Food Science, Technology and Nutrition for Babies and Children

Infants and children are regularly fed with processed foods, yet despite their importance in human development, these foods are rarely studied. This important book provides an exhaustive analysis of key technologies in the development of foods for babies and children, as well as the regulation and marketing of these food products. Contributors cover different aspects of food science and technology in development of baby foods, making this text an unique source of information on the  subject. 

Food Science, Technology, and Nutrition for Babies and Children includes relevant chapters on infant milk formulas, essential fatty acids in baby foods, baby food-based cereals and macro- and micronutrients. This book also offers alternatives from the point of view of food technology for babies and children with special diet regimes associated to metabolic or enzymatic diseases such as allergy to casein, phenylalanine (phenylketonuria or commonly known as PKU) and gluten (celiac disease), or lactose intolerance. This book also addresses some nutritional aspects of babies and children in terms of the childhood obesity, child’s appetite and parental feeding. With its comprehensive scope and up-to-date coverage of issues and trends in baby and children’s foods, this is an outstanding book for food scientists and technologists, food industry professionals, researchers and nutritionists working with babies and children.

• Language: English
• Publisher: Springer
• Release date: Mar 13, 2020
• ISBN: 9783030359973

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© Springer Nature Switzerland AG 2020

T. J. Gutiérrez (ed.)Food Science, Technology and Nutrition for Babies and Childrenhttps://doi.org/10.1007/978-3-030-35997-3_1

1. Food Manufacturing for Babies and Children: Editor’s Perspective

Tomy J. Gutiérrez¹  

(1)

Thermoplastic Composite Materials (CoMP) Group, Faculty of Engineering, Institute of Research in Materials Science and Technology (INTEMA), National University of Mar del Plata (UNMdP) and National Scientific and Technical Research Council (CONICET), Mar del Plata, Buenos Aires, Argentina

Tomy J. Gutiérrez

Email: [e-mail]

Abstract

Child feeding has been the focus of attention for various international, national and non-governmental organizations (NGOs), the most important of which is the United Nations International Children’s Emergency Fund (UNICEF). In this sense, some efforts for the development of infant foods have been conducted to improve the nutritional quality of this susceptible demographic population. Future perspectives on food development in terms of food science, technology and nutrition for babies and children will be given in this first chapter as an introduction to this book.

Keywords

Allergenic foodsBaby foodCeliacChild appetiteChildren’s dietsFood parentingInfant feedingInfant foodsInfant milk formulasLactose intoleranceMacro- and micronutrientsObese childrenPhenylketonuriaPrebiotics and probiotics

1.1 Present and Future Perspectives

It is well known that the physiological and cognitive development of humans are determined from the moment of conception until advanced the first years of life. One of the key factors in the proper development of babies and children is an adequate diet, which is linked to the nutritional composition of the ingested food and feeding conditions. Some hot spots on children’s diets such as allergenic foods (Giavi et al. 2016), child appetite (Yackobovitch-Gavan et al. 2019), childhood obesity (Hayes et al. 2019), food parenting (Power et al. 2019), infant milk formulas (Halabi et al. 2020), nutritional composition (Machado et al. 2019), among others, will be discussed in this book. It should be noted that the design of food for babies and children has multiple nutritional and regulatory requirements, which can be more complex when babies or children have some metabolic disease such as celiac (Gutiérrez 2018), phenylketonuria (Blau 2016), diabetes mellitus (Steck et al. 2017), and associated diseases. The perspectives in this field are oriented to the manufacture of foods that allow the best care and development of babies and children, and this is related to the care of the intestinal microbiota and the regulation of the biochemical processes associated with the metabolism of nutrients, which allow to improve the immune response and promote adequate physical and cognitive performance. With this in mind, many of these points will be reviewed, discussed and analyzed in the following chapters.

Acknowledgements

The author would like to thank the Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) (Internal postdoctoral fellowship PDTS-Resolution 2417), Agencia Nacional de Promoción Científica y Tecnológica (ANPCyT) (grant PICT-2017–1362), Universidad Nacional de Mar del Plata (UNMdP) for financial support, and Dr. Mirian Carmona-Rodríguez.

Conflicts of Interest

The author declares no conflict of interest.

References

Blau, N. (2016). Genetics of phenylketonuria: Then and now. Human Mutation, 37(6), 508–515. https://​doi.​org/​10.​1002/​humu.​22980.CrossrefPubMed

Giavi, S., Vissers, Y. M., Muraro, A., Lauener, R., Konstantinopoulos, A. P., Mercenier, A., Wermeille, A., Lazzarotto, F., Frei, R., Bonaguro, R., Summermatter, S., Nutten, S., & Papadopoulos, N. G. (2016). Oral immunotherapy with low allergenic hydrolysed egg in egg allergic children. Allergy, 71(11), 1575–1584. https://​doi.​org/​10.​1111/​all.​12905.CrossrefPubMed

Gutiérrez, T. J. (2018). Plantain flours as potential raw materials for the development of gluten-free functional foods. Carbohydrate Polymers, 202, 265–279. https://​doi.​org/​10.​1016/​j.​carbpol.​2018.​08.​121.CrossrefPubMed

Halabi, A., Deglaire, A., Hamon, P., Bouhallab, S., Dupont, D., & Croguennec, T. (2020). Kinetics of heat-induced denaturation of proteins in model infant milk formulas as a function of whey protein composition. Food Chemistry, 302, 125296. https://​doi.​org/​10.​1016/​j.​foodchem.​2019.​125296.CrossrefPubMed

Hayes, A., Tan, E. J., Lung, T., Brown, V., Moodie, M., & Baur, L. A. (2019). A new model for evaluation of interventions to prevent obesity in early childhood. Frontiers in Endocrinology, 10, 132. https://​doi.​org/​10.​3389/​fendo.​2019.​00132.CrossrefPubMedPubMedCentral

Machado, M. L., Mello Rodrigues, V., Bagolin do Nascimento, A., Dean, M., & Medeiros Rataichesck Fiates, G. (2019). Nutritional composition of Brazilian food products marketed to children. Nutrients, 11(6), 1214. https://​doi.​org/​10.​3390/​nu11061214.Crossref

Power, T. G., Johnson, S. L., Beck, A. D., Martinez, A. D., & Hughes, S. O. (2019). The food parenting inventory: Factor structure, reliability, and validity in a low-income, Latina sample. Appetite, 134, 111–119. https://​doi.​org/​10.​1016/​j.​appet.​2018.​11.​033.CrossrefPubMed

Steck, A. K., Larsson, H. E., Liu, X., Veijola, R., Toppari, J., Hagopian, W. A., Haller, M. J., Ahmed, S., Akolkar, B., Lernmark, Å., Rewers, M. J., Krischer, J. P., & the TEDDY Study Group. (2017). Residual beta-cell function in diabetes children followed and diagnosed in the TEDDY study compared to community controls. Pediatric Diabetes, 18(8), 794–802. https://​doi.​org/​10.​1111/​pedi.​12485.CrossrefPubMedPubMedCentral

Yackobovitch-Gavan, M., Gat-Yablonski, G., Shtaif, B., Hadani, S., Abargil, S., Phillip, M., & Lazar, L. (2019). Growth hormone therapy in children with idiopathic short stature-the effect on appetite and appetite-regulating hormones: A pilot study. Endocrine Research, 44(1–2), 16–26. https://​doi.​org/​10.​1080/​07435800.​2018.​1493598.CrossrefPubMed

© Springer Nature Switzerland AG 2020

T. J. Gutiérrez (ed.)Food Science, Technology and Nutrition for Babies and Childrenhttps://doi.org/10.1007/978-3-030-35997-3_2

2. Infant Milk Formulas

A. Logeshwaran¹, Pavidharshini Selvasekaran¹ and Ramalingam Chidambaram²  

(1)

Instrumental & Food Analysis Laboratory, Industrial Biotechnology Division, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamilnadu, India

(2)

Instrumental & Food Analysis Laboratory, Industrial Biotechnology Division, School of Bioscience & Technology, Vellore Institute of Technology (VIT), Vellore, Tamilnadu, India

Ramalingam Chidambaram

Email: [e-mail]

Abstract

Milk is the most important nutritional source for newborns and infants during the initial months of their lives. Breast milk is healthy for infants as it is easily digestible. Apart from its nutritional value, breast milk is known to have a positive impact on infants’ growth and development as it provides biochemical and immunological components including proteins, cytokines and hormones. Breast milk also decreases the risk of diarrhea, and morbidity from respiratory tract and urinary tract infections. In addition, breast feeding helps mothers to regain pre-pregnancy body weight and to return the uterus to its normal size and shape. In a few cases, however, breastfeeding is not possible due to conditions associated with the modern era such as malnutrition, the absence of the mother, insufficient lactation, food allergies and other maternal health issues. Because of these problems, infant milk formula may be preferred as an alternative, and is manufactured by industries to mimic the nutritional value of breast milk. Infant formulas, baby formulas or baby milk commonly use cow’s milk or soymilk as a base with added nutritional supplements. Nevertheless, infants fed with formula are at a higher risk from acute otitis media, asthma, type 1 and 2 diabetes, eczema, lower respiratory tract infections, sudden infant death syndrome (SIDS) and obesity. This article reviews human breast milk and problems associated with breast feeding, the need for infant formulas as an alternative form of nutrition, different types of infant formulas, the health benefits and risks of infant formulas, guidelines for the manufacture of infant formulas, and the global market.

Keywords

Breast feedingClinical trialsFormula typesGlobal market

2.1 Introduction

Infancy is a vulnerable period of life and milk is the sole source of food for newborns, providing all the essential nutrients for their development and growth during the initial 3–6-months of their lives. Breast milk consists of micro and macro nutrients, hormones (Picciano 2001), proteins, vitamins and immune factors that together meet all the requirements for the growth of infants (Prentice 1996). Breastmilk benefits infants by reducing the risk of obesity, middle ear infections (Persico et al. 1983), sudden death syndrome (Vennemann et al. 2009; Hauck et al. 2011), type 2 diabetes, asthma and eczema (Pratt 1984). It also decreases the probability of diarrhea as it is easily digestible, and morbidity caused by respiratory tract and urinary tract infections. In addition, breast feeding helps mothers to regain pre-pregnancy body weight, restore the uterus to its normal shape and size, and reduce the risk of breast cancer (Allen and Hector 2005; Gartner et al. 2005). Breast milk is healthier for infants than cow’s milk and milk formulas and is thus preferable as a food source (Michaelsen et al. 1994). In a few cases, however, breast milk is contraindicated, e.g. if the mother suffers from conditions such as Human Immune Deficiency Virus (HIV) infection, tuberculosis or other illnesses that could affect the health of the infants (Cleveland 2016). Some other common problems such as lactation insufficiency (Spitzer et al. 2001), social pressures, the absence of the mother, and babies that are unable to breastfeed (Van Odijk et al. 2003) also necessitate the use of infant milk formulas or milk donors. Infant milk formulas are reconstituted powders or liquids fed to young children and infants that serve as human milk substitutes. They are generally considered to be a good alternative to maternal breast milk as they contain whey, casein or soy proteins, iron and vitamin D supplements (Boehm et al. 2002). In industrialized countries most newborns and older babies will receive infant formula at some point during the first 6–12 months of their lives. The components of infant milk formulas and those contained in human milk can complement each other during the combined feeding of these two liquids. Because of this the production of milk formulas is fast increasing and new types are constantly being developed. The components of infant formulas have been improved by the addition of nucleotides, which modify the fat composition in fat mixtures and fortify the formulas with iron. Recently in the United States, infant formulas with added docosahexaenoic acid (DHA) and arachidonic acid (AA) (compounds produced by genetic engineering) and probiotics have been made available in the market. Although infant formulas mimic the components present in breast milk, they also contain preservatives and additives that are added to lengthen shelf life. Some of these preservatives and additives have been found to be toxic for the infants and can result in gastroenteritis, atopic dermatitis and lower respiratory tract infections, and have also been linked to a decrease in intellectual quotient (IQ) (Kerr and Lie 2008), obesity (Melnik 2012), diabetes and sudden infant death syndrome (SIDS). The measurement of safety parameters is thus crucial before new additives or ingredients are introduced so that the formulas pose minimal or no risk to infants. Nevertheless, because the global market for baby food and infant milk formulas is high, new types of formulas that vary in color, taste, nutrient content and shelf life are constantly emerging (WHO 2003; Brady 2012). As these formulas often also contain toxic additives the risk of infants becoming ill is gradually increasing.

2.2 Human Breast Milk

The best source of infant nutrition is the mother’s own milk. Human breast milk contains proteins, vitamins, fats, carbohydrates, enzymes for digestion, hormones and minerals. Apart from its nutritional value breast milk also contains stem and immune cells including macrophages. These molecules are biologically active as they are derived from proteins (and are thus indigestible) and lipids. The oligosaccharides contained in human milk possess anti-inflammatory properties, and also protect the gastrointestinal tract of infants against pathogens such as Campylobacter, Listeria and Salmonella by binding them with decoys. In addition, oligosaccharides help colonize 70–90% of the infant gut microbiome with a balanced and diverse microbiota (Walker 2013). Breast milk contains more than one hundred oligosaccharides (HMOs) not found in infant formulas. These oligosaccharides act as prebiotics for the development of the intestinal flora and as decoy receptors (Bode 2015), which prevent pathogens from attaching to the cell walls thereby protecting infants from disease. There are many other bioactive agents contained in breast milk, which influence the functioning of the immune system and the gastrointestinal tract, and are also involved in brain development. Furthermore, according to recent research, human breast milk prevents the onset of infant obesity and type-2 diabetes (Savino et al. 2013). The composition of breast milk varies due to several maternal factors such as ethnicity, health, genetic determinants, and neuroendocrine regulatory mechanisms. The American Academy of Pediatrics recommends breastfeeding for 8–12 months, and the World Health Organization (WHO) states that infants should be breastfed during at least the initial 6 months after birth (Eidelman and Schanler 2012) and ideally, together with additional complimentary foods, until they reach 12 months. Breast feeding is convenient and inexpensive, and in addition to its nutritional value, creates a bonding experience between infant and mother. A few months old babies and toddlers should be breastfed along with a few other food items before they are given solid foods (Lessen and Kavanagh 2015). The decision to breastfeed is, however, influenced by many factors and is highly personal. Human milk is considered an evolutionary adaption reflecting its role in infant nutrition. The physiological processes that occur in the mammary glands, which synthesize breast milk, are influenced by maternal characteristics during the lactation period, and are sometimes initiated months or years before lactation begins. These characteristics cause variation in milk synthesis between populations (Miller et al. 2013). During the first few days after birth colostrum, a thin yellowish fluid mostly consisting of proteins and antibodies that give passive immunity to the infant, is produced in the mammary glands. The colostrum gradually changes into milk, and is at first watery and sweet tasting before becoming thicker and creamier. The concentration of immunoglobulin A (IgA) in milk is high up to 7 months after post-partum (Rechtman et al. 2002). Human breast milk is not sterile, and contains many species of bacteria such as Bifidobacterium breve, B. bifidum, B. dentium and B. longum (Martín et al. 2009).

2.2.1 Role of Breast Milk in Child Growth

Breast milk naturally provides all the nutrients essential for infant growth. The immunoglobulins present protect the infants from disease until they start to produce their own antibodies. Breast milk also regulates appetite, so the infants do not eat as much (Becker and Becker 2000; Thomas et al. 2004), and promotes the development of infant intestinal flora. The polyunsaturated fatty acids (PUFAs) and DHA present in human milk contribute to the development of the eyes and brain (Brenna and Carlson 2014). Breast feeding is thus a far better choice for infants than milk formulas.

2.2.2 Protein Content of Breast Milk

The alveolar cells produce proteins (α-lactalbumin and casein) that increase lactoferrin, immunoglobulins and serum albumin (Verd et al. 2018). Breast milk has 0.5–0.7% protein in total made up of casein, IgA, immunoglobulin G (IgG), lysozyme and β-lactoglobulin.

Casein is one of the major proteins which become clots or curds in the stomachs of infants, and whey is a type of protein that remains liquid for easy digestion (Martin et al. 2016). During the early stages of lactation whey and casein make up 30–70% of the proteins consumed by infants, which settles to around 50% at late lactation (Lönnerdal 2003). Postpartum, the concentration of whey protein in breast milk ranges between 80% and 50% depending on the lactation stage of the mother (Guo 2014). Lactaferrin, α-lactalbumin and secretory IgA are considered to be the main whey proteins, however, other proteins such as lysozyme, casein, amylase, haptocorrin, antichymotrypsin and lipase also play a vital role in the growth of newborns.

2.2.3 Essential Fats

Breast milk contains 95% of triglycerides in the form of lipids and fats (Martin et al. 2016). Fat is responsible for making the milk viscous and also acts as a carrier of aroma and taste. Fats also supply nutrients which help in the development of the central nervous system of infants. Human breast milk contains mostly saturated fatty acids (Guo 2014), although other monounsaturated fatty acids such as linoleic acid, α-linolenic acid, oleic acid are also present. AA and eicosapentaenoic (EPA) are synthesized by the conversion of linoleic and α-linolenic fatty acids. Both these fatty acids are then converted into DHA. All these fatty acids regulate growth, cognitive development, brain development, immune function development and the inflammatory response in newborns. The amounts of AA, EPA and DHA present in breast milk are influenced by the diet of the mother during pregnancy (Weseler et al. 2008) and mothers who consume large quantities of fish during this time show higher concentrations of DHA in their breast milk (Makrides et al. 1996).

2.2.4 Immunoglobulin

The concentrations of immunoglobulin M (IgM), IgG and IgA in milk increase by 5, 8, and 20 fold, respectively, one month after postpartum. Immunoglobulin activates the antibacterial response of the infants thus preventing diseases. Some of the antibacterial proteins present in breast milk during lactation are lysozyme, IgA and lactoferrin. These play an important role in developing the immune response of the newborns (Perrin et al. 2017). The breast milk of postpartum mothers contains high amounts of IgA from day 10–7.5 months (Rechtman et al. 2002).

2.2.5 Vitamins in Human Breast Milk

Breast milk is a good source of several vitamins such as vitamins A, C, E, B6, riboflavin, niacin and thiamin. However, vitamins D and K, essential for the proper development of newborns, are only found in very low concentrations (Bowen and Lawrence 2005). Even though the nutrient content of maternal milk is high, breastfed infants still have a high risk of developing rickets and inadequate bone mineralization due to a lack of vitamin D. It is not recommended for newborns to be over exposed to sunlight, however, only a high dosage will result in a satisfactory level of 25-OH-D. Vitamin K is responsible for blood coagulation: the lower the vitamin K concentration, the higher the chance of hemorrhagic diseases in newborns (Guo 2014). The insufficient amounts of these vitamins in breast milk may be balanced by using infant milk formulas, which contain these compounds in concentrations adequate for their growth.

2.2.6 Minerals and Bio Active Components Present in Breast Milk

Breast milk contains sufficient amounts of several minerals including calcium, chlorine, magnesium, phosphorus, potassium, selenium and sodium (Barlow et al. 1974; De Onis et al. 2006). Other minerals, such as copper, iron, manganese and zinc are also present, but in much lower quantities than those required by newborns. They can be administered, however, by feeding the infants with milk formulas with added mineral supplements (Martin et al. 2016).

2.3 Disadvantages and Risks of Breastfeeding

Lactation starts during pregnancy and breast feeding is recommended as it benefits both mother and infant. If, however, the mother is not able to feed the baby with her own milk she can choose to use infant formula and/or donor mother milk. The health of both the mother and the baby must be considered before choosing to breastfeed. If the mother is infected with any communicable diseases such as HIV, or is extremely ill, has had breast surgery, or is undergoing cytotoxic chemotherapy for cancer treatment, it is not advisable for her to breastfeed her baby (Cleveland 2016). In a few cases, the baby is considered to be at the risk of malnutrition even though he/she is being breastfed as the mother lacks sufficient nutritional intake. It is important, therefore, that mothers always consume enough nutrients to ensure their breast milk contains adequate concentrations of nutrients. Other common reasons why breast feeding might not be recommended are lactation insufficiency, the absence of the mother, social pressures and food allergies (Spitzer et al. 2001). In such cases, a milk donor or infant milk formula is necessary. If a mother is allergic to a food item, albeit a nutritious one, and consumes it while breastfeeding, this may provoke allergic reactions in the infant. Furthermore, some environmental pollutants such as polychlorinated biphenyl can accumulate in humans through the food chain and are sometimes found in breast milk (Rogan et al. 1987). Breastfeeding is not recommended in any of these cases.

2.4 Milk Banks and Milk Donors

Donating breast milk is a way to nourish infants who need it and can also benefit the lactating mother. It is the only alternative and natural method for providing infants with human breast milk from a non-biological mother (Simmer and Hartmann 2009). The intestinal flora of a breastfed child differs from a child fed in other ways (Moro 2018). A mother who cannot breastfeed her baby can obtain milk from milk donors or from a milk bank. The WHO and the United Nations Children’s fund both recommend donor breast milk as the best replacement for the mother’s breast milk (Pate 2009; Moro 2018). In America, Europe and Australia, and developing countries such as Brazil, India, South Africa and Singapore, child nutrition is very much a concern, and they are therefore encouraging the establishment of regional milk banks. In addition, North America has formulated guidelines for the establishment and operation of donor human milk banks which provides protocols for safe milk collection, preservation and use.

2.5 Infant Milk Formulas

Infant milk formulas are produced and marketed as a healthy substitute for breast milk, and aim to mimic the nutritional components present in it. Milk formulas are designed by the manufacturers to not cause any dietary problems that would interfere with the health of infants. Apart from mimicking breast milk, infant formulas contain additional nutrients to provide proper nourishment for infants, toddlers and also elder babies. These may include components such as vitamins D and K which are found at low concentrations in breast milk. The manufacturing of milk formulas is highly regulated and carefully monitored to meet the requirements of national and international quality guidelines (Martin et al. 2016).

The fats contained in infant milk formulas contribute around 40–50% of the daily energy intake required by infants. Fats used in infant milk formulas are of vegetable origin. Structured triacylglycerols and PUFAs are also obtained from other added ingredients present in the manufactured formulas. Breast milk has a high palmitic acid content and thus initially, in order to mimic this, infant formulas rich in palmitic acid were developed.

Carbohydrates are the most important energy source, and are necessary for ensuring the growth of infants. Carbohydrates such as sucrose, glucose, dextrin and other starches are used in infant formulas (Fomon 1993). Few milk-based formulas contain carbohydrates in the form of lactose, as most are lactose free formulas, specialized protein formulas and hydrolyzed protein formulas. Soy-based formulas do not generally contain lactose either, but other forms of carbohydrates are present (Boehm et al. 2005).

Nucleotides are the second most important component of milk formulas and are involved in energy metabolism and enzymatic reactions. The nucleotides present in milk formulas (such as Deoxy Ribonucleic Acid (DNA) and Ribonucleic Acid (RNA)) mimic those contained in human breast milk (Boehm et al. 2005). Since cow’s milk only contains low levels of nucleotides, such as uridine, cytidine and inosine, these components are added to the milk formulas as per the amounts required. Apart from this, proteins, fats, linoleic acid, folic acid, iodine, potassium chloride, minerals, calcium, niacin and the vitamins A, B1, B2, B6, B12, C, D, E, K are added to formulas as they are all essential for the growth of infants (Ball et al. 2013).

Liquid formulas can be either presented as ready to use or as concentrated solutions for use after dilution. Many formulas take the form of powdered or granulated mixtures to which hot water is added before consumption. Milk formulas are generally based on cow’s milk, soy proteins and protein hydrolysates, and formulas with specialized mixes for premature infants and infants with specific medical conditions are also available (Koletzko et al. 2013).

2.5.1 Types of Infant Milk Formula

Infant milk formulas can be classified into three major classes: cow’s milk-based formulas, soy-based formulas and specialized formulas to meet a variety of needs and requirements of consumers. These differ from each other in their nutrient composition, taste, calories, digestion and cost.

2.5.2 Cow’s Milk-Based Formulas

Infant formulas prepared from milk obtained from cows were the first milk formulas introduced and manufactured on an industrial scale, and most infant formulas continue to be based on bovine milk. The American Academy of Pediatrics stated that infants aged under 10–12 months should not consume raw cow’s milk (i.e. it should be pasteurized) and this milk also requires modification as it does not provide sufficient iron, vitamins and essential fatty acids (Koletzko et al. 2013). In addition, cow’s milk must be diluted and skimmed as it contains high levels of minerals, proteins and fats compared to human breast milk which can lead to digestion problems in infants (Cook 1989; Koletzko et al. 2005). Healthy infants can be fed with cow’s milk formulas containing 2–2.5 g/100 mL proteins, whereas formulas containing a higher protein content in the range above 2.9 g/100 mL is appropriate for preterm and low birth weight newborns (Fanaro et al. 2010). Formulas containing a higher protein content could, however, possibly lead to excessive weight gain and obesity. It is thus important to consider the protein requirements of preterm infants before feeding them with cow’s milk based infant formulas (Fanaro et al. 2010). Protein absorption, and the concentration and metabolism of amino acids are highly affected by the whey to casein ratio found in a formula. Casein is predominant in cow’s milk protein whereas whey is predominant in human milk at ratios of 18:32 (whey to casein) and 70:30 (whey to casein), respectively (Kunz and Lönnerdal 1992). Preterm formulas also require higher ratios of whey-to-casein to achieve proper plasma concentration and growth. Supplements of taurine are also required in cow’s milk-based formulas due to the low levels of this element in cow’s milk (Rassin et al. 1978). It can be seen then that most of the proteins found in cow’s milk are modified in order to mimic those found in human breast milk. One of the major causes of the allergic reactions of infants to cow’s milk is that they are given it after breast feeding has stopped, and the infant’s body is not able to adapt to this new substance (Hochwallner et al. 2014). The type and severity of cow’s milk allergies varies widely between infants as they represent adverse reactions to milk proteins such as casein and whey, mediated by immune mechanisms (Luyt et al. 2014). Two types of immune mechanisms are responsible for milk allergies and the symptoms can be immediate or delayed. The mechanism associated with immunoglobulin E (IgE) is the cause of 60% of milk allergies. The onset of the allergic reactions associated with IgE are immediate and commence within 1–2 h after ingestion, affecting the skin, and the gastrointestinal and respiratory tracts (Hochwallner et al. 2014). Non-IgE associated mechanisms are the cause of the other 40% of cow milk allergies, and the reactions have been observed to affect the gastrointestinal tract from 2 h to several days after consumption. Non-IgE associated reactions also include enterocolitis, proctocolitis, eosinophilic esophagitis and enteropathy (Fiocchi et al. 2010). Systemic anaphylactic reactions are also possible in rare and severe cases.

2.5.3 Soy-Based Formulas

Soy based formulas are made from soy extract and modified with vitamins and minerals. They also contain chemicals called phytoestrogens, which increase the levels of estrogen when consumed (Setchell et al. 1997). Babies fed only with soy-based formulas may be affected in later life during the development of the reproductive system due to an increase in the levels of phytoestrogens in the body. Although this remains controversial, soymilk formulas are not recommended for premature babies or babies under 6 months old with food allergies (Strom et al. 2001; Adgent et al. 2012). Infants who develop allergic reactions to cow-based milk formulas are also more likely to be allergic to soymilk formulas (Adgent et al. 2012). Lactose intolerance, which includes symptoms such as abdominal pain, bloating wind and diarrhea, is rare in babies, but can occur if the baby is unable to absorb lactose, a sugar found in milk and milk-based products (Lasekan et al. 2011). Infants with congenital or galactosemia lactase deficiency, however, can be successfully fed with soy-based formulas. Soy-based formulas were made commercially available for the first time in 1929. Initially these formulas were not accepted by parents as they contained soy flour, which caused foul-smelling and loose stools, stained clothing and diaper rash. In the mid-1960s after years of research, it was found that adding isolated soy protein to the formulas gave a product similar to milk-based formulas making it acceptable to parents. In a few cases, however, deficiencies of vitamin K were reported due to the elimination of this compound in the soy during the soy protein isolation process (Deckelbaum et al. 2004). In the United States 40% of the milk formulas currently marketed are soy based.

2.5.4 Goat’s Milk-Based Formulas

The gross composition of goat’s milk includes proteins, fats and ash at concentrations higher than those found in cow milk. The content of lactose in goat’s milk is, however, lower than that of cow’s milk. Goat’s milk formulas are recommended by medical professionals in certain situations where bovine milk can cause allergies in infants. The five major proteins found in goat’s milk-based formulas are αS2-casein, β-casein, β-lactoglobulin, κ-casein and α-lactalbumin. As vitamins C and D are deficient in both cow’s and goat’s milk infant formulas, these components must be added separately. The percentage of folic acid present in goat’s milk is lower than that of human breast milk and cow’s milk. Goat’s milk-based formulas are thus fortified with folic acid in order to prevent infants from becoming anemic. Infants fed only on goat’s milk are over supplied with protein which can cause digestion difficulties. However, the fats in goat’s milk formulas are present as small globules and are thus easily digestible. The supply of calcium and phosphate to infants is one of the most important contributions of milk formulas. Goat’s milk formulas contain 300 mg per serving of calcium and 250 mg per serving of phosphate, making the concentrations of these minerals higher than in human breast milk. An excess of calcium and phosphorus can be given to infants in relation to their daily energy requirement without any negative effects. Nevertheless, the high concentrations of chloride and potassium in goat’s milk formulas mean that they should be diluted