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Soy Protein Infant Formulae and Follow-On Formulae: A Commentary by the ESPGHAN Committee on Nutrition

Agostoni, Carlo*; Axelsson, Irene; Goulet, Olivier; Koletzko, Berthold§1; Michaelsen, Kim Fleischerm; Puntis, John; Rieu, Daniel#3; Rigo, Jacques**; Shamir, Raanan††; Szajewska, Hania‡‡2; Turck, Dominique§§ESPGHAN Committee on Nutrition:

Journal of Pediatric Gastroenterology and Nutrition: April 2006 - Volume 42 - Issue 4 - p 352-361
doi: 10.1097/
Medical Position Paper

ABSTRACT: This comment by the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Committee on Nutrition summarizes available information on the composition and use of soy protein formulae as substitutes for breastfeeding and cows' milk protein formulae as well as on their suitability and safety for supporting adequate growth and development in infants. Soy is a source of protein that is inferior to cows' milk, with a lower digestibility and bioavailability as well as a lower methionine content. For soy protein infant formulae, only protein isolates can be used, and minimum protein content required in the current European Union legislation is higher than that of cows' milk protein infant formulae (2.25 g/100 kcal vs. 1.8 g/100kcal). Soy protein formulae can be used for feeding term infants, but they have no nutritional advantage over cows' milk protein formulae and contain high concentrations of phytate, aluminum, and phytoestrogens (isoflavones), which might have untoward effects. There are no data to support the use of soy protein formulae in preterm infants. Indications for soy protein formulae include severe persistent lactose intolerance, galactosemia, and ethical considerations (e.g., vegan concepts). Soy protein formulae have no role in the prevention of allergic diseases and should not be used in infants with food allergy during the first 6 months of life. If soy protein formulae are considered for therapeutic use in food allergy after the age of 6 months because of their lower cost and better acceptance, tolerance to soy protein should first be established byclinical challenge. There is no evidence supporting the use of soy protein formulae for the prevention or management of infantile colic, regurgitation, or prolonged crying.

*University of Milano, Milano, Italy; †University of Lund, Malmö, Sweden; ‡Hôpital Necker Enfants-Malades, Paris, France; §Ludwig-Maximilians-University, Munich, Germany; ∥The Royal Veterinary and Agricultural University, Frederiksberg, Denmark; ¶The General Infirmary, Leeds, United Kingdom; #University of Montpellier, Montpellier, France; **University of Liège, Liège, Belgium; ††Meyer Children's Hospital of Haifa, Haifa, Israel; ‡‡The Medical University of Warsaw, Warsaw, Poland; §§University of Lille, Lille, France. 1Committee Chair; 2Committee Secretary; 3Guest

Received October 18, 2005; accepted October 18, 2005.

Berthold Koletzko is Committee Chair, Hania Szajewska is Committee Secretary, and Daniel Rieu is a guest of the ESPGHAN Committee on Nutrition.

Address correspondence and reprint requests to Dominique Turck, Unité de Gastro-entérologie, Hépatologie et Nutrition, Clinique de Pédiatrie, Hôpital Jeanne de Flandre, 2, avenue Oscar Lambret, 59037 Lille cedex, France. (e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.