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Fermented infant formulas without live bacteria: a systematic review

Abstract

Fermented formulas, i.e., those fermented with lactic acid-producing bacteria during the production process and not containing significant amounts of viable bacteria in the final product, are widely available in many countries. Our aim was to systematically review published evidence related to the safety and health effects of the administration of fermented infant formulas compared with standard infant formulas. The Cochrane Library, MEDLINE, and EMBASE databases and major pediatric conference proceedings were searched. Five randomized controlled trials (RCTs) involving 1326 infants met the inclusion criteria. Compared with standard formula, the use of fermented formula resulted in a similar weight gain and length gain during the study period. Data from one RCT, albeit large, suggest the effectiveness of fermented formula in preventing and treating acute diarrhea. Fermented formula has the potential to reduce some, albeit not well-defined, digestive symptoms. Current evidence does not support the use of fermented formula for preventing cow’s milk allergy.

Conclusion: Limited available evidence suggests that the use of fermented infant formula, compared with the use of standard infant formula, does not offer clear additional benefits, although some benefit on gastrointestinal symptoms cannot be excluded.

What is known
Fermented formulas, i.e., those fermented with lactic acid-producing bacteria during the production process and not containing significant amounts of viable bacteria in the final product, are widely available in many countries.
What is new
Limited evidence available suggests that the use of fermented infant formula, compared with the use of standard infant formula, does not offer clear additional benefits, although some benefit on gastrointestinal symptoms cannot be excluded. At the same time, no negative health effects have been documented.

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Fig. 1

Abbreviations

BB C5:

Bifidobacterium breve C50

BF:

Breastfed

ESPGHAN:

European Society for Paediatric Gastroenterology, Hepatology and Nutrition

FF:

Fermented formula

GI:

Gastrointestinal

IF:

Infant formula

IF+:

Infant formula containing only a prebiotic mixture of short-chain galactooligosaccharides and long-chain fructooligosaccharides

lcFOS:

Long-chain fructooligosaccharides

LF15+:

Infant formula containing a prebiotic mixture of short-chain galactooligosaccharides and long-chain fructooligosaccharides and 15 % LactofidusTM

LF50:

Infant formula containing only 50 % Lactofidus

LF50+:

Infant formula infant formula containing a prebiotic mixture of short-chain galactooligosaccharides and long-chain fructooligosaccharides and 50 % Lactofidus

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

RCT:

Randomized controlled trial

scGOS:

Short-chain galactooligosaccharides

ST065:

Streptococcus thermophilus

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Authors’ contributions

HS conceptualized the study. All authors contributed to the design of the study and read and approved the manuscript. All authors contributed to the development of the first and the final draft of the manuscript.

Discussed under Ethical Approval

Funding

There was no funding for this review.

Conflict of interest

HS has served as a speaker for Danone and Nutricia. AS and MPL declare no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Correspondence to Hania Szajewska.

Additional information

Communicated by Peter de Winter

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Szajewska, H., Skórka, A. & Pieścik-Lech, M. Fermented infant formulas without live bacteria: a systematic review. Eur J Pediatr 174, 1413–1420 (2015). https://doi.org/10.1007/s00431-015-2629-y

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  • DOI: https://doi.org/10.1007/s00431-015-2629-y

Keywords

  • Children
  • Feeding
  • Fermented formula
  • Nutrition
  • RCT