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Plant-Derived Amino Acid-Based vs. Bovine-Derived Protein Human Milk Fortifiers in Preterm Infants at <34 Weeks'
Nikhil Kumar Mudmal1, Viraraghavan Vadakkencherry Ramaswamy1,2, Nasreen Banu Shaik1
1Department of Neonatology, Ankura Hospital for Women and Children, Kukatpally, Hyderabad 500072, Telangana, India.
Nutrients
|August 13, 2026
Summary
A new plant-derived human milk fortifier (HMF) is safe and feasible for preterm infants. This fortifier showed improved in-hospital weight gain compared to bovine-derived HMFs, warranting further research.
Area of Science:
- Neonatal nutrition
- Pediatric gastroenterology
- Clinical nutrition
Background:
- Bovine milk protein-based human milk fortifiers (HMFs) are standard for preterm infants but carry risks.
- Plant-derived amino acid-based HMFs offer a potential alternative, yet comparative trial data is limited.
- This study addresses the need for evidence on plant-derived HMFs in low- and middle-income countries (LMICs).
Purpose of the Study:
- To assess the feasibility, safety, and growth outcomes of a novel plant-derived amino acid-based HMF.
- To compare these outcomes against a traditional bovine-derived whole-protein-based HMF in preterm infants.
- To generate hypothesis for future, larger-scale clinical trials.
Main Methods:
- A pilot randomized controlled trial (RCT) involving preterm infants (<34 weeks' gestation).
- Infants were randomized to receive either plant-derived (n=66) or bovine-derived (n=70) HMF.
- Primary outcomes included time to reach 180 mL/kg/d enteral feeds and growth velocities; safety was also monitored.
Main Results:
- No significant difference was observed in the time to reach 180 mL/kg/d enteral feeds between the groups.
- Infants receiving the plant-derived HMF exhibited significantly higher in-hospital weight gain.
- Subgroup analysis indicated this weight gain benefit was most pronounced in infants with higher birth weights (≥1500 g).
Conclusions:
- The plant-derived amino acid-based HMF is clinically feasible and well-tolerated in preterm infants.
- It demonstrated improved in-hospital weight gain compared to bovine-derived HMF, potentially due to macronutrient differences.
- Results are promising but require confirmation in adequately powered future studies.
