BACKGROUND: Palm oil (PO) is used in infant formulas in order to achieve palmitic acid (PA) levels similar to those in human milk. PA in PO is esterified predominantly at the SN-1,3 position of triacylglycerol (TAG), and infant formulas are now available in which a greater proportion of PA is in the SN-2 position (typical configuration in human milk). As there are some concerns about the use of PO, we aimed to review literature on health effects of PO and SN-2-palmitate in infant formulas. METHODS: PubMed and Cochrane Database of Systematic Reviews were systematically searched for relevant studies on possible beneficial effects or harms of either PO or SN-2-palmitate in infant formula on various health outcomes. RESULTS: We identified 12 relevant studies using PO and 21 studies using SN-2-palmitate. Published studies have variable methodology, subject characteristics, and some are underpowered for the key outcomes. PO is associated with harder stools and SN-2-palmitate use may lead to softer stool consistency. Bone effects seem to be short-lasting. For some outcomes (infant colic, faecal microbiota, lipid metabolism), the number of studies is very limited and summary evidence inconclusive. Growth of infants is not influenced. There are no studies published on the effect on markers of later diseases. CONCLUSIONS: There is insufficient evidence to suggest that PO should be avoided as a source of fat in infant formulas for health reasons. Inclusion of high SN-2-palmitate fat blend in infant formulas may have short-term effects on stool consistency but cannot be considered essential.

Childhood Nutrition Research Centre UCL GOS Institute of Child Health London UK

Children's Hospital Zagreb University of Zagreb School of Medicine Zagreb Croatia

CNRC Baylor College of Medicine Houston Texas

Department of Clinical Sciences Pediatrics Umeå University Umeå Sweden

Department of Gastroenterology Hepatology and Nutrition University Children's Hospital University Medical Centre Ljubljana Slovenia

Department of Neonatal Intensive Care Oslo University Hospital Oslo Norway

Department of Nutrition Exercise and Sports University of Copenhagen

Department of Paediatric Gastroenterology Erasmus MC Sophia Children's Hospital Rotterdam The Netherlands

Department of Paediatrics University Hospital Motol Prague Czech Republic

Department of Paediatrics University of Granada Spain

Department of Pediatrics San Paolo Hospital Department of Health Sciences University of Milan Milan Italy

Human Nutrition School of Medicine Dentistry and Nursing University of Glasgow New Lister Building Glasgow Royal Infirmary Glasgow UK

Leeds teaching hospitals NHS trust Leeds UK

Newcastle Neonatal Service Newcastle Hospitals NHS Trust and Newcastle University Newcastle upon Tyne UK

Ospedale Pediatrico Giovanni XXIII University of Bari Bari Italy

Paris Descartes University APHP Necker Enfants Malades hospital Paris France

Pediatric Nutrition Unit Copenhagen University Hospital Rigshospitalet Copenhagen Denmark

J Pediatr Gastroenterol Nutr. 2020 Mar;70(3):e64. doi: 10.1097/MPG.0000000000002550. PubMed

J Pediatr Gastroenterol Nutr. 2020 Mar;70(3):e64. doi: 10.1097/MPG.0000000000002594. PubMed

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Infant formula with cow's milk fat and prebiotics affects intestinal flora, but not the incidence of infections during infancy in a double-blind randomized controlled trial