Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants

Abstract

There is no evidence to support feeding with a hydrolysed formula for the prevention of allergy in preference to exclusive breast feeding. In high risk infants who are unable to be completely breast fed, there is evidence that prolonged feeding with a hydrolysed compared to a cow's milk formula reduces infant and childhood allergy and infant CMA. Further trials are required to determine if significant clinical benefits persist beyond 5 years of age and if there is any additional benefit from use of an extensive compared to a partially hydrolysed formula. Incremental costs of formula and the effect on compliance should be measured.

Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis

“…Subgroup analysis suggested a significant difference in outcome according to study design or disease risk, with a more positive outcome in the single quasi-randomised controlled trial of normal risk infants. Analysis of data from randomised controlled trials for the most commonly studied partially hydrolysed formula (Nan HA/Good Start/Nidina HA/Beba HA, Nestlé, Vevey, Switzerland) showed no significant effect on risk of eczema at age 0-4 (0.94, 0.75 [5][6][7][8][9][10][11][12][13][14]. Direct comparison of extensively versus partially hydrolysed formula, and casein versus whey dominant extensively hydrolysed formula, did not show a significant difference in risk of eczema at age 0-4 or 5-14.…”

“…Direct comparison of extensively versus partially hydrolysed formula, and casein versus whey dominant extensively hydrolysed formula, did not show a significant difference in risk of eczema at age 0-4 or 5-14. When we combined data for partially and extensively hydrolysed formula as "any hydrolysed formula" there was evidence of reduced eczema at age 0-4 (but not at age [5][6][7][8][9][10][11][12][13][14]. This analysis necessitated use of per protocol data from the GINI study, had high statistical heterogeneity, and showed evidence of publication bias (fig 8).…”

“…[55][56][57] Data from the Chandra studies played an important role in a 2003 Cochrane review, which concluded that hydrolysed formula reduces allergic disease. 58 Subsequent systematic reviews have excluded the Chandra data. The evidence of publication bias that we found, however, suggests that these systematic reviews might still overestimate the possibility that hydrolysed formula has beneficial effects.…”

Hydrolyzed dietary casein as compared with the intact protein reduces postprandial peripheral, but not whole-body, uptake of nitrogen in humans

“…Another important implication relates to the widespread use of hydrolyzed protein-based formulas for infant feeding. The effect on growth and metabolism warrants further research, especially in children that can tolerate ingestion of whole protein (47).…”

Study finds little impact of hydrolysed formula on risk of allergic disease, but study methods may limit conclusions and generalisability

“…[1][2][3] In 2012, the Food and Drug Administration (FDA) concluded that a particular partial whey hydrolysate could reduce the risk of eczema in high-risk infants. Boyle and colleagues, however, come to a different conclusion, and state that the current guidelines recommending hydrolysates to prevent allergic disease in high-risk infants are not supported.…”