Mild processing and addition of milk fat globule membrane in infant formula may better mimic intragastric behavior of human milk: A proof of concept trial in healthy males

Background: During breastfeeding the macronutrient composition of breastmilk changes gradually from relatively low-fat (foremilk) to relatively high-fat (hindmilk), initially exposing the gastrointestinal tract to a relatively low fat concentration. In contrast, infant formulae (IF) are homogenous. Mild processing and addition of milk fat globule membrane (MFGM) may impact gastric emulsion instability, potentially impacting the phased release of nutrients as observed during breastfeeding. Objective: To assess gastric emulsion stability, gastric emptying, and the postprandial plasma metabolome of an experimental minimally processed IF (EF) with an altered fat-globule interface and a control IF (CF). Methods: Twenty healthy males participated in this double-blind randomized crossover trial. Gastric MRI scans and blood samples were obtained before and after consumption of 600 ml CF or EF over a 2-h period. Outcomes included gastric top layer formation, total gastric volume, and blood parameters (free fatty acids (FFA), insulin, glucose, and nuclear magnetic resonance (NMR-)metabolomics). Results: EF showed an earlier onset (13.4 min, p = 0.017), smaller maximum volume (49.0 ml, p = 0.033), and a shorter time to maximum top layer volume (13.9 min, p = 0.022), but similar AUC (p = 0.915) compared to CF. Total gastric volume did not show a treatment*time effect. Insulin concentrations were lower for EF. FFA and glucose did not differ. EF yielded higher serum concentrations of phospholipid- and cholesterol-related metabolites. Conclusion: An EF displayed faster gastric creaming than a CF, thereby potentially better mimicking the behavior of breastmilk which leads to phased release of nutrients into the intestine. Overall physiological benefits of this difference in gastric behavior remain to be studied further in infants.