Dairy products in infant feeding: artificial milk (I)

After two days in which we talked about the first of cow's milk derivatives that some babies usually try, artificial milk, focusing on its drawbacks, we will talk today about artificial milk from several points of view to try to clarify any doubts that may arise to those mothers who, for whatever reason, are feeding their babies with this type of milk.

Types of artificial milk

The adapted formulas are classified, removing those special ones whose objective is to treat a problem in the baby, such as gastroesophageal reflux or constipation, in start formula and continuation formula.

This classification is carried out in Europe, where the composition of these formulas is regulated by the Nutrition Committee of the European Society of Pediatric Gastroenterology and Nutrition (ESPGAN) and by the Scientific Committee for Food (CCA), of the European Union.

In the United States and other countries, such classification cannot be carried out, basically because the American Academy of Pediatrics (AAP) recommends a single type of formula for the entire first year of life, whose composition is very similar to the beginning we have here in Europe.

The starting formula

The starting formula or type "1" milk is intended to cover the nutritional needs of newborns up to six months, at which time it must be supplemented with other foods.

The continuation formula

The formula of continuation of milk type "2" is used from six months of age, being cheaper than the starting formula. It is a milk with more protein than the starter and, therefore, of a milk less adapted to babies (less processed). It is for this reason that babies under six months should not take it.

From that moment on, babies have a greater tolerance to proteins and that is why they can start drinking these milks, however, the one that most closely resembles breast milk is still more recommendable (infants with six months of age may continue taking breast milk without any problem) and have less protein, which is the starting formula (being more processed costs more expensive).

Composition of artificial milk

Both starter formulas and continuation formulas provide 60-75 kcal / 100 ml, which is the average contribution of breast milk. Many people believe that continuation formulas provide more calories because babies have grown and need more energy. The truth is that this is not so, since they must continue to provide the energy provided by breast milk.

As for the amount of protein, it usually ranges between 1.2 and 1.9 grams per 100 ml. Breast milk has about 1 gram of protein per 100 ml, which is what a baby requires. The starter formulas have a minimum of 1.2 g because being proteins with a lower biological value, more quantity is needed to alleviate this deficiency.

The continuation formulas, being less processed and adapted than the starter ones, have a greater amount of protein, approaching 2 grams per 100 ml (there are manufacturers that place the figure near 1.7 g / 100 ml and others that exceed 2 g / 100 ml). Luckily, ESPGAN and other organizations have long pressed for manufacturers to reduce this amount of protein in the continuation formulas because it has been seen that babies and children take more protein than they should, causing a renal overload of solutes and hydrogen, an excess of weight gain, etc.

With respect to carbohydrates, the adapted formulas should contain about 5.4-8.2 g / 100 ml. The main carbohydrate is lactose, as in breast milk, however one comes from the woman (it forms in the breast) and the other comes from the cow, being the second worst tolerated by babies (who have to end up taking formulas lactose free if not tolerated).

If we talk about the fatWe must make it clear that babies need large amounts of fat to grow and live. The adapted formulas should contain about 2.9-4.1 g / 100 ml. This means that fats should account for 45-55% of the energy contribution.

The absorption of cow's milk fat is lower than that of breast milk (60% vs. 90%). ESPGAN recommends that the absorption be at least 85% and for this it recommends that the fatty acids be poorly saturated (the more saturation the worse the absorption). The origin of fat (vegetable or animal) seems to be unimportant, since both are heterogeneous in terms of their composition of triglycerides, fatty acids and fat-soluble vitamins.

On trans fats, it is recommended that its concentration be as low as possible (less than 6% of the fat intake), so Hydrogenated fats are discouraged in the manufacture of formulas (I personally have seen hydrogenated fats in the composition of some artificial milk).

The CEC limits trans fatty acids to 4% and establishes that the sum of palmitic and lauric acid is less than 15% due to possible atherogenic effects (create atheroma plaques that deposit in the arteries).

If we talk about minerals and trace elements It should be noted that the sodium needs in children are higher than those of adults, but it is difficult for them to excrete it. For this reason the concentration of sodium, chlorine and potassium has to be much lower than that existing in cow's milk to resemble human milk. The sum of the three cannot exceed 50 mEq / l.

Calcium absorption is affected by high fat and phosphorus intake. In addition, the calcium in the adapted formulas is absorbed worse than that in human milk, so the content should not be less than 60 mg / 100 kcal.

Both human milk and cow's milk have little iron, although that of breast milk is highly bioavailable (70% versus 30% of cow's milk) and is therefore absorbed much better.

Formula milk should contain a minimum of 1 mg of iron per 100 kcal, although the AAP recommends 1.8 mg / 100 kcal.

Why the continuation formulas exist

If you look, when talking about the composition of the milk the guidelines are the same for both the starting formula and the continuation formula, except for the amount of protein and some other element with few differences (the starting formulas must have between 40 and 70 mg / 100 ml of Calcium and those of continuation> 60, for example).

If we take into account that there is pressure for manufacturers to decrease the protein concentration of the continuation formulas, to approximate the better the concentration in the starter formulas, it seems not logical that at six months you change milk for another one that tries to resemble the first one.

The truth is that continuation milk exists only in response to a commercial and economic need. On the one hand, to relieve the pockets of parents who feed their children with formula milk, since the continuation is cheaper than the start and on the other, because the Royal Decree 867/2008 that regulates in Spain the Marketing of breast milk substitutes prohibits the advertising of starter formulas, but not that of continuation formulas.

If the continuation formulas did not exist the brands could not advertise their milks in any way. Thus, with the appearance of these milks from six months (some brands more daring and less committed to the health of children recommend them even after four months) manufacturers can make as much publicity as they want of their type milks 2 to indirectly advertise the type 1, which are packaged in exactly the same boats with the only difference of the number "1" for the start and "2" for the continuation.

To be continue

In a few days we will continue talking about artificial milk, commenting on the various modifications that are made with different objectives (anti-constipation milks, anti-colic, etc.), among other things.

Video: Cows Milk Protein Allergy in Infants - Dr. Aliza Solomon (March 2024).