Literature review for - Flourish Paediatrics

VII Safe use of infant formula
Infant Formula
Issues that have changed since the 2003 Guidelines
1.Introduction of solid foods in formula fed infants (Dewey 2005).
There is no evidence in the literature that this should be any different to breastfed infants, that
is “introduction of solid foods at around six months of age”.
2. Protein Levels in Infant Formula
Formula fed infants grow at a different rate to breastfed infants and are heavier at 12 months
of age and have a slightly increased risk of later obesity (WHO European Region 2007). For
this reason, a major trial of lower protein formula was undertaken in Europe (Koletzko, von
Kries et al. 2009; Koletzko, von Kries et al. 2009). In this well conducted RCT the authors
concluded that a ‘higher protein content of infant formula is associated with higher weight in
the first 2 years of life but has no effect on length. Lower protein intake in infancy might
diminish the later risk of overweight and obesity.’ Subsequent to this study many brands of
infant formula in Europe have improved the quality of the protein they contain and reduced
overall protein levels.
Human breastmilk contains protein levels of 1-1.1 grams per 100mls compared to cow’s milk
of 3.3 grams per 100mls (Prentice 1996). The infant formulas on the market in Australia
contain amounts of protein that vary from 1.3 to 1.7 grams of protein. Reduction in protein
levels is limited by the need to meet minimum amounts of specified amino acids, especially
tryptophan.
Under Australian Food regulations (Standard 2.9.1) the protein content of infant formula
must be between 0.45 and 0.7 grams per 100KJ, and must also meet specific amino acid
requirements.
3. Soy based Infant Formula
A detailed review of the use of soy formula has been published by the Canadian Paediatrics
Society (CPS 2009). This statement updates older reviews by the American and Australian
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