Discussion
gastrointestinal symptoms, flatulence, diarrhea, burping, gastrointestinal symptoms burping, digestive complications, abdominal distension, immature gastrointestinal system, gastrointestinal disorders
GASTROINTESTINAL COMPLICATIONS, GASTROINTESTINAL DISORDERS
In this observational, real-life setting study in Mexico, gastrointestinal and digestion-related outcomes of different commercially available infant formulae were studied in healthy term subjects. Most infants had soft or formed stools, although odds for having hard stools were different between groups. Further significant differences were found in stool amount and color. No significant differences between groups were reported on stool frequency, dry matter content, or fecal pH. Gastrointestinal symptom scores revealed significant differences for burping and diarrhea, while other gastrointestinal symptoms did not differ. Interestingly, although calprotectin levels were within the expected ranges for healthy infants, differences among groups could be established. Furthermore, calprotectin levels correlated with the severity of the gastrointestinal symptoms burping, flatulence, abdominal distension, and diarrhea.Several gastrointestinal disorders are associated with changes in stool characteristics, causing them to be monitored by parents and in clinical practice [Next to the stool characteristics, gastrointestinal symptoms were also studied. As the study population consisted of healthy infants, it was in line with expectations that many gastrointestinal symptoms were reported to be absent or very mild in many of the registrations. This is in line with observations of several countries where mild gastrointestinal disorders have previously been observed in otherwise healthy infants [The inflammatory marker calprotectin was lower in fecal samples of infants consuming IF A compared to IF D. Interestingly, fecal calprotectin correlated with the gastrointestinal symptoms burping, flatulence, and diarrhea. With respect to gastrointestinal complications, fecal calprotectin has limited use in standard clinical practice [Combined, the differences in gastrointestinal symptoms and fecal calprotectin might partly be related to the different formulae consumed, with diet impacting digestive challenges that may be caused by the immature gastrointestinal system in early life [Different infant formulae are available on the market, with variation in composition, predominantly related to the protein and fat source, and the presence of optional ingredients. With respect to the protein source, hydrolyzed protein formulae have previously been demonstrated to reduce digestive complications mostly associated with regurgitation [Strengths of this study include the observational setting, which enables real-world data collection. Subjects were recruited in different centers across Mexico, making the results generalizable to the wider population of, at least, Mexican infants. A limitation of the study was that outcomes were assessed based on parental reports, likely increasing the variation. Therefore, several objective and potential mechanistic measures, and the validated Amsterdam Infant Stool Scale [