Ultra-High Temperature Treatment and Storage of Infant Formula Induces Dietary Protein Modifications, Gut Dysfunction, and Inflammation in Preterm Pigs

SCOPE

Ready-to-feed liquid infant formula is increasingly used for preterm infants when human milk is unavailable. These formulas are sterilized by ultra-high temperature treatment, but heating and storage may reduce bioactivity and increase formation of Maillard reaction products with potential negative consequences for immature newborns.

METHODS AND RESULTS

Using preterm pigs as a model for sensitive newborn infants, the study tests the intestinal responses of feeding experimental liquid formula within 5 days. A pasteurized formula (PAST) with the same nutrient composition but less protein modifications serves as control to ultra-high temperature-treated formula without (UHT) and with prolonged storage (SUHT). Relative to PAST, UHT contains lower levels of lactoferrin and IgG. Additional storage (40 °C, 60 days, SUHT) reduces antimicrobial capacity and increases non-reducible protein aggregates and Maillard reaction products (up to 13-fold). Pigs fed SUHT have more diarrhea and show signs of intestinal inflammation (necrotizing enterocolitis) compared with pigs fed PAST and UHT. These clinical effects are accompanied by accumulation of Maillard reaction products, protein cross-links, and inflammatory responses in the gut.

CONCLUSION

The results demonstrate that feeding UHT infant formulas, particularly after prolonged storage, adversely affects gut maturation and function in preterm pigs used as a model of preterm infants.

Physicochemical Properties of Liquid Infant Formula Stored at Different Temperatures

Changes in the physicochemical properties of ready-to-feed liquid infant formula (LIF) stored at different temperatures (10, 20, 30, and 40°C) for 6 mon, focusing on 5-hydroxymethylfurfural (HMF) content, color, pH, fat globule size distribution, and rheological properties were determined. The HMF content increased with storage time, and LIF stored at 40°C had a higher HMF content than that of LIF stored at 10°C. The lightness (L*) decreased while redness (a*) and yellowness (b*) increased with increasing HMF content. The fat globule size and pH of LIF stored at 10°C did not change. However, in the case of LIF stored at 30°C and 40°C, the fat globule size increased and the pH decreased during storage for 6 mon. LIF stored at 40°C had a higher apparent viscosity (η_a,10) than that of LIF stored at 10°C, and the shear-thinning behavior of LIF stored at higher temperature was stronger than that of LIF stored at low temperature. The physicochemical changes of LIF during storage were accelerated by Maillard reaction (MR) at higher storage temperatures. Therefore, even if LIF is aseptically manufactured, we recommend that sterilized LIF should be stored at low temperature in order to minimize quality changes during storage.