Global standard for the composition of infant formula: recommendations of an ESPGHAN coordinated international expert group.

The Codex Alimentarius Commission of the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) develops food standards, guidelines and related texts for protecting consumer health and ensuring fair trade practices globally. The major part of the world's population lives in more than 160 countries that are members of the Codex Alimentarius. The Codex Standard on Infant Formula was adopted in 1981 based on scientific knowledge available in the 1970s and is currently being revised. As part of this process, the Codex Committee on Nutrition and Foods for Special Dietary Uses asked the ESPGHAN Committee on Nutrition to initiate a consultation process with the international scientific community to provide a proposal on nutrient levels in infant formulae, based on scientific analysis and taking into account existing scientific reports on the subject. ESPGHAN accepted the request and, in collaboration with its sister societies in the Federation of International Societies on Pediatric Gastroenterology, Hepatology and Nutrition, invited highly qualified experts in the area of infant nutrition to form an International Expert Group (IEG) to review the issues raised. The group arrived at recommendations on the compositional requirements for a global infant formula standard which are reported here.

[1]  S. Atkinson,et al.  Protein and Non-Protein Nitrogen in Human Milk , 1989 .

[2]  B. Lönnerdal,et al.  Iron, zinc, copper and selenium status of breast‐fed infants and infants fed trace element fortified milk‐based infant formula , 1994, Acta paediatrica.

[3]  P. Klein,et al.  The importance of alpha-lactalbumin in infant nutrition. , 1991, The Journal of nutrition.

[4]  S. Hanaka,et al.  Comparison of the fatty acid composition of total lipids and phospholipids in breast milk from Japanese women , 2000, Pediatrics international : official journal of the Japan Pediatric Society.

[5]  W. Maclean,et al.  Amino Acid Metabolism in Human Milk-Fed and Formula-Fed Term Infants , 2019, Protein and Non-Protein Nitrogen in Human Milk.

[6]  Robert G. Jensen,et al.  Handbook of milk composition , 1995 .

[7]  K. Dewey,et al.  Protein requirements of infants and children. , 1996, European journal of clinical nutrition.

[8]  P. Moughan,et al.  The amino acid composition of human milk corrected for amino acid digestibility , 1998, British Journal of Nutrition.

[9]  G. Schubiger,et al.  Prevention of vitamin K deficiency bleeding: efficacy of different multiple oral dose schedules of vitamin K , 1997, European Journal of Pediatrics.

[10]  O. Hernell,et al.  Iron supplementation of breast-fed Honduran and Swedish infants from 4 to 9 months of age. , 2001, The Journal of pediatrics.

[11]  Assessment of nutrient requirements for infant formulas. , 1998, The Journal of nutrition.

[12]  B. Lönnerdal,et al.  Copper nutrition during infancy and childhood. , 1998, The American journal of clinical nutrition.

[13]  B. Koletzko,et al.  Short and Long Term Effects of Breast Feeding on Child Health , 2013, Advances in Experimental Medicine and Biology.

[14]  N. Butte,et al.  Energy requirements of lactating women derived from doubly labeled water and milk energy output. , 2001, The Journal of nutrition.

[15]  M. Neville,et al.  B – Major Minerals and Ionic Constituents of Human and Bovine Milks , 1995 .

[16]  G. Putet,et al.  Nutritional evaluation of protein hydrolysate formulas. , 1995, European journal of clinical nutrition.

[17]  R. Gibson,et al.  Supplementation of infant formula with long-chain polyunsaturated fatty acids does not influence the growth of term infants. , 2005, The American journal of clinical nutrition.

[18]  S. Premakumari,et al.  Energy and protein requirements. , 1986, WHO chronicle.

[19]  J. Cook,et al.  Soy protein, phytate, and iron absorption in humans. , 1992, The American journal of clinical nutrition.

[20]  R. Ball,et al.  Amino acid needs for early growth and development. , 2004, The Journal of nutrition.

[21]  Y. Chou,et al.  Effect of Nucleotides on Diarrhea and Immune Responses in Healthy Term Infants in Taiwan , 2003, Journal of pediatric gastroenterology and nutrition.

[22]  S. Donovan,et al.  Non‐Protein Nitrogen and True Protein in Infant Formulas , 1989, Acta paediatrica Scandinavica.

[23]  R. Ball,et al.  The methionine requirement is lower in neonatal piglets fed parenterally than in those fed enterally. , 2003, The Journal of nutrition.

[24]  E. Haschke-Becher,et al.  Whey Predominant, Whey Modified Infant Formula with Protein/energy Ratio of 1.8 g/100 kcal: Adequate and Safe for Term Infants From Birth to Four Months , 2002, Journal of pediatric gastroenterology and nutrition.

[25]  F. Pizarro,et al.  Prevention of iron-deficiency anemia: comparison of high- and low-iron formulas in term healthy infants after six months of life. , 1998, The Journal of pediatrics.

[26]  S. Abrams,et al.  Iron Absorption and Red Blood Cell Incorporation in Premature Infants Fed an Iron-Fortified Infant Formula , 1998, Pediatric Research.

[27]  M. Picciano,et al.  Indices of protein metabolism in term infants fed either human milk or formulas with reduced protein concentration and various whey/casein ratios. , 1987, The Journal of pediatrics.

[28]  M. Boekel,et al.  Addendum to the evaluation of the Kjeldahl factor for conversion of the nitrogen content of milk and milk products to protein content. , 1987 .

[29]  B. Zemel,et al.  Infant weight gain and childhood overweight status in a multicenter, cohort study. , 2002, Pediatrics.

[30]  B. Koletzko,et al.  Do trans fatty acids impair linoleic acid metabolism in children? , 1995, Annals of nutrition & metabolism.

[31]  P. Dallman,et al.  Iron absorption in infants: high bioavailability of breast milk iron as indicated by the extrinsic tag method of iron absorption and by the concentration of serum ferritin. , 1977, The Journal of pediatrics.

[32]  M. Picciano CHAPTER 8 – Vitamins in Milk: A. Water-Soluble Vitamins in Human Milk , 1995 .

[33]  E. Hertrampf,et al.  High absorption of fortification iron from current infant formulas. , 1998, Journal of pediatric gastroenterology and nutrition.

[34]  S. Carlson,et al.  trans Fatty acids: infant and fetal development. , 1997, The American journal of clinical nutrition.

[35]  A. Ogunleye,et al.  Fatty acid composition of breast milk from Nigerian and Japanese women. , 1991, Journal of nutritional science and vitaminology.

[36]  S. Abrams,et al.  Iron absorption in breast-fed infants: effects of age, iron status, iron supplements, and complementary foods. , 2002, The American journal of clinical nutrition.

[37]  B. Koletzko,et al.  Physiological aspects of human milk lipids. , 2001, Early human development.

[38]  Berthold Koletzko,et al.  Polyunsaturated Fatty Acids in Human Milk and Their Role in Early Infant Development , 2004, Journal of Mammary Gland Biology and Neoplasia.

[39]  O. Hernell,et al.  Iron status of infants fed low-iron formula: no effect of added bovine lactoferrin or nucleotides. , 2002, The American journal of clinical nutrition.

[40]  H. Nguyen,et al.  Amino acid composition of human milk is not unique. , 1994, The Journal of nutrition.

[41]  F. Haschke,et al.  Effect of iron fortification of infant formula on trace mineral absorption. , 1986, Journal of pediatric gastroenterology and nutrition.

[42]  G. Putet,et al.  Nutritional evaluation of various protein hydrolysate formulae in term infants during the first month of life , 1994, Acta paediatrica (Oslo, Norway : 1992). Supplement.

[43]  A. Eden Iron fortification of infant formulas. , 2000, Pediatrics.

[44]  P. Reeds,et al.  Nitrogen cycling in the gut. , 1998, Annual review of nutrition.

[45]  S. Abrams New approaches to iron fortification: role of bioavailability studies. , 2004, American Journal of Clinical Nutrition.

[46]  M. Heinig,et al.  Determinants of energy, protein, lipid, and lactose concentrations in human milk during the first 12 mo of lactation: the DARLING Study. , 1991, The American journal of clinical nutrition.

[47]  O. Levander Selenium requirements as discussed in the 1996 joint FAO/IAEA/WHO expert consultation on trace elements in human nutrition. , 1997, Biomedical and environmental sciences : BES.

[48]  K. Carroll Upper limits of nutrients in infant formulas: polyunsaturated fatty acids and trans fatty acids. , 1989, The Journal of nutrition.

[49]  J. Paul Zimmer,et al.  Handbook of Milk Composition , 1996 .

[50]  S. Tarlo,et al.  Anaphylaxis to carrageenan: a pseudo-latex allergy. , 1995, The Journal of allergy and clinical immunology.

[51]  B. Koletzko Trans fatty acids may impair biosynthesis of long‐chain polyunsaturates and growth in man , 1992, Acta paediatrica.

[52]  B. Koletzko,et al.  Identifying children at high risk for overweight at school entry by weight gain during the first 2 years. , 2004, Archives of pediatrics & adolescent medicine.

[53]  A. Bendich Dietary reference intakes for vitamin C, vitamin E, selenium, and carotenoids institute of medicine washington, DC: National Academy Press, 2000 ISBN: 0-309-06935-1 , 2001 .

[54]  E. Forsum,et al.  Casein content of human milk. , 1985, The American journal of clinical nutrition.

[55]  B. Lönnerdal Nutritional aspects of soy formula , 1994, Acta paediatrica (Oslo, Norway : 1992). Supplement.

[56]  N. Butte,et al.  Qualitative Analysis of Human Milk Produced by Women Consuming a Maize-Predominant Diet Typical of Rural Mexico , 1998, Annals of Nutrition and Metabolism.

[57]  L. Davidsson,et al.  Erythrocyte incorporation of iron by infants: iron bioavailability from a low-iron infant formula and an evaluation of the usefulness of correcting erythrocyte incorporation values, using a reference dose or plasma ferritin concentrations. , 2000, The British journal of nutrition.

[58]  Orvillea·Levander Selenium requirements as discussed in the 1996 joint FAO/IAEA/WHO expert consultation on trace elements in human nutrition. , 1997 .

[59]  O. Hernell,et al.  Iron supplementation affects growth and morbidity of breast-fed infants: results of a randomized trial in Sweden and Honduras. , 2002, The Journal of nutrition.

[60]  P. Pencharz,et al.  Use of amino acid profiles of preterm and term human milks in evaluating scoring patterns for routine protein quality assessment of infant formulas. , 1996, Journal of AOAC International.

[61]  Peter D. Klein,et al.  The Importance of α-Lactalbumin in Infant Nutrition , 1991 .

[62]  A. Chicz–DeMet,et al.  Effect of high dietary manganese intake of neonatal rats on tissue mineral accumulation, striatal dopamine levels, and neurodevelopmental status. , 2002, Neurotoxicology.

[63]  P. Trumbo,et al.  Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. , 2002, Journal of the American Dietetic Association.

[64]  Kwaku Poku Asante,et al.  Determination of iron absorption from intrinsically labeled microencapsulated ferrous fumarate (sprinkles) in infants with different iron and hematologic status by using a dual-stable-isotope method. , 2004, The American journal of clinical nutrition.

[65]  O. Hammarsten Zur Frage, ob das Caseïn ein einheitlicher Stoff sei. , 1883 .