Gastrointestinal tolerability of organic infant formula compared to traditional ‎infant formula: A systematic review

Table 1 Compares the European and American organic infant formulas

	European organic infant formula	American organic infant formula
Regulations	EC has stricter standards than the United States FDA. For instance, all infant formulas must be organic, and there is a limit on certain ingredients, such as pesticides and antibiotics	The FDA regulates infant formulas through USDA & NOP, which have less strict standards than the EC. Not all infant formulas are required to be organic, & the FDA does not limit certain ingredients
Cultural attitudes toward the formula	Very strong positive attitude across the countries	Less than in Europe
Guidelines & regulations	Updated yearly	Not as frequent as European guidelines
Labelling and claims	Must meet standardized requirements, and products displaying the EU Organic Logo adhere to these regulations	Must comply with the NOP guidelines. The USDA Organic seal signifies adherence to these standards
Ingredients	It is more likely to be made with organic ingredients, such as milk from grass-fed cows or goats. They are also more likely to contain probiotics, beneficial bacteria that can help support gut health	It is more likely to contain added iron, which is essential for preventing iron deficiency anemia. They may also have other ingredients not allowed in European formulas, such as corn syrup solids
Probiotics	It is more likely to contain probiotics, which are beneficial bacteria that can help support gut health	Less likely to contain probiotics
Percentage of organic ingredients	Not less than 95%	Not less than 70%
Calories sources	Must have at least 30% of calories from lactose	Not required
	The inclusion of sucrose is prohibited, except in small quantities in some specialty formulas, such as premature or hypoallergic formulas	It may contain Sucrose, glucose, and maltodextrins
Added iron	It is less likely to contain added iron, which is vital for preventing iron deficiency anemia	More likely to contain added iron
Synthetic additives, pesticides, steroids, hormones, & GMOs	Strictly prohibited	Synthetic additives and GMOs are also prohibited, but specific regulations may differ
Taste	Some parents say that European formulas taste better than American formulas. This is likely because they are made with more natural ingredients	There is no consensus on whether European or American formulas taste better. Some parents prefer the taste of European formulas, while others prefer the taste of American formulas
Cost	Typically, they are more expensive than American formulas. This is because they are made with higher-quality ingredients & have stricter regulations	Typically, they are less expensive than European formulas. This is because they are made with less expensive ingredients and have less strict regulations

EC: The European Commission; EFSA: European Food Safety Authority; FDA: Food and Drug Administration; GMOs: Genetically modified organisms; NOP: The National Organic Program; USDA: The United States Department of Agriculture.

Table 2 The different compositions between the main organic infant first-stage regular formulas

	Brand	Country of origin	Protein source/100 mL	Fat source/100 mL	Carbohydrate source/100 mL	Other ingredients
1	Arla Baby & Me Organic	Denmark	1.4 g, Whey Protein Concentrate, Whey/ Casein Ratio 60/40	3.6 g, vegetable oils (sunflower, soy)	6.7 g, Lactose	GOS, FOS, DHA of algal oil origin, ARA of fungal oil origin, Lecithin, choline, inositol, L-carnitine, tocopherol-rich extract
2	HiPP Organic	Germany	1.2-1.5 g, Whey protein concentrate, W/C Ratio 60:40	3.5-4.4 g, Palm olein oil, rapeseed oil, coconut oil, sunflower oil	6.5-7.5 g, Lactose	DHA, ARA, choline, taurine, nucleotides, lactoferrin, Metafolin, symbiotics (L. fermentum and GOS)
3	Kendamil Organic	United Kingdom	1.4 g, Whey protein concentrate, W/C Ratio 60:40	3.5 g, Whole milk fat and reduced levels of Organic vegetable oils (sunflower, coconut, rapeseed). No palm oil	7 g, Lactose	Marine algae-derived DHA, ARA, choline, taurine, nucleotides, lactoferrin, inositol, L-Carnitine, Organic GOS, 3'GL - Galactosyllactose
4	Holle Organic	Germany	1.4 g, contains the A2 protein. W/C Ratio 60:40	3.4 g, vegetable oils (palm, sunflower, rapeseed oil), oil from the microalgae Schizochytrium sp.2, Mortierella Alpina oil (No palm oil)	7.7 g, Lactose	Algae-derived DHA, ARA, choline, taurine, nucleotides, lactoferrin
5	Bellamy's Organic	Australia	1.5 g, Whey protein concentrate, W/C Ratio 60:40	3.4 g, Palm olein oil, soybean oil, sunflower oil	7.6 g, Lactose	Dried DHA and ARA oils [fish oil (tuna), choline, taurine, nucleotides, a Prebiotic GOS, 16 essential vitamins & minerals
6	Bubs Australia	Australia	1.56 g, Organic Whey Protein Concentrate, Whey/ Casein Ratio 60/40	3.7 g, Organic Vegetable Oil Blend (High Oleic Sunflower, Coconut, Soy, Canola)	7.3 g, Organic Lactose	Organic GOS, DHA, from Algae, ARA, Probiotic Bifidobacterium longum BB536
7	Similac Organic with A2 milk	United States	1.55 g, Whey Protein Concentrate, A2 beta-caseins, W/C of 48:52	4.2 g, Organic High Oleic Sunflower Oil, Soy Oil, Coconut Oil	8 g, Organic Lactose	DHA, lutein, Choline, Beta-Carotene, Lycopene, Inositol, Nucleotides, Taurine, L-carnitine, L-methionine, Short-chain FOS
8	Happy Family Organics	United States	1.38 g, Organic Whey Protein Concentrate, W/C ratio of 30:70	3.4 g, Organic Palm Olein or Palm Oil, Soy Oil, Coconut Oil, High Oleic (Safflower or Sunflower) Oil	8 g, ORGANIC LACTOSE	DHA Algal Oil, Organic FOS and GOS, Choline, soy Lecithin, Beta-Carotene
9	Baby's Only Organic	United States	1.54 g, Organic Whey Protein Concentrate, A2 Protein, W/C Ratio 60:40	4.2 g, Organic High Oleic Sunflower and/or Organic High Oleic Safflower Oils), Organic Soybean Oil, Organic Coconut Oil	7.76 g, Organic Lactose	Choline, Taurin, Organic, Inositol, Non-Hexane Extracted Source of DHA & ARA
10	Plum Organics	United States	1.38 g, Organic Whey Protein Concentrate W/C Ratio 60:40	3.7 g, Organic Palm Oil Or Palm Olein, Soy Oil, Coconut Oil, High Oleic (Safflower or Sunflower) Oi	6.9 g, Organic Lactose	Plant-based DHA, & ARA. Tocopherol, Choline, Taurine, Lecithin
11	Honest Company Organic	United States, there was an issue about containing 11 non-organic elements	1.6 g, Organic Whey Protein Concentrate, W/C Ratio 60:40	3.9 g, Organic Palm Oil or Palm Olein, Soy Oil, Coconut Oil, High Oleic (Safflower or Sunflower) Oil	7.9 g, Organic Lactose, Organic Glucose Syrup Solids	Sodium Selenite, Taurine, Choline, Beta carotene, and Inositol Do not disclose the DHA/ARA extraction method
12	Enfamil Simply Organic	United States, the first organic formula that has certified USDA	1.49 g, Organic nonfat milk W/C Ratio 20:80	3.6 g, organic vegetable oil (organic palm, organic coconut, organic soy, and organic high oleic sunflower oils)	7.5 g, Organic Lactose, organic maltodextrin	Omega-3 DHA, Inositol, Choline, taurine, L-carnitine, & organic GOS
13	Nature’s One Baby’s Only	United States	1.5 g, Organic Whey Protein Concentrate W/C Ratio 60:40	4.2 g, Organic High Oleic Sunflower, Soybean Oil, Coconut Oil	7.7 g, Organic Lactose	Choline, Inositol
14	Bobbie Formula	United States	1.47 g, organic whey protein concentrate, W/C Ratio 60:40	3.9 g, organic high oleic (sunflower or safflower) oil, canola oil, coconut oil, linoleic sunflower or safflower) oil	8 g, Organic lactose	Choline, Inositol, Biotin, DHA, ARA
15	Earth's Best Organic	United States	1.64 g, Whey protein concentrate, W/C Ratio of 70/30	4 g, Palm olein oil, soy oil, coconut oil, sunflower oil, Linolic acid 750 mg	8 g, Lactose	DHA, ARA, choline, lutein, taurine, carnitine, selenium nucleotides, Iron, prebiotic FOS fiber

ARA: Arachidonic acid; DHA: Docosahexaenoic acid, FOS: Fructooligosaccharides; GOS: Galactooligosaccharides; W/C ratio: Whey/Casein ratio.

Table 3 Comparison between human milk and organic formula

Feature	Human milk	Organic infant milk
Source	Produced by lactating mothers	Derived from organic cow's milk
Composition	Complex and ever-changing, tailored to the individual baby's needs	Mimics the composition of human milk but may not be identical
Nutrients	Contains all the nutrients a baby needs for optimal growth and development, including antibodies, enzymes, hormones, and growth factors	It contains most of the nutrients a baby needs but may not be as high in certain nutrients as human milk
Digestibility	Easily digestible, less strain on baby's digestive system, and well-absorbed	It may be more difficult to digest than human milk, especially for preterm babies. Generally easy to digest but may be more difficult to digest than human milk, especially for preterm babies. Some babies may have sensitivities
Allergies	It may help protect against allergies	Despite being organic, it may not offer the same protection against allergies as human milk
Infections	It may help protect against infections	It may not offer the same protection against infections as human milk
Growth Factors	Contains growth-promoting factors	Contains growth factors for the development
Probiotics	Contains beneficial bacteria	It may contain added probiotics
Cost	Free (if breastfeeding)	Varies, but typically more expensive than conventional infant formula
Availability	Available from any mother who is breastfeeding; no preparation is needed	Available at most grocery stores and online retailers, Requires preparation and storage
Environmental Impact	Minimal carbon footprint, no packaging waste	It may have a higher carbon footprint and packaging waste
Emotional Bonding	Promotes bonding between mother and baby	Less direct emotional bonding

Table 4 The main differences between the organic and non-organic formulas

	Organic	Non-organic
Dairy source	Milk often comes from organically ‎raised cows or other ‎organic animal sources	Milk may come from ‎conventionally raised cows ‎with potential hormone and ‎antibiotic use
Ingredients	The certified organic formula must be at least 95% organic, including the milk, vitamins, minerals, and other nutrients—no synthetic ‎pesticides, antibiotics, hormones, herbicides, GMOs, or ‎artificial additives	It may include non-organic ‎ingredients, synthetic pesticides, ‎GMOs, artificial additives, non-organic corn syrup solids, soy oil, and palm oil
Nutrient levels	Provides essential nutrients ‎for infant growth and ‎development	Meets similar nutritional ‎needs as the organic formula
Fat	3.5-4.0 g/100 mL	3.0-3.5 g/100 mL
	Emphasis on organic and natural ingredients, including organic vegetable oils (palm, coconut, soy, sunflower, etc.)	Similar use of vegetable oils as fat sources may not be organic
	Aim for a closer resemblance to breast milk in terms of balanced omega-3 and omega-6 fatty acids. Slightly higher content of omega-3 fatty acids	Aim to provide appropriate ratios of fatty acids essential for infant development
CHO	Formulated to meet the nutritional needs of infants. Organic lactose is the primary milk CHO mimicking breast milk in most organic formulas, especially the European formula. The American formula may add other CHO, such as corn syrup, glucose Syrup, and maltodextrin. The lactose amount is typically around 40% of the total calories, about 6-7 g/100 mL. Is easier to digest. Has a better texture & provides a creamy consistency	Formulated to meet the nutritional needs of infants. Lactose is the pr imary CHO source, designed to mimic the CHO composition of breast milk, especially the European formula. The American formula may add other CHO, such as corn syrup, glucose Syrup, Brown Rice Syrup, and sucrose. The lactose amount is typically around 40% of the total calories, about 8-9 g/100 mL
Proteins	It comes from organic dairy sources and contains easily digestible whey and casein proteins with smaller size molecules in a ratio (usually 60/40) and an amino acid pattern that mimics breast milk, supporting optimal digestion and balanced growth	Dairy sources are from conventionally raised cows, with whey and casein proteins with large-sized molecules, but the ratio might differ from breast milk. The amino acid pattern is designed to provide essential amino acids for infant growth
Flavors and colors	It may contain natural flavors & colors, such as vanilla or strawberry	It may contain artificial flavors and colors
Processing ‎methods	Gentler processing to ‎preserve nutrient content	It may undergo more intensive ‎processing, potentially ‎leading to some nutrient loss
Regulations	Subject to regulations set by health authorities (e.g., FDA in the U.S., EFSA in the EU	Subject to regulations set by health authorities (e.g., FDA in the U.S., EFSA in the EU)
Consumer preferences	Chosen by parents who prioritize natural and organic ingredients, absence of synthetic additives, pesticides, and GMOs	Chosen based on many factors like cost, availability, and a high standard of nutritional quality
Environmental ‎considerations	Emphasizes organic ‎farming practices and ‎reduced chemical use	It may involve more intensive ‎chemical use with potential ‎environmental impacts

CHO: Carbohydrates; EFSA: European Food Safety Authority; EU: The European Union; FDA: Food and Drug Administration; GMOs: Genetically modified organisms; U.S: United States.

Table 5 The factors that affect the gastrointestinal tolerability of infant formula

Item	Possible factor
Formula-related	Protein source and composition
	Lactose content
	Fat source and composition
	Presence of prebiotics and/or probiotics
	Fiber content
	Osmolality and osmolarity
	Additives and nutrient density
Infant-related factors	Presence of individual sensitivities
	Medical Co-morbidities. e.g., prematurity
	Hydration status
Feeding procedure factors	Milk temperature
	The flow rate of the bottle
	The amount of the milk/feed
	The feeding technique