guidelines and peer‐reviewed expert recommendations on their management.MethodsNational and international guidelines and peer‐reviewed expert recommendations on the management of regurgitation, infantile colic and functional constipation were examined and summarised.ResultsRegurgitation, infantile colic and functional constipation cause frequent parental concerns, lead to heavy personal and economic costs for families and impose a financial burden on public healthcare systems. Guidelines emphasise that the first‐line management of these common FGIDs should focus on parental education, reassurance and nutritional advice. Nutritional advice should stress the benefits of continuing breastfeeding, while special infant formulas may be considered for non‐breastfed infants with common FGIDs. Drug treatment is seldom required, with the exception of functional constipation.ConclusionBy providing complete and updated parental education, reassurance and nutritional advice, healthcare professionals can optimise the management of FGIDs and related symptoms and reduce the inappropriate use of medication or dietary interventions.

Types of Special Infant Formulas Marketed in Korea and Their Indications.

Infant formula is classified into standard cow's milk-based and special formulas. This review aimed at summarizing the types of special milk formulas currently sold in Korea, and the appropriate indications for the use of these formulas; lactose free formula, soy-based formula, protein hydrolysate formula, amino acid-based formula, preterm formula, medium chain triglyceride formula, low-phosphorus formula, protein-energy-enriched formula, and formulas for inborn errors of metabolism.

Principles of personalized diet therapy of cow’s milk allergy in children

Cow’s milk allergy protein (CMPA) is the leading cause of food allergy in infants and young children. The personalized diet prescription, providing individual medical nutrition can be reliable guaranty of effective treatment for diverse range of CMPA symptoms. In spite of the fact that there are a lot of special infant formula in Russia, pediatricians and allergologists have difficulties in choosing appropriate diet. The suggested algorithm of individual option of extensively hydrolyzed proteinbased formula for CMPA patients will help doctors to optimize diet.

Consumption of a low-carbohydrate and high-fat diet (the ketogenic diet) exaggerates biotin deficiency in mice

ObjectiveBiotin is a water-soluble vitamin that acts as a cofactor for several carboxylases. The ketogenic diet, a low-carbohydrate, high-fat diet, is used to treat drug-resistant epilepsy and promote weight loss. In Japan, the infant version of the ketogenic diet is known as the “ketone formula.” However, as the special infant formulas used in Japan, including the ketone formula, do not contain sufficient amounts of biotin, biotin deficiency can develop in infants who consume the ketone formula. Therefore, the aim of this study was to evaluate the effects of the ketogenic diet on biotin status in mice. MethodsMale mice (N = 32) were divided into the following groups: control diet group, biotin-deficient (BD) diet group, ketogenic control diet group, and ketogenic biotin-deficient (KBD) diet group. Eight mice were used in each group. ResultsAt 9 wk, the typical symptoms of biotin deficiency such as hair loss and dermatitis had only developed in the KBD diet group. The total protein expression level of biotin-dependent carboxylases and the total tissue biotin content were significantly decreased in the KBD and BD diet groups. However, these changes were more severe in the KBD diet group. ConclusionThese findings demonstrated that the ketogenic diet increases biotin bioavailability and consumption, and hence, promotes energy production by gluconeogenesis and branched-chain amino acid metabolism, which results in exaggerated biotin deficiency in biotin-deficient mice. Therefore, biotin supplementation is important for mice that consume the ketogenic diet. It is suggested that individuals that consume the ketogenic diet have an increased biotin requirement.

The effect of early nutritional supplementation with a mixture of probiotic, prebiotic, fiber and micronutrients in infants with acute diarrhea in Indonesia.

A randomized double blind clinical trial was conducted to assess the efficacy of a special infant formula containing Lactobacillus rhamnosus LMG P-22799 (probiotic: 5 x 10(8) CFU/100mL), inulin (prebiotic: 0.15 g/100mL), dietary fiber (soy polysaccharides: 0.2 g/100mL) and increased amounts of zinc+iron (+0.4 and +0.6 mg/100mL, respectively) as active ingredients for the early dietary management of 58 Indonesian well-nourished male infants aged 3-12 months suffering from acute diarrhea with moderate dehydration. After adequate oral rehydration, the patients were randomly assigned to receive either a low lactose infant formula supplemented with added precooked rice (1.5 g/100mL) with the above active ingredients (study group) or a low lactose infant formula with added precooked rice without the above active ingredient supplement (control group). No antibiotic, anti-secretory drug or antiemetic was given at all. Both study and control groups showed similar outcomes for weight gain and stool weight. The duration of diarrhea was significantly shorter in the study group than in the control group (1.63 versus 2.45 days; p<0.05; for the study and control group respectively). No treatment failure or other side effects were observed during the course of the study. The present study supports the evidence for the efficacy of a special anti-diarrhea infant formula containing probiotic, prebiotic, fiber and iron+zinc after oral rehydration by shortening the duration of infantile diarrhea in developing countries. However, from the results of our study we cannot discern the individual contribution of the active ingredients and also not whether they may act independent from each other or in a synergistic way.

Early dietary treatments with Lorenzo’s oil and docosahexaenoic acid for neurological development in a case with Zellweger syndrome

We treated a girl with Zellweger syndrome using a special infant formula supplemented with middle chain triglyceride (MCT) milk, docosahexaenoic acid (DHA), Lorenzo’s oil, and Lunaria oil, which is rich in nervonic acid (C24:1). We examined the fatty acid contents of the plasma and red blood cell (RBC) membrane. Neurological development was evaluated using Denver developmental screening test and auditory brainstem response (ABR). Her delayed neurological development, liver dysfunction, and cholestasis were all improved 2 weeks after starting the dietary treatment. DHA level in RBC membranes was increased and very long chain fatty acid (VLCFA,C26:0) levels were decreased. Our findings suggest that the dietary treatment with combination of MCT milk, DHA, Lorenzo’s oil, and Lunaria oil in the patients with Zellweger syndrome bring some benefits for neurological development.

Genetic and environmental risk factors for the development of food allergy

To review recent clinical and experimental studies of genetic and environmental risk factors for the development of food allergy. It may be true, although it is yet to be shown, that food allergies in early childhood are becoming more common and that the causes are the same as for later-developing respiratory allergies. The mother not only transfers 50% of her genes to her baby, but she is also the exclusive environment during gestation and continues to be a major environmental factor while breast-feeding her infant. Non-genetic maternal influences increasing the likelihood of food allergy include Caesarian section and high maternal age. Allergy to sesame seems to be increasing in children. This is possibly a consequence of increased use in processed foods. The search for dietary risk factors is not limited to allergenic foods, but may include other nutrients, for example excessive intake of vitamins. Two meta-analyses have seriously questioned the use of special infant formulas for allergy prevention. Novel prevention strategies, such as probiotic bacteria, have yet to be documented further. The causes of food allergy are still unknown and no particular genes associated particularly with food allergy have been identified, although there is a strong association in general between genetic susceptibility to food allergy and that to IgE-mediated allergy. There are still no measures for general recommendation in order to prevent food allergy and no genes have been linked conclusively to disease. Further research concentrating on food allergy is obviously needed.

Lead content in Spanish market infant formulas and toxicological contribution

Lead content was investigated in infant formulas by using graphite furnace atomic absorption spectroscopy (GFAAS). Formulas were distinguished as ‘beginner’, ‘continuation’ and ‘special infant formula’, the latter being classified as subtypes ‘hypoallergenic’, ‘without lactose’, ‘vegetable base’ and ‘others’. The mean concentrations of lead were 25.7±8.4, 36.9±6.4 and 43.5±16.3 μgkg−1 for beginner, continuation and special infant formula, respectively. Two-factor (types and subtypes) variance analyses were made and Tukey's mean homogeneity test (p <0.05) was also performed for the formation of homogeneous groups. Significant differences (p < 0.001) were observed between types and two homogeneous groups were formed by the special infant formula type, with the highest lead content; the other group was constituted by the beginner type; and included in both groups were the continuation type infant formula. Their contribution to the provisional weekly intake (PTWI) was calculated from the mean concentrations in each type of infant formula, showing them to be food with a low toxicological risk (<30% PTWI).

Cadmium content in infant formulas. Toxicological evaluation.

Cadmium content was investigated in infant formulas by using graphite furnace atomic absorption spectroscopy (GFAAS). Formulas were distinguished as "beginner", "continuation" and "special infant formulas", the last ones were classified as subtypes "hypoallergenic", "without lactose", "vegetable base" and "others". The mean concentrations of cadmium were 1.97 +/- 0.84, 1.86 +/- 0.65 and 2.98 +/- 2.59 micrograms/kg for "beginner", "continuation" and "special infant formulas", respectively. Two-factor (types and subtypes) variance analyses were made and Turkey's mean homogeneity test (p < 0.05) was also carried out for the formation of homogeneous groups. Significant differences (p < 0.001) were observed between subtypes and 3 homogeneous groups were formed, one for "hypoallergenic" and "others", another group was constituted by "without lactose" and, finally another group, one with the highest cadmium content, was formed by subtype "vegetable". Their contribution to the provisional weekly intake (PWI) was calculated from the mean concentrations of each type and subtype of infant formulas, showing them to be food with a low toxicological risk.

Nutritional Status of Irritable Bottle-Fed Infants

Infant irritability, commonly referred to as colic, often causes distress to families and may have long term effects on family functioning. Most research studies have focused on the treatments of infantile colic and the infant and mother relationship but there had been no study on the nutritional status of colicy infants. The purpose of this study was to assess nutritional status of bottle-fed irritable infants. The subjects were bottle-fed infants whose mothers sought professional help at our research center because of their excessive crying and fussing. Before consultation, preliminary data were gathered which included family history, anthropometry, crying and feeding habits. The mothers were asked to keep 48 hours of crying and feeding diaries. The following results were obtained from 19 consecutive infants (10 males, age 3.6±1.8 months). Mean Z scores for weight for age, length for age and weight for length were 1.12±0.97,0.23±1.09, and 1.05±1.13, respectively. None of these infants was malnourished. On the contrary, weight for length of five infants (26%) was > 95th percentiie. The mean crying time was 134±88minutes per day which is less than Wessel's crying time criteria of infantile colic of 3 hours per day. Solid foods had already been introduced in 10 infants (53%), mostly as a measure for reducing colic. Changing infant formula was another common practice for reducing colic. Three infants (16%) had been given special infant formulas in order to avoid cow's milk protein. The mean feeding volume was 756±148ml/day (range 480-1030ml) providing 77±23kcal/kg (range 40-124kcal/kg) and 1.9g of protein/kg/day (range 0.9-3.4g/kg/day). This study suggests that some of the irritable infants may be overfed and nutrition education with emphasis on normal infant feeding is indicated for parents of irritable infants.

Osmolality of Commonly Used Medications and Formulas in the Neonatal Intensive Care Unit

The objective of the study was to measure the osmolality of medications and special infant formulas commonly used in contemporary neonatal intensive care units. The osmolalities of 75 medications and 20 infant formulas were determined in triplicate by freezing point depression, and the means were reported. A majority of the medications (54 of 75) analyzed had a measured osmolality in excess of 2000 mOsm/kg. Most infant formulas possessed an osmolality within American Academy of Pediatrics (AAP) recommendations (400 mOsm/L), with the exception of powder‐fortified human milk and a protein hydrolysate formula concentrated to 30mL. Final osmolality of infant feedings should be measured or calculated when medications are added and when calories are concentrated beyond 24 kcal/oz. Oral administration of medications, powdered fortification of human milk, and the concentration of some infant formulas may potentiate adverse gastrointestinal effects associated with hyperosmolar feedings and should be postponed until full volume enteral nutrition has been established.

Potential Aluminium Toxicity in Infants Fed Special Infant Formula

Aluminium was measured in samples of plasma and samples of feed obtained from 74 infants with normal renal function established on various feeds (breast, whey-based, fortified whey-based, preterm, soy, and casein hydrolysate). All infants were bolus fed, and blood samples were collected midway between feeds. Aluminium was measured using electrothermal atomization and atomic absorption spectrometry. Mean aluminium concentrations in milks were as follows: breast, 9.2 micrograms/L [95% confidence interval (CI), 5.6-12.7]; whey-based, 165 micrograms/L (95% CI, 151-180); fortified, 161 micrograms/L (95% CI, 143-180); preterm, 300 micrograms/L (95% CI, 272-328); soy, 534 micrograms/L (95% CI, 470-598); casein hydrolysate, 773 micrograms/L (95% CI, 632-914). Mean plasma aluminium concentrations in infants receiving different milks were as follows: breast, 8.6 micrograms/L (95% CI, 5.6-10.6); whey-based, 9.2 micrograms/L (95% CI, 7.4-11.0); fortified, 10.3 micrograms/L (95% CI, 8.3-12.3); preterm, 9.7 micrograms/L (95% CI, 5.3-17.1); soy, 12.5 micrograms/L (95% CI, 5.0-20.0); casein hydrolysate, 15.2 micrograms/L (95% CI, 10.7-19.8). Mean plasma aluminium concentration was significantly different in infants fed casein hydrolysate formulae than in those fed breast milk (difference, 6.7 micrograms/L; 95% CI, 2.8-10.5; p = 0.028). We conclude that infants may be at risk from aluminium toxicity when consuming formula containing > 300 micrograms/L--in particular, casein hydrolysate formulae. We speculate that the aluminium compounds found in breast milk are more bioavailable than those found in other milks and that some constituents of infant formula affect aluminium absorption from the gut lumen.

Potential Aluminium Toxicity in Infants Fed Special Infant Formula

SummaryAluminium was measured in samples of plasma and samples of feed obtained from 74 infants with normal renal function established on various feeds (breast, whey‐based, fortified whey‐based, preterm, soy, and casein hydrolysate). All infants were bolus fed, and blood samples were collected midway between feeds. Aluminium was measured using electrothermal atomization and atomic absorption spectrometry. Mean aluminium concentrations in milks were as follows: breast, 9.2 (xg/L [95% confidence interval (CI), 5.6–12.7]; whey‐based, 165 μLg/L (95% CI, 151–180); fortified, 161 μg/L (95% CI, 143–180); preterm, 300 μg/L (95% CI, 272–328); soy, 534 (μg/L (95% CI, 470–598); casein hydrolysate, 773 μg/L (95% CI, 632–914). Mean plasma aluminium concentrations in infants receiving different milks were as follows: breast, 8.6 μg/L (95% CI, 5.6–10.6); whey‐based, 9.2 μg/L (95% CI, 7.4–11.0); fortified, 10.3 μ,g/L (95% CI, 8.3–12.3); preterm, 9.7 μg/L (95% CI, 5.3–17.1); soy, 12.5 μg/L (95% CI, 5.0–20.0); casein hydrolysate, 15.2 μg/L (95% CI, 10.7–19.8). Mean plasma aluminium concentration was significantly different in infants fed casein hydrolysate formulae than in those fed breast milk (difference, 6.7 μg/L; 95% CI, 2.8–10.5; p = 0.028). We conclude that infants may be at risk from aluminium toxicity when consuming formula containing &gt;300 μg/L–in particular, casein hydrolysate formulae. We speculate that the aluminium compounds found in breast milk are more bioavailable than those found in other milks and that some constituents of infant formula affect aluminium absorption from the gut lumen.

Comparison of Short Term Indirect Calorimetry and Doubly Labeled Water Method for the Assessment of Energy Expenditure in Preterm Infants

The accuracy of 8-hour indirect calorimetry (IDC) as an estimate of energy expenditure was investigated in 8 healthy preterm infants (birth weight 1,270 +/- 193 g, gestational age 32 +/- 3 weeks, mean +/- SD) in comparison with an analysis over 5 days using the doubly-labeled water (2H2(18)O) method (DLW). The infants that were fed continuously by nasogastric drip with 120 kcal/kg/day of special infant formula were measured twice under thermoneutral conditions in a closed system indirect calorimeter during 8 h with a 4-day interval; simultaneously isotope decay was measured by isotope ratio mass spectrometry in urine samples collected daily during 5 days from 6 h after an oral dose of 2H2(18)O on the first day of IDC, all during the 4th postnatal week. The mean differences between carbon dioxide production rate (rCO2) measured either by single 8-hour IDC or by duplicate 8-hour IDC and the 5-day DLW method, using the two-point analysis or the multipoint analysis were not significantly different from zero. The rCO2 calculated from the DLW method using the two-point analysis differed -1.4 +/- 1.7% from that measured by the multipoint analysis. The mean differences between the metabolic rate estimated from 8 h of IDC and from the 5-day DLW method based on a measured RQ of 0.90 was -6.7 +/- 6.2% and based on the RQ of the feeding -4.5 +/- 6.0%. These differences were not significantly different from zero. We conclude that IDC over 8 h and two-point DLW measurement over 5 days, both methods that can be applied with relative ease in practice, offer an adequate average estimate of energy expenditure in continuously fed preterm infants under thermoneutral conditions.

Effect of formula carbohydrate concentration on tolerance and macronutrient absorption in infants with severe, chronic diarrhea

To determine how the carbohydrate (CHO) content of "semielemental" formulas affects tolerance and macronutrient absorption, we enrolled 12 infants with severe diarrhea in two successive metabolic balance studies. The infants received, in random order, one of two isocaloric formulas that differed mainly in their CHO and fat concentrations. No significant differences were found between the two feeding periods for peak breath hydrogen levels and fecal osmolality. The low-CHO formula was tolerated better than the high-CHO formula, as indicated by a significantly lower stool output (mean +/- SD 387 +/- 230 vs 764 +/- 443 gm, respectively; p less than 0.05), and higher fecal pH (5.9 +/- 0.7 vs 4.9 +/- 0.5; p less than 0.05). Macronutrient absorption was greater during the ingestion of the low-CHO formula, as indicated by a significantly higher coefficient of fat absorption (p less than 0.005) and lower total fecal energy (mean +/- SD for high- vs low-CHO formula, 372 +/- 205 vs 207 +/- 102 kcal; p less than 0.05), which resulted from a lower CHO excretion (p less than 0.05). A correlation coefficient between the energy derived from CHO in feces and the total stool output was significant for both the high-CHO formula (r = 0.83; p less than 0.001) and the low-CHO formula (r = 0.7; p = 0.01). The CHO concentration of the special infant formula that we tested had an overriding effect on stool output and on fat and energy absorption.