What we should know about the carbohydrate component of infant formula

Abstract

The article is devoted to the discussion of the carbohydrate component of infant formula for feeding healthy and sick children. The role of glycemic and non-glycemic carbohydrates is shown. In addition to lactose, the following glycemic carbohydrates can be used in infant formulas: maltose, sucrose, glucose, glucose syrup, maltodextrins, pretreated starch and gelatinized starch. Resistant oligosaccharides, nonstarch polysaccharides, and resistant modified starches are also used in child nutrition. The composition and amount of lactose, the main carbohydrate of women’s milk, is discussed. The article presents data on the role of galactose, which is conditionally essential for children in the first months of life due to the rapid growth rate of the infant. Information is presented on the lactose breakdown, the importance of enzymes in the digestion and assimilation processes, the prebiotic effects of lactose, and its effect on the absorption of calcium and other minerals. Advantages of lactose include its low glycemic index, as well as its reduced sweetness, which affects the proper development of taste and low risk of dental caries compared to other fermentable sugars. Specific requirements for the carbohydrate composition of low-lactose and lactose-free formulas are discussed because of the often unwarranted increase in the frequency of their use. Evidence is presented using the Cochrane Systematic Review (2018) that reducing or eliminating lactose from infant formulas in infants with infantile colic is not always appropriate. Special low-lactose and lactose-free formulas replace lactose with glucose polymers such as maltodextrin, glucose syrup, and solid glucose syrup, which are produced by hydrolyzing starches (corn, rice, or potato). The article discusses the data on the effect of maltodextrin on the state of the intestinal mucosa, the microbiota of the large intestine and the possible role of this ingredient in the pathogenesis of chronic inflammatory bowel diseases. The results of various studies regarding the effect of maltodextrin on the intestinal microbiota are contradictory. However, special low-lactose or lactose-free products are prescribed in the presence of symptoms of lactase deficiency in an artificially fed baby. It is a major mistake to prescribe lactose-free mixtures on the basis of intact protein or partially hydrolysed ones for secondary lactase deficiency caused by an allergy to cow’s milk proteins. The carbohydrate component of Friso therapeutic hydrolysates contains no maltodextrin, and lactose is partially or completely replaced with glucose syrup.