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The composition of fat in breast milk and infant formula

The fat in breast milk provides a rich source of energy (as calories) and accounts for approximately 50% of the energy content of breast milk. 

 

Fat molecules exist as fork-shaped triglycerides, which can have different fatty acids bound to the sn-1, sn-2, or sn-3 position on their glycerol backbone 

 

 

Breast milk contains various fatty acids, with one of the most abundant being palmitic acid. Palmitic acid makes up 20-25 % of the total fatty acid content of breast milk1. The fat blend of vegetables oils used in infant formula are designed to match the overall fatty acid composition of breast milk4.

 

In breast milk, Palmitic acid largely exists (60-70%) on the sn-2 position, whereas the sn-1 and sn-3 positions are commonly occupied by unsaturated fatty acids such as oleic and linoleic2,3. In infant formula, palmitic acid is primarily linked to the sn-1 and sn-3 positions of the triglyceride molecule3.  

 

Research shows that the position of the individual fatty acids on the triglyceride molecule plays an important role in their absorption. Due to the different positioning of the palmitic acid in infant formula, absorption is poorer than breast milk. For this reason, higher amounts of palmitic acids are found in the stools of formula-fed infants than breastfed infants3 and this in turn is correlated with harder stools.

 

In recent studies, infants fed on formula with an increased proportion of palmitic acid at the sn-2 position had softer stools containing a lower proportion of palmitic acid. They also had reduced formation of insoluble calcium-fatty acid soaps and their stool biochemistry and characteristics were intermediate between those seen in breastfed infants and those seen in infants fed standard formula3, 5, 6, 7, 8.  

 

Breast milk also contains two particularly important long chain polyunsaturated fatty acids (LCPs); the omega-6 fatty acid, arachidonic acid (AA) and the omega-3 fatty acid, docosahexaenoic acid (DHA)9, 10.  LCPs are important components of cell membranes and play a key role in the development of the brain, eye, and nervous system11, 12.  Although LCPs can be made within the body from the essential fatty acids linoleic acid and alpha-linolenic acid, infants have a high demand for them and benefit from having LCPs in their diet9.

 

Following scientific workshops in 1999 and 2008, experts recommended the minimum levels of AA and DHA that should be added to infant formulae13, 14 to support visual and cognitive development. 

 

 

References
  1. Innis, S.M et al. Saturated fatty acid chain length and positional distribution in infant formula: effects on growth and plasma lipids and ketones in piglets.  Am J Clin Nutr. 1993; 57: 382-390.
  2. Martin J et al.  Triacylglycerol structure of human colostrums and mature milk.  Lipids 1993; 28: 637-643.
  3. Kennedy K et al.  Double-blind, randomized trial of a synthetic triacylglycerol in formula-fed term infants: effects on stool biochemistry, stool characteristics, and bone mineralization.  Am J Clin Nutr 1999;70:920–7.
  4. Innis SM.  Human milk and formula fatty acids.  J Pediatr 1992; 120: S56-S61.
  5. Carnielli VP et al. Structural Position and Amount of Palmitic Acid in Infant Formulas: Effects on Fat, Fatty Acid, and Mineral Balance. J Pediatr Gastroenterol Nutr. 1996;23(5):553-560.
  6. Carnielli VP et al. Feeding premature newborn infants palmitic acid in amounts and stereoisomeric position similar to that of human milk: effects on fat and mineral balance. Am J Clin Nutr. 1995;61(5):1037-1042.
  7. Lucas A et al. Randomised controlled trial of a synthetic triglyceride milk formula for preterm infants. Arch Dis Child Fetal Neonatal Ed. 1997;77(3):F178-F184.
  8. Quinlan PT et al. The relationship between stool hardness and stool composition in breast- and formula-fed infants. J Pediatr Gastroenterol Nutr. 1995;20(1):81-90.
  9. Morris G et al. A novel infant formula milk with added long-chain polyunsaturated fatty acids from single-cell sources: a study of growth, satisfaction and health. Eur J Clin Nutr 2000; 54: 883–886
  10. Birch EE et al. Visual acuity and the essentiality of docosahexaenoic acid and arachidonic acid in the diet of term infants. Pediatr Res 1998; 44: 201–209.
  11. Fleith M, Clandinin MT.  Dietary PUFA for preterm and term infants: review of clinical studies.  Crit Rev Food Sci Nutr 2005; 45(3): 205-29. 
  12. Willatts P et al. Effect of long-chain polyunsaturated fatty acids in infant formula on problem solving at 10 months of age.  Lancet 1998;352(9129):688-91. 
  13. Koletzko B et al. Long chain polyunsaturated fatty acids (LC-PUFA) and perinatal development. Acta Paediatr 2001;90:460-4. 
  14. Koletzko B et al.  The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations.  J Perinat Med 2008; 36: 5-14.
  1. Innis, S.M et al. Saturated fatty acid chain length and positional distribution in infant formula: effects on growth and plasma lipids and ketones in piglets.  Am J Clin Nutr. 1993; 57: 382-390.
  2. Martin J et al.  Triacylglycerol structure of human colostrums and mature milk.  Lipids 1993; 28: 637-643.
  3. Kennedy K et al.  Double-blind, randomized trial of a synthetic triacylglycerol in formula-fed term infants: effects on stool biochemistry, stool characteristics, and bone mineralization.  Am J Clin Nutr 1999;70:920–7.
  4. Innis SM.  Human milk and formula fatty acids.  J Pediatr 1992; 120: S56-S61.
  5. Carnielli VP et al. Structural Position and Amount of Palmitic Acid in Infant Formulas: Effects on Fat, Fatty Acid, and Mineral Balance. J Pediatr Gastroenterol Nutr. 1996;23(5):553-560.
  6. Carnielli VP et al. Feeding premature newborn infants palmitic acid in amounts and stereoisomeric position similar to that of human milk: effects on fat and mineral balance. Am J Clin Nutr. 1995;61(5):1037-1042.
  7. Lucas A et al. Randomised controlled trial of a synthetic triglyceride milk formula for preterm infants. Arch Dis Child Fetal Neonatal Ed. 1997;77(3):F178-F184.
  8. Quinlan PT et al. The relationship between stool hardness and stool composition in breast- and formula-fed infants. J Pediatr Gastroenterol Nutr. 1995;20(1):81-90.
  9. Morris G et al. A novel infant formula milk with added long-chain polyunsaturated fatty acids from single-cell sources: a study of growth, satisfaction and health. Eur J Clin Nutr 2000; 54: 883–886
  10. Birch EE et al. Visual acuity and the essentiality of docosahexaenoic acid and arachidonic acid in the diet of term infants. Pediatr Res 1998; 44: 201–209.
  11. Fleith M, Clandinin MT.  Dietary PUFA for preterm and term infants: review of clinical studies.  Crit Rev Food Sci Nutr 2005; 45(3): 205-29. 
  12. Willatts P et al. Effect of long-chain polyunsaturated fatty acids in infant formula on problem solving at 10 months of age.  Lancet 1998;352(9129):688-91. 
  13. Koletzko B et al. Long chain polyunsaturated fatty acids (LC-PUFA) and perinatal development. Acta Paediatr 2001;90:460-4. 
  14. Koletzko B et al.  The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations.  J Perinat Med 2008; 36: 5-14.

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