Alfamino® Junior HMO
Hypoallergenic amino acid-based formula (AAF) with 2 HMO (2'-FL and LNnT) for effective first-line symptom relief in children (>12 months) with severe forms of CMPA, Multiple Food Protein Allergy and other conditions requiring an AAF.
Nutritionally complete from 12 months to 13 years of age – can be used as oral or enteral feeding.
Advancing the
Management of
Cow’s Milk
Protein Allergy
Preparing Alfamino Junior® HMO is very similar to how you prepare standard infant formula. The step-by-step instructions on how to prepare Alfamino Junior® HMO are:
STEP 1 Wash hands before preparation.
STEP 2 Wash bottle, teat and cap.
STEP 3 Boil bottle for for 5 min. Leave covered until use.
STEP 4 Boil drinking water for 5 min, allow to cool.
STEP 5 Pour exact amount of lukewarm water into bottle as per feeding table on tin.
STEP 6 Add exact number of level scoops for age of babyas per feeding table on tin.
STEP 7 Shake bottle until powder fully dissolved. Use immediately and do not keep unfinished bottle, discard contents.
STEP 8 Close tin tightly after each use and store in a cool, dry place. Must be used within 3 weeks of opening.
WARNING “Unboiled water, unsterilsed bottles or incorrect dilution can make your baby ill. Incorrect storage, handling, preparation and feeding can also lead to adverse effects. Follow instructions carefully.”
| AGE | QTY PER MEAL (ML) | QTY PER MEAL (SCOOPS) | MEALS PER DAY |
|---|---|---|---|
|
1-2 weeks
|
90
|
3
|
6
|
|
3-4 weeks
|
120
|
4
|
7
|
|
2nd month
|
150
|
5
|
5
|
|
3-4 months
|
180
|
6
|
5
|
|
5-6 months
|
210
|
7
|
5
|
|
From 5th (7th) month**
|
210
|
7
|
3-4
|
Glucose syrup, amino acids, vegetable oils (sunflower, rapeseed, structured palm oil), minerals (calcium glycerophosphate, potassium citrate, potassium chloride, calcium citrate, sodium citrate, sodium phosphate, magnesium oxide, ferrous sulphate, zinc sulphate, manganese sulphate, copper sulfate, potassium iodide, sodium molybdate, sodium selenate, chrom chloride), MCT, starch, emulsifier (E472c), choline bitartrate, fibres (2'-fucosyllactose, lacto-N-neotetraose), Mortierella aplina oil (ARA), Schizochytrium sp. oil (DHA), acidity regulator (E330), vitamines (C, E, niacine, pantothenic acid, riboflavin, B6, thiamine, A, folic acid, K, biotin, D, B12), inositol, taurine, L-carnitine.
Osmolarity = 474 mOsm/l
RE= Retinal Equivalent
NE = Niacin equivalent
ARA = Arachidonic acid
- Proven hypoallergenic with a tolerance of 100% in infants and children with cow’s milk protein allergy (CMPA)1
- Supports growth and is well tolerated when fed to children with mixed diagnosis (fed up to 1 year by tube)2
- Provides immune enhancing properties with the addition of 2 HMO (2’-FL and LNnT†), to support the growth of beneficial bacteria and the production of important short chain fatty acids3,4
- Designed to support tolerance and absorption with 24.4% MCT5
- Inspired by breastmilk with structured lipids (40% in sn-2 position) - associated with higher bone mineral density and better stool consistency6-9
†LNnT = Lacto-N-neotetraose; 2’-FL= 2’-Fucosyllactose; HMO = Human milk oligosaccharides; MCT, Medium chain triglycerides; HMO, Human milk oligosaccharides.
Immune-Nurturing Benefits
CMPA is an immune-mediated condition. It is associated with gut microbiota dysbiosis, which impacts immune system maturation and leaves infants at an increased risk of infections and future allergies.10 Alfamino® Junior HMO contains lactose, as well as 2’-fucosyllactose (2’-FL) and lacto-N-neotetraose (LNnT). 2’-FL and LNnT are structurally identical to two significant human milk oligosaccharides (HMO).11
HMO are bioactive components that support the infants in the following ways.12,13
Patient Case Example For Alfamino Junior® HMO
NAME & AGE
Noah, 3.5 years old
DIAGNOSIS
Eosinophilic Esophagitis (EoE)
DIETARY MANAGEMENT
Alfamino Junior® HMO
Case presentation: Noah
Noah is a 3 ½-year-old boy who presented with weight loss (weight 13kg - weight for age z-score (WAZ) <0; previous weight 14.3kg WAZ 0 = [normal]), dysphagia, pain, reflux and vomiting. He was starting on proton pump inhibitors (PPIs), but his symptoms did not resolve. He was referred to a gastroenterologist who undertook an endoscopy. His esophageal histology showed an eosinophil count of 50 eosinophils/0.3mm2 – diagnostic of eosinophilic esophagitis (EoE). He was treated initially with different levels of the food elimination diet (FED) before changing to an elemental diet. His PPIs were discontinued as he developed diarrhea.
Eosinophilic esophagitis (EoE) and faltering growth.
He was diagnosed by the gastroenterologist who referred him to the dietician for an exclusion diet for 6-8 weeks. He was initially started on a 2 FED but his symptoms had not resolve so the dietician initiated a 4 FED. However, following 2 weeks on the 4 FED he was admitted to hospital with pain, vomiting, dehydration and no weight gain (12.8kg – WAZ close to -2 = faltering growth – 3 yrs 6 ½ months). He was seen by the gastroenterologist who proposed the 6 FED along with a supplemental feeding to support his growth. The dietician provided advice on the 6 FED and prescribed Alfamino Junior HMO 300ml/day (300kcal) as a top-up. He was discharged on this regimen. One week later his parents called the dietician to say that he liked the formula but was still in pain, and they were concerned about his weight. On discussion with the gastroenterologist, it was decided to stop all foods for a period of 4-8 weeks while continuing Alfamino Junior HMO as a sole source of nutrition.
He was seen in clinic with his mother. He had gained almost 1 kg weight and was now 13.6 kg (WAZ close to 0). He liked Alfamino Junior HMO and had less pain and vomiting. However, as he was not 100% improved (weight not back to normal) it was decided by the team to continue on this regimen for a further 6 weeks. The gastroenterologist arranged for a repeat the endoscopy.
At his follow up review he had gained weight and was now 14.8 kg (WAZ close to 0). His repeat endoscopy showed a significant reduction in his eosinophil counts (now 20 eosinophils/0.3mm2). It was decided to continue on Alfamino Junior HMO for another 6 weeks as his counts were still outside the normal ranges and his weight was not fully yet back to normal.
His repeat endoscopy (at 3 to 4 months) showed normalization of his eosinophil counts (<10 eosinophils/0.3mm2) and he was considered in remission. His weight was now 15.2 kg WAZ = close to 0 [normal]. The dietician started food reintroductions.
By 4 years of age Noah was back eating almost all foods again orally, avoiding only dairy and wheat which he reacted to. His diet was nutritionally complete, maintaining a normal growth curve, and therefore he did not require Alfamino Junior HMO. Instead, he was replacing milk/dairy with plant-based drinks and otherwise had a very healthy diet with limited processed foods and meat, and lots of vegetables and fruits.
Introducing Our Plant-Based Packaging Designed to Be Recyclable
Our plant based plastic is made from sugar cane which is a renewable resource unlike fossil based material. Additionally, we have ensured a lighter pigment colour to improve recyclability.
…of the plastic in the Alfamino lid and scoop combined are now made with plant-based materials (sugar cane) instead of fossil fuel-based materials.
How We Convert Sugar Cane to Plant Based Plastic
Curious to learn more about how our plant based plastics are typically made?
This is where the resin to make our plant based plastic comes from.
Alfamino® Junior HMO FAQs
Answers to common questions
about
Alfamino® Junior HMO
.
The tin size of Alfamino® Junior HMO is 400g.
It is 4.4g – so 1 scoop of Alfamino® Junior HMO is equal to 4.4g of powder.
Yes, Alfamino® Junior HMO can be used for patients requiring enteral tube feeding. Instructions need to be followed according to local guidance as well as the patient’s individual nutritional management plan.
Alfamino® Junior HMO is suitable for those following a halal or kosher diet. The protein used in Alfamino® Junior HMO is based on 100% free amino acids. This formula meets the hypoallergenicity criteria of the American Academy of Pediatrics (AAP) and can be used for the dietary management of young children with CMPA.1
1.Nowak-Wegrzyn A, et al. Clin Pediatr. 2015.
The following conditions have been included in a practical evidence based guide1 on the use of AAF:
- Failure on an extensively hydrolyzed formula (eHF)
- Eosinophilic Esophagitis
- Growth faltering, in particular with multisystem involvement (gastrointestinal tract/and or skin) and multiple food eliminations
- Anaphylaxis
Meyer R, et al. J Allergy Clin Immunol Pract. 2018;6:383-99.
Alfamino® Junior HMO is based on 100% free amino acids, contains 24% of it’s fat as medium-chain triglycerides (MCT) and is lactose free. These are important attributes for managing children with severe forms of CMPA and also supports those with severe gastrointestinal (GI) impairment. MCT are easily absorbed and are hydrolyzed both faster and more completely than long-chain triglycerides (LCT).1 This has been shown to be useful for children with GI impairment.2 Meanwhile being lactose free supports those cases with secondary lactose intolerance.
1. Bach AC, & Babayan VK. Am J Clin Nutr. 1982;36(5):950-62.
2. Delplanque B, et al. J Pediatr Gastroenterol Nutr. 2015;61(1):8-17.
Medium-chain triglycerides (MCT) are made up of a mixture of triacylglycerols consisting of saturated fatty acids with a chain length of 6–10 carbons.1-3 MCT are easily absorbed because they are relatively soluble in water.3 Consequently, they are hydrolyzed both faster and more completely than long-chain triglycerides (LCT), the faster action of pancreatic lipase being facilitated by their small molecular weight.3 These benefits appear to be useful for infants with an immature gut or those with intestinal
failure.4 MCT therefore provide a rapid energy source.5 Adding MCT to formulas has been shown to be beneficial in severe fat malabsorption, such as intestinal failure.4 Alfaré® HMO, Alfamino® HMO and Alfamino® Junior HMO contain 40%, 24% and 24% respectively of MCT fats, which may support energy uptake in infants with severe gastrointestinal impairment (including infants with severe enteropathy affecting fat absorption related to CMPA).
1. Bach AC, & Babayan VK. Am J Clin Nutr. 1982;36(5):950-62.
2. Marten B, et al. Int Dairy J. 2006;16:1374-82.
3. Clegg ME. Int J Food Sci Nutr. 2010;61(7):653-79.
4. Delplanque B, et al. J Pediatr Gastroenterol Nutr. 2015;61(1):8-17.
5. Babayan VK. Lipids. 1987;22: 417-20.
The aim of adding structured lipids to Alfamino® HMO and Alfamino® Junior HMO was to mimic the composition and structure of palmitic acid in breastmilk (at the sn-2 position), which has been shown to facilitate fat and calcium absorption.1,2 Human milk is comprised of 20 to 30% palmitic acid, with 70% at the sn-2 position.3 Increasing the proportion of sn-2 palmitate in formula resulted in higher bone mineral content, reduced stool soap fatty acids, and produced softer stools more like those of breastfed infants.4 Structured lipids are triacylglycerols that have been modified to change the fatty acid composition and/or their positional distribution in the glycerol backbone.5,6
Structured lipids in Alfamino® HMO and Alfamino® Junior HMO are different from palm olein oil (found in vegetable oil-based formulas), where the palmitic acid is located at sn-1 and sn-3 positions.7
1. Delplanque B, et al. J Pediatr Gastroenterol Nutr. 2015;61(1):8-17.
2. Mazzocchi A, et al. Nutrients. 2018;10(5):567.
3. Innis SM, et al. J Nutr. 1995;125(1):73-81.
4. Kennedy K, et al. Am J Clin Nutr. 1999;70:920-7.
5. Babayan VK. Lipids. 1987; 22: 417-20.
6. Osborn HT, & Akoh CC. Compr Rev Food Sci Food Saf. 2002;1(3):110-20.
7. Fabiana FY, et al. PLEFA 2013; 89 (2013) 139–143.
Differences in lipid composition between these formulas relate to the target population of the formulas. For example, gastrointestinal impairment, which can:
occur in combination with CMPA symptoms: Alfaré® HMO is recommended
or
occur in those with severe CMPA symptoms: Alfamino® HMO is recommended (or Alfamino® Junior HMO when the child is >1 year)
Alfaré® HMO, Alfamino® HMO and Alfamino® Junior HMO contain medium-chain triglycerides (MCT). MCT are easily absorbed, which is useful for infants with an immature gut or intestinal failure.1,2 Althéra® HMO does not contain MCT and is indicated, as first line management, for infants with CMPA.
In addition, only Alfamino® HMO and Alfamino® Junior HMO contain structured lipids, mimicking the composition and structure of palmitic acid in breastmilk, to facilitate fat and calcium absorption.2,3
Regardless of their lipid composition, the four formulas in the range, Althéra® HMO, Alfaré® HMO and Alfamino® HMO and Alfamino® Junior HMO are suitable for the management of CMPA.
They all contain the essential fatty acids linoleic acid (LA) and α-linolenic acid (ALA), as well as the long-chain polyunsaturated fatty acids (LCPUFA), arachidonic acid (ARA) and docosahexaenoic acid (DHA), which are important for brain and immune development.2
1. Bach AC, & Babayan VK. Am J Clin Nutr. 1982;36(5):950-62.
2. Delplanque B, et al. J Pediatr Gastroenterol Nutr. 2015;61(1):8-17.
3. Mazzocchi A, et al. Nutrients. 2018;10(5):567.
HMO structures are quite complex, and the replication of HMO (that are structurally identical, but not sourced from human milk) was not possible until recently.
That’s why formulas have often been supplemented with simpler oligosaccharides such as galacto-oligosaccharides (GOS), a (non-human) milk-derived oligosaccharide (enzymatically produced from galactose)1 or a plant-based variety, fructo-oligosaccharides (FOS) – not found in human breastmilk1,2.
Advances in biotechnology, after almost 30 years of research and development by Nestlé and their partners, enabled the production of HMO, including 2’fucosyllactose (2’-FL) and lacto-N-neotetraose (LNnT); now produced on an industrial scale to introduce into standard and specialty infant formulas. 2’-FL and LNnT in Nestlé formulas are structurally identical to two of the top 10 HMO in human milk.2
1.Sela D & Mills D. Trends Microbiol. 2010 July ; 18(7): 298–307.
2.Bode L, & Jantscher-Krenn E. Adv Nutr. 2012;3(3):383S-91S.
More than 200 HMO have been identified in breastmilk,1 with 2’fucosyllactose (2’-FL) and lacto-N-neotetraose (LNnT) being among the 10 most abundant, accounting for more than 30% of all HMO.2 They are well studied and are considered to be safe for use in standard infant formula and in speciality infant formulas by the European Food Safety Authority (EFSA).3
The first clinical studies in healthy infants using standard infant formulas supplemented with 2’-FL and LNnT demonstrated their safety, supporting normal growth, with beneficial effects on immunity, gut microbiota development and the rate of some infections as well as the need for some medications.4-6 Clinical studies in infants with cow’s milk protein allergy (CMPA) showed that our specialty formulas containing 2’-FL and LNnT were hypoallergenic, supported normal growth, effectively alleviated CMPA symptoms, reduced the risk of infections and potentially the need for some medications,7 and positively shaped the gut microbiome.7-10
Infants with CMPA can now benefit from two of the most abundant HMO in human milk, 2’-FL and LNnT, which have been proven to nurture the infants’ immune system, addressing gut microbiota dysbiosis and reduce the risk of infections4-10 and potentially the need for some medications.7
1.Walsh C, et al. J Funct Foods. 2020;72:104074.
2. Azad MB, et al. J Nutr. 2018;148(11):1733-42.
3. EC No 258/97. EFSA J. 2015;13(7):4183.
4. Berger B, et al. mBio. 2020;11(2):e03196-19.
5. Puccio G, et al. J Pediatr Gastroenterol Nutr. 2017;64(4):624-31.
6. Roman Riechmann E, et al. Nutr Hosp. 2020;37(4):698-706.
7. Vandenplas Y, et al. Nutrients. 2022, 14, 530
8. Nowak-Wegrzyn A, et al. Nutrients. 2019;11:1447.
9. Boulangé CL, et al. Int. J. Mol. Sci. 2023, 24, 11422.
10. Gold MS, et al. Nutrients. 2022, 14, 2297.
No, HMO are specific to human breastmilk (hence the name, human milk oligosaccharides). Domesticated farm animals (e.g., cows) also contain “milk oligosaccharides” (MO). Human milk contains 100 to 1000 times more MO than that found in milk from domesticated farm animals, including bovine milk oligosaccharides in cow’s milk.1,2
Furthermore, MO present in milks from farm animals are qualitatively different from those in human milk. They have a higher proportion of sialylated and a lower proportion of fucosylated MO.3
1. Walsh C, et al. J Funct Foods. 2020;72:104074.
2. Donovan SM, & Comstock SS. Ann Nutr Metab. 2016;69(Suppl 2):42-51.
3. Oliveira D, et al. Int J Dairy Technol. 2015;68(3), 305-21.
HMO are not sensitive to heat. They also resist cold and are not affected by pasteurization and freeze-drying.1
1. Vandenplas Y, et al. Nutrients. 2018;10(9):1161.
2’-FL and LNnT in Nestlé infant/young child formulas are structurally identical to those found in breastmilk.1
For decades, Nestlé has studied HMO and production has recently become technically feasible. Our range of specialty formulas, Althéra® HMO, Alfaré® HMO, Alfamino® HMO and Alfamino® Junior HMO are the first to be supplemented with both 2’-FL and LNnT.
1. EC No 258/97. EFSA J 2015;13(7):4183.
Tailored Solutions* with Immune Nurturing Benefits
We’ve developed tailor-made, immune-nurturing nutritional formula solutions.
*Food for Medical Purposes to be used under medical supervision
Alfaré® HMO
From birth onwards.
Althéra® HMO
From birth onwards.
Alfamino® HMO
From birth onwards.
