Ingredients in infant formula

What’s in infant formula?

The ingredients in cow’s milk-based infant formula are generally: a cow’s milk base such as skim milk powder, sugars, plant-based oils, vitamins, minerals, emulsifiers, stabilizers, and various other items. They are listed on the container. In soy formula, protein extracted from soy beans replaces the cow’s milk products. Formulas for allergic children have a similar range of ingredients, but the cow’s milk base is treated to break down the protein into smaller bits to prevent allergic reactions. Specialty formulas have other changes. The standards for production and marketing of infant formula can vary by country.

A) Infant formula standards

1) Codex Alimentarius

A United Nations group called the Codex Alimentarius creates standards for the regulation of food and food products by countries (Codex). In particular, it sets standards for the manufacturing of infant formula (formula). It is not immune to politics or the pressures of the formula industry nor are its standards necessarily followed (Arendt 2018; Jacobs 2018; Kent 2015; Koletzko 2006).

It is up to individual countries to decide on their standards, labelling requirements, and acceptable levels of marketing (DiMaggio 2019).

Ideally, labelling is clear and consistent. A summary of the nutritional characteristics should be present on the front of the package. In contrast, labelling on infant formula and toddler milks has been shown to be unclear, inconsistent, and variable across brands and countries (Bridge 2020).  

2) The United States

For example, in the United States, formulas can be marketed before they are approved by the U.S. Food and Drug Administration (FDA) (US FDA 2006). However, all formulas marketed in the United States must meet federal nutrient requirements, and formula manufacturers must notify the FDA before marketing a new formula.

3) The European Union

The European Union has other criteria. Unlike the U.S., it does not allow the following (EU 2006):

  • Detectable levels of pesticides
  • Table sugar (sucrose) in regular formula
  • Thickeners such as locust gum, guar gum, pectins, fructans (like inulin), and carrageenan
  • Trans fats
  • The use of bovine growth hormone in cows
  • Genetically modified ingredients

Some European manufacturers go further and only use milk from biodynamic farms, which is a strict type of organic farming that uses sustainable practices.

B) Ingredients of infant formula

In general, there are only small differences between members of each type of formula (Dipasquale 2019).

The ingredients in formula are listed on each container and vary between manufacturers and formula types.

Table: Main Ingredients Found in Cow’s Milk-Based Formula (Green Corkins and Shurley 2016)

(Links to more information about the topics in the above table: regular cow’s milk-based formula; sugars; lactosepalm olein; probiotics and probioticslong-chain polyunsaturated fatty acids; nucleosides.)

In soy formula, protein extracted from soy beans replace the cow's milk products.

Goat's milk is used instead of cow's milk in some formula.

Formulas for allergic children and other digestive challenges have a similar range of ingredients, but the cow’s milk base is treated to break down the protein into smaller bits or even into amino acids to prevent allergic reactions. These products may also have different oils such as MCT oil and do not contain lactose.

Specialty formulas have a range of other changes.

Formula may also contain unintended items.

References

Arendt M. Codex Alimentarius: What Has It To Do With Me? J Hum Lact. 2018 Nov;34(4):704-710

Bridge G, Lomazzi M, Bedi R. A cross-country exploratory study to investigate the labelling, energy, carbohydrate and sugar content of formula milk products marketed for infants. Br Dent J. 2020 Feb;228(3):198-212 

DiMaggio DM, Du N, Scherer C, et al. Comparison of Imported European and US Infant Formulas: Labeling, Nutrient and Safety Concerns. J Pediatr Gastroenterol Nutr. 2019 Oct;69(4):480-486
 
Dipasquale V, Serra G, Corsello G, et al. Standard and Specialized Infant Formulas in Europe: Making, Marketing, and Health Outcomes. Nutr Clin Pract. 2019 Feb 11
 
European Commission (EC). COMMISSION DIRECTIVE 2006/141/EC of 22 December 2006 on infant formulae and follow-on formulae and amending Directive 1999/21/EC. Brussels: Commission of the European Communities; 2006 Dec 22
 
Green Corkins K, Shurley T. What's in the Bottle? A Review of Infant Formulas. Nutr Clin Pract. 2016 Dec;31(6):723-729
 
Jacobs A. Opposition to Breast-Feeding Resolution by U.S. Stuns World Health Officials. New York: New York Times; 2018 Jul 8
 
Joint FAO/WHO Codex Alimentarius Commission (Codex). Rome: World Health Organization; Food and Agriculture Organization of the United Nations; [date unknown] [cited 2018 Sep 30]
 
Kent G. Global infant formula: monitoring and regulating the impacts to protect human health. International Breastfeeding Journal. 2015;10:6
 
Koletzko B, Shamir R. Standards for infant formula milk: Commercial interests may be the strongest driver of what goes into formula milk. BMJ. 2006;332(7542):621-622
 
U. S. Food and Drug Administration (US FDA). Questions & Answers for Consumers Concerning Infant Formula. Maryland: U. S. Food and Drug Administration; 2006 Mar 1 [cited 2019 Jul 8]