COVER STORY
FOLLOW-ON FORMULA: FRIEND OR FOE? Judy Paterson Registered Dietitian, Hampshire Hospitals NHS Foundation Trust
Judy has worked as a Paediatric Dietitian for two years in general paediatrics and neonates, with a special interest in gastroenterology. She is passionate about evidencebased nutritional care and promoting the role of the dietitian.
Follow-on formula milk (FOFM) is targeted at infants starting to introduce complementary foods from six to 12 months of age. This article discusses the definition, purpose and suitability of FOFM for infants and the effects of the marketing of such on breastfeeding in the UK. The legal definition of FOFM from the Department of Health (DH) is: ‘foodstuffs intended for particular nutritional use by infants when appropriate complementary feeding is introduced and constituting the principal liquid element in a progressively diversified diet of such infants.’1 The main difference between first infant formula milk and FOFM is the iron content.2 The other subtle differences include vitamin D, protein and carbohydrate content (see Table 1). Prior to 2014, FOFM had higher protein levels which are associated with risks of obesity.2-4 As a result of guidance from the European Food Safety Authority (EFSA), protein content has been reduced in recent years,5,6 but is still higher than estimated in breastmilk, due to disparities in amino acid profile between breastmilk and bovine milk.2-5 Regulations require infant formula to contain an available quantity of each amino acid at least equal to that found in human breastmilk.3-6 FOFMs contain more carbohydrate and are sweeter than first infant milk. Two FOFMs (see Table 1) also contain maltodextrin which reduces their sugar content, although it is not clear whether this also reduces their sweetness. Finally, the cost of FOFM is marginally higher than first infant milk in the region of £0-2 per month.
Goats’ milk based FOFM, which was previously excluded from the European market due to safety concerns, became available in the UK market following a revision of guidance by EFSA in 2012.7 These have not been included in Table 1 overleaf. However, it is likely to present additional challenges for healthcare professionals with respect to claims of being ‘free from cows’ milk protein’, whilst also being more expensive than their cows’ milk based counterparts. MICRONUTRIENT COMPOSITION
A possible advantage to using FOFM over first infant formula is related to its fortification with iron. Iron-deficiency anaemia is one of the most common nutritional deficiencies in infants and toddlers.8 Babies’ iron stores are much reduced at around six months of age and require iron-containing solids to be introduced in complementary feeding to meet demands for growth.9 A recent study10 found FOFM to be positively associated with iron status in late infancy, whilst cows’ milk was www.NHDmag.com April 2017 - Issue 123
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