Milk Fat Globule Membrane Supplementation in Children: Systematic Review with Meta-Analysis

This summary is adapted from ‘Milk Fat Globule Membrane Supplementation in Children: Systematic Review with Meta-Analysis’ by Ambrozej et al. 2021 Fats are the largest energy source in human breast milk, contributing 40-55% of the total energy needed by the infant¹. Fats are secreted by the mammary glands as droplets, enclosed by the milk fat globule membrane (MFGM) which is made up of different types of fats to the core of the droplet. There is increasing evidence that MFGM has a beneficial effect on many of the body’s functions, such as the immune system, central nervous system, and metabolism². This makes MFGM a key component of breast milk for infant health. However, MFGM is usually absent from infant formula, as even though there is a bovine form of MFGM present in cow’s milk, this is broken down during the production process and replaced by vegetable oils. This may be a contributing factor to the superiority of breast milk over infant formula. Thus, efforts have been made to add bovine MFGM to formulas at an appropriate phase of the processing to ensure they are not broken down and can still benefit the infant. One such infant formula has been put on the market. The purpose of the study summarised here was to evaluate the safety and health benefits of MFGM supplementation in infants as investigated in clinical trials. 10 different clinical trials were included in this review. 5 of these studies were carried out in Europe, 1 in South America, and 5 trials in Asia, as 3 of the trials were conducted in multiple centres. Most of the trials included participants under 2 months of age at the start of the trial. The trials included mainly used formulas from Anmum Infacare and Arla Food Ingredients, along with experimental formulas which were not on the market. Infants received the formulas from between 3 months and 18 months. The outcome measures taken included weight, length, daily weight gain, cognitive development or infection prevalence. From the data that were suitable to be combined, no difference was found in mean weight, length, and head circumference at the age of four months, when MFGM enriched formulas were compared with standard infant formulas. This was mirrored in the studies which were not suitable to be combined. The same was found in weight-for-age and length-for-age. This indicated that MFGM enrichment does not impair growth when added to infant formula. When MFGM-enriched formulas were compared to breastfeeding, some studies found formula-fed infants had slightly lower mean body weight and head circumference compared to breastfed infants. Body length did not differ. Other studies did not find a significant difference in these measurements. Again, this indicates that MFGM-enriched formula does not impair infant growth. In terms of cognitive development, there was evidence of improvement with MFGM-enriched formulas compared with standard infant formulas. Increased scores for hand and eye coordination, language and general IQ were seen. However there were no differences in locomotor, hearing and speech scores. Compared to breastfeeding, cognitive scores were similar. The age at which this was assessed and the instruments used varied a lot between trials which limits the ability to draw definite conclusions. As for the risk of infections, a lower incidence of ear infections, respiratory tract infections and diarrhea in the MFGM-enriched formula group compared to standard formula was found. However, in contrast, there was one study that found an increased incidence of diarrhea associated with MFGM-enriched formula. There were no differences in the infection rate between MFGM-enriched formula and breastfed infants. This was a positive result, as infant formula is typically associated with increased risk of infections compared to breastfeeding. MFGM-enriched formula was not seen to be effective in the prevention of diarrhea in developing countries, where there is a higher incidence. There were multiple studies that evaluated the metabolic effects of different formula types, meaning the chemical processes in the body that may be influenced in the infant by formula intake. Infants that received MFGM-enriched formulas had higher cholesterol than those who received standard formula, coming closer to the levels seen in breastfed infants. This was a positive result as cholesterol has a number of important roles in the health of the infant, therefore levels similar to that of breastfeeding are desirable. Metabolic effects were only present during the exclusive feeding period and therefore could not be detected at 12 months of age. The effect of MFGM-enriched formula on the microbiome was also investigated, but no concrete conclusions were made. Again, no differences were found after the weaning period. None of the studies found safety concerns related to MFGM-enriched formulas. Adverse events were similar to that of standard infant formula, indicating that this approach is safe. The currently available data of MFGM-enriched infant formula indicate potential beneficial effects and a good safety profile. Further studies are needed which should be high quality, using unified outcomes and large sample sizes. This will hopefully give a definite answer as to whether MFGM-enriched formula should be recommended for infants.

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References

1. German, J.B. Dietary lipids from an evolutionary perspective: Sources, structures and functions. Matern. Child Nutr.2011, 7 (Suppl. 2), 2–16.
2. Norris, Gregory H., et al. "Protective properties of milk sphingomyelin against dysfunctional lipid metabolism, gut dysbiosis, and inflammation." The Journal of nutritional biochemistry 73 (2019): 108224.