Infant feeding tolerance on formula supplemented with sn-2 palmitate and oligofructose

Monday, Jan 21, 2019

This study explored the stool characteristics and feeding tolerances of infants fed formulas supplemented with sn-2 palmitate and oligofructose, both exclusively and when mixed-fed with human milk.


Mao M, Zheng L, Ge J, Yan J, Northington R, Yao M, Nowacki J, Hays NP. Infant feeding regimens and gastrointestinal tolerance: A multicenter, prospective, observational cohort study in China. Global Pediatric Health. 2017;5:1-12.
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sn-2 palmitate may help improve crying and sleep patterns in infants


  • It was previously found that compared with non-supplemented formulas, stool hardness decreased in infants exclusively feeding on formulas with increased proportion of sn-2 palmitate (sn-2) and dietary fibre oligofructose (OF)
  • This new study investigated the feeding effects in infants who are mixed-fed together with human milk



  • 3 groups of Chinese infants (35 - 49 days old) were recruited based on their current feeding regimens:
    • Exclusively breastfed (n = 147)
    • Exclusively fed high sn-2 formula (43% palmitate in sn-2 position + 3 g/L OF; n = 150)
    • Fed both high sn-2 formula and human milk (mixed-fed; n = 163)
  • After an observational period of 48 days, study outcomes analysed include stool characteristics and gastrointestinal tolerance using the Infant Gastrointestinal Symptom Questionnaire (IGSQ)


Key Findings


Breastfed Mixed-fed Formula-fed Comments
Incidence of hard stools 0% ≤ 0.8%
≤ 2.1%
  • No significant differences
Incidence of watery stool ≥ 5.1% ≥ 7.3% ≤ 5.0%
  • Study days 2 – 4: Formula-fed group significantly lower than breastfed group (p = 0.003), mixed-fed group significantly lower than the breastfed group (p = 0.44)
  • Study days 15 – 17: Formula-fed group significantly lower than breastfed group (p = 0.002)
Stool consistency Breastfed group had softest stools, followed by mixed-fed, then formula-fed, mean score of 2-3 (runny to mushy-soft)
  • Significant differences (p < 0.001) but magnitude was small
GI tolerance 16.3 18.2 17.5
  • A lower score indicates better tolerance, lowest possible = 13, highest score = 65
  • Formula-fed and mixed-fed groups had slightly higher scores than breastfed group in mid-study at day 18 (p = 0.03 and p = 0.003 respectively)



  • Low incidences of hard and watery stools , as well as good feeding tolerance were observed in infants fed formula containing high sn-2  and OF, either exclusively or in combination with human milk


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