Effect of Dietary Fat on Cardiovascular Risk Factors in Infancy

Abstract

Objective. To determine the effects of feeding regimens of varying fat composition on dietary intake and serum lipid and lipoprotein concentrations in older infants. Design, setting, and participants. One hundred four healthy infants aged 4 to 6 months were enrolled from private pediatric practices or public health clinics and were randomly assigned to one of four feeding groups until 12 months of age. Interventions. Infants received whole cow milk or a standard infant formula (48% to 49% of energy as fat from butterfat or a soy-coconut oil blend, respectively) or one of two nearly identical investigational lower fat follow-up formulas (36% kcal from a fat blend of palm olein, corn, and safflower oils) as their primary food source in addition to table foods. Main outcome measures. Nutrient intakes during the study period were characterized qualitatively and quantitatively. Serum lipids, lipoprotein concentrations, and anthropometrics were determined at baseline and at 12 months of age (study completion). Results. Total energy intake was equivalent among feeding groups. Infants fed cow milk had higher mean daily intakes of total fat, saturated fat, monounsaturated fat, and cholesterol. Linoleic acid intake by infants fed cow milk, including that from table foods, was insufficient to meet current recommendations. Mean serum total cholesterol was significantly higher in the infants fed cow milk at age 12 months, whereas mean low density lipoprotein and apolipoprotein B were lower in the infants fed the follow-up formulas. Infants consuming the infant formula or whole cow milk demonstrated greater increases in mean serum total cholesterol, low density lipoprotein, and apolipoprotein B by 12 months of age compared with infants ingesting follow-up formula. Ponderal, linear, and head circumference growth was equivalent among feeding groups. Conclusions. (1) Older infants fed lower fat formula have adequate total energy intake and normal growth. (2) The fat composition of the diets fed to the infants influenced serum lipid and lipoprotein profiles. (3) The fat composition of cow milk is inferior compared with commercial formulas. (4) The optimal fat blend for older infants including the consequences of the standard practice of adding high percentage of coconut oil to infant formulas should be defined further.

Palm Oil and Beta‐palmitate in Infant Formula

“…A lower serum TAG level at day 90 in the non‐POL group when compared with the POL‐group was found in the first study but there was no difference in TAG levels when compared with a human milk group in any of the formula groups (37). In the other study, infants consuming POL‐based follow‐up formula had lower increases in mean serum total cholesterol, LDL, and apo B by 12 months of age compared with infants ingesting the standard infant formula or whole cow milk (36).…”

“…Published studies that did not include growth as primary outcome (26,33–38,43–45,51,52,54–57) did not show any significant differences between PO/POL/SN‐2‐palmitate base formulas and controls. In an animal experiment, a small but significant improvement in most growth parameters was found in the rats fed beta‐palmitate‐based diet when compared with controls (86).…”

“…The RCT by Fuchs et al has shown that older infants fed lower fat formula have adequate total energy intake and normal growth and that the fat composition of the diets influenced serum lipid and lipoprotein profiles. The design of the study, however, does not allow any POL‐specific conclusions, and POL as source of dietary fat may not necessarily be fully responsible for the above‐mentioned metabolic changes (36). Results of an RCT by Nelson and Innis (57) suggest that at least 50% of the dietary SN‐2‐palmitate is conserved through digestion, absorption, and chylomicron TAG synthesis in breastfed and formula‐fed infants.…”

“…No relevant intervention studies were found focused primarily on the effect of PO/POL-containing formula on predictors (markers) of metabolic diseases (cardiovascular health, T2DM, hypertension, etc) in infants and children. Two RCTs were identified that focused on lipid profile in healthy infants with several months of follow-up (36,37). A lower serum TAG level at day 90 in the non-POL group when compared with the POL-group was found in the first study but there was no difference in TAG levels when compared with a human milk group in any of the formula groups (37).…”

Macronutrient and Energy Intakes in Young Children Fed Milk Products Containing Different Quantities and Qualities of Fat and Protein

“…On the contrary, a diet rich in monounsaturated fats seems to reduce the total and LDL cholesterol, which could decrease the risk for coronary heart disease (6). Current dietary recommendations for children propose a total fat intake of 30% of the daily energy intakes and a saturated fat intake of approximately 10% of energy from 2 to 3 years of age (4‐6).…”