Nutr Res Pract.  2022 Jun;16(3):344-353. 10.4162/nrp.2022.16.3.344.

A partially hydrolyzed whey formula provides adequate nutrition in high-risk infants for allergy

Affiliations
  • 1Department of Integrated Biomedical and Life Science, Graduate School, Korea University, Seoul 02841, Korea
  • 2Maeil Innovation Center, Maeil Dairies Co., Ltd., Pyeongtaek 17714, Korea
  • 3Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea
  • 4Department of Pediatrics, Ajou University School of Medicine, Suwon 16499, Korea
  • 5Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea
  • 6Department of Pediatrics, Soonchunhyang University Hospital, Seoul 04401, Korea
  • 7Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
  • 8Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Korea

Abstract

BACKGROUND/OBJECTIVES
Hydrolyzed formula is often fed to infants with gastrointestinal or immune issues, such as malabsorption or cow's milk allergy, because enzymatic treatment has rendered it more digestible and less allergenic than standard cow's milk formula (SF). Partially hydrolyzed formula (PHF) should be considered for those infants who are intolerant to extensively hydrolyzed formula. However, there are concerns about the nutritional insufficiencies of PHF. We aimed to evaluate the effects of PHF on the growth and health indicators in infants who were at high-risk of allergic disease and potential candidates for consuming PHF.
SUBJECTS/METHODS
A total of 83 infants aged 0–2 mon with a family history of allergies were assigned to consume either PHF or SF until 24 weeks of age. Anthropometric measures were obtained at baseline, 12 weeks, and 24 weeks; blood samples were drawn and evaluated at the end of the study.
RESULTS
No significant differences were observed in weight, height, and weight-for-height at any time point in each sex between the PHF and SF groups. At 24 weeks of age, the weightfor-age and height-for-age z-scores of the SF group were higher than those of the PHF group, but there was no significant difference in the weight-for-height z-score. There were no significant differences in levels of white blood cells, hemoglobin, ferritin, protein, albumin, aspartate aminotransferase, alanine aminotransferase, eosinophil cationic protein, and immunoglobulin E.
CONCLUSIONS
In this study, there were no differences in growth and blood panels between the infants consuming PHF or SF. Therefore, infants who are unable to tolerate SF can be fed PHF without nutritional concerns about growth.

Keyword

Infant formula; nutritional sciences; protein hydrolysates; infant; clinical trial

Figure

  • Fig. 1 Flow diagram of the study participants.PHF, partially hydrolyzed formula; SF, standard cow's milk formula.


Reference

1. World Health Organization. The optimal duration of exclusive breastfeeding: report of the expert consultation [Internet]. Geneva: World Health Organization;2001. cited 2020 August 17. Available from: https://apps.who.int/nutrition/publications/infantfeeding/WHO_NHD_01.09/en/index.html.
2. Odom EC, Li R, Scanlon KS, Perrine CG, Grummer-Strawn L. Reasons for earlier than desired cessation of breastfeeding. Pediatrics. 2013; 131:e726–e732. PMID: 23420922.
3. Perrine CG, Galuska DA, Dohack JL, Shealy KR, Murphy PE; MLIS, Grummer-Strawn LM, Scanlon KS. Vital signs: improvements in maternity care policies and practices that support breastfeeding - United States, 2007–2013. MMWR Morb Mortal Wkly Rep. 2015; 64:1112–1117. PMID: 26447527.
4. Kakute PN, Ngum J, Mitchell P, Kroll KA, Forgwei GW, Ngwang LK, Meyer DJ. Cultural barriers to exclusive breastfeeding by mothers in a rural area of Cameroon, Africa. J Midwifery Womens Health. 2005; 50:324–328. PMID: 15973270.
5. Savino F, Palumeri E, Castagno E, Cresi F, Dalmasso P, Cavallo F, Oggero R. Reduction of crying episodes owing to infantile colic: a randomized controlled study on the efficacy of a new infant formula. Eur J Clin Nutr. 2006; 60:1304–1310. PMID: 16736065.
6. Vandenplas Y, Devreker T, Hauser B. A double-blinded, prospective trial with a new formula in distressed and regurgitating infants. Open Nutr J. 2008; 2:48–50.
7. Xinias I, Analitis A, Mavroudi A, Roilides I, Lykogeorgou M, Delivoria V, Milingos V, Mylonopoulou M, Vandenplas Y. Innovative dietary intervention answers to baby colic. Pediatr Gastroenterol Hepatol Nutr. 2017; 20:100–106. PMID: 28730134.
8. von Berg A, Koletzko S, Grübl A, Filipiak-Pittroff B, Wichmann HE, Bauer CP, Reinhardt D, Berdel D. German Infant Nutritional Intervention Study Group. The effect of hydrolyzed cow's milk formula for allergy prevention in the first year of life: the German Infant Nutritional Intervention Study, a randomized double-blind trial. J Allergy Clin Immunol. 2003; 111:533–540. PMID: 12642834.
9. Skripak JM, Matsui EC, Mudd K, Wood RA. The natural history of IgE-mediated cow's milk allergy. J Allergy Clin Immunol. 2007; 120:1172–1177. PMID: 17935766.
10. American Academy of Pediatrics. Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics. 2000; 106:346–349. PMID: 10920165.
11. Giampietro PG, Kjellman NI, Oldaeus G, Wouters-Wesseling W, Businco L. Hypoallergenicity of an extensively hydrolyzed whey formula. Pediatr Allergy Immunol. 2001; 12:83–86. PMID: 11338291.
12. Ragno V, Giampietro PG, Bruno G, Businco L. Allergenicity of milk protein hydrolysate formulae in children with cow's milk allergy. Eur J Pediatr. 1993; 152:760–762. PMID: 8223811.
13. Rugo E, Wahl R, Wahn U. How allergenic are hypoallergenic infant formulae? Clin Exp Allergy. 1992; 22:635–639. PMID: 1393761.
14. Adler-Nissen J. Enzymic hydrolysis of food proteins. London: Elsevier Applied Science Publishers;1986.
15. Siemensma AD, Weijer WJ, Bak HJ. The importance of peptide lengths in hypoallergenic infant formulae. Trends Food Sci Technol. 1993; 4:16–21.
16. Cabana MD. The role of hydrolyzed formula in allergy prevention. Ann Nutr Metab. 2017; 70(Suppl 2):38–45.
17. Greer FR, Sicherer SH, Burks AW. American Academy of Pediatrics Committee on Nutrition. American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008; 121:183–191. PMID: 18166574.
18. Alexander DD, Cabana MD. Partially hydrolyzed 100% whey protein infant formula and reduced risk of atopic dermatitis: a meta-analysis. J Pediatr Gastroenterol Nutr. 2010; 50:422–430. PMID: 20216095.
19. Boyle RJ, Ierodiakonou D, Khan T, Chivinge J, Robinson Z, Geoghegan N, Jarrold K, Afxentiou T, Reeves T, Cunha S, et al. Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis. BMJ. 2016; 352:i974. PMID: 26956579.
20. Vandenplas Y, Latiff AHA, Fleischer DM, Gutiérrez-Castrellón P, Miqdady MS, Smith PK, von Berg A, Greenhawt MJ. Partially hydrolyzed formula in non-exclusively breastfed infants: a systematic review and expert consensus. Nutrition. 2019; 57:268–274. PMID: 30223233.
21. Lucassen PL, Assendelft WJ, Gubbels JW, van Eijk JT, Douwes AC. Infantile colic: crying time reduction with a whey hydrolysate: a double-blind, randomized, placebo-controlled trial. Pediatrics. 2000; 106:1349–1354. PMID: 11099588.
22. Vandenplas Y, Hauser B, Van den Borre C, Clybouw C, Mahler T, Hachimi-Idrissi S, Deraeve L, Malfroot A, Dab I. The long-term effect of a partial whey hydrolysate formula on the prophylaxis of atopic disease. Eur J Pediatr. 1995; 154:488–494. PMID: 7671948.
23. World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development [Internet]. Geneva: World Health Organization;2006. cited 2020 August 17. Available from: https://www.who.int/childgrowth/standards/en/.
24. Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015; 372:803–813. PMID: 25705822.
25. Perkin MR, Logan K, Tseng A, Raji B, Ayis S, Peacock J, Brough H, Marrs T, Radulovic S, Craven J, et al. Randomized trial of introduction of allergenic foods in breast-fed infants. N Engl J Med. 2016; 374:1733–1743. PMID: 26943128.
26. Katz Y, Rajuan N, Goldberg MR, Eisenberg E, Heyman E, Cohen A, Leshno M. Early exposure to cow's milk protein is protective against IgE-mediated cow's milk protein allergy. J Allergy Clin Immunol. 2010; 126:77–82.e1. PMID: 20541249.
27. Schoemaker AA, Sprikkelman AB, Grimshaw KE, Roberts G, Grabenhenrich L, Rosenfeld L, Siegert S, Dubakiene R, Rudzeviciene O, Reche M, et al. Incidence and natural history of challenge-proven cow's milk allergy in European children--EuroPrevall birth cohort. Allergy. 2015; 70:963–972. PMID: 25864712.
28. Peters RL, Koplin JJ, Dharmage SC, Tang MLK, McWilliam VL, Gurrin LC, Neeland MR, Lowe AJ, Ponsonby AL, Allen KJ. Early exposure to cow's milk protein is associated with a reduced risk of cow's milk allergic outcomes. J Allergy Clin Immunol Pract. 2019; 7:462–470.e1. PMID: 30267891.
29. Szajewska H, Horvath A. Meta-analysis of the evidence for a partially hydrolyzed 100% whey formula for the prevention of allergic diseases. Curr Med Res Opin. 2010; 26:423–437. PMID: 20001576.
30. Vandenplas Y, Alarcon P, Fleischer D, Hernell O, Kolacek S, Laignelet H, Lönnerdal B, Raman R, Rigo J, Salvatore S, et al. Should partial hydrolysates be used as starter infant formula? A working group consensus. J Pediatr Gastroenterol Nutr. 2016; 62:22–35. PMID: 26513620.
31. Fleischer DM, Spergel JM, Assa'ad AH, Pongracic JA. Primary prevention of allergic disease through nutritional interventions. J Allergy Clin Immunol Pract. 2013; 1:29–36. PMID: 24229819.
32. von Berg A, Filipiak-Pittroff B, Krämer U, Hoffmann B, Link E, Beckmann C, Hoffmann U, Reinhardt D, Grübl A, Heinrich J, et al. Allergies in high-risk schoolchildren after early intervention with cow's milk protein hydrolysates: 10-year results from the German Infant Nutritional Intervention (GINI) study. J Allergy Clin Immunol. 2013; 131:1565–1573. PMID: 23506844.
33. Osborn DA, Sinn JK, Jones LJ. Infant formulas containing hydrolysed protein for prevention of allergic disease. Cochrane Database Syst Rev. 2018; 10:CD003664. PMID: 30338526.
34. Turner PJ, Feeney M, Meyer R, Perkin MR, Fox AT. Implementing primary prevention of food allergy in infants: new BSACI guidance published. Clin Exp Allergy. 2018; 48:912–915. PMID: 30133860.
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