Feeding premature

newborn infants palmitic acid in

amounts and stereoisomeric
position similar to that of
human milk: effects on fat and mineral balance13
Virgilio

P Carnielli,

Iiigrid

Boerlage,

Herman

J Degenhart,

ABSTRACT

The

triglycerides

Twelve

effect

on intestinal

infants

were

Luijendijk,
and

of

the

each

fed,

JJ

structure

fat absorption

of

remains

human

for 1 wk in a crossover

The

human

milk (26% palmitic

acid, esterified
predominantly
position)
whereas
in the a formula,
which

triglycerides
palmitate
mineral

contained

similar
was mainly
balances

period.
better

Myristic,
from
the

reduced.

During

only

in triglyceride

triglycerides

were

measured

palmitic,
3 formula,
the

at

feeding

design,
in

to the
contained

formula.

Am

KEY
WORDS
triglyceride
structure,
fat absorption,

Formula
infant

premature

J Clin

study,
formula,

in the presence

free

FAs

and

of sufficient

well-absorbed

as free

FAs,

monoglyceride.

The

absorption

calcium

fatty
acid
in comparison

Nutr

intestinal
with

1995;61:l037-42.

calcium

acid,

insoluble
magnesium.

be greater

position
positions.

from

containing

diets

formation

and

though

early

onstrate

(eg,

infant

studies

in term

newborn

similar

infants

(20,

Introduction

lack

of effect.

in preterm
most infant
formulas.
is almost
complete,
nates
(2-5).

exhibit
This

denal
(8-10).

concentrations
In addition,

of energy

Whereas
newborns

impaired
is believed

absorption
during
the
to be caused
mainly

is reported

to be lower

difference

has

than

milk

lipase
(6, 7) and
of fat from infant

from

explained

first weeks
of life
by low intraduo-

human
by

the

milk

(4,

absorption.

accounts
esterified

for
mainly

In human

milk

presence

triglycerides,

bile salts
formulas

1 1-13).
of

human
milk (14, 15) and by the unique
stereoisomeric
of human
milk triglycerides
(1, 16) that favor
their

and

(1) and in

Nuir

lipases

1037-42.

calcium

studied

et al (18)

in rats

indicated

better

We

in the

and

Al-

by Filer

absorption

of

of the diet fat,

failed
to dem-

Differences

in the

from
their
populations

whether

soap

of calcium.

fatty

acid

palmitic
acid
may explain

palmitic

acid

f3

in the

and in amounts
similar
to those
fat, FAs, and calcium
absorption

did this

isomeric

using

synthetic

position

triglycerides

of palmitic

that

acid.

palmitic

Printed

in USA.

1995

American

Patients

and

Formulas,

methods

subjects,

and

infant
and

formulas
fatty acid

clinical

design

used
profile,

in this study
but different

had a similar
isomeric
po-

in
I From

structure
digestion

the Department

University

acid

20-25%
of total
milk
fatty
acids
and
it
to the center
sn-2 position
of the triglyceride

l995;6l:

infants.
only

The two
composition

This

2 Supported
3 Reprints

Sophia

Society

of Pediatrics,

Hospital/Erasmus

University

Sophia

Childrens

Rotterdam,

Hospital

Rotterdam,

and

Nether-

lands.

is

glycerol
(f3 position)
(1, 16). In contrast,
in cow milk fat or in
vegetable
oils, it is predominantly
esterified
to the sn-i
and
sn-3 positions
(a positions)
(16). Because
the acyl chain
at the
Aiz J Cli,z

differed

We

sn-2

in human
adults
fat absorption
and especially
premature
neo-

of pancreatic
the absorption

been

in human

by avoiding

21).

as

therefore,

at the

esterified
to the sn-2 position
in premature
infants
have

benefits

as
not

at the sn-1,3
in high-calcium-

absorption

of the formulas,
apart
differences
in the patient

and

such
are

absorbed

acid,

it is esterified

by Tomarelli

position
of dietary
triglycerides
found
in breast
milk improves

source

better

palmitic

formulas)

balance

Fat is the major

of

of

is well-absorbed
with bile acids

probably

intestinal

composition
content,
and
the

are

activ-

products

divalent
cations
fatty acids,
which

fat when

improving

palmitic
acid when
more
recent
studies

mineral

soaps
with
Saturated

lipase

final

than when
it is esterified
predominantly
This could
also be advantageous

et al (19)

triglycerides,
fatty acids,

absorption,

form
and

could

excre-

the

1-wk

each

are

digestion
i 7). 2-Monoglyceride
it readily
forms
mixed
micellae

absorbed
was
not

of

pancreatic

2-monoacylglycerol

end

synthesized
palmitic

infants,

ity,

triglyceride
because

tion was lower, urinary

calcium
higher, and urinary phosphate
lower. A formula
containing
triglycerides
similar
to those in

conventional

resistant
to the lipolytic
action
of
acids (FAs)
in the 3 position
remain
during
digestion
and
absorption.

cannot
calcium

fecal

human
milk
has significant
effects
on
absorption
and improves
mineral
balance

Anneke

is relatively
lipase,
the fatty
monoglycerides

Therefore,

to those

acids
were
fat excretion

of /3 formula

J Sulkers,

currently
marketed,
Fatty acid, fat, and

the

and stearic
but total

Eric

13 position
pancreatic
intact
as

milk

configuration.
similar

to those
in formulas
at the sn-l,3
positions.

Goudoever,

controversial.

formulas

formula

B van

Sauer

Childrens

GJ, Rotterdam,

for

by grants
not

from

available.
Hospital,

Room

Zoetermeer,

Netherlands.

correspondence

to

Sp 3456,

Dr Molewaterplein

VP

Carnielli,
60, 3015

Netherlands.

Received

December

Accepted

for publication

Clinical

Nutricia,
Address

Nutrition

22,

1993.
October

31,

1994.

I037

Downloaded from ajcn.nutrition.org by guest on October 11, 2015

differed

Johannes

Pieter

two

sn-2

that

HT

CARNIELLI

1038

f3

El

AL

sition of the FM in triacylgiycerols

(Table
1). The
formula
contained
triglycerides
similar
to those in human
milk: 26%

TABLE

Clinical

characteristics

(wt:wt)

two

of FM

as palmitic

acid,

which

is predominantly

ester-

1-wk

diet

of preterm

ified to the sn-2 (3) position.

The a formula
contained
similar
amounts
of palmitic
acid but it was mainly
esterified
to the
sn-1,3 (a) positions.
Part of the fat in the 3 formula
consisted
of synthetic

triglycerides

by interesterifying
ture
of other
Rhizomucor

gen)

known

as Betapol.

a tripalmitin-rich
by using
the

oils

(code

miehei

palm
sn-1,3

SP-392;

This
fraction
specific

Novo

with a mixlipase
from

Industries,

Copenha-

(22).

Twelve

tween

preterm

infants

28 and 32 wk were

13formula

for

were then
subsequent

crossed
week.

formula

and

born

1 wk at a postnatal

then

over
Half

after

randomly

a gestation

assigned
age

other
were

whereas

Head

age (wk)

circumference

infants

29.9

1.4

27.8

1.2

Length(cm)

(3 Formula

period

1.4 0.2

(kg)

Gestational

and at the end of the

a Formula

period

2.1 0.3

2.1 0.3
-

31.8

31.6

1.1

442

1.6

442

Postnatal

age (d)

38 7

38 6

Fat mass

(%)

8.6 3.5

8.2 3.1

be-

of 38 7 d. The

to receive
the
of the infants

the f3 formula

ranging

to be fed the a or

at birth

At birth
Weight

is produced

infants

periods

SD; n = 12. During

the a formula
week

and six

the formulas

the first

infants

were

week

were

reversed.

of the study

six infants

the f3 formula.

fed
There

were

During

were

no significant

density

value

fed

the second
differences.

formula
for the
first fed the a

the other

half

multiplying

received

the

volume

by

the

of

1035

g/L,

which was identical

for both formulas.
Balance
studies with separate
collections
of urine (24 h) and
feces (72 h) were performed
during the last 3 d of each feeding

pometric

red. Fifty milligrams

distilled
water
and

the

characteristics

of the patients

7-d feeding
periods
are
The study was conducted

Ethical

Committee

Netherlands,

of

which

Declaration

reported
according

the

agree

at birth

and

in Table
to the

2.

Erasmus

with

at the end

guidelines

University,

of

of the

Rotterdam,

the principles

expressed

in the

period.

Fecal

of the

balance

period

ing the first

of

the

formulas

bottles or by recording
tube feeding.
Conversion

were

determined

by

weighing

the

the volume
with syringes
in the case of
from volume
into grams was done by

collection

diapers

for

losses

of formula

fed to preterm

infants

13 Formula

a Formula

(%)

1.99

much

4.16

measured

Calcium

0.102

0.099

Phosphate

0.045

0.046

0.0065

0.0067

(%)
(%)
Magnesium
(%)
Fatty

acids

(% of total

fatty

acids

by wt)
4.5

6:0-10:0

(ND)

4.0

12:0

12.1 (17.2)

14:0

5.4 (3.3)

16:0

25.7

(ND)

(16.2)

4.9 (3.9)

(9.8)

2.6 (1.1)

18:0

10.6
25.4

(58.0)

3.7 (2.4)

(ND)

0.26

(ND)

during

hydrochloric

2380;

concentrated
measured

H2S04
and urinary

effects

were

(ND)

0.05

(ND)

0.17

(ND)

0.21

(ND)

pounds
of interest.
dividing
the apparent
the intake, and then

(ND)

22:1

0.03

(ND)

0.08

(ND)

24:1

0.02

(ND)

0.03

(ND)

18:2w6

12.1 (22.1)

12.6

(5.1)

18:3w3

2.0 (0.3)

Value

position.

in parentheses
Both

is the fatty

ready-to-feed

and docosahexaenoic

acid

formulas
(22:6o3).

acid

composition

are devoid
ND,

2.7 (0.5)
(wt:wt)

of arachidonic

not determined.

in each

collected

red stool

were

(double

added.

includ3

placed

made

d later

inside

for

weighing

the

accidental

of the diaper)

of the infants
total amount

(double
of feces

period
was
weighed
of the homogenate

(or

were

urine)

Determination
The

of the sn-2

was
were

(20:4w6)

were

Calcium
CT)

(2:1, by vol)].
calcium
and

and
was

by

FA

by

magnesium

after

[3 h at

acid

digestion

mixture
The total
magnesium

of

of HNO3

and

urine volume
were also

was
mea-

In all

Phosphate
cases,

the

standard

by

multiplying

the

the

concentration

in the formulas
of the

and

volume

transesterified
(C9),

by

HCI

heptadecanoic

methanol
(C17),

of
com-

by
by

in the feces

formulas

after
and

the

calculated
excretion)

and

of the

determined
by gas chromatography
(GC),
and
done in triplicate.
Fresh
fecal samples
of 5-10

nonanoic

was
matrix
addition

of

Intestinal
absorption
was
amount absorbed
(intake
multiplying
by 100.

content

were

(model

means

calculated
produced

of FAs

individual

and

spectrophotometer

spectrophotometry.
method
(24).

eliminated

method
(25).
Excretions

0.03

(13.2)

twice

were

to the buttocks
swabs).
The

sured by atomic-absorption
measured
by a colorimetric

16:lco7

0.32

Corrections

Norwalk,

24:0

34.8

sheets

of a concentrated

feces

(ND)

Plastic

Perkin-Elmer,
#{176}C
in 5 mL

300

0.12 (ND)

(41.8)

in 3 mL
tube or in

of the 72 h) and

were

the last

an atomic-absorption

0.11 (ND)

0.20

period.

acid

with

0.22

34.8

excluding

the 3-d balance

a small
sample

and

measured

at the end

Feces

and

sticking
cleaning

22:0

18:1w9

it was
and

averaged.

20:0

20:1

by carmine

freeze-dried.
Fat excretion
was determined
by using a modification of the method
of Jeejeebhoy
et al (23), with twice as

4.08

Fat (%)

out bracketed

red were
dissolved
via the nasogastric

stool;

into the diapers

the feces
of the

2.01

Protein

red

collection.

of feces

collected
homogenized

Composition

first

red stool

for each

and for
weighing
TABLE

carried

(at the beginning

the two determinations

studies

Intakes

were

of carmine
given
either

the mouth just before the 1200 feed on days 4 and 7 of each
diet. Intestinal
transit time was assumed
to be equal to the time
elapsing
from the administration
of the carmine
red and the
production

of Helsinki.

Balance

collections

the

feces

analyses
mg each

addition

tricosanoic

of
(C23)

Downloaded from ajcn.nutrition.org by guest on October 11, 2015

the formula
in the reverse
order.
All infants
were free of
manifest
disease,
were not receiving
any medication,
and had
grown
normally
before
the study.
The investigators
were
blinded
to the type of formula
given to the infants. The anthro-

3-PALMITATE
acids

as internal

FA

methyl

standards.

esters

Hewlett
fused-silica

Packard,
column

diameter,

0.25-sm

The

was

separation

performed

Amstelveen,
(Supelcowax

film

and

by

GC

IN

5890

Netherlands)
equipped
10, 60 m X 0.25 mm

thickness;

Supelco,

of

TABLE

Concentrations

with
a
internal

Leusden,

at 60 #{176}C
initially

was raised
15 mm.
peak

temperature

#{176}C.
Helium
areas

(Hewlett

were

sanoic acids
by comparing

was

was

then

used

the

oven

increased

with

using

Prep,

Elysian,

MN).

All

reagents

were

fatty

acids

in feces

and the /3 formula

1 wk
acid

for

of infants

fed the a

1 wk

a Formula

/3 Formula

feces)
fat)

6.8 0.6

5.1 0.7

2.7

1.9

0.1

0.22

14:0
(mg/g

wet

feces)

11.8 1.0

7.7 0.8

fat)

4.7 0.2

2.8 0.22

(% of fecal
16:0

software

(mg/g

wet

feces)

140.4

10.0

fat)

56.3

1.6

38.6

1.62

feces)

28.7

2.1

22.4

1.7

(% of fecal

trico-

were identified
standards
(Nu
analytical

wet

(% of fecal

and

and

Fatty acids
with known

Fatty

#{176}C/min

station

heptadecanoic,

as internal
standards.
the retention
times

of selected

for

(mg/g

for

0.2

gas (2 mL/min)

HP-Chem

nonanoic,

formula

12:0

temperature

again

as a carrier

calculated

Packard)

Chek

then

20 #{176}C/min
to 205 #{176}C
and held at this temperature
The

to 222

for 5 mm,

Nether-

lands),
a flame-ionization
detector
(280 #{176}C),
and a split-splitless injector
used
in splitless
mode
(280 #{176}C).
The GC was
operated

1039

INFANTS

II;

identification

(model

PRETERM

106.0

9.8

18:0
(mg/g

wet

(% of fecal

grade.

fat)

8.5 042

1 1.5 0.4

18:1w9
(mg/g

Statistical
are

stated.
paired

presented

Comparison
data after

significant

as group

mean

of means
was made
analysis
of variance

period

effect

for

all the

unless

SE

by Students
t test
(ANOVA)
showed

studied

variables.

for
no

(mg/g

patients

(mg/g

All

at the

design

time

Fecal

when

kg

the clinical

of each

for

significantly
60 2%)

output,

fed

study

characteristics

were

almost

of

identical

kg

the
a

although

somewhat

a formula
(6.1
f3 formulas,

. d
,
in the

higher

0.8 and
respectively),

and

different
by treatment.
Neither
nor fat (1.5
0.2 and 1.3

tively.

Mean

4.3

was

0.6
not

water
(66 2 and
0.3 g kg_i
. d1)

in infants
intestinal

fed
transit

concentrations

stearic
(18:0)
oleic (18:1w9)
when

fed

of

acids
and

the

a and

time

was

the

myristic

f3 formulas,
also

of myristic,

13 formula.

the

palmitic,

infants
a

and

received

formula.

not

respec-

Intestinal

lower
and fat absorption
with the a formula,
but
(Table

4).

(16:0),

and

concentrations
in their feces

of
than

acid

between
in Table

the two groups.

4. The intestinal

stearic

the

palmitic

lower
acids

acids

(18:3w3)

was

3 formula

than

absorption

of

5%
these

in feces

was

Fat and FA
absorption

significantly
when

oleic

better

they
and

were
of

different
between
the a
was on average
0.2 g kg
higher
with the
differences
were

fed

25.5

5.22

8.8 1.0

1.0

feces)

0.9 0.1

1.5 0.3

fat)

0.4 0.06

0.5 0.06

12.
different

Significantly

0.002,

0.7

lower,
whereas

and

2.3

phosphorus
the

mg

period
was

/3 than
.

not

excretion

kgt

d,

retained

period,

0.001,

<

0.004,

fecal

excretion
82.0 9.9
excretion

of calcium
kg

mg
was

was

higher,

d1
4.0

kg
d (P < 0.05),
than during
(Table
4). The intestinal
absorption
of

mg

different

of phosphorus
the

a formula:

58.8 7.8 and

urinary
calcium

0.5

the a formula
urinary

from

0.01.

the /3 formula

periods

between
was

periods;
significantly

respectively,

(11.4

P < 0.02).

significantly

more

however,
lower

the
during

1.9 and
16.7

On the /3 formula

phosphorus

than

2.3
the

when

fed

the a formula
(58.1 3.3 and 49.2 2.7 mg kgt
d,
respectively,
P < 0.03).
Urinary
phosphorus
losses
were
inversely
and significantly
correlated
with calcium
absorption
(r
-0.43,
P = <0.05).
Magnesium
data were not different
during
the two diet
periods
(Table 4). Palmitic
acid was the major fecal fatty acid
in the majority
of the infants. We found significant
correlations
between
fecal calcium
excretion
and the excretions
of fat and
of the major
fatty acids.
Palmitic
acid showed
the highest
correlation
coefficient,
followed
by oleic acid and linoleic
acid
(Figure
1).
The fecal calcium
content
was significantly
correlated
with
myristic
(r
0.42, P = 0.04), palmitic
(r = 0.46, P = 0.039),
and stearic (r = 0.42, P = 0.025)
acids,
ie, the major
saturated
fatty acids, but not with the mono- or the polyunsaturated
fatty
acids. No correlation
was observed
between
the fecal concentrations

of fat

or of individual

fatty

acids

and

phosphorus

or

magnesium.

linoleic

and

3.7

significantly

Linolenic

acids was not significantly

periods.
Total fat excretion

significant

(14:0),

and significantly
linoleic
(18:2co6)

not significantly
different
balance
data are reported
when

wet

infants

different
between
diet periods:
29 4 and 30 5 h, respectively, for the a and /3 formula.
The fecal concentrations
of the major FAs are reported
in
Table 3. When fed the a formula,
the infants had significantly
higher

9.6 2.3

fat)

significantly
(P < 0.05),

the

accounted
for this difference
in stool
weight.
No differences
were
found
in urine
production,
87
2 and
91

mL

feces)

iSE;n=
2-5

infants

1.72

(% of fecal

SYS-

2). The intake of the formulas

was similar between
13 periods:
154 4 and 158 5 mL kg

respectively.
g

wet

During

(Table
a and

9.12

29.8

18:3w3

Correla-

Results

the

82.3

14.3 1.4

(% of fecal

4 P

of the crossover

36.3

18:2w6

otherwise

tions between
the data were by simple
linear regression.
calculations
were performed
with the statistical
package
TAT, version
5.2 (SYSTAT,
mc, Evanston,
IL).

Because

4.6

fat)

feces)

/3
d

/3 formula
than
not statistically

Discussion
The results
of this study
structure
of dietary triglyceride

support
the
on intestinal

importance
of the
FA absorption
and

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Data

wet

(% of fecal

analysis

1040

CARNIELLI

TABLE

El

AL

Fat, fatty

acid

for

and the /3 formula

1 wk

(FA),

and mineral

balances

for

of infants

fed the a formula

1 wk

13 Formula

a Formula
Fat
6.3 0.6

6.6 0.7

1.5 0.2

1.3 0.2

76 3

81 4

12:0

951

971

14:0

803

9022

16:0

516

7342

Intake

(g . kg

Fecal

excretion

Intestinal

absorption

intestinal

FA

. d)

(gkg1

absorption

.d_i)

(%)
(%)

912

18:0

6152

18:1w9

883

824

18:2w6

913

845

18:3w3

951

961

FIGURE
(mg

Fecal

. kg

. d

excretion

Intestinal

(mg . kg
(mg . kg

(mg .

. d

. d

i)

i)

(%)

162.1

5.1

162.2

4.9

18:1,

82.0

9.9

58.8

7.8

acid.

49.2

5.9

63.7

5.1

2.3

0.5

4.0

073

10.5

77.9

99.5

8.2

47.7

5.9

61.3

5.0

71.9

2.2

75.3

2.3

Phosphorus
Intake

(mg . kg

Fecal

excretion

. d

Urinary

excretion

Retention

(mg

. d

6.0 1.2

i)

(%)

absorption

Intestinal

i)

(mg . kg
(mgkg
. kg_i

.di)

. d_i)

(%)

5.8 1.0

91.9

1.5

92.2

16.7

2.3

11.4 1.9

1.5

49.2

2.7

58.1

3#{149}35

69.0

4.0

77.0

3.8

Magnesium
Intake

(mg

Fecal

. kg

excretion

Intestinal

. d

excretion

Retention

. d

40.8

(mg . kg_i

(mg.kg_i

. d_i)

.f
4

<

0.02,

<

48.6

6.4

2.8 0.8

2.9 0.9

.d_i)

27.5

SE; n =
Significantly

5.6 0.7

7.0

1.4 0.3

(%)
2-5

1 1.0 0.3

6.1 0.7

1)

(%)

absorption

Urinary

10.4 0.3

i)

(mg . kg

2.6 0.9
23.2

8.5

8.8

12.

different

from

a formula:

<

0.01,

<

0.05,

0.03.

and

1. Correlations
18:2.o6.

to provide
on growth
periods.

All

on mineral
metabolism.
The perception
that the positional
distribution
of the FM in human
milk and in formula
triglyceride is important
during
the processes
of digestion
and abinterest

is not

new

of researchers

(26)
for

and

this

many

problem

years

has

(18-21).

attracted
No

the

conclusive

80

100

Excretion

between
regressions

120

(mg

kg

the excretion
are

140

160

180

d1)

#{149}

#{149}

of calcium

statistically

and of 16:0,

significant.

information
on the effect of the dietary
of the infants,
because
of its relative

FA,

fatty

triglyceride
short study

When
fed the a formula
the infants
had in their feces
significantly
higher
concentrations
of myristic,
palmitic,
and
stearic
acids, and significantly
lower concentrations
of oleic
and linoleic
acids than when fed the /3 formula.
A similar
pattern
of fecal FA concentrations
was described
by Verkade
et
al (21), who compared
the fecal FAs of a group of premature
infants
fed a lard-modified
formula
containing
88% of its
palmitic
acid in the sn-2 position
(and only 14% of oleic)
with
a group fed a formula
that had only 16% of palmitate
but 40%
of the oleic acid in the same position.
These
authors
found
higher concentrations
of oleic acid and lower concentrations
of
myristic
and palmitic
acids in the feces of the infants fed the
lard-modified
formula.
In the above-mentioned
study important differences
in the FA profiles of the formulas
(ie, mediumchain triglycerides
were present
in the control formula
but not
in the lard-modified

sorption

60

formula)

prevented

the authors

from

draw-

ing firm conclusions

on the effects
of the sn-2 palmitic
acid.
Nevertheless,
the fecal concentrations
of palmitic
and oleic
acids showed
a pattern
similar
to our results.
If we had measured
only the fecal concentrations
of the FM
(qualitative
data) we would
have probably
discussed
the advantage

of the

sn-2

position

and

the

negative

effect

of esteri-

data had been obtained

to date. Our study was novel because
we used synthetic
triglycerides,
and were thus able to produce
infant formulas
with profiles
identical
to those of major FM,
differing
only in the isomeric
position
of FM in the triacylglycerols.
Formulas,
as opposed
to human milk, do not contain
lipolytic
enzymes,
which improve
fat absorption;
therefore,
the
only difference
between
the study periods
was the structure
of
the dietary triglycerides.
A different
study including
a human
milk-fed
group would
not have been as informative
as the
present
study because
of the uncontrolled
effects
of the lipolytic enzymes
and variable
mineral
content.
Furthermore
the
crossover
design
is well suited
for the study of premature
infants
known
to have a large variability
in intestinal
fat absorption
(20). Thus we could study the two formulas
in the
same infant and during two periods
of comparable
gastrointes-

fication
to the sn-1,3
positions.
However,
because
the fecal
output
was higher
(although
not significantly)
during
the a
formula
period
than during
the /3 formula
period,
the FA
balance
data show
better
intestinal
absorption
of myristic,
palmitic,
and stearic acids during the /3 formula
period,
but no
significant
differences
for oleic and linoleic
acids. The latter
FM
were significantly
more abundant
in the feces of infants
fed the /3 formula
than of those fed the a formula.
The large
variability
introduced
when excretions
are calculated
(fecal
concentrations
are multiplied
by the more variable
fecal output)
may have contributed
to the lack of statistical
difference.
We
cannot explain
the larger (although
not significant)
fecal output
during the a formula
period. Other factors than those measured
difference.

The

tinal

absorption

of

function.

drawback

of

our

study

was

its

inability

by

us

(FM,

fat,

water,

balance
the

saturated

and

data

minerals)

indicate
FAs

may

that

outweighed

account

for

the improvement
the

slightly

the

in
re-

Downloaded from ajcn.nutrition.org by guest on October 11, 2015

excretion

Retention

. d)

(%)

absorption

Urinary

i)

40
Calcium

Calcium
Intake

20

/3-PALMITATE
duced
absorption
advantage
of the
infants.

Lipid

in term

digestion

infants

contribution
salts.

of the other
FAs.
We speculate
/3 position
could
be even
greater
absorption

in preterm

of pancreatic

The

latter

absorption

are

are reported

infants,

lipase

of

more

abundant

important

for

has

long

between
explored

fecal

calcium

(27).

Increasing

children
(28) and in neonates
and of saturated
FAs. In our
from

during

the

palmitate

both
a

tion

bile

have

observations

so

we

a larger
trapped

of higher

During

and fecal

22

sn-2

can

only

amount

a large

intakes

free

d
26%

of fat
was

9.

the

kg

the mean

calcium

the

that

10.

testinal

in human
been

30).

j3 formula

milk.

reported

could

period

100 mg
intrauterine

in human

acids

d
(31). An
however,
could

retention

of
(26%

the

FM.

The

with

of

of mineral

We gratefully

FAs

balance.

acknowledge

to the recruitment

had

of

a structure

We

15.

3.

in human

In: Lebenthal

acid,

16.

SA,

Bryan

MH,

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Pediatr

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19.
20.

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1975;69:

C, Hamosh

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contained

dominantly
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and

706-13.

11.

retention

with

Alternatively,

metabolism

which

contents

metabolism

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acid (unlike

market),

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mg Ca . kg
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The relationship
FA

and

than

IN

1042

CARNIELLI
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