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SN2-Palmitate Improves Crying and Sleep in Infants Fed Formula with Prebiotics: A Double-Blind Randomized Clinical Trial

Fabiana Bar-Yoseph, Yael Lifshitz, Tzafra Cohen, Patrice Malard, Zailing Li, Hong Cui, Aimin Zhang, Jing-Lan Wu and Chundi Xu

Background and Aim: Palmitic acid (PA, C16:0), one of the major saturated fatty acids in human milk fat being 17-25% of the fatty acids, is esterified mainly at the SN2-position (SN2-palmitate). Contrary in vegetable oils, which are commonly used as fat source in infant formulas, PA is esterified mainly at the outer positions, i.e, SN1 and SN3 positions, resulting in reduced fat absorption and harder stools. SN2-palmitate and prebiotics have been shown to improve digestion and reduce stool hardness. Our aim was to study the potential effects of SN2-palmitate in addition to prebiotics in formula-fed Chinese infants.

Methods: 171 healthy term infants were included (within 14 days from birth) in the study. Formula-fed infants were randomly assigned to receive either SN2-palmitate containing formula (INFAT®, Advanced Lipids), (n=57) or a Control formula (n=57). The two study formulas (Biostime, China) differed only in the ratio of PA at the SN2-position (43% vs. 13%). A similar group of breastfed infants (n=57) was included as a reference.

Results: The pattern of crying and sleep differed between the formula-fed groups. Fewer infants in the SN2 group cried at 12 weeks (23.2% vs. 45.5%, p<0.05); they had fewer crying episodes (2.0 vs. 3.6, at 6 weeks, p<0.05 and 1.0 vs. 2.2 at 12 weeks, p<0.02) and the duration of crying was lower (25.1 vs. 41.3 min at 6 weeks, p<0.05 and 11.2 vs. 21.2 min at 12 weeks, p<0.01) similar to the crying pattern of breastfed infants. Moreover, the infants in the SN2 group had longer daily sleep duration.

Conclusions: SN2-palmitate formula improves crying and sleeps patterns in addition to prebiotics in the first weeks of life. Thereby, SN2-palmitate improves the well-being of formula-fed infants and consequently the quality of life of their parents, further emphasizing the importance of SN2-palmitate for infant nutrition.