Milk protein-based infant formula containing rice starch and low lactose reduces common regurgitation in healthy term infants: a randomized, blinded, and prospective trial

J Am Coll Nutr. 2014;33(2):136-46. doi: 10.1080/07315724.2013.828578.


Objective: Spit-up (regurgitation) reduction with prethickened milk protein-based infant formulas containing rice starch has been clinically demonstrated in infants with heavy spit-ups but not in otherwise healthy normal infants with common spit-ups. The objective of this study was to evaluate growth, gastrointestinal tolerance, and efficacy to reduce common spit-up in normal, healthy term infants fed an investigational rice starch prethickened lactose-free milk protein-based infant formula.

Methods: This double-blind, randomized, parallel study evaluated the investigational rice starch prethickened lactose-free (low lactose < 100 mg/L) milk protein-based infant formula compared to a standard, commercially available, iso-nutrient, lactose-containing (100% of carbohydrate) milk-based infant formula (control) for growth and gastrointestinal tolerance in healthy term infants (n = 132/group) fed from 14 ± 3 days to 112 days of age. Data were classified and analyzed as evaluable (EV; subjects completing study per protocol) or intent-to-treat data (ITT; all subjects with available data).

Results: Growth as indicated by weight gain (primary variable) and formula intake were not significantly different (p > 0.05) between feeding groups (EV or ITT). Though both formulas were well tolerated, spit-up frequency was significantly lower (p < 0.05) in the rice versus control group by 53% at 28 days of age, 54% at 56 days, 48% at 84 days, and 32% at 112 days (EV). Importantly, infants in the rice group were 1.6 to 1.8 times more likely to report zero spit-up than infants in the control group. The rice group also had higher percentages of soft and yellow stools.

Conclusions: The rice starch prethickened lactose-free milk protein-based formula (rice) supported normal growth and safe use as the sole source of feeding for normal infants over the first 4 months of life. The rice formula was efficacious in providing a clinically relevant reduction of spit-up frequency in otherwise healthy term infants.

Keywords: gastrointestinal tolerance; growth; low lactose; reflux; regurgitation; rice starch; spit-up; term infants.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Double-Blind Method
  • Female
  • Humans
  • Infant
  • Infant Formula / chemistry*
  • Infant, Newborn
  • Lactose / analysis*
  • Laryngopharyngeal Reflux / prevention & control*
  • Male
  • Milk Proteins / analysis*
  • Oryza*
  • Prospective Studies
  • Starch
  • Treatment Outcome


  • Milk Proteins
  • Starch
  • Lactose