PEDIATRICS Vol. 79 No. 5 May 1987, pp. 748-755
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Protein Quality in Feeding Low Birth Weight Infants: A Comparison of Whey-Predominant Versus Casein-Predominant Formulas

Sudha Kashyap MD1, Emi Okamoto MD1, Shinobu Kanaya MD1, Christine Zucker MS1, Kirsten Abildskov MS1, Ralph B. Dell MD1, and William C. Heird MD1

1 From the Department of Pediatrics, College of Physicians and Surgeons, Columbia University, and Babies Hospital (Presbyterian Hospital), New York

Growth (Dgrweight, Dgrlength, Dgrhead circumference, and Dgr skinfold thickness), nitrogen retention, and chemical indices of metabolic tolerance (BUN concentration and acid-base status; plasma amino acid concentrations including free and bound cyst(e)ine; urinary excretion of sulfur amino acids) were determined serially in low birth weight infants (900 to 1,750 g) fed formulas differing only in protein quality. One contained unmodifled bovine milk protein (a ratio of whey proteins to caseins of 18:82); the other contained modified bovine milk protein (a ratio of whey proteins to caseins of 60:40). Both provided protein and energy intakes, respectively, of approximately 3.4 g/kg/d and 120 kcal/kg/d. Neither weight gain nor the rate of increase in length, head circumference, and skinfold thickness differed between the two groups. Nitrogen retention of the two groups also did not differ. Although BUN concentration and blood acid-base status did not differ, there were differences in the plasma concentrations of some amino acids. Plasma tyrosine concentration was higher in infants fed the casein-predominant protein, and plasma threonine concentration was higher in infants fed the whey-predominant protein. Neither plasma-free nor bound cyst(e)ine concentration differed between the two groups, but the greater cyst(e)ine intake of the whey-predominant group resulted in greater cyst(e)ine retention; this was accompanied by greater urinary taurine excretion, a reflection of greater taurine stores.

Key Words: protein quality • low birth weight infant • whey-predominant formula • casein-predominant formula

Submitted on March 31, 1986
Accepted on June 10, 1986




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