Whey-based formulas are associated with improved gastric emptying times and fewer episodes of regurgitation compared to casein-predominant formulas. A study of 9 children with spastic quadriplegia found that whey formulas led to significantly less residual gastric content at 60 and 120 minutes compared to a casein formula, and also significantly fewer vomiting episodes. The type of whey formula did not significantly impact residual gastric levels.

1. Improved Gastric Emptying
Whey-based formulas are associated with
improved rates of gastric emptying
when compared to casein predominant formulas.
J Pediatr 1992;120:569-572

2. Decrease in gastric emptying time and episodes of
regurgitation in children with spastic quadriplegia
fed a whey-based formula.
Fried MD, Khoshoo V, Secker DJ, Gilday DL, Ash JM,
Pencharz PB.
Division of Clinical Nutrition, Hospital for Sick Children,
Toronto, Ontario, Canada.
J Pediatr. 1992 Apr;120:569-72.

3. Study Objective
To determine whether whey-based formulas would improve the rate of
gastric emptying and decrease the amount of regurgitation
in patients with
cerebral palsy,
spastic quadriplegia,
severe developmental delay,
scoliosis
who have been fed casein-predominant formulas.

4. Study Method
Inclusion Criteria:
Profound mental retardation with developmental delay
Spastic quadriplegia
Scoliosis
> 3 years of age
Gastrostomy tube fed
Clinical evidence of gastroesophageal reflux
Subjects:Nine patients (age range 3-18 years) recruited from the clinical nutrition
clinic due to frequent episodes of vomiting who were being fed a formula
containing casein (80%) and soy (20%).
Delayed gastric emptying was observed in all nine patients.

5. Study Method (cont)
Subjects:
Each patients participated in a double-blind, randomized trial with gastric-emptying scans
that compared the effects of three different types of whey-based formulas: whey
predominant, whey hydrolysate, and whey hydrolysate with 70% of the fat as MCT
Whey hydrolysate
Casein predominant Whey predominant Whey hydrolysate
(70% MCT)
80% Casein / 20% 60% Whey / 40% 100% Whey 100% Whey
Protein source
Soy Casein hydrolysate hydrolysate
Protein (gm) 5.1 3.4 3.6 6.0
Carbohydrate (gm) 20.0 17.2 16.6 19.1
Fat (gm) 6.6 7.7 7.7 5.8
Percentage of fat as
21.0 8.0 9.0 70.0
MCT
Osmolality (mOsm/kg
314.0 470.0 403.0 318.0
water)
Energy (kcal) 159.0 150.0 150.0 150.0

6. Study Results
The results of the gastric-emptying scans at 60 and 120 minutes are expressed as the
mean ± SD percentage of residual gastric radioactivity for all 9 patients for ea. formula.
60 minutes 120 minutes
Casein predominant 85%±11% 69%±14%
Whey predominant 48%±19% 24%±18%
Whey hydrolysate 56%±23% 31%±26%
Whey hydrolysate
59%±19% 27%±13%
(70% MCT)
• The difference in the mean percentage of residual gastric activity among the three
whey-based formulas at 60 and 120 minutes was not statistically significant
• There was a reduction in episodes of vomiting in all patients fed whey-based
formulas (2±2 episodes, range up to 7 episodes) compared to casein predominant
formula (mean 12±11 episodes, range 4 to 35 episodes; p <0.05).

7. Study Results
100
Casein predominant
Whey predominant
80 Whey hydrolysate
Whey hydrolysate (70% MCT)
60
40
f ot necr e P
20
i rt sa G a ud se R
0
60 minutes 120 minutes
l i
J Pediatr 1992;120:569-572

8. Study Summary
The gastric emptying times associated with whey-based formulas
were significantly shorter than casein-based formula
Patients fed whey-based formulas had significantly fewer episodes
of emesis than fed casein-based formula
Whey-based formulas reduce the frequency of emesis by
improving the rate of gastric emptying
The difference residual gastric activity among the whey formulas
at 60 and 120 minutes was not statistically significant.
J Pediatr 1992;120:569-572