Gastrointestinal tolerability of organic infant formula compared to traditional infant formula: A systematic review

BACKGROUND Infants'nutrition significantly influences their growth,development,and overall well-being.With the increasing demand for organic infant formula driven by the perception of health benefits and growing awareness of natural feeding options,it is crucial to conduct a comparative analysis of the gastrointestinal tolerability between organic and traditional infant formulas.AIM To provide a concise and precise analysis of the gastrointestinal tolerability of organic infant formula compared to traditional infant formula.Due to limited direct comparisons,the review synthesizes available literature on each formula type,presenting insights into their potential effects on infants'digestive health.METHODS An extensive literature search was conducted,compiling studies on organic and traditional infant formulas,their compositions,and reported effects on gastrointestinal tolerability.We searched academic databases such as PubMed and Google Scholar and specialized nutrition,paediatrics,and infant health journals using relevant keywords till October 1,2023.RESULTS Although specific comparative studies are scarce and formula heterogeneity is a significant limitation,this systematic review provides an in-depth understanding of organic infant formulas'composition and potential benefits.While scientific evidence directly comparing gastrointestinal tolerability is limited,organic formulas strive to use carefully selected organic ingredients to imitate breast milk composition.Potential benefits include improved lipid profiles,higher methionine content,and decreased antibiotic-resistant bacteria levels.Understanding the gastrointestinal tolerability of organic and traditional infant formulas is crucial for parents and healthcare providers to make informed decisions.CONCLUSION Despite limitations in direct comparisons,this systematic review provides insights into the composition and potential benefits of organic infant formulas.It emphasizes the need for further research to elucidate their gastrointestinal effects comprehensively.

Validation of Molecular Detection Methods for Gluten Allergens in Infant Formula

[Objectives]To verify the specificity,sensitivity,precision and negative-positive deviation of the foodproof gluten component de-tection kit for the detection of gluten allergens in milk powder matrix,and to establish a real-time fluorescent PCR legal method for the detec-tion of gluten allergens in milk powder.[Methods]The specificity,sensitivity,precision and negative-positive deviation of the detection method of foodproof gluten component detection kit(PCR-probe method)were verified by artificially adding different concentrations of wheat bran and extracting sample DNA by kit method,and applied to sample detection.[Results] The specific detection results of two kinds of milk powder with wheat bran and buckwheat added showed that the foodproof gluten component detection kit(PCR-probe method)had good speci-ficity for wheat gluten.The results of artificially added wheat bran positive samples showed that the false positive rate and false negative rate of the kit in the milk powder matrix were O,and the sensitivity and precision were high.[Conclusions]The kit is simple to operate and has high accuracy,which is suitable for the detection of gluten allergen components in milk powder.

Dietary exposure assessment of perchlorate and chlorate in infant formulas marketed in Shanghai,China

Perchlorate and chlorate are ubiquitous pollutants that can adversely affect the thyroid function in humans.This study assessed the potential health risks associated with the dietary exposure of infants and young children to perchlorate and chlorate present in infant formulas available in Shanghai.The assessment was based on risk monitoring data from 150 samples of infant formulas in Shanghai between 2020 and 2022,along with the dietary consumption data of infants and young children.The detection rates of perchlorate and chlorate in infant formulas were 46.0%and 98.7%,with mean contents of 9.98μg/kg and 112.01μg/kg,and the maximum values of 151.00μg/kg and 1475.00μg/kg,respectively.The mean and 95th percentile(P95)values of daily perchlorate exposure of 0-36-month-old infant and young children via infant formulas were 0.07 and 0.17μg/kg body weight(bw)per day,respectively,which were lower than the tolerable daily intake(TDI)of perchlorate(0.3μg/kg bw per day).The mean and P95 values of chlorate exposure via infant formulas in 0-36-month-old infants and young children were 0.83 and 1.89μg/kg bw per day,which were lower than the TDI of chlorate(3μg/kg bw per day).The P95 exposure of different age groups(0-6 months,7-12 months and 13-36 months)of infants and young children to perchlorate and chlorate in infant formulas was below the TDI.Therefore,the risk associated with the exposure of 0-36-month-old infants and young children to perchlorate and chlorate from infant formulas in Shanghai is considered acceptable.Prioritizing environmental pollution control efforts to reduce the levels of perchlorate and chlorate in food products is important to safeguard the health of the infants and children under the One Health concept.

A Survey on Occurrence of Melamine and Its Analogues in Tainted Infant Formula in China

Objective To investigate the occurrence and concentrations of melamine and its analogues in tainted infant formula and to identify the etiologic factors for the urinary stones epidemic in infants and young children in China in 2008. Methods Sanlu infant formula samples were collected from families of the affected children in Gansu province, and markets in Gansu and Hebei provinces and Beijing city. Melamine and its analogues, including cyanuric acid, ammeline, and ammelide were measured by gas chromatography/tandem mass spectrometry. Results High prevalence and concentrations of melamine were found in Sanlu infant formula samples, with low concentrations of cyanuric acid, ammeline and ammelide. Melamine were detected in 87 out of 111 Sanlu infant formula samples with a range of 118 to 4 700 mg/kg, Conclusion The results provide strong evidence for melamine as the etiological factor for the urinary stones epidemic in infants and young children in China in 2008.

Consumer confidence and consumers’ preferences for infant formulas in China

A series of safety incidents related to domestically-produced infant formulas(DIFs) almost destroyed Chinese consumer confidence in domestic dairy products. Understanding consumer confidence and its effect on consumption behavior is important to restore consumer confidence and enhance the competitiveness of domestic dairy industry. This article first measures Chinese consumer confidence in DIFs safety using a two-dimension scale(optimism and pessimism) and then investigates its effect on consumers’ preferences for DIFs through a choice experiment. Involving 450 consumers residing in Beijing, Tianjin and Shijiazhuang, the experiment elicited information on their preferences for DIFs with six attributes(organic raw milk, farm-to-table traceability, region of origin, quality certification, animal welfare, and price). Our analysis yields four findings. First, Chinese consumers still lack confidence in DIFs safety. Second, quality certification is the most preferred product characteristic, followed by organic raw milk and farm-to-table traceability. Third, serving as a signal of high quality, price exerts a positive impact on choices of DIFs for pessimistic consumers. Finally, consumer preferences for farm-to-table traceability and region of origin are significantly influenced by consumer confidence.

A Method for the Measurement of Lutein in Infant Formula

Lutein is an antioxidant that is deposited in the macular region of the eye and is crucial to macular function. Lutein is present in human milk and recently has been added to infant and toddler formulas. A method for the extraction and quantification of lutein from lutein-fortified infant formula and toddler milk products was developed. The lipids and carotenoids were extracted from the samples with ethanol and hexane:tetrahydrofuran. Polar xanthophylls were ex-tracted from the organic mixture with ethanol:water, leaving behind lipids and less polar carotenoids. The ethanol:water extracts were dried, reconstituted in mobile phase, and the lutein was quantified by high performance liquid chromatography with UV detection. A C30 carotenoid column and a mobile phase gradient of methyl-tert-butyl ether and methanol were used for the chromatographic separation. Validation data showed repeatability with relative stan-dard deviations < 4% and intermediate precision with relative standard deviations <20% at a low fortification level, 25 mcg lutein/L, and <12% at a high fortification level, 200 mcg lutein/L. Overall recoveries from sample matrix ranged from 88% to 106%. This liquid:liquid extraction method for the quantification of lutein in infant formulas is precise and accurate. Keywords: Lutein;carotenoid;infant formula;toddler milk;xanthophylls.

Assessment on Dietary Melamine Exposure from Tainted Infant Formula

Objective To estimate the dietary melamine exposure in Chinese infants and young children from the consumption of melamine adulterated Sanlu infant formula. Methods Four age groups of infants and young children （3, 6, 12, and 24 months） were chosen as the assessed subjects and the maximum amount of infant formula consumption was estimated based on the recommended usage level in the package insert of Sanlu infant formula and other brands. Melamine was analyzed in 111 Sanlu infant fbrmula samples collected from the markets in Beijing and Gansu province using the LC-MS-MS with a limit of quantification of 0.05 mg/kg. Four levels of melamine concentration were chosen to estimate the dietary intakes, including the mean, median, 90th percentile, and maximum. Results The infants of 3 months had the highest intake of melamine, and with the increase of the age （inonth）, the intake decreased. Based on the median melamine concentration （1 000 mg/kg） as an example, the melamine intakes fur the infants of 3, 6, 12, and 24 months were 23.4, 21.4, 15.0, and 8.6 mg/kg bw/d, respectively. Conclusion Dietary melamine intakes from tainted Sanln infant formula significantly exceeded the TDI level （0.2 mg/kg bw/d） recommended by the WHO Expert Meeting in 2008. However, the present assessment has some limitations including the poor representative samples, the varied melamine concentrations in the adulterated Sanlu infant formula, and other brand infant formula possibly consumed by these infants.

Assay of ghrelin concentration in infant formulas and breast milk

AIM: To test if total ghrelin is present in infant formulas. METHODS: Using a radioimmunoassay, we measured total ghrelin concentrations in 19 samples of commercial infant formulas and in 20 samples of human milk. We also determined ghrelin concentration in the serum of infants and lactating mothers. RESULTS: Ghrelin concentrations were significantly higher in artificial milk (2007.1 ± 1725.36 pg/mL) than in human milk (828.17 ± 323.32 pg/mL) (P = 0.005). The mean ghrelin concentration in infant serum (n = 56) was 1115.86 ± 42.89 pg/mL, and was significantly higher (P = 0.023) in formula-fed infants (1247.93 ± 328.07 pg/mL) than in breast-fed infants (1045.7 ± 263.38 pg/mL). The mean serum ghrelin concentration (mean ± SD) in lactating mothers (n = 20) was 1319.18 ± 140.18 pg/mL. CONCLUSION: This study provides evidence that total ghrelin is present in infant formulas. This findingraises diverse questions regarding the uptake, absorption and metabolic effects of this hormone.

A Survey of Urolithiasis in Young Children Fed Infant Formula Contaminated with Melamine in Two Townships of Gansu,China

Objective To determine the prevalence of urolithiasis in young children fed infant formula（IF） contaminated with melamine,and the association between IF consumption and urolithiasis.Design A total of 2 733 children ≤3 years of age on September 1,2008 in two townships of Gansu Province,China were studied.Cases of urolithiasis were diagnosed by ultrasonography.Milk product consumption was determined by their caregivers.Remaining IF samples were tested for melamine and cyanuric acid.Results Of 2 733 eligible children in the two townships,2 186（80%） were enrolled in our study.Overall,16.6%（362） of 2 186 children had urolithiasis.The prevalence was 24.6% in children exclusively fed Sanlu brand IF,9.7% in those fed other IF,and 8.5% in those fed exclusively on other milk products.For children exclusively breast-fed,no urolithiasis was found（P0.05）.The prevalence of urolithiasis was 11.4% in children fed 400 g of Sanlu IF,rising to 37.5% in children fed over 25 600 g.Of 48 Sanlu IF samples,91.7% contained melamine（median=1 800 ppm;range=45-4 700） and 66.7% contained cyanuric acid（median=1.2 ppm;range=0.4-6.3）.Melamine was also detected in 22.2% of 36 other brand IF（median=27.5 ppm,range=4-50）.Conclusions Urolithiasis was associated with melamine-contaminated IF.Although one product caused most morbidity,other milk products may have also contributed to the outbreak.

Effects of carob-bean gum thickened formulas on infants' reflux and tolerance indices

AIM: To examine the effect of carob-bean gum(CBG) thickened-formulas on reflux and tolerance indices in infants with gastro-esophageal reflux(GER). METHODS: Fifty-six eligible infants(1-6 mo old) were randomly allocated to receive for two weeks a formula with either 0.33 g/100 m L(Formula A) or 0.45 g/100 m L(Formula B) of cold soluble CBG galactomannans respectively, or a formula with 0.45 g/100 m L of hot soluble CBG galactomannans(Formula C). No control group receiving standard formula was included in the study. Data on the following indices were obtained both at baseline and follow-up from all study participants: 24 h esophageal p H monitoring indices, anthropometrical indices(i.e., body weight and length) and tolerance indices(i.e., frequency of colics; type and frequency ofdefecations). From the eligible infants, forty seven were included in an intention-to-treat analysis to examine the effects of the two-week trial on esophageal 24 h p H monitoring, growth and tolerance indices. Repeated Measures ANOVA was used to examine the research hypothesis.RESULTS: Regarding changes in 24 h p H monitoring indices, significant decreases from baseline to followup were observed in the "Boix Ochoa Score"(i.e., an index of esophageal acid exposure), in the total number of visible refluxes and in all symptoms related indices due to acid reflux only for infants provided with Formula A, while no significant changes were observed for infants provided with Formulas B and C. In addition, the significant decreases observed in two symptoms related p H monitoring indices(i.e., "Symptom index for reflux" and "Percentage of all reflux") for infants provided with Formula A were also found to differentiate significantly compared to the changes observed in the other two groups(P = 0.048 and P = 0.014 respectively). Concerning changes in anthropometric indices, body weight significantly increased among infants provided with Formulas A and C, but not for infants provided with Formula B. As far as tolerance indices were concerned, the numbers of total and diarrheic defecations increased significantly only in infants provided with Formula B and these changes were significantly higher compared to the decreases observed in infants fed with Formulas A and C(P = 0.003 and P = 0.015 respectively. Lastly the number of colics significantly decreased in all infants, irrespective of the tested formula. CONCLUSION: Formula A(i.e., 0.33 g/100 m L of cold galactomannans) was effective in reducing certain p Hmonitoring indices of uncomplicated GER, increased body weight and was well-tolerated by infants.

Women's experiences of formula feeding their infants:an interpretative phenomenological study

Objective: This study aimed to explore the experiences of women in the process of formula feeding their infants. The World Health Organization has emphasized the importance of breastfeeding for infant health. After decades of breastfeeding promotions,breastfeeding rates in Hong Kong have been rising consistently; however, the low continuation rate is alarming. This study explores women's experiences with formula feeding their infants, including factors affecting their decision to do so.Methods: A qualitative approach using an interpretative phenomenological analysis(IPA) was adopted as the study design. Data were collected from 2014 to 2015 through individual in-depth unstructured interviews with 16 women, conducted between 3 and 12 months after the birth of their infant. Data were analyzed using IPA.Results: Three main themes emerged as follows:(1) self-struggle, with the subthemes of feeling like a milk cow and feeling trapped;(2) family conflict, with the subtheme of sharing the spotlight; and(3) interpersonal tensions, with the subthemes of embarrassment,staring, and innocence. Many mothers suffered various stressors and frustrations during breastfeeding. These findings suggest a number of pertinent areas that need to be considered in preparing an infant feeding campaign.Conclusions: The findings of this study reinforce our knowledge of women's struggles with multiple sources of pressure, such as career demands, childcare demands, and family life after giving birth. All mothers should be given assistance in making informed decisions about the optimal approach to feeding their babies given their individual situation and be provided with support to pursue their chosen feeding method.

Detection and Molecular Characterization of <i>Cronobacter sakazakii</i>Isolated from Powdered Infant Formula (PIF) from North Central Region, Nigeria

Cronobacter sakazakii is an emerging ubiquitous and opportunistic pathogen that currently contaminates a wide spectrum of foods including powdered milk and poses a lethal threat to neonates, the elderly and persons with immune deficiencies. They cause life threatening neonatal meningitis, septicemia, and necrotizing enterocolitis. A total of 360 samples of powdered infant formula were collected from postnatal hospital attendees reconstituting the PIF for their children in the North Central region of Nigeria where cases of infant mortality are very high and presenting as enterocolitis and diarrhea. Pre-enriched samples were cultured in chromogenic Cronobacter broth and were then further sub-cultured into a chromogenic Cronobacter sakazakii agar. They were positive, exhibiting yellowish cultures typical of Cronobacter sakazakii. Biochemical tests of the isolates were also carried out and indicated the presence of Cronobacter sakazakii. The isolates were then characterized molecularly using specie specific PCR detection of Cronobacter sakazakii. The targeted genes of interest were ompA gene and CPA gene. The isolates tested showed bands for ompA gene on electrophoresis imager and were confirmed as Cronobacter sakazakii. In Nigeria, majority of infants are still fed with PIF. There is no existing data on the detection of Cronobacter sakazakii previously reported in the North central region of Nigeria hence the need to carry out the present study. The result of the study demonstrated the need for effective prevention and control measures as contamination of PIF with Cronobacter sakazakii constituted potential public health risk to neonates and infants.

Characteristics of Microencapsulated Nutritional Oil for Infant Formula Food

Nutritional oil for infant formula food was microencapsulated by the spray drying method with coating materials including maltodextrin （MD）, soy protein isolate （SPI）, and emulsifier （soy lecithin）. Vegetable oil blend was prepared by mixing coconut oil, safflower oil and soybean oil at a ratio to achieve a fatty acid profile comparable to human milk fat （HMF）. The fatty acid composition of the product was determined by capillary gas chromatograph. As a result, the composition was as close as possible to that of HMF, it could be used for infant fomular food to make up some deficiencies of milk powder in nutrition and functional properties. Furthermore, the glass transition temperature （Tg） of the wall material was determined by DSC and its Tg was 66.42℃. It provided a theoretical basis for the storage of the product at the normal temperature.

Screening for Enterobacteriaceae Bacteria in Infant Formula Powder

A total of 151 infant formula powder samples were tested for the screening of the Enterobacteriaceae bacteria, and it had been contaminated by the conditioned pathogen like Enterobacter sakazakii, Klebsiella pneumoniae, Klebsiella oxytoca, and Enterobacter cloacae. The results showed that six samples were separated Enterobacter sakazakii, 24 samples were separated Enterobacteriaceae by using the traditional validation and real-time fluorescence quantitative PCR. Then the result identified by API20E biochemistry test and VITEC2 identification system. Through the study we concluded the potential safety hazard of the current infant formula powder and should regard Enterobacteriaceae as an indicator to carry out effective management, the neglected mild and discontinuity contamination could be easily found, thus to guarantee the safety of the special group.

Production of Infant Formula Analogs by Membrane Fractionation of Caprine Milk: Effect of Temperature Treatment on Membrane Performance

A two-step-cascade membrane separation by ultrafiltration was performed on caprine milk prepared under different temperature conditions to eliminate beta-lactoglobulin (β-Lg) from the whey fraction. Effects of temperature treatment and membrane pore size on the elimination of β-Lg and retention of alpha-lactalbumin (α-La) were examined to determine the optimum permeate fraction for production of infant formula analogues from caprine milk. The frozen raw caprine milk, with and without prior pasteurization, showed the best membrane separation performance. The permeates obtained from the 800/30kDa membrane combination showed the optimal results. The infant formula analog produced using the casein and 800/30kDa-permeate fractions of the treated caprine milk had the closest similarity to human milk with respect to the total protein content (1.3g 100g-1), beta-lactoglobulin content (1% - 2%), and casein- α-lactalbumin ratio (0.6 - 0.7). Membrane performance during ultrafiltration of caprine milk was affected by temperature treatment of the milk prior to membrane separation.

Organochlorine Pesticides in Infant Milk Formulas Marketed in the South of Mexico City

The nature of organochlorine pesticides (OCP) and their physical-chemical properties exert immediate action of control on live systems, which has justified their use in agricultural practices. Their long life makes them a persistent ecological aggressor and biomagnifier. They reach foods by biotic and abiotic means, and are absorbed and accumulate in adipose tissue. In lactation processes, they are excreted in milk through the mobilization of fats. Diverse studies have identified them as neurotoxic, affecting reproductive processes, altering the immunological response and act as endocrine disruptors. An analysis was made of the content of organochlorine pesticides in twenty-one samples of infant milk formulas marketed in the south of Mexico City in 2010. The determinations were made following the protocols of the International Dairy Federation, by means of gas chromatography with electron capture detector, and the majority presence was found of α-HCH (100%), β-HCH (95.2%), γ-HCH (90.5%), aldrin (85.7%), heptachlor (80.9%) and heptachlor epoxide (80.9%) with mean values of 0.24, 0.13, 0.32, 0.62, 0.92 and 0.18 μg/kg of fat, respectively;all below the limits permitted by the Codex Alimentarius. With null or lower recurrence and in lowerquantities, the family of DDT, endrin, endrin aldehyde and the endosulphanes were quantified.

Growth Profile of 100 Breastfeeding Children with Early Introduction of Infant Formulas in Abidjan, Côte d’Ivoire

Objective: To describe the growth profile of breastfeeding babies following early introduction of infant formulas to improve the feeding pattern of the young infant. Methodology: This is a longitudinal descriptive study conducted in 2 medical clinics in Abidjan from 11-Jun-2013 to 15-Dec-2016 on 100 healthy newborn babies with the introduction of infant formulas before 6 months of life. The anthropometrics parameters were compared to those of WHO. Results: The exclusive breastfeeding rate was 5%. Ablactation occurred within 12 months in 95% of cases. All Infants have doubled and tripled their birth weight at 3 and 9 months respectively. The height and the head circumference at birth increased by 50% and 37% respectively at 12 months. Compared to WHO growth charts, the weight gain for the girls at 3 months was 12.4% higher and for the boys was 7.3% higher at 6 months. On the other hands, the statural gain at 12 months was 50% lower than the WHO standards while the head circumference was 37.8% and 45.5% higher than the WHO standards in boys and girls respectively. At 3 months, the prevalence of stunting was 26.1% for boys and 13.3% for girls. Lastly, at 12 months, the BMI showed 10% overweight and 19% obesity. Conclusion: Breastfeeding associated with an early introduction of infant formulas increases the risk of malnutrition of the young infant. We advise to avoid it and recommend an exclusive breastfeeding.

Assessment of Lipid Quality and Composition of Commercial Infant Milk Formulas in Mexico: Emphasis on Trans Fatty Acid Isomers

Objective: To assess the lipid quality focusing on trans fatty acids (TFA) content of standardized milk formulas marketed in Mexico for infants aged from 0 to 36 months. Material and Methods: A total of 27 infant formulas from eight different leading brands were analyzed. Nine of them belonged to stage 1 (age 12 months). Acquired products were treated by duplicate for extraction of total lipid content with the modified Folch method before their expiration date. Fatty acids were esterified in an alkaline medium followed by an acid-catalyzed esterification. Analysis was performed on a gas chromatograph (5890 Series II;Hewlett-Packard, USA) with a flame ionization detector. Results: Thirty-four fatty acids (C8 to C22) were identified. Most products complied with ESPHAGAN compositional requirements. Only one product exceeded the suggested limit (>3%) for TFA. Long chain polyunsaturated fatty acids (LC-PUFAs) content was consistently meager (≈78%), with low amounts of arachidonic (Conclusion: Most milk formulas complied with ESPHAGAN global recommendations. The content of TFA and LC-PUFAs was scarce in the majority of samples.

EFFECT OF INFANT FORMULA SUPPLEMENTED WITH OLIGOSACCHARIDES ON STOOL CHARACTERISTICS OF INFANTS

Objective To determine whether addition of oligosaccharides to a regular infant formula can lead to changes in the colonic function in vivo, particularly the fecal characteristics. Methods One hundred and two health full term infants were randomly assigned to one of two experimental formula groups: oligosaccharide formula (OF) group or regular formula (RF) group. Fifty breast-fed infants served as a control group during the same period. During the 3 weeks’ study, stool characteristics, including stooling frequency, stool consistency, pH and color, were recorded daily by parents. Results The mean fecal frequency of the infants in the OF group was significantly more than those of the RF group (P<0.05). The stools of the RF group were significantly harder than those in the OF group(P<0.001). Although the mean stool pH score and stool color score of infants in the OF group were not significantly different from that of infants in the RF group, it was much closer to that of breast-fed infants. Conclusion The addition of oligosaccharides to a normal infant formula could lead to improvements in fecal characteristics.

Clinical,laboratory,and therapeutic differences between immunoglobulin E-mediated and non-immunoglobulin E-mediated cow’s milk protein allergy in children

BACKGROUND Although breast milk is ideal for newborns,in some cases,it is replaced with cow’s milk,which contains proteins that increase the risk of cow’s milk protein allergy(CMPA).AIM To evaluate CMPA prevalence in Bahrain and compare clinical characteristics of children with immunoglobulin E(IgE)-and non-IgE-mediated CMPA.METHODS This retrospective cohort study examined children with CMPA diagnosed at the pediatric gastroenterology outpatient clinic of the Salmaniya Medical Complex,Bahrain,between 2014 and 2022,and assessed CMPA prevalence.Clinical presentations,laboratory findings,dietary modifications,and outcomes were compared between children with IgE-mediated and non-IgE-mediated CMPA.Categorical variables were compared using Fisher’s exact test or Pearson’sχ2 test,whereas continuous variables were compared using Student’s t-test or the Mann-Whitney U test.RESULTS Of 8332 patients,6022(72.3%)adhered to their appointment.Of them,618(10.3%)were suggested of having CMPA and 595(96.3%)were included;CMPA prevalence was 2%.Most patients were Bahraini(93.8%)and males(55.3%).Non-IgE-mediated type accounted for 77.3%cases and IgE-mediated type,22.7%.IgE-mediated CMPA presented more in boys(P=0.030),and later in life(5.1 months±4.5 months vs 4.2 months±4.2 months,P=0.016,95%CI:0.08-1.73),had more associated diseases(P<0.001);and presented with more cutaneous(P=0.024)and respiratory(P=0.003)manifestations,severe symptoms[rash/dry skin(P=0.031),facial swelling/angioedema(P=0.003),failure to thrive(P=0.013),apparent life-threatening event(P<0.001)],and positive physical findings(P=0.002)than non-IgE-mediated CMPA.Most patients were exclusively fed cow milk formula(50.3%).The amino acid-based formula(AAF)was most prescribed(60.5%)with no difference between the two types(P=0.173).Although breastfeeding was recommended to 49.6%,only 8.2%were exclusively breastfed.IgE-mediated CMPA was associated with a longer follow-up duration than non-IgE-mediated CMPA(17.3 months±14.0 months vs 13.5 months±13.4 months,P=0.005,95%CI:1.1-6.3).CONCLUSION This study revealed a high CMPA prevalence with clinical differences between both types that can influence treatment.AAF was most prescribed,while breastfeeding with dietary modification is rarely applied.