What is the best infant formula for your baby?
Manuel FernándezWhat is the best infant formula? It is well known that breast milk is the best milk you can offer your baby. But there are many occasions when you will need to rely on formula, whether on your paediatrician's advice or by maternal preference. And today we are lucky that infant formulas have evolved a great deal, but which one should you buy?
That is why our midwives at Happymami have written this post, with the latest evidence on the types of milk, to help you choose the best one for your particular situation.
What should you consider when choosing an infant formula?
To answer this question, we need to know that the quality standard for infant formula is how similar it is to the best milk, which is obviously breast milk; therefore, the closer it is to breast milk, the better the formula will be. In addition, there is a regulation that governs them, and another aspect to bear very much in mind: the degree of compliance with the Technical and Health Regulations (RTS) in the manufacture of Spanish infant formulas.
That is why we have researched and analysed the current options, and we bring you the results we found in a study published by the AEPED on how well these milks meet the recommendations, both in the nutritional composition and in the daily intake of infants.
Composition of breast milk
As we have seen, the quality standard for infant formulas, both first and follow-on, will be breast milk. So let us find out what breast milk is like, and for that the following table shows the composition of breast milk in terms of energy and nutrients. You will also see its correlation with first infant formula in general, with the percentage of adequacy to it. And the comparison of growing-up milk with cow's milk and its adequacy to the latter.
Bear in mind that below we will discuss the composition of each type of milk, so having a general idea of the parameters of breast milk will help you to know which one resembles it more or less, as it is the quality standard.
Ca: calcium; DE: standard deviation; Fe: iron; LCr: growing-up milk; LI: first infant formula; LM: breast milk; LV: cow's milk; Vit: vitamin; -: data not available.
a First infant formulas from table 1.
b Data taken from the Tratado de Nutrición by Ángel Gil, 2010.
c Mean values of the composition of formula milks.
d To calculate the % of adequacy, the average of the energy, protein, carbohydrates and lipids of breast milk was used.
Data taken from the Spanish food composition table, Mataix Verdú.
Are infant formulas suitable?
It is well known that the best milk for your baby is breast milk. This is due to the specificity and bioavailability of its nutrients, and the supply of something that makes it unique: living cells, digestive enzymes, immunomodulators and growth factors.
But if you need an infant formula, you know that these try to reproduce the properties, composition and bioavailability of breast milk. That is why in Spain they are regulated by law, and those currently on the market have an energy and macronutrient content within the margin indicated in the RTS (Technical and Health Regulations) and comply with the recommended amounts.
And as you will see below, bear in mind that most micronutrients such as phosphorus, calcium, retinol, vitamin D, E, C, B6, B12, thiamine, riboflavin and folates are at the lower limit of the RTS (Technical and Health Regulations).
However, the recommended amount of first infant formula exceeds the RDIs for vitamin E, C, retinol, B-group vitamins and folates, and of vitamin B12 for follow-on formulas.
What is the best infant formula according to the World Health Organization?
The World Health Organization (WHO) emphasises that the best option for feeding babies during the first six months of life is exclusive breastfeeding. According to the WHO, this practice provides all the nutrients needed for optimal growth and development of infants, as well as protecting them against common illnesses such as diarrhoea and pneumonia. After six months, it is recommended to complement breast milk with nutritious solid foods, maintaining breastfeeding until two years of age or beyond. (https://www.who.int/tools/elena/interventions/exclusive-breastfeeding)
If, for specific reasons, breastfeeding is not possible, the WHO suggests the use of a suitable and safe infant formula. However, there is no “best” brand of infant formula universally recommended by the WHO, as the choice must be based on the quality of the product and the individual needs of the baby, as well as local health and nutrition conditions. It is crucial that formulas comply with international standards of composition and safety, and that they are used according to the recommendations of a healthcare professional.(https://www.who.int/news/item/15-01-2011-exclusive-breastfeeding-for-six-months-best-for-babies-everywhere)
Who regulates the composition of milk?
In Spain, they are regulated by Royal Decree 867/2008 of 23 May, which transposes the EU directive (2006/141/EC) approving the specific Technical and Health Regulations (RTS) for first and follow-on infant formulas.
This Decree sets the minimum and maximum values of nutritional content. Its aim is to provide values for establishing nutritionally adequate intakes from infant formulas.
Bear in mind that these values are established independently, on the basis of scientific tests carried out on babies and taking the composition of breast milk as a reference.
A very interesting point is that for growing-up milk there is no specific directive on composition, which is why manufacturers of infant formula follow the existing recommendations for follow-on formulas.
Which first infant formula is most similar to breast milk?
In a study published in the Spanish annals of paediatrics, the similarity of the types of infant formulas to breast milk was checked, and these are the results. This study reviewed 31 infant formulas, of which 18 were first infant formulas, 10 follow-on formulas and 3 growing-up milks.
And before looking at the tables, as a conclusion, the main differences between first and follow-on formulas are a greater supply of energy and nutrients in the latter. In addition, growing-up milks provide more energy (76 kcal/100 ml), protein, phosphorus, calcium, retinol, vitamin D, riboflavin and folates than follow-on formulas.
First infant formulas comply with Spanish regulations regarding macronutrient composition. But if we compare them with breast milk, the supply of micronutrients such as phosphorus, calcium, retinol, vitamins D, E, C, thiamine, riboflavin, vitamins B6, B12 and folates is lower than the average of the reference values. In contrast, they are higher than breast milk in iron and niacin content.
Comparison of infant formulas
TABLE 1. Composition in energy and nutrients of first-stage formula milks
AGMI: monounsaturated fatty acids; AGPI: polyunsaturated fatty acids; AGS: saturated fatty acids; Ca: calcium; Fe: iron; Mg: magnesium; Na: sodium; P: phosphorus; Vit: vitamin. Blank boxes: information not available. Values are expressed in units/100 ml of product reconstituted to liquid. The nutritional information for the first-stage and special milks has been copied from the Parapharmacy Catalogue (Vademecum) 2010 of the Consejo General de Colegios Oficiales de Farmacéuticos and from the information the manufacturer gives to consumers on the tubs and cartons available for sale.
a Milks designed to cover the nutritional needs of infants with some type of physiological or metabolic disorder that may alter the absorption, digestion or metabolism of a substance.
Which follow-on and growing-up formula is most similar to breast milk?
As with first infant formula, this study checked follow-on and growing-up milks against breastfeeding, obtaining the following results. On a general level, as we will see, follow-on and growing-up milks have a deficit in vitamins D, E, C, retinol, thiamine, riboflavin, niacin, vitamins B6, B12 and folates. They do not reach the average of the reference values; on the contrary, they are above them for minerals such as phosphorus, calcium and iron.
TABLE 2. Composition in energy and nutrients of follow-on and growing-up formula milks
AGMI: monounsaturated fatty acids; AGPI: polyunsaturated fatty acids; AGS: saturated fatty acids; Ca: calcium; Fe: iron; Mg: magnesium; Na: sodium; P: phosphorus; Vit: vitamin. Blank boxes: information not available. Values are expressed in units/100 ml of product reconstituted to liquid. The nutritional information for the first-stage and special milks has been copied from the Parapharmacy Catalogue (Vademecum) 2010 of the Consejo General de Colegios Oficiales de Farmacéuticos and from the information the manufacturer gives to consumers on the tubs and cartons available for sale.
a Milks designed to cover the nutritional needs of infants with some type of physiological or metabolic disorder that may alter the absorption, digestion or metabolism of a substance.
What is the main difference between first and follow-on formulas?
The main differences, which you will see in the tables below, between first and follow-on infant formulas are a greater supply of energy and nutrients in the latter. In addition, growing-up milks provide more energy (76 kcal/100 ml), protein, phosphorus, calcium, retinol, vitamin D, riboflavin and folates than follow-on formulas.
Is it necessary to switch from first infant formula to follow-on formula?
The AEPED has published its opinion on the matter, and I quote verbatim: “follow-on formula is a commercial invention with hardly any practical use. In the United States, the American Academy of Pediatrics recommends giving babies who are not breastfed the same milk throughout the first year. The WHO also considers follow-on formulas unnecessary.”
A suggestion from the book ‘Mi hijo no me come’ by Carlos González:
“(…) It is not that follow-on formula is better for older babies. It is worse than first infant formula, because it is less adapted. But older babies have enough capacity to metabolise it and can tolerate it. Naturally, the dairy industry's advertising tries to turn things around and sell follow-on formula as “enriched with proteins to cover your child's growing needs”. And then it says that those proteins are not needed, that it is nonsense.”
Do these milks cover my baby's needs?
To answer this question, we have a post with a wonderful table that will guide you perfectly, with the amount of milk by age of the newborn, but from a scientific point of view, we can tell you that:
According to the percentages of nutritional requirements covered by the intake of formula milks, an intake of 910 ml of first infant formula ensures and in several cases exceeds the recommended daily amount. The supply of phosphorus, retinol, vitamin E, C, thiamine, riboflavin, niacin, B6, B12 and folates is higher than recommended.
As for half a litre of follow-on formula, it can be seen that it covers 36% of energy requirements, around 50% of macronutrients, vitamin B6 and niacin, between 60% and 70% of the requirements for calcium, iron, retinol and vitamin D, and more than 80% of the requirements for phosphorus, vitamin E, vitamin C, thiamine, riboflavin, vitamin B12 and folates.
The daily intake of half a litre of growing-up milk provides 30% of the recommended energy, around 50% of protein and vitamin C, between 60% and 70% of the requirements for calcium, iron, niacin and folates, and more than 80% of the requirements for phosphorus, retinol, vitamin D, riboflavin and vitamin B12. As for the content of carbohydrates, vitamin E, B6 and thiamine, growing-up milk does not cover 50% of the recommendations.
Table 3. Percentage of nutritional requirements covered by the intake of formula milks
LC: follow-on formula; LCr: growing-up milk; LI: first infant formula; Ca: calcium; DE: standard deviation; Fe: iron; ND: not determined; Vit: vitamin; -: data not available.
a AI: Adequate Intake. (a, b, c) A child aged 3, 9 and 18 months ingests 910, 500 and 500 ml of formula respectively according to the recommendations of the Clínica Universidad de Navarra, 2011.
b RDI: recommended dietary intakes for the Spanish population, 2009.
c DRI: Dietary Reference Intakes of the Institute of Medicine of the National Academies of the United States and
Canada, 2002.
Which infant formula is the best?
Undoubtedly, after all this information, things may not be entirely clear to you, and unless your paediatrician has recommended a specific milk because of a particular characteristic of your baby, our recommendation is to choose the milk you trust most. Because, looking at the data, all milks comply with the Technical and Health Regulations (RTS) in the manufacture of Spanish infant formulas. Therefore, they guarantee their safety and their functionality for feeding your baby if you need or want to use infant formula.
Conclusion: What is the best infant formula?
As we always tell you, every case is unique, and you should adapt this information to your own situation. Undoubtedly, many mums, when they talk to us to design their bottle, ask us about an infant formula, and our answer is always the same: try the one you trust most!
Because we can tell you that, for example, it worked well for my daughter, but your baby may not like it, because just as you do not like every milk, neither does your baby.
Another piece of advice we give, and which I will take the opportunity to introduce here, is to buy the smallest tub, so that if they do not like it, you spend as little money as possible, and also, some pharmacies give out milk samples, so you can try several before making any purchase. Lots of encouragement for this intense stage!
