Differential growth patterns among healthy infants fed protein hydrolysate or cow-milk formulas

Abstract

Objective: Infant formulas differ considerably in composition and sensory profiles. In this randomized study, we examined whether healthy infants fed an extensively protein hydrolysate formula (PHF) would differ in feeding behavior and growth from those fed cow-milk formula (CMF).

Patients and methods: Infants were randomly assigned to be fed CMF or PHF between 0.5 and 7.5 months of age. Each month for 7 months, infants were weighed and measured and then videotaped while being fed their assigned formula. Anthropometric z scores were calculated by using World Health Organization growth standards. Multilevel linear growth and piecewise mixed-effects models compared trajectories for growth measures and formula acceptance.

Results: When compared with infants fed CMF, infants fed PHF had significantly lower weight-for-length z scores across ages 2.5 to 7.5 months. There were no differences in length-for-age z scores, which indicate that group differences resulted from gains in weight, not length. Infants fed PHF also had significantly slower weight gain velocity compared with infants fed CMF. During the monthly assessments, PHF-fed infants consumed less formula to satiation than did CMF-fed infants across the study period. Maternal ratings of infants' acceptance of the formula did not differ at any age.

Conclusions: z-score trajectories indicate that CMF-fed infants' weight gain was accelerated, whereas PHF-fed infants' weight gain was normative. Whether such differences in growth are because of differences in the protein content or amino acid profile of the formulas and, in turn, metabolism is unknown. Research on the long-term consequences of these early growth differences is needed.

Trial registration: ClinicalTrials.gov NCT00994747.

Figures

FIGURE 1

Infant weight-for-age (A), weight-for-length (B), and length-for-age (C) z-score trajectories from birth to 7.5 months according to formula group. z scores were calculated by using the WHO growth standards. The arrow (↓) indicates the age at which infants were randomly assigned to either CMF or PHF. Infants randomly assigned to PHF had significantly lower weight-for-age and weight-for-length z scores and significantly less weight-for-age and weight-for-length z score change than did infants randomly assigned to CMF. No effect of formula was found for length-for-age z scores. A z score of 0 is considered normative, and z score-tracking is a clinical indicator of normative growth. a Groups differed significantly at P < .05 in the posthoc comparison.

FIGURE 2

A, Infant weight-gain velocity, calculated as weight change (in kilograms) divided by age change (in days) between assessments (which were ∼1 month apart), from 1.5 to 7.5 months for infants randomly assigned to either CMF or PHF. B, Infant linear-growth velocity, calculated as length change (in centimeters) divided by age change (in days) between assessments (which were ∼1 month apart), from 1.5 to 7.5 months for infants randomly assigned to either CMF or PHF. x-axis values represent the end point for the monthly linear-growth velocity calculation (eg, 1.5 months represents the length change between the 0.5- and 1.5-month visits). Infants randomly assigned to PHF had significantly slower overall weight-gain velocity (F1,44 = 6.60; P < .05) (A) but no difference in linear-growth velocity (F1,44 = 0.02; P = .89) (B) across the study period than did infants randomly assigned to CMF.