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Our Unique Formulation: Milk Fat as a source of Fat and naturally occurring Milk Fat Globule Membrane (MFGM)

 

Article Summary

  • Industry standard is to source 100% of fat in formula from vegetable oils (aka cooking oils). Kendamil uses mammalian milk fat instead of relying solely on vegetable oils
  • Mammalian milk fat has naturally occurring short and medium chain fatty acids which are easier to digest. These fatty acids are absent in vegetable oils (with the exception of coconut and palm oil) .
  • Palmitic acid is a major saturated fatty acid source found in mammalian milk. Vegetable oil blends rely on palm oil to deliver this content. The chemical positioning of the palmitic acid on a glycerol backbone differs between mammalian milk sources versus palm oil.
  • The palmitic acid found in palm oil is harder to digest and has been correlated to hard stool, constipation and bone demineralisation as it cross reacts with calcium to form hard soaps in the gut. 
  • Infants on drinking formula with milk fat experienced less gut discomfort, crying and fussiness as well as less hardening fatty soap content in stools. 
  • Naturally occurring Milk Fat Globule Membrane (MFGM) is found in the milk fat used in Kendamil. Clinical studies done on infants have shown that MFGM improves neurodevelopment and language development. MFGM also reduces the amount of episodes of diarrhoea and respiratory sickness, as well as infection in general. 

 

The Case for Whole Milk Fat Over Vegetable Oils 

Fats are one of the three primary macronutrients in breastmilk that a baby relies on for energy and development. Fat accounts for about 33% of the dry weight content of breast milk, the second most abundant nutrient after carbohydrates, and infants get 50% of their energy intake from fat. (4,5) As such, adequate fat content and the proper types of fats play a vital role in early infant development. The goal of this section will be to lay out the reason Kendamil chooses to use whole fat dairy milk from local farms instead of vegetable oils to provide the fat content of its formula.

The composition of breastmilk solids (excluding water content)

 

Most of the current infant formula market worldwide utilises a blend of various vegetable oils to provide fat content for their formulas. The most popular vegetable oils used in modern formula production include coconut oil, corn oil, palm oil, soya oil, sunflower oil, high oleic safflower oil, and rapeseed (often called canola) oil. (6) The main reasons for the use of these vegetable oils is to provide cost saving measures to the manufacturers and to increase the amount of polyunsaturated fats found in the formulas. (7) While common place for the formula industry, Kendamil favours the use of mammalian milk fat over vegetable oils for a multitude of reasons. 

The primary reason Kendamil uses real milk fat over vegetable oils is because evidence has shown that mammalian milk fat is far closer to naturally resembling the fat profile of human breast milk than vegetable oils. For one thing, bovine milk contains about 4% milk fat similar to that of a human mother mentioned previously. (5) The fat content in both human and other mammalian milks are triglycerides bound up in fat globules. These fat globules come together to form what is known as a milk fat globule membrane, or MFGM. The MFGM is a unique mix of glycoproteins and enzymes that come together with a mixture of glycerides (tri, di and mono) as well as sterols. (8) The importance in this similarity can be found within the natural polar lipid profile within the MFGM which help to encompass phospholipids and sphingolipids. (9) These polar lipids help with the emulsification of fats into an aqueous layer for easier digestion. (10) The standard vegetable oils used in many formulas lack these important features and require the addition of industrialised emulsifiers such as lecithin from soya. (11) 

The benefits of MFGM and its various subcomponents have been widely reported on in scientific literature. One study showed that infants supplied with MFGM between the ages of 2 to 6 months resulted in an increase in serum choline, a nutrient extremely important for brain function and development. (12) Other clinical studies have demonstrated marked increases in cognitive function for 6 to 12 month olds with MFGM in their diet, however it is noted that it is likely not one single underlying MFMG factor. Instead, these studies suggest that a coupled effect of multiple important factors in the MFGM are responsible for the cognitive improvements. (13, 14) It should also be noted that a 2019 article in The Journal of Paediatrics reported a randomised control trial with infants receiving formula containing bovine MFGM versus those that did not have the membrane complex present in formula. The study found infants regularly consuming formula with bovine MFGM had improved neurodevelopment and language development while having significantly fewer diarrhoea and respiratory adverse events. (15, 16) 

Brain growth and development is not the only important factor the MFGM assists the infant in regulating. MFGM proteins have been shown to help regulate the immune system and gut health on various levels. One study showed that osteopontin, an MFGM component, was able to lower intestinal inflammation through regulation of cytokine production. (17) Another study showed that lactadherin, another MFGM component (especially prevalent in goat milk), was able to help protect infant gut epithelial cells by balancing their homeostatic state and allowing for mucosal repairs. (18)  Furthermore, MFGM seems to play a role in reducing risk for infection. For example, infants who were fed formula with bovine MFGM had a reduced risk of developing otitis media. (19) Current evidence based literature seems to widely support the importance of MFGM factors in proper infant health and development. 

Human milk fat, other mammalian milk fat and vegetable oils are all primarily made up of triglycerides in various forms. Approximately 98% of fats in all three of these sources are in the form of triglycerides. (20) A triglyceride is a fat based molecule with a glycerol backbone containing three fatty acid molecules along the backbone. While all three fat sources are primarily composed of triglycerides, the fatty acid profiles attached to the glycerol backbone vary between all three, with the largest differences coming between the animal based fatty acids and the plant based (vegetable oil) fatty acids. Human milk has nearly 200 fatty acids ranging from C4:0 to C26:0. Bovine milk, for example, has a similar range with an even larger count of nearly 400 unique fatty acids. (5) Most of the vegetable oils do not have a similar range (with coconut oil being an exception) and lack the short and medium chain fatty acids in the C4:0 to C12:0 range. In addition the vegetable oils do not offer odd numbered fatty acid chains. (21) The result is a fatty acid profile that is lower in highly digestible short and medium chain fatty acids and an overall less diverse fatty acid profile falling short of the abundance of fatty acids found in both human and other mammalian milk fat. This typically leads to many manufacturers needing multiple vegetable oils to approach the fatty acid profile of human breast milk. 

The comparison of human breast milk fat to bovine or caprine milk fat is far closer in natural fatty acid make up than that of vegetable oils. For instance, the two primary fats found in human breast milk and bovine milk are oleic and palmitic acid. (20) Oleic acid is a monounsaturated fatty acid and palmitic acid is a saturated fatty acid common to most animals. Palmitic acid is extremely important to infants. Palmitic acid alone is estimated to provide an infant with 10% of their energy intake. (22)  Many plant based vegetable oils are higher in polyunsaturated fatty acids and have difficulty mimicking these fat profiles. As mentioned before, many formula companies will use high oleic safflower oil to constitute the oleic portion. However, most formulas that are exclusively vegetable oil based require palm oil to obtain palmitic acid content. (20) While the addition of palmitic acid from palm oil may provide the fatty acid, the chemical formation of palmitic acid on a glycerol backbone is very different between human and other mammalian milk sources compared to palm oil. 

Triglycerides contain three fatty acids on a glycerol backbone. The three positions on the glycerol backbone are referred to as sn-1, sn-2 and sn-3 for the first, second and third position for fatty acids, respectively. In human, bovine and caprine milk fat, the bulk of palmitic acid is found in the middle of the glycerol backbone, the sn-2 position. (23) Current research estimates that human breast milk contains 70 to 88% of palmitic acid at sn-2 positions and bovine milk contains 40 to 45% of palmitic acid at the sn-2 position. (24) In contrast, most vegetable oil including palm oil contain palmitic acid in the sn-2 position at a 10 to 20% ratio. (23, 25) The problem with this lies in how human digestion of triglycerides occurs. 

When triglycerides are first introduced to the human small intestine, the pancreas releases lipases responsible for partial fatty acid breakdown. Pancreatic lipase enzymes selectively target sn-1 and sn-3 fatty acids for liberation. (7) As a result, the remaining sn-2 fatty acid is present as a monoglyceride. The resulting monoglyceride is more polar than its free fatty acid counterparts and is more readily absorbed and utilised by the infant. (22) This means that palmitic acid, an essential fatty acid to infant nutrition, is often absorbed and utilised in the monoglyceride form found in bovine, caprine and human milk. 

To the contrary, most vegetable oils have palmitic acid in the sn-1 or sn-3 position, liberating the palmitic acid into its free form with the pancreatic lipase release. (20) The problem with free form palmitic acid is that it is a nonpolar saturated fat not easily absorbed by the intestines in its free form. Instead of being utilised for energy, most free form palmitic acid in the gut will bind with calcium. This can lead to a host of problems for the infant as the free palmitic acid molecules can form hard soap with the calcium, a type of chemical process known as saponification (soap making). Resulting problems may include hard stools, constipation and demineralisation of bones in the earliest stages of life while the infant is solely reliant on the formula for nutritional needs. (26, 27) A randomised double blind study published in the journal Paediatrics provided conclusive evidence that infants using formula that contained palm oil for palmitic acid suffered from significant reduction in bone mineralization. (28) So while palm oil may technically provide palmitic acid, it is in a chemical form that is not as useful, and possibly detrimental, to the infant. In contrast, bovine and caprine milk fat has a much higher ratio of sn-2 located palmitic acid in triglyceride form, making it digestible and viable for energy use. 

Another clear difference when comparing breast and other mammalian milk to vegetable oils is the cholesterol content. While dietary cholesterol has different concerns for varying age groups, evidence suggests that cholesterol is of vital importance for infant development. Cholesterol is important for developing brains and the process of myelination. (29) It is also a required molecule for many important steroid hormones vital to growth and development. Furthermore, cholesterol is needed to form proper lipoproteins which are necessary for absorbing and mobilising long chain fatty acids to proper destinations throughout the body. (20) Both human breast milk and bovine milk contain cholesterol in the MFGM, however many formulas using vegetable oils have significantly lower levels of cholesterol. (5, 30) Further evidence that infants need adequate cholesterol intake is that infants on a formula diet have internal cholesterol synthesis rates that are 3 times higher than their breast fed counterparts. (31)

Comparing the fat content of Kendamil with other brands

 

Other scientific evidence has helped guide Kendamil in our choice to use whole fat bovine or caprine milk over vegetable oils. A recent article in The Asian Pacific Journal of Paediatrics examined infants on a milk fat formula diet compared to a vegetable oil fat formula diet. The study examined 409 infants and found evidence that infants on the milk fat diets experienced less gut discomfort, crying and fussiness as well as less hardening fatty soap content in stools. (32) This seems to not only support milk fat based formulas but raises further concerns of calcified saponification products present in the gut of infants consuming palmitic acid from palm oil. Another recent meta analysis study in the American Journal of Clinical Nutrition. The meta analysis looked at over 14 studies spanning 20,897 children to examine whether full fat milk was correlating with childhood obesity when compared to lower fat alternatives. The authors found the opposite to be true, with children consuming whole milk products having a lower chance of childhood obesity when compared to those consuming low fat alternatives. (33) 

The above are some of the many reasons we decide to favour whole bovine milk fat or whole caprine milk fat in our products instead of using a full vegetable oil blend. While we are not the only company to use milk fat in our infant formula, many companies opt for a skimmed or part skimmed alternative robbing the formula of the rich fatty acid profiles present in the original product. We also believe in supporting small sustainable farming operations and seek out full fat milk from local farms over larger industrial operations with harder global impacts. Not only is this good for the environment, but sourcing local milk fat allows us to reduce the number of processing and heating steps involved without formula that many other companies are participating in when buying dried powder for formula production. By taking these steps, Kendamil insists on taking our fat materials straight from the farm for our own processing, ensuring a greater degree of quality and control with a higher level of ingredient integrity for our formula.

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Shelley M Vanderhout, Mary Aglipay, Nazi Torabi, Peter Jüni, Bruno R da Costa, Catherine S Birken, Deborah L O’Connor, Kevin E Thorpe, Jonathon L Maguire, Whole milk compared with reduced-fat milk and childhood overweight: a systematic review and meta-analysis, The American Journal of Clinical Nutrition, Volume 111, Issue 2, February 2020, Pages 266–279, https://doi.org/10.1093/ajcn/nqz276