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Choline Content of Term and Preterm Infant Formulae Compared to Expressed Breast Milk-How Do We Justify the
Anna Shunova1, Katrin A Böckmann1, Michaela Minarski1
1Department of Neonatology, University Children's Hospital, Tübingen University Hospital, 72076 Tübingen, Baden-Wuerttemberg, Germany.
Insights
Infant formulas often lack adequate choline and the correct forms compared to breast milk, potentially impacting preterm infant development. Revision of formula composition and clear labeling are needed for optimal infant nutrition.
Area of Science:
- Nutritional Science
- Biochemistry
- Pediatrics
Background:
- Choline and phosphatidylcholine are vital for infant growth, especially during the third trimester.
- Preterm infants have higher choline requirements (~50-60 mg/kg/day) than term infants (17-18 mg/kg/day) to match fetal plasma concentrations.
- Enteral feeding introduces choline via various carriers, necessitating analysis of infant formulas.
Purpose of the Study:
- To quantify choline carriers and related components in infant formulas and fortifiers compared to breast milk.
- To calculate choline supply from formulas at full feeds (150 mL/kg/day).
- To assess if current formulas meet the choline needs for achieving fetal plasma concentrations in preterm infants.
Main Methods:
- Analysis of choline concentrations and types (free choline, phosphatidylcholine, glycerophosphocholine, phosphocholine) in various infant formulas and fortifiers.
- Comparison with breast milk composition.
- Calculation of choline supply based on standard feeding volumes (150 mL/kg/day) using tandem mass spectrometry.
Main Results:
- Choline concentrations varied significantly among formulas, with some exceeding breast milk levels.
- Specific formulas like Humana 0-VLB, Aptamil-Prematil, Aptamil-Prematil HA, and Humana 0 showed high choline concentrations.
- Most formulas predominantly contained free choline or phosphatidylcholine, unlike human milk, which is rich in glycerophosphocholine and phosphocholine.
Conclusions:
- Most infant formulas analyzed do not provide the necessary amount and physiological forms of choline to achieve target fetal plasma concentrations in preterm infants.
- A revision of choline content in formulas and fortifiers is recommended.
- Clear declaration of choline components in infant formulas is required for informed parental and clinical choices.
Abstract:
Choline/phosphatidylcholine concentrations are tightly regulated in all organs and secretions. During rapid organ growth in the third trimester, choline requirement is particularly high. Adequate choline intake is 17-18 mg/kg/day in term infants, whereas ~50-60 mg/kg/day is required to achieve fetal plasma concentrations in preterm infants. Whereas free choline is supplied via the placenta, other choline carriers characterize enteral feeding. We therefore quantified the concentrations and types of choline carriers and choline-related components in various infant formulae and fortifiers compared to breast milk, and calculated the supply at full feeds (150 mL/kg/day) using tandem mass spectrometry. Choline concentration in formula ranged from values below to far above that of breastmilk. Humana 0-VLB (2015: 60.7 mg/150 mL; 2020: 27.3 mg/150 mL), Aptamil-Prematil (2020: 34.7 mg/150 mL), Aptamil-Prematil HA (2020: 37.6 mg/150 mL) for preterm infants with weights < 1800 g, and Humana 0 (2020: 41.6 mg/150 mL) for those > 1800 g, comprised the highest values in formulae studied. Formulae mostly were rich in free choline or phosphatidylcholine rather than glycerophosphocholine and phosphocholine (predominating in human milk). Most formulae (150 mL/kg/day) do not supply the amounts and physiologic components of choline required to achieve fetal plasma choline concentrations. A revision of choline content in formulae and breast milk fortifiers and a clear declaration of the choline components in formulae is required to enable informed choices.
