Palm Oil and Beta-Palmitate in Infant Formula - A Position Paper by the ESPGHAN Committee on Nutrition

Background: Palm oil (PO) is used in infant formulas in order to achieve palmitic acid (PA) levels similar to those in human milk. PA in PO is esterified predominantly at the SN-1,3 position of triacylglycerol (TAG), and infant formulas are now available in which a greater proportion of PA is in the SN-2 position (typical configuration in human milk). Since there are some concerns about the use of PO, we aimed to review literature on health effects of PO and SN-2-palmitate in infant formulas. Methods: PubMed and Cochrane Database of Systematic Reviews were systematically searched for relevant studies on possible beneficial effects or harms of either PO or SN-2-palmitate in infant formula on various health outcomes. Results: We identified 12 relevant studies using PO and 21 studies using SN-2-palmitate. Published studies have variable methodology, subject characteristics and some are underpowered for the key outcomes. PO is associated with harder stools and SN-2-palmitate use may lead to softer stool consistency. Bone effects seem to be short-lasting. For some outcomes (infant colic, faecal microbiota, lipid metabolism), the number of studies is very limited and summary evidence inconclusive. Growth of infants is not influenced. There are no studies published on the effect on markers of later diseases. Conclusions: There is insufficient evidence to suggest that PO should be avoided as a source of fat in infant formulas for health reasons. Inclusion of high SN-2-palmitate fat blend in infant formulas may have short-term effects on stool consistency but cannot be considered essential. Address correspondence and reprint requests to Jiri Bronsky, MD, PhD, Assoc. Prof. of Paediatrics Gastroenterology and Nutrition Unit, Department of Paediatrics, University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic (e-mail: jiri.bronsky@gmail.com). Received 22 October, 2018 Accepted 4 February, 2019 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). Secretary of CoN: # Iva Hojsak Chair of CoN: ¤Magnus Domellöf Conflicts of Interest: MF conducted a trial using beta-palmitate which was funded by Industry (Cow & Gate, now Nutricia; in 1995) and has received honoraria for attending two Consultancy meetings with Enzymotec (a company involved in the manufacture of beta-palmitate for infant formulas). Authors report following conflicts of interest outside the submitted work: JB reports personal fees and non-financial support from AbbVie, Nutricia, Biocodex, personal fees from MSD, Nestlé, Ferring, Walmark. CC received research funding from ORDESA Laboratories and Abbott Nutrition. NE reports receipt of grants/research supports from National Institutes for Health Research (UK), Prolacta, Bioscience (US) and Danone Early life Nutrition. He also served as member of Advisory board for Danone Early life Nutrition and received payment/honorarium for lectures from Danone Early life Nutrition, Nestle Nutrition Institute, Baxter and Fresenius Kabi. KG reports personal fees from Nutricia, research grants and personal fees from Nestle and Nutricia and personal fees from Dr Falk. IH reports receipt of payment/honorarium for lectures from BioGaia, Nutricia, Nestle, GM pharma and receipt of payment/honorarium for consultation from Farmas,Chr Hansen. JH reports receipt of grants/research supports from Nutricia Advanced Medical Nutrition Netherlands and Danone Medical care (global). FI has participated as a clinical investigator and/or consultant and/or speaker for Arla Food, Biogaia, Nestle, Nestle Nutrition Institute, Wyeth, Danone and Abbott. AL received lecture fees and/or non-financial support from Baxter, Fresenius, Nestle [Combining Acute Accent] and Mead Johnson Nutrition. NFM acknowledges support of the Slovenian Research Agency (P3–0395: Nutrition and Public Health; L3-8213, L3-7538). CM reports receipt of grants/research supports from European Commission Innovation Fund Denmark, Nordea-fonden, Arla Foods, Chr. Hansen, USDEC, Gate Foundation. SJM reports receipt of grants/research supports from DSM Nutritional Products, she served as member of advisory board and received payment/honorarium for consultation from Baxter and received payment/honorarium for lectures from Baxter and Fresenius Kabi. EV reports grant/research support from Nutricia Italia Spa, Nestle Health Science - Vitaflo Italy, FoodAR srl Italy, PIAM Pharma and Integrative Care. RV reports no conflict of interest. MD has recived speaker fees from Baxter, Fresenius, Semper, Abbvie, Nestlé and research support from Baxter and Prolacta. © 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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