Summary: Impact of Palm Olein in infant formulas on stool consistency and frequency: a meta-analysis of randomised clinical trials

Summary: Impact of Palm Olein in infant formulas on stool consistency and frequency: a meta-analysis of randomised clinical trials

This summary has been adapted from "Impact of palm olein in infant formulas on stool consistency and frequency: a meta-analysis of randomised clinical trials, Food & Nutrition Research (2017)." Human breast milk contains a unique blend of fats, carbohydrates, proteins and minerals in order to serve the nutritional needs of an infant. Whether through necessity or choice, some mothers do not breastfeed their infants which leads to the market for infant formula development. Most infant formulas in the current market rely on vegetable oil blends to provide the fat profile needed to meet infant caloric and nutritional needs. Palmitic acid is an essential fatty acid crucial to human breast milk content. Because many vegetable oils lack this important fatty acid, many formula companies rely on the use of palm oil to deliver this fat content (1). It is currently estimated that palmitic acid comprises around 20% of the triglycerides in the fat of human breast milk (2). It has been reported that palm oil digestion results in unabsorbed free palm olein present in the gastrointestinal tract of infants. When this unabsorbed material is able to cross react with free calcium ions, they bind together and form an unabsorbable fatty acid-soap complex. To date, the effects of this soap on infant health have not been widely studied. To address this issue a team of scientists from Wayne State University, Detroit medical centre and Ann Adams Department of Paediatrics have come together to perform a meta analysis on the many studies on the effects of the calcium soaps. This crossover team had a goal to assemble a list of the physiological effects of using palm oil in infant formula.
The reason that palm oil is not absorbed in the gastrointestinal tract of infants is that the fatty acids of palm oil predominantly found on the sn-1 (first) and sn-3 (third) position of the triglyceride backbone, whereas in human milk the palmitic acid content is predominantly found on the sn-2 position (middle). When triglycerides reach the infant gut the sn-1 and sn-3 position fatty acids are liberated by enzymes while the palmitic acid in the sn-2 position remains absorbable. This results in palmitic acid in the sn-1 and sn-3 positions (as with palm oil) becoming unabsorbable in the form of calcified soaps while the sn-2 palmitic acid (as in bovine and human milk) is rapidly absorbed for energy use as a monoglyceride. There were nine studies (3) that outline the effects of unabsorbed palmitic acid on infant health. The infants of these studies were between 28-42 weeks of age, highlighting the lack of long term breastfeeding effects on this topic. The infants who were not fed infant formula containing palm oil had higher bone mass, as a result of proper fat, palmitic acid and calcium absorption. The infants fed formula with palm oil had lower bone mass and bone demineralisation. This has implications of osteoporosis (4) further along in life and childhood fractures (5), as low bone mass density is related to insufficient bone mass. Based on this research Kendamil takes an evidence based approach to excluding palm oil from its formula to avoid potential health detriments to infants consuming our product. References:
  1. Benson JD, Masor ML: Infant formula development: past, present and future. Endocr Regul 28:9–16, 1994
  2. Havlicekova, Z., Jesenak, M., Banovcin, P. et al. Beta-palmitate – a natural component of human milk in supplemental milk formulas. Nutr J 15, 28 (2015). https://doi.org/10.1186/s12937-016-0145-1
  3. Nelson SE, Rogers RR, Frantz JA, Ziegler EE: Palm olein in infant formula: Absorption of fat and minerals by normal infants. Am J Clin Nutr 64:291–296, 1996.
  4. National Institutes of Health (NIH): Osteoporosis prevention, diagnosis, and therapy. NIH Consensus Statement 17:1. Bethesda, MD: NIH 2000.
  5. Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, Hodsman AB, Eriksen EF, Ish-Shalom S, Genant HK, Wang O, Mitlak BH. Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–41, 2001.
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