Recently, the American Academy of Pediatrics released a statement written by Dr. Frank Greer and Dr. Steven Abrams about what pediatricians need to know about the new low-calorie and low-protein formulas.
Infant formulas with lower energy density and lower protein content than those historically sold in the United States are being introduced this spring.
This change follows the recent addition of novel components such as pre- and probiotics into some formulas.
As the number of formula choices increases and the selection process becomes more complicated, families might want to seek their pediatrician’s advice.
Pediatricians, therefore, should be on alert for new formulas and be familiar with the research on formulas with varying amounts of energy and protein.
Since obesity is a national concern and because the risk of overweight is higher in formula-fed infants than breast-fed infants, some nutritionists support lowering the protein content and energy density of infant formulas.
It has been reported that the intake of both protein and total energy in formula-fed infants exceeds that of breast-fed infants.
Limited evidence indicates that this difference is primarily because of the increased volume of intake in formula-fed infants compared to breast-fed.
It also has been observed that the average energy density of formula is higher than that of breast milk — 67 kilocalories per 100 milliliters of formula versus 65.2 kilocalories per 100 milliliters in mature human milk.
The average protein content in formula also is higher than that found in mature breast milk — 1.4 grams versus 1.3 ± 0.1 grams per 100 milliliters (range 0.8 to 2.1 grams per 100 milliliters).
There are two important issues here. The first is whether the historically used protein content (1.4 grams per 100 milliliters) and energy density (67 kilocalories per 100 milliliters) in formulas can be decreased safely. The second is whether such changes will meet the objective of decreased weight gain.
The minimal amount of protein in formula permitted by the Food and Drug Administration based on the Infant Formula Act is 1.2 grams per 100 milliliters. The Infant Formula Act does not specify a minimum energy density requirement for infant formulas.
However, a minimum level of 63 kilocalories per 100 milliliters is recommended in a 1998 report on nutrient requirements of infant formulas from the Life Sciences Research Office of the American Society for Nutritional Sciences.
A study in Sweden compared the new lower-calorie, lower-protein formula versus the standard formula versus breast-fed infants for the first year of life.
There were no significant differences in growth during the first year of life between the three groups. Infants did drink more of the lower-calorie formula between 2 and 6 months.
For those parents using WIC, there might be changes with the formula they have been receiving. They might not be able to continue with the present choice of formula.
If this is a concern, please discuss it with your health care provider and the personnel at WIC.
Sally Robinson is a clinical professor of pediatrics at UTMB Children’s Hospital, and Keith Bly is an associate professor of pediatrics and director of the UTMB Pediatric Urgent Care Clinics. This column isn’t intended to replace the advice of your child’s physician.