Folate in infant formula and follow-on formula

• The B-vitamin folate is an essential nutrient needed for optimal cell division, tissue growth and cognitive development. Therefore it is particulary important during this period of rapid growth and development in infancy.
• Folic acid is currently the only folate source approved for use in infant formula and follow-on formula. 
• MTHF is the predominant form of folate in breast milk and a recent study has demonstrated the safety of use and the nutritional suitability of MTHF for use in infant formula and follow-on formula.

The role of folate for optimal infant development

The B-vitamin folate is an essential nutrient needed for optimal cell division, tissue growth and cognitive development. Therefore it is particulary important during the period of rapid growth and development in early life.

Folic acid is a synthetic form of folate which does not occur in nature and is only found in foods fortified with folic acid. Currently, folic acid is the only folate source approved for use in infant formula and follow-on formula. In breast milk, the predominant form of folate is MTHF, an active form of folate. Folic acid on the other hand needs to be activated in the body. Depending on the genotype, not everybody is able to do this efficienty.¹

Generally folic acid is metabolized to MTHF in the enterocytes in the gut lining. At higher intakes, this mechanism is overloaded and folic acid enters the plasma unmetabolized.² Unmetabolized folic acid is not present in breast milk, unless maternal intakes via supplements or fortified foods are high. It is important to consider the genetic differences in ability to metabolize folic acid, which may decrease the availability of active folate.

MTHF provides a more natural solution for infant and follow-on formula, and a new study has been published that investigated the safety and suitability of using MTHF as source of folate.³

Investigating the potential of MTHF

The study assessed growth, tolerance and indicators of safety in infants who were fed a formula containing MTHF, compared to infants fed a standard formula with folic acid. 

Infants who consumed the formula with MTHF did not show significant differences in growth and tolerance compared to infants fed the same formula including folic acid. Weight gain was comparable between both groups and the addition of MTHF did not raise any safety concerns or result in any adverse effects. The results have demonstrated that MTHF is a safe approach to providing adequate folate intake without increasing the amount of unmetabolized folic acid in the plasma of formula-fed infants.    

DSM supports the WHO recommendation that infants should be exclusively breastfed for the first six months of life, and then breastfed alongside complementary food for up to the age of two years or beyond, to achieve optimal growth, development and long-term health. Not all infants can be breastfed. So, infant formula and follow-on formula need to be optimized to provide a nutritional, safe and adequate alternative. The results of the study represent an important step in achieving approval for MTHF as a natural form of folate.