How many times has a parent come to you with concerns over formula tolerance in their infant? In our practices, it happens regularly. Whether it be fussiness, constipation or spit-ups, perceived intolerance is frequently reported by families as a reason for switching infant formulas.
We don’t know about you, but we’re always looking for little tips and tricks to offer families, especially regarding infant formula. We’re going to dive a little deeper today on the addition of palm olein to infant formula and how it may be impacting infant stooling patterns.
What is palm olein?
The fat sources in commercially available infant formulas vary and typically include some combination of coconut, sunflower, soy and safflower oils.
Palm olein (PO), from fractionated palm oil, is added to some infant formulas to try and match the fat profile of human milk, 23% palmitic acid and 34% oleic acid. However, the chemical structure of PO from plant sources (ie. fractionated palm oil) is different from that in human milk. The added PO results in insoluble fatty acids that form poorly absorbed calcium salts which are excreted in the stool.
Are there differences in stool patterns for infants fed formulas containing palm olein?
Yes. Lloyd published a study in Pediatrics in 1999 showing infants fed formula containing PO, compared to formula without, have been found to have firmer, greener in colour and less frequent stools.
The theory is that the level of poorly absorbed calcium salts is correlated with stool hardness.
What about fat and calcium absorption?
A 2006 review of Medline and Cochrane by Koo found that infants consuming formula containing palm olein in levels to match palmitic acid in human milk had lowered absorption of calcium and fat, and lowered bone mass compared to infants who consumed formula without PO.
However ….
Authors of this study were critiqued in that even the lower bone mass was considered to be in the normal range and therefore could not be considered adverse to infant health. Additionally, a longer term study by Young was not included in this 2006 review. It found no differences at 4 years of age in bone mineral density between children fed formula containing PO versus without.
Pearls
We are always looking for new tricks and tips to add to our toolkit. For parents who are concerned about harder or infrequent stools in their formula-fed infant, trialing a formula without palm olein would be a worthwhile consideration.
Interested in reading the research on palm olein?
Check out these key studies:
Lloyd B, Halter RJ, Kuchan MJ, Baggs GE, Ryan AS, Masor ML. Formula tolerance in postbreastfed and exclusively formula-fed infants. Pediatrics. 1999 Jan;103(1):E7. https://www.ncbi.nlm.nih.gov/pubmed/9917487
Koo WW, Hockman EM, Dow M. Palm olein in the fat blend of infant formulas: effect on the intestinal absorption of calcium and fat, and bone mineralization. J Am Coll Nutr. 2006 Apr;25(2):117-22. https://www.ncbi.nlm.nih.gov/pubmed/16582027
Young RJ, Antonson DL, Ferguson PW, Murray ND, Merkel K, Moore TE. Neonatal and infant feeding: effect on bone density at 4 years. J Ped Gastr Nutr. 2005;41:93. https://www.ncbi.nlm.nih.gov/pubmed/5990636
We’d love to hear from you .Is PO something that’s been on your radar for some time or is this new to you?
Stay safe!
Charlene and Julie
