Overview
The CHARLIE study aimed to understand infant preferences for whole goat milk formula (WGMF) and cow milk formula (CMF) using research and clinical practice tools assessing feeding behaviour and quality of life. Infants fed WGMF exhibited greater general appetite and better quality of life than CMF-fed infants. There was no difference in food enjoyment. The findings suggest that WGMF is an attractive alternative to whey-based CMF.
Methods
Principal Investigator: Dr Marc Bellaïche, Pediatric Gastroenterology and Nutrition, Robert-Debré Hospital, France
Ethics approval: Registered at ClinicalTrials.gov (NCT03488758)
Formulations: Manufactured Whole Goat Milk Formula** (20:80 whey to casein ratio; 48% total fat from goat milk; no added whey) and manufactured CMF (60:40 whey to casein ratio; 22% total fat from cow milk).
The CHARLIE study was a multi-centre, double-blinded, randomised controlled trial. Healthy term, exclusively or partially formula-fed infants less than four months of age were recruited in or near Paris, France. Infants were switched to WGMF (n=33) or CMF (n=32) at enrolment for an intervention period of four weeks. Both caregivers and researchers were unaware of which formula was given.
Infants were assessed at enrolment and after four weeks of consuming the formula. Enjoyment of food, food responsiveness, slowness in eating, satiety responsiveness and general appetite were assessed using the validated Baby Eating Behaviour Questionnaire (BEBQ).2 The quality of life of the infants, including psychomotor and socio-emotional development, was assessed using the QUALIN questionnaire.3 The QUALIN questionnaire is validated for children from three months to three years old and was modified to remove questions unsuitable for infants under three months old. Feeding difficulties were assessed using the Montreal Children’s Hospital Feeding Scale (MCH-FS; developed by paediatricians).
Key findings
Based on the BEBQ, infants enjoyed the formulas equally, and there was no difference in the pace at which they consumed either formula. Infants switching to a WGMF had improved food responsiveness (drive to eat) and general appetite scores.* Infants receiving CMF had a higher satiety responsiveness score (P=0.049), indicating they were full more quickly, potentially due to cow milk proteins forming a harder curd under the acidic stomach conditions.4 The growth of infants in the WGMF and CMF groups was equivalent,† suggesting that the improved general appetite of infants consuming WGMF does not indicate overconsumption or higher weight gain.
The quality of life of infants who switched to the WGMF was greater than that of the infants fed the CMF.‡ The QUALIN questionnaire is based on criteria used by parents, caregivers, paediatricians, and nurses when they think about the quality of life for a baby. There was no difference in feeding difficulties between the groups receiving WGMF and CMF (MCH-FS; only a few infants had feeding difficulties).
Conclusion
Infants fed WGMF were more willing to consume it, had a greater appetite, were more satisfied, and were less fussy. Switching from cow milk formula to goat milk formula could improve infants’ quality of life, facilitate feeding, or stimulate appetite.
The QUALIN questionnaire was adapted for infants under three months old. The study was interrupted because of the COVID pandemic, limiting the number of infants enrolled.
References
CMF: cow milk formula; WGMF: whole goat milk formula.
**Capricare formula with added DHA and ARA
*Improved food responsiveness (WGMF: 0.15 ±1; CMF: -0.48 ±0.81; P=0.010) and greater general appetite (WGMF: 0.26 ±1.2; CMF: -0.48 ±0.88; P=0.012).
†D28±3 weight (g) WGMF: 5540.1±1213.2; CMF: 5104.6±1500.7; P=0.20. D28±3 length (cm) WGMF: 58.9±4.4; CMF: 58.7±4.5; P=0.85.
‡Better quality of life (WGMF: 4.6 ±9.4; CMF: -0.40 ±7.6; P=0.03).
1 Jung et al. Nutrients. 2023;15(18):4057.
2 Llewellyn et al. Appetite. 2011;57(2):388–396.
3 Manificat et al. Arch Pediatr. 2000;7(6):605–614.
4 Hodgkinson et al. Food Chem. 2019;276:619–625.