Infant milks contain less and less lactose

02.2025
Author Dr. Martin Claßen, Bremen

Dietary habits have changed over the last few decades, and some of these developments have an impact on infants. One element of diets which is the subject of increasing critical public discussion is lactose. Cross-sectional data from the NHANES database in the USA from 1999 to 2020 was analysed to investigate whether feeding children with infant milks containing a carbohydrate other than lactose has increased in recent years. A total of 36,084 feeds, 13,045 of which were breast milk, were given to 3709 children under 12 months old. Of these children, 884 (23.83%) were given only human milk, 462 (12.46%) were given human milk plus formula, and 2,363 (63.71%) were given only formula. The average age was 5.77 months (SD: 3.11), and the median age was 6 months. A comparison of the period between 1999 and 2004 (1,512 of 5,082 feeds – 29.8%) and the period between 2017 and 2020 (2,319 of 2,966 feeds – 78.2%) shows a huge increase in the use of milks which contain other carbohydrates in addition to lactose. In the latter period, 19.7% of these milk formulae contained corn syrup solids, 14% contained maltodextrin, 0.8% contained sucrose, and 43.8% contained multiple sugars.

Comment: Lactose is the main carbohydrate in human milk, which means it is also the gold standard for infant milk. Only a negligible number of infants cannot tolerate lactose – in contrast to adults, where the majority of the world’s population has a genetic adult lactase deficiency. Studies suggest that carbohydrates other than lactose in infant milks may have harmful effects on weight gain in children and increase the risk of obesity. Thus, it is important to make parents aware of the positive effects of lactose (including colonisation of the intestine with bifidobacteria and production of butyrate through intestinal bacteria). Apart from a small number of exceptions, there is no medical reason to replace lactose with other sugars or starch in infant nutrition. The alternatives used are all cheaper than lactose, so to that extent it suits the industry to change the recipe. 
For me, Pre formula – which is only allowed to contain lactose – is still the first choice in the first year of life for children who are not breastfed; other carbohydrates should always come second. We should make clear that genetic (adult) lactose intolerance does not manifest itself in the first year of life, and that most plant-based drinks are not a nutritious alternative to infant milk made from cow’s milk owing to their calcium content, the low bioavailability of calcium and the low essential amino acid content. And more in-depth research on the long-term effects of other carbohydrates in infant milks is needed.

Reference:
DiMaggio DM, Abersone I, Porto AF. Infant consumption of 100% lactose-based and reduced lactose infant formula in the United States: Review of NHANES data from 1999 to 2020. J Pediatr Gastroenterol Nutr. 2024 Nov;79(5):1017-1023. doi: 10.1002/jpn3.12292.