Infants With Different Weight for Age Percentiles May Benefit From Stratified Daily Formula Milk Intake Recommendations

OBJECTIVES: Currently available guidelines on the daily formula milk requirements of infants, including those from the Institute of Medicine (IOM) and FAO/WHO/UNU, are based on the needs of infants with median body weight and the fact that their growth pattern follows the 50(th) percentile of the weight-for-age growth curve. Hence, current recommendations might not be sufficiently detailed to meet the needs of infants across the broad spectrum of body weight percentiles. This study aimed to provide stratified recommendations for daily formula milk intake of fully formula-fed infants across different weight-age categories from 0 to 4 months. METHODS: At first, theoretical age- and gender- specific weight ranges were constructed for infants across five predefined weight-for-length percentile categories of the WHO growth standard: small (10(th) percentile), medium-small (15(th) to 25(th) percentiles), medium (50(th) percentile), medium-large (75(th) to 85(th) percentiles), and large (90(th) percentile) infants. Thereafter, total daily energy requirements for each category were calculated using IOM equation and converted to daily formula milk needs. Subsequently, these stratified age- and weight- formula milk recommendations were compared to actual daily and relative formula milk of infants in these categories retrieved from pooled individual infant formula milk intake (6.174 data points, from 13 clinical intervention studies). RESULTS: Qualitative comparison between theoretical calculation and actual formula milk intakes were both following the same trend with the median daily formula milk volume intake of infants increasing across increasing weight-for-age categories at each timepoint, with larger variations observed in “real life” data compared to theoretical recommendations. Interestingly, the relative daily formula milk volume intake (ml/kg/day) was relatively stable over time but was relatively higher in smaller infants compared to larger infants. CONCLUSIONS: Qualitative evaluation of both theoretical calculations as well as real-life daily formula intake data showed that one fixed value as formula milk volume intake recommendation may not be optimal for the nutritional needs of infants growing at different percentiles of weight for age. FUNDING SOURCES: Danone Nutricia Research.