Lactose-Reduced Infant Formulas Are Over-Consumed Whereas Hypoallergenic Infant Formulas Are Not - When Compared to Medical Necessity

Objectives We aimed to report the macronutrient composition of powdered infant formula purchased from major US physical-location retailers from 2017 through 2019. We then compared the percentage of lactose-reduced and hypoallergenic powdered infant formula consumed with the estimated prevalence of infant conditions necessitating a lactose-reduced or hypoallergenic formula. We also compared the proportion of formula consumed that was lactose-reduced between WIC and non-WIC purchases. Methods Annual powdered infant formula volume and purchase data from all major brick-and-mortar stores in the United States (excluding Costco) from 2017 through 2019 was obtained from IRi (Information Resources Inc). Protein, carbohydrate, fat composition and scoop size for each formula was obtained from formula companies and equivalent liquid ounces (“formula consumed”) was calculated. Small can sizes of “standard” (intact and partially hydrolyzed protein) formulas served as proxies for WIC purchases. Proportions were compared to published medical prevalence by calculating a z-ratio, t-test. Results Average infant carbohydrate consumption consisted of 56.6% lactose, 37.7% glucose, and 5.7% sucrose. 21% of formula consumed contained sucrose. 55% of all formula and 47% of standard formula consumed was lactose-reduced, both higher than the estimated 7.5% prevalence of medical necessity (p < 0.0002). Lactose-reduced standard formula represented 51% of non-WIC sales which was greater than the 44% of WIC sales (p = 0.003). Protein consumption consisted of 5.0% soy protein, 74.1% intact dairy, 11.1% partially hydrolyzed dairy, 7.1% fully hydrolyzed protein, and 0.3% amino acid based. Hypoallergenic (fully hydrolyzed and amino acid-based) formula represented 7.4% of formula consumed, which did not differ from liberal estimates of cow's milk allergy prevalence (7.5%). Conclusions Estimated consumption of hypoallergenic formula in the US matches liberal estimates of medical necessity. However, a high proportion of formula-fed infants are consuming non-lactose-based carbohydrate; more than is medically warranted, necessitating further research into metabolic implications. Funding Sources None.

Forcible medical intervention as a violation of Article 3 of the European Convention on Human Rights

The European Court of Human Rights has on multiple occasions considered the question of whether an act of forcible medical intervention constituted a violation of Article 3 of the European Convention on Human Rights. It found that it did not if the applicant could not prove he dissented to the medical intervention being carried out, if the act was one of medical necessity or if the medical intervention was necessary for obtaining evidence for use in criminal proceedings. However, national authorities must follow strict rules both in the determination of whether forcible medical intervention will be carried out and in its methods of execution.