FOR HEALTHCARE PROFESSIONAL USE ONLY

New SMA First Infant Milk

To help bottle-fed babies get off to the best possible start, SMA First Infant Milk has been scientically reformulated to more closely reect the composition of breast milk

More information is available at smahcp.co.uk or from our Careline on 0800 0 81 81 80

small steps, for their future

New SMA First Infant Milk

Small steps for their future

Research highlights the important impact of an infants early nutrition on their later health. Thats why we continually improve our formulas to reect the most up-to-date scientic thinking so that by doing the best we can for babies today, they can have the best possible tomorrow.

Another step forward in infant nutrition

New SMA First Infant Milk has been scientically developed to more closely match the composition of breast milk, meaning it now:
Has a new SN-2 Palmitate fat blend closer to that found in breast milk
which leads to softer stools more like those of a breastfed baby1 which has been shown to promote calcium absorption2-5 and one study showed improved bone mineralisation in early infancy4

Delivers an early rate of growth closer to that of a breastfed baby6

due to an improved protein quality and balance that is closer to that of breast milk

Has a prebiotic effect17,18

which leads to a higher level of benecial gut bacteria, closer to that of breastfed babies

in independent studies using an infant formula with an SN-2 enriched fat blend rate of weight gain

Why fat is important in an infants diet

Fats are needed for the absorption of vitamins such as A, D, E and K Essential fatty acids are required to support healthy growth and development Fat provides approximately 50% of energy in breast milk4,7

How fat digestion plays a role

The fat found in food is mainly made up of triglycerides each one contains three fatty acids

fatty acid

A new fat blend

fatty acid

fatty acid

When fats are digested, free fatty acids are released some fatty acids can bind to calcium in the intestine to form a type of compound called a soap8 these soaps are known to contribute to stool hardness8

The stool soap content of faeces is related to stool consistency8

There are important differences between the fats found in breast and formula milk that inuence the absorption of nutrients and the consistency of an infants stools

Stool soaps increase

Stool hardness increases

Why fat structure matters

Palmitic acid and oleic acid are the most abundant fatty acids in breast and formula milk these fatty acids have a different arrangement in the fat structure in standard formula compared with breast milk4
P P
P Ca 2+ P

In formula palmitic acid is primarily on the outside of the fat molecule

When fats are digested, the fatty acids on the outside of the molecule are released free palmitic acid more readily forms soaps with calcium than oleic acid therefore, when palmitic acid is on the outside of the triglyceride molecule, more soaps are formed

O P P

Palmitic acid can bind to calcium to form a soap

More soaps formed leading to harder stools

During digestion, the outside fatty acids are released

palmitic acid

oleic acid

In breast milk palmitic acid is primarily in the middle of the fat molecule

O P O

O Ca 2+

Fewer soaps formed leading to softer stools

During digestion, the outside fatty acids are released

Oleic acid does not readily bind to calcium

palmitic acid

oleic acid

New SMA First Infant Milk a decreased stool soaps content

New SMA First Infant Milk has a new SN-2 Palmitate fat blend, designed to more closely resemble that found in breast milk

New SMA First Infant Milk a softer stool consistency

Infants fed with new SMA First Infant Milk had softer stools than those fed standard formula the percentage of formed or hard stools was nearly half that seen in the standard formula group1

46% decrease in stool soaps

Compared to infants fed standard whey-dominant formula, infants fed new SMA First Infant Milk had nearly half as many soaps in their stools1

Stool consistency was intermediate between breast milk and standard formula1

78.3 80 65.4 60 51.2 % stools 41.4 40 29.3 20 4.9 5.9

When calcium binds to fatty acids during digestion, it forms stool soaps this can result in reduced absorption of calcium

14.9 3.6 2.4 mushy soft Stool consistency at week 8 formed

1.1 0.7 watery

0.5 0.3 0.2 hard

in independent clinical studies, an infant formula with an SN-2 Palmitate enriched fat blend was shown to promote calcium absorption2-5 and one study showed improved bone mineralisation in early infancy4
standard formula

runny

new SMA First Infant Milk

breastfed

These changes in stool consistency were seen without any effect on stool frequency1

SMA First Infant Milk the importance of protein quality

Cows milk is the primary starting point for the manufacture of most infant formulas Breast milk contains 66% less protein than cows milk (an average of 1.2g/100ml versus 3.3g/100ml)9 it is much richer in alpha-protein (a type of whey protein) than cows milk10 Alpha-protein is an important source of essential amino acids, particularly cysteine and tryptophan10 Breast milk does not normally contain beta-protein , which conversely makes up over 9% of the total protein content in cows milk11 Beta-protein is thought to be antigenic and could contribute to cows milk allergy12,13

SMA First Infant Milk an improved protein quality

SMA First Infant Milk contains an increased content of alpha-protein and a reduced content of beta-protein

SMA First Infant Milk has a protein prole closer to breast milk than standard formula11
Breast milk

% alpha-protein

30 20 10 0

% of total protein composition

27%

SMA First Infant Milk

18%

Typical rst infant milks

11% 0%
10 20 30

% beta-protein

12%

29%

% of total protein composition11 alpha-protein Breast milk Cows milk 27% 4% beta-protein 0% 9%

A slower rate of growth

Improving the protein quality of SMA First Infant Milk has allowed a reduction in protein quantity to 13g/L

Alpha-lactalbumin Beta-lactoglobulin

SMA First Infant Milk the effect of protein quantity

It has long been observed that formula-fed infants tend to gain weight at a faster rate than those who are mainly breastfed15 Rapid weight gain in early infancy is associated with an increased risk of later obesity15 Typical infant formulas have a higher protein content than breast milk, which is thought to contribute to faster weight gain in formula-fed infants compared with breastfed infants16

SMA First Infant Milk a slower rate of early weight gain

SMA First Infant Milk has been shown to deliver a slower early weight gain velocity, closer to that of breastfed infants, than infants fed standard whey-dominant formula6

Weight gain velocity6

Standard formula protein content 1.4g/100ml

28.1
p=0.04

SMA First Infant Milk protein content 1.3g/100ml

27.8

Breast milk protein content 1.2g/100ml

0 20 25

26.6
30

Mean weight gain velocity (grams per day) [All subjects baseline to day 120, n=321]

A large independent study has shown an effect of a lower protein intake from infant formula on weight-for-length and BMI at the end of the rst 2 years of life16 Reducing the protein content of infant formulas has been suggested as a potential approach to reduce the risk of later obesity16

SMA First Infant Milk a prebiotic effect

SMA First Infant Milk is enriched with alpha-protein it is thought that the digestion of alpha-protein may stimulate the growth of bifidobacteria17 Over 8 weeks, SMA First Infant Milk was shown to have a prebiotic effect, similar to that seen in breastfed infants18

New SMA First Infant Milk another step forward in infant nutrition
SMA First Infant Milk is being continually improved so that by using the most up-to-date knowledge, we can help formula-fed babies get the best possible start

Breast milk

SMA stage 1

Aptamil stage 1

Cow & Gate stage 1

SMA First Infant Milk has a prebiotic effect18

Non-nutritional bioactive components

Breast milk

10.5

9 9 9 9

8 8

8 8

SMA First Infant Milk

0 1 2 3 4 5 6 7 8 9

10.7
10 11

A fat blend rich in SN-2 Palmitate

9 9
1

Benecial bacteria concentration: Colony Forming Units per gram of faeces (CFU/g) Results after 8 weeks

Softer stools

9
8 8

9
8 8 8

Enriched with alpha-protein

9 9 9 9
6

Reduced beta-protein content

9
n/a

A study showing a weight gain velocity closer to the rate of breastfed infants

Prebiotic effect

17,18

A prebiotic effect

Alpha-lactalbumin Beta-lactoglobulin naturally rich in alpha-protein *not typically present in breast milk

A range to set us apart from the rest

While the other brands stage their milks as follows:

Our staging is much simpler

1
First

2
Extra Hungry

3
Follow on

4
Toddler

From birth +

From birth +

6 months +

12 months +

First Infant Milk From birth +

Follow-on Milk From 6 months +

Toddler Milk From 12 months +

SMA has an Extra Hungry Milk available but it is not a part of our core range staging. This is because while hungry milks may be used to delay weaning if needed, it is not always necessary for all infants to progress to an extra hungry milk.

Our unique range Simple 1,2,3 staging The rst whey-dominant follow-on milk Omega 3 & 6 LCPs throughout

SMAs Advanced Gold System is a range of scientically developed formulas to help meet the nutritional needs of babies and young children. Every product has a tailored nutrient prole for each stage of growth and development.

Advanced Gold System

References: 1. Yao M et al. High 2-palmitate and oligofructose in lower protein alpha-lactalbumin-enriched term infant formula: effects on stool characteristics and stool composition. J Pediatr Gastroenterol Nutr 2010; 50 (Suppl 2): PO-N-444. 2. Carnielli VP et al. Effect of dietary triacylglycerol fatty acid positional distribution on plasma lipid classes and their fatty acid composition in preterm infants. Am J Clin Nutr 1995; 62: 776-81. 3. Carnielli VP et al. Structural position and amount of palmitic acid in infant formulas: effects on fat, fatty acid, and mineral balance. J Ped Gastroenterol Nutr 1996; 23: 553-60. 4. Kennedy K, Fewtrell MS, Morley R et al. Double-blind, randomized trial of a synthetic triacylglycerol in formula-fed term infants: effects on stool biochemistry, stool characteristics, and bone mineralization. Am J Clin Nutr 1999; 70: 920-7. 5. Lucas A et al. Randomised controlled trial of synthetic triglyceride milk formula for preterm infants. Arch Dis Child Fetal Neonatal Ed 1997; 77: F178-F184. 6 Trabulsi J et al. Effect of an alpha-lactalbumin-enriched infant formula with lower protein on growth. Eur J Clin Nutr 2011; 65: 167-74. 7. Kleinman RE. (ed.) Pediatric Nutrition Handbook, 5th ed. AAP: Elk Grove Village, IL, 2004. 8. Quinlan PT et al. The relationship between stool hardness and stool composition in breast- and formula-fed infants. J Ped Gastroenterol Nutr 1995; 20: 81-90. 9. Food Standards Agency (2002). McCance and Widdowsons The composition of foods. Sixth summary edition. Cambridge: Royal Society of Chemistry, p.24. 10. Lien EL. Infant formulas with increased concentrations of alpha-lactalbumin. Am J Clin Nutr 2003; 77: 1555s-1558s. 11. Lien EL et al. Growth and safety in term infants fed reduced protein formula with added bovine alpha-lactalbumin. J Pediatr Gastroenterol Nutr 2004; 38: 170-6. 12. Natale M et al. Cows milk allergens identication by two-dimensional immunoblotting and mass spectrometry. Mol Nutr Food Res 2004; 48: 363-9. 13. Slo I et al. Allergy to bovine beta-lactoglobulin: specicity of human IgE to tryptic peptides. Clin Exp Allergy 1999; 29: 1055-630 14. Dewey KG. Growth characteristics of breast-fed compared to formula-fed infants. Biol Neonate 1998; 74: 94-105. 15. Ong KK, Loos RJ. Rapid infancy weight gain and subsequent obesity: systematic reviews and hopeful suggestions. Acta Paediatr 2006; 95: 904-8. 16. Koletzko B et al. Lower protein in infant formula is associated with lower weight up to 2 y: a randomised clinical trial. Am J Clin Nutr 2009; 89: 1836-45. 17. Kullen M et al. Characterization of peptides derived from alpha-lactalbumin digestion and demonstration of their prebiotic effect through stimulation of bidobacteria in a model of the gastrointestinal tract. J Pediatr Gastroenterol Nutr 2009; 48(Suppl 3): E88, 0P3-06. 18. Bettler J, Kullen MJ. Infant formula enriched with alpha-lactalbumin has a prebiotic effect in healthy term infants. J Pediatr Gastroenterol Nutr 2007; 44(Suppl.1): e197. PN1-11.

Pzer Ltd., Vanwall Road, Maidenhead, Berkshire SL6 4UB www.smahcp.co.uk

Important notice Breastfeeding is best for babies. Good maternal nutrition is important for the preparation and maintenance of breastfeeding. Introducing partial bottle-feeding may have a negative effect on breastfeeding and reversing a decision not to breastfeed is difcult. You should always seek the advice of a doctor, midwife, health visitor, public health nurse, dietitian or pharmacist on the need for and proper method of use of infant milks and on all matters of infant feeding. Social and nancial implications should be considered when selecting a method of infant feeding. Infant milk should always be prepared and used as directed. Inappropriate foods or feeding methods, or improper use of infant formula, may present a health hazard. SMA Follow-on Milk is only suitable for babies over 6 months as part of a mixed diet and is not a breast milk substitute. The decision to start weaning or to use follow-on milk before 6 months, should be made only on the advice of a doctor, midwife, health visitor, public health nurse, dietitian or pharmacist, based on your babys specic growth and development needs. SMA Toddler Milk is for young children over 1 year, as part of a healthy balanced diet. ZCO0942/03/11