Enfalac ARGGG…

When infant formulas are changed they are not necessarily improved. The latest version of Enfalac is evidence of this. Changes are, more often then not, dictated by the need to use a new marketing spin, create a new wrinkle and add hype to otherwise stagnant promotions. This time the product is trading on an infant feeding habit of parents adding cereal to their baby’s formula, in the hope that the baby will sleep longer or through the night. This habit is discouraged by health care workers. The product also claims that the formula becomes even thicker when it hits the baby’s stomach where acidic conditions cause more swelling of the starch.

Is this formula an improvement for infants? We think not!

The role of lactose in infant nutrition
Reading the ingredients listing we note, in order of quantities present: non-fat milk solids, rice starch, lactose… Rice starch, as the second ingredient is clearly replacing a major portion of the lactose that is the normal carbohydrate source for young infants and newborns.

Lactose, a disaccharide, is the major source of carbohydrate in human milk. When digested it splits into glucose and galactose. Lactose provides a very important function in the infant’s digestive tract by establishing healthy intestinal flora. By working in tandem with the bifidus factor in human milk, lactose stimulates the growth of Lactobacillus bifidus. The high lactose content of the gut, the low protein content, as well as low bulk encourages this favourable gut growth resulting in a more acidic environment and thus limiting the growth of potentially harmful pathogenic bacteria.

Ability to digest rice starch
At birth infants have a structurally immature stomach and intestinal system. Their digestive capabilities are fully geared to digest human milk. Intestinal enzymes required to break down non-breastmilk constituents such as amylases needed to digest starch are present in low levels. However, to digest lactose, the level of lactase in the newborn is very high.

What happens when large amounts of undigested starch are excreted by young infants? Are valuable micronutrients lost through increased fecal output?

Should newborns and young infants be encouraged to sleep longer and to sleep through the night?
Small stomachs need frequent feeding. Imagine the stomach of a newborn to be the size of a golfball. An infant’s growth needs requires frequent easily digestible feeds. What is the effect of swelling starch in the infant’s stomach? Is this going to reduce the number of feeds? Does a sleepier baby get less stimulation and parental contact?

Complementary foods are not needed until at about six months.
Rice starch, the main ingredient of rice cereal, must be considered a complementary food and should not be introduced into the baby’s diet until at about six months. The Enfalac label recommends the product for “infants to 12 months”. This would certainly include newborns, and young infants before the age of six months.

Is there scientific support to suggest this product is suitable for infants under 6 months?
A preliminary review of literature and a med-line search produced very little research showing the impact of feeding rice starch as replacement for a large part of the milk lactose to newborns and young infants. One study(1) showed that rice cereal carbohydrates are not completely digested in the small intestines of 2 month old infants and was associated with increased fecal protein loss and increased fecal bacterial levels. We did locate several studies testing cereal feeding on older infants. One study(2) tested (only 14 subjects) 4 month old infants for 3 to 4 days, feeding them formula and rice cereal to determine the impact on calcium and iron absorption. The study concluded that there was no negative effect on the absorption as the rice cereal was also fortified with calcium and iron. Another study determined that the addition of rice cereal to the infants diet did not increase fecal protein loss at ages 3 to 5 months and concluded that “infants aged 4 months, in contrast with younger infants, are able to digest and absorb cereal”. Digestibility does not mean suitability and numerous issues remain unanswered as infants again become the test subjects for marketing needs.

References:
1. Shulman, R.J. et al. Impact of dietary cereal on nutrient absorption and fecal nitrogen loss in formula-fed infants. J. Pediatr 118: 39-43, 1991 BACK

2. Lifschitz, C.H. Addition of Rice Cereal to Formula. Does Not Impair Mineral Bioavailability. J Pediatr Gastroenterol Nutr 26: 175-178-1998 BACK

3. Shulman, R.J. et al. Cereal feeding and its impact on the nitrogen economy of the infant. Am J. Clin Nutr 62: 969-972, 1995