Alfaré® HMO
Whey based extensively hydrolyzed, nutritionally complete hypoallergenic, lactose-free formula with 2 HMO and Medium Chain Triglycerides (MCT) for effective first-line symptom relief in infants and young children with CMPA-related malabsorption.
A sole source of nutrition from birth to 12 months of age. Supplement in combination with age-appropriate complementary foods from around 6 months of age.
Advancing the
Management of
Cow’s Milk
Protein Allergy
Preparing Alfaré® HMO is very similar to how you prepare standard infant formula. The step-by-step instructions on how to prepare Alfaré® HMO are:
STEP 1 Wash hands thoroughly 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
|
Maltodextrin (Corn), Enzymatically Hydrolyzed Whey Protein (Milk), Vegetable Oils (Palm Olein, Sunflower, Rapeseed, Blackcurrant Seed), Medium Chain Triglycerides (2.5%), Potato Starch, Minerals (Calcium Glycerophosphate, Magnesium Chloride, Sodium Chloride, Potassium Phosphate, Potassium Chloride, Calcium Phosphate, Ferrous Sulphate, Zinc Sulphate, Copper Sulphate, Potassium Iodide, Manganese Sulphate, Calcium Chloride), Emulsifier (E472c), Vitamins [Sodium Ascorbate (Vit C), Dl-Alpha-Tocopheryl Acetate (Vit E), Niacinamide (Niacin), Calcium Pantothenate, Riboflavin (Vit B2), Retinyl Acetate (Vit A), Pyridoxine Hydrochloride (Vit B6), Thiamine Mononitrate (Vit B1), Folic Acid, Phylloquinone (Vit K1), D-Biotin, Cholecalciferol (Vit D3), Cyanocobalamin (Vit B12)], Fish Oil, Taurine, Choline Bitartrate, Inositol, Nucleotides (Cytidine 5’-Monophosphate, Uridine 5’-Monophosphate, Adenosine 5’-Monophosphate, Guanosine 5’-Monophosphate), L-Carnitine. Contains Fish Oil and Milk.
Osmolarity = 180 mOsm/l
- Proven hypoallergenicity with a tolerance of 98.4% in infants with cow’s milk protein allergy (CMPA)1
- Promotes growth and induces tolerance in cases with gastrointestinal-related disorders2-4
- 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 acids5,6
- Reduces the risk of common respiratory-tract infections as well as medication use in infants with CMPA through the addition of 2’-FL and LNnT† to formula5
- Designed to support tolerance and absorption with 40% MCT7-11 and osmolality of 200mOsm/kg H20
- Highest degree of hydrolysis amongst extensively hydrolysed formulas12
†LNnT = Lacto-N-neotetraose; 2’-FL= 2’-Fucosyllactose; 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.13 Alfaré® HMO contains lactose, as well as 2’-fucosyllactose (2’-FL) and lacto-N-neotetraose (LNnT). 2FL and LNnT are two significant human milk oligosaccharides (HMO) that are structurally identical to those found in breastmilk.14
HMO are bioactive components that support the infants in the following ways.15,16
Reducing Infections and Medication Use
Infants fed formula with 2’-FL and LNnT† had fewer upper and lower respiratory tract infections17
Infants fed formula with 2’-FL and LNnT† had lower antibiotic and antipyretic use17,18
Patient Case Example For Alfaré® HMO
NAME & AGE
Emma, 2.5 months old
DIAGNOSIS
Food Protein Induced Enteropathy (FPE) related to CMPA
DIETARY MANAGEMENT
Alfaré® HMO
Case presentation: EMMA
Emma, a term formula fed 2 ½ month baby girl, presented to the GP with recurrent vomiting, crying, lethargy and diarrhea (wihtout blood), and poor growth (4.5kg weight-for-age z score [WAZ] between <0) – birth weight 3.5kg (weight-for-age z score [WAZ] >0 (normal). Mum reported that she was sleeping a lot and seemed weak. Her GP advised mum to continue on her current formula while waiting to see a local pediatrician for assessment.
On assessment she had a distended abdomen and low albumin (hypoalbuminemia) but she was well hydrated. The pediatrician suspected a gastrointestinal disorder that might be allergic in nature, so referred her to an allergy specialist (keeping her on the same formula). Emma was 3 ½ months of age when seen by the allergist with worsening symptoms (weight 4.8kg; WAZ close to -2SD). She had negative Skin Prick Test (SPT) to milk and soy, so the allergist suspected non-IgE-mediated food allergy, possibly, Food Protein Induced Enteropathy (FPE). Her symptoms included vomiting, crying, severe diarrhea (without blood) and lethargy without shock (ruling out FPIES) and hypoalbuminemia - her CoMiSS score was 12 (regurgitation/vomiting 3; crying 3; loose/watery stools 6). Emma was referred to a specialist dietitian to review her feeds. She also started on iron supplements due to iron deficiency (without anaemia).
The dietician suggested changing her feed from standard infant formula to Alfaré HMO (gradually over a few days). Alfaré HMO was recommended due to the enteropathy causing severe diarrhea, vomiting/regurgitation, and hypoalbuminemia. Alfaré HMO was selected because it is lactose free and contains MCT, which might be beneficial in cases of enteropathy. The dietician recommended her to continue for a period of 4 weeks while they monitored her symptoms and growth. She felt an amino-acid formula was not necessary for Emma at this point, although her weight gain was poor.
4 weeks later Emma was reviewed by the dietician (4 ½ months of age). Her weight had improved to 5.6kg (WAZ close to 0). However, it was decided not to challenge Emma as her symptoms had not fully resolved. As much as she had generally improved, she continued to have some vomits/regurgitation, loose stools, low albumin (though improved), and some distension. Her CoMiSS score was 8 (regurgitation/vomiting 1; crying 3; loose stools 4). Although her iron status had improved, she was continued on iron supplements. Mum was advised to start complementary feeding (dairy and soy free) at around 5 months.
3 months later Emma was reviewed by the allergist and the dietician (7½ months of age). Her weight had improved to 7.4kg (WAZ close to 0), she was vomiting/regurgitating and crying less, her abdomen was less distended, and her albumin and iron were within the normal ranges. Her iron supplements were therefore discontinued. She also had significantly less diarrhea – her CoMiSS score was now 2 (regurgitation/vomiting 1; crying 1). She had started CF and was progressing well. It was decided to start milk reintroduction using the milk ladder, taking it slowly. However, after just 2 weeks mum called to say she felt Emma was not tolerating the dairy well, with the reoccurrence of loose/watery stools – CoMiSS score 6-8 (crying 2; loose stools/watery stools 4-6). Therefore, the reintroduction of milk was stopped, and it was agreed not to restart until she was 12 months of age. Other foods were introduced as normal, avoiding milk/dairy. She was tolerating commercially available soy foods/drinks and Alfaré HMO (as her main drink). Her follow-up review was arranged for when she was 12 months of age.
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.
Alfaré® HMO FAQs
Answers to common questions
about
Alfaré® HMO
.
The tin sized of Alfaré® HMO is 400g.
It is 4.4g – so 1 scoop of Alfaré HMO is equal to 4.4g of powder.
Alfaré® HMO is suitable for those following a halal diet (halal certified) but is not kosher certified.1 The protein hydrolyzate used in Alfaré® HMO is uniquely produced with non-porcine enzymes.1 These enzymes (proteases) are of plant origin. This formula meets the hypoallergenicity criteria of the American Academy of Pediatrics (AAP) and can be used for the dietary management of infants and young children with CMPA.2
1. Data on file (Halal certification).
2. Nowak-Wegrzyn A, et al. Allergy 2019;74(8):1582-4.
Yes, Alfaré® HMO can be used for infants requiring enteral tube feeding. Instructions need to be followed according to local guidance as well as the patient’s individual nutritional management plan.
No, Alfaré® HMO does not contain palm oil.
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.
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 and 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 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
Althéra® HMO
From birth onwards.
Alfamino® HMO
From birth onwards.
Alfamino® Junior HMO
