Is Formula Just as Healthy as Breast Milk?

          The nutritional quality of breast milk fed to newborns is because of the specificity and bioavailability of its nutrients and the contribution of live cells, digestive enzymes, immunomodulators, and growth factors. Although breast milk is very nutritional and beneficial, 54.1% of 6-month infants and 78.3% of one-year-old infants are fed with infant formulas. The formulas try to reproduce the properties, composition, and bioavailability of breast milk. Technical Sanitary Regulations (TSR) establish minimum and maximum values of nutritional content. It provides values to determine the nutritionally adequate contributions of infant formulas. These values come from scientific tests performed in human infants, taking breast milk composition as a reference. This study was done to see if companies adhere to these values and the effect on health based on energy and nutritional needs. Does the nutritional composition of these milks satisfy the daily recommended intake in infants?

            Spanish formulas were assessed to see if they were compliant with TSR and recommendations for nutritional composition and the Dietary Reference Intakes for infants. 31 samples of artificial milk commercially available in Spain were analyzed: 18 infant formulas, 10 continuation (follow-on) formulas, and 3 growing-up milks. The nutritional composition figures were taken from the information provided by the manufacturer on the bottles and cartons for sale and the Parapharmacy Catalog 2010. The mean values of energy and nutrients contained in these formulas were calculated. The mean composition of initiation and continuation artificial milks was compared with the TSR. There is no regulation available for growing up milks, so they were compared with cow’s milk. The Recommended Dietary Intakes (RDI) for the Spanish population is used for energy, proteins, and micronutrients (calcium, iron, retinol, vitamin D, vitamin E, vitamin C, thiamine, riboflavin, niacin, vitamin B6, vitamin B12, and folates). The Dietary Reference Intakes (DRI) of the Institute of Medicine of the National Academics of the United States and Canada was used for glucides and lipids comparison. An intake of 910mL has been considered at 3 months and 500mL intake at 9 and 18 months while also receiving complementary feeding to determine the energy and nutritional contribution.  

            

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          The main difference between initiation and continuation formulas is the higher energy and nutrient content of the follow-on formulas. Growing up formulas have a higher energy content and higher content of proteins, phosphorus, calcium, retinol, vitamin D, riboflavin, and folates compared to continuation milks. Initiation infant formulas comply with regulation regarding macronutrient content, but levels of micronutrients (phosphorus, calcium, retinol, vitamins D, E, C, riboflavin, vitamins B6, B12, and folates are lower than mean reference values. Initiation formulas contain more iron and niacin. Continuation formulas also comply with macronutrient regulation but fall below mean reference value with micronutrients (vitamins D, E, C, retinol, thiamine, riboflavin, niacin, vitamins B6, B12, and folates). The mineral contents of phosphorus, calcium, and iron exceeded regulation limits. Micronutrients were within the limits permitted by regulation and discrepancies were minor.

         

           The mean concentration of proteins in initiation milk was higher than breast milk. Micronutrients: phosphorus, calcium, & iron and vitamins: retinol, vitamins D & E, thiamine, riboflavin, niacin, B6, B12, and folates were also higher than breast milk. Growing up milks had higher energy content and higher levels of carbohydrates, iron, vitamins D, E, C, retinol, niacin, and folates when compared to cow’s milk. The intake of 910mL of initiation milk exceeds the daily recommended amount in several cases. The content of phosphorus, retinol, vitamin E, C, thiamine, riboflavin, niacin, B6, B12, and folates is higher than recommended. The intake of 500mL of continuation milk met 36% energy requirements, 50% macronutrients, vitamin B6, and niacin requirements, 60-70% of calcium, iron, retinol, and vitamin D requirements, and over 80% of phosphorus, vitamin E, vitamin C, thiamine, riboflavin, vitamin B12, and folates. The daily intake of 500mL of growing up milk provides 30% of the energy recommended, 50% of proteins and vitamin C, 60-70% of calcium, iron, niacin, and folates, and more than 80% of the requirements of phosphorus, retinol, vitamin D, riboflavin, and vitamin B12. The content of glucides, vitamin E, B6, and thiamine does not fulfill 50% of the recommendations.

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            This data shows that these infant milks met nutritional needs and shows the need to review regulations. The energy and macronutrient content of infant milk is in the center of the range indicated in TSR and matches the amounts recommended. Infant milks provide more iron and micronutrients than breast milk because of their lower bioavailability. The main micronutrients in initiation milk are vitamins E, C, B-group vitamins and folates, and vitamin B12 in continuation milk. Although initiation and continuation milks contain vitamins and minerals within the range of TSR, the nutritional content is much higher than values established for RDI for riboflavin (230%), vitamin B12 (500%), and folates (214%) in initiation milks. An excess of vitamin B12 (283%) in continuation milks. This may be an excessive, harmful, nutritional content since RDI is based on the appropriate intake to maintain the health of healthy individuals.

            Some studies have associated high levels of vitamins in infant formulas with an increase in fat mass, obesity, and diabetes. There are also genetic and environmental factors involved that may affect these different pathologies. Feeding with infant formulas led to a higher accumulation of fat, which may later represent a higher risk of obesity. A study showed that the excess of proteins in infant formulas affects the BMI and increases the risk of suffering from obesity during school years. The TSR should be reviewed because these excess amounts of proteins and micronutrients could be harmful. Although, there is not enough scientific research done to prove that the excess nutrient supplementation may be a cause of the obesity epidemic.

            As we have learned in class, it can be dangerous to be deficient in macronutrients and micronutrients such as vitamins and iron. There can also be dangers to having excess or too much vitamins or macronutrients as we have also discussed. Therefore, I think that there could be an issue to having excess nutrient supplements than the Recommended Dietary Intake (RDI) for infant formula and for us as adults. We learned that taking multiple supplements could harm you more than benefit you. In this case, we should try to get our nutrients from our diet before turning to supplements. 

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Works Cited:

 Piñana, C. Jardí, N. Aranda Pons, C. Bedmar Carretero, and V. Arija Val. "Nutritional Composition of Infant Milk Formulas. Level of Compliance in Their Manufacture and Adequacy of Nutritional Needs." Anales De Pediatría (English Edition) 83.6 (2015): 417-29. Print.