CMPA 
Q&A

There is no established method to evaluate taste preference in infants. A method for measuring sweet taste has been developed for children from 5 years of age¹; although experts recognize it may not be appropriate for younger children.¹ However, we do know that both HCP and parents/caregivers consider the taste or palatability of infant formula relevant.

In a survey conducted with 50 HCPs diagnosing and managing CMPA, and 3 groups of 100 caregivers (n=300) from 2 cities in France, they reported several important findings. The survey was performed using blinded tastings of different whey and casein-based formulas as well as amino-acid based formulas, with and without the addition of HMO and perceptions were recorded.² Overall findings are presented in Figures 1 and 2 below.

They found that:

• 92% of HCPs agreed that a formula with better palatability would reduce the chance of rejection by the family; while 92% of caregivers said they would feel better giving a formula with better palatability to their baby. 
• 96% of HCPs and 86% of caregivers felt better formula palatability would reduce waste.

<sup>1. Coldwell SE, et al. Neurology 2013;80(11 Suppl 3):S20-4. 
2. Muraro A, et al. Abstracts (wiley.com). EAACI 2021: #727.</sup>

An unborn infant’s sense of taste actually starts to develop as early as the last trimester of prenatal development, during which taste buds are capable of detecting and communicating information to central nervous system structures.¹ It is consequently not surprising that the newborn is sensitive and responsive to taste stimuli at birth.¹ Children’s basic biology predisposes them to prefer sweet tastes and to avoid bitter-tasting foods.¹ Evidence suggests that detection of sweet taste stimuli is possible during late gestation, likely preparing newborns to detect and accept the basic sweet taste found in breastmilk, which contributes to their survival.¹ The compositions of our formulas are optimized to mitigate bitterness due to protein hydrolysis. Althéra® HMO contains whey proteins and lactose, both known to improve palatability.^2,3 Alfamino® HMO contains a carefully selected blend of amino acids and the right carbohydrate source (maltodextrin) to alleviate bitterness.⁴

<sup>1. Forestell CA. Ann Nutr Metab 2017;70(suppl 3):17-25. 
2. Maslin K, et al. Pediatr Allergy Immunol 2018;29(8):857-62. 
3. Miraglia Del Giudice M, et al. Ital J Pediatr 2015;41:42. 
4. Nestle internal data.</sup>

In some cases, yes. For example, the hydrolyzed proteins in some extensively hydrolyzed formulas (eHFs) are very bitter. The differences in taste are related to various factors, including:

• protein source (i.e., casein, whey, plant-based) 
• degree of hydrolysis 
• presence or absence of lactose

Therefore, palatability may influence formula choice, especially in older infants. In a head-to-head trial, comparing Althéra® (a whey-based eHF) to Nutramigen® (a casein-based eHF), a higher proportion of infants dropped out of the Nutramigen® group due to formula refusal.¹

^{1.Vandenplas Y, et al. Acta Paediatr 2013;102(10):990-998.}