Should Partial Hydrolysates Be Used as Starter Infant Formula? A Working Group Consensus

Abstract

Partially hydrolyzed formulas (pHFs) are increasingly used worldwide, both in the prevention of atopic disease in at-risk infants and in the therapeutic management of infants with functional gastrointestinal manifestations. Because prevention is always preferable to treatment, we reviewed the literature aiming to find an answer for the question whether pHF may be recommended for feeding all infants if breast-feeding is not possible. PubMed and Cochrane databases were searched up to December 2014. In addition, to search for data that remained undetected by the searches, we approached authors of relevant articles and major producers of pHFs asking for unpublished data. Because few data were found, nonrandomized, controlled trials and trials in preterm infants were included as well. Overall, only limited data could be found on the efficacy and safety of pHF in healthy term infants. Available data do not indicate that pHFs are potentially harmful for healthy, term infants. With respect to long-term outcomes, particularly referring to immune, metabolic and hormonal effects, data are, however, nonexistent. From a regulatory point of view, pHFs meet the nutrient requirements to be considered as standard formula for term healthy infants. Cost, which is different from country to country, should be considered in the decision-making process. Based on limited available data, the use of pHF in healthy infants is safe with regard to growth. The lack of data, in particular for metabolic consequences and long-term outcomes, is, however, the basis for our recommendation that health authorities should develop and support long-term follow-up studies. Efficacy and long-term safety data are required before a recommendation of this type of formula for all infants can be made.

Use of partially hydrolysed formula in infancy and incidence of eczema, respiratory symptoms or food allergies in toddlers from the ELFE cohort

“…A working group consensus concluded the paucity of data unables to recommend pHF for every infants as second choice for infant feeding when breastfeeding is not possible. 38 In this nationwide cohort, the use of pHF-HA at 2 months was not associated with a lower risk of any of the studied allergy-related symptoms up to 2 years and was even associated with a higher risk of wheezing, FA, and, to a lesser extent, eczema. These findings must be confirmed in other studies worldwide but raise questions about the harmlessness of the largescale pHF use and contribute to the debate around the accuracy of recommending pHF as a way of preventing allergy development in non-breastfed at-risk infant.…”

“…A working group consensus concluded the paucity of data unables to recommend pHF for every infants as second choice for infant feeding when breastfeeding is not possible . In this nationwide cohort, the use of pHF‐HA at 2 months was not associated with a lower risk of any of the studied allergy‐related symptoms up to 2 years and was even associated with a higher risk of wheezing, FA, and, to a lesser extent, eczema.…”

A partially hydrolyzed 100% whey formula and the risk of eczema and any allergy: an updated meta-analysis

“…However, available data do not indicate that pHFs are potentially harmful for healthy, term infants. Based on limited available data, summarized elsewhere, the use of pHF in healthy infants is safe with regard to growth [35]. …”

Infant formula feeding practices associated with rapid weight gain: A systematic review

“…Three studies considered the effects of protein-hydrolysed formula (Mennella et al, 2011;Roche et al, 1993;Rzehak et al, 2009), in which the protein has been either partially or extensively broken down into smaller peptides (Vandenplas et al, 2016) on weight gain. An RCT found infants (n = 250) fed extensively hydrolysed casein formula had a lower BMI (WHO Multicentre Growth Reference population [2006] charts) growth to 11 months than those fed partially hydrolysed whey 2 One paper involves exposure variables in both the nutrient profile and parent feeding practices section and is included in the parent feeding practice table (Table 3).…”