Comparison of Fecal Calprotectin in Exclusively Breastfed and Formula or Mixed Fed Infants in the First Six Months of Life

  • Masoumeh Asgarshirazi Mail Department of Pediatrics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Mamak Shariat Maternal-Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Fatemeh Nayeri Department of Neonatology, Maternal-Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Hosein Dalili Department of Neonatology, Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Alireza Abdollahi Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Fecal calprotectin, Breastfed, Formula fed, Mixed fed


We conducted this study to compare fecal calprotectin between exclusively breastfed and formula or mixed fed infants aged one month and six months. Sixty term infants were enrolled from the labor ward of Valiasr Hospital between Oct 2011 and July 2015 and their fecal calprotectin was checked by the ELISA method and Hycult biotech kits. The enrolled infants had a birth weight of 2500-4000 g and no perinatal insults or hospitalization. Stool sampling was done at 1±1 week and at 6n±1 months. The six-month infants had no recent disease, antibiotic use or vaccination. The mean fecal calprotectin was higher in exclusively breastfed infants at first and sixth months than formula and mixed fed infants (368.85±204.49 and 283.21±381.41 µg/g versus 152.59±139.13 and 113.62±92.75 µg/g respectively). (P=0.0001 and 0.018) Fecal calprotectin was higher in infants with GERD than healthy babies in the first and sixth months (P=0.0001 and 0.004). Based on the role of calprotectin in inflammation, its higher levels in exclusively breastfed infants is contrary to breast milk benefits and may be a sign of enhanced mucosal immune maturity in them.


Yui S, Nakatani Y, Mikami M. Calprotectin (S100A8/S100A9), an inflammatory protein complex from neutrophils with a broad apoptosis-inducing activity. Biol Pharm Bull 2003;26:735-60.

Campeotto F, Butel MJ, Kalach N, Derrieux S, Aubert- Jacquin C, Barbot L, et al. High fecal calprotectin concentrations in newborn infants. Arch Dis Child Fetal Neonatal Ed 2004;89:F353-5.

Vaos G, Kostakis ID, Zavras N, Chatzemichael A. The role of calprotectin in pediatric disease. Biomed Res Int2013;2013:542363.

Li F, MaJ, Geng S, Wang J, Ren F, Sheng X. Comparison of the different kinds of feeding on the level of fecal calprotectin. Early Hum Dev 2014;90:471-5.

Oswari H, Prayitno L, Dwipoerwantoro PG, Firmansyah A, Makrides M, Lawley B, et al. Comparison of stool microbiota compositions, stool alpha1- antitrypsin and calprotectin concentrations, and diarrhoeal morbidity of Indonesian infants fed breast milk or probiotic/prebiotic- supplemented formula. J Paediatr Child Health 2013;49:1032-9.

Dorosco SM, Mackenzie T, Connor I. Fecal calprotectin concentrations are higher in exclusively breastfed infants compared to those who are mixed-fed. Breastfeed Med2008;3:117-9.

Vandenplas Y, Rudolph C, Dilorenzo C, Hassal E, Liptak G, Mazur L, et al. Pediatric gastroesophageal reflux clinical practice guidelines: Joint recommendations of the NASPGHAN and ESPGHAN. JPGN 2009;49:498- 547.

Kleinman L, Rothman M, Strauss R, Orenstein S, Nelson S, Vandenplas Y, et al. The infant gastroesophageal reflux questionnaire revised: Development and validation as an evaluative instrument. Clin Gastroenterol Hepatol 2006;4:588-96.

Maslin K, Brown T, Venter C. Infantile colic- a guideline emphasizing simple measures of support- and when cow's milk allergy should be considered the cause [dissertation]. Portsmouth: University of Portsmouth, 2015:1-8.

Waugh N, Cummins E, Royle P, Kandala N-B, Shyangdan D, Arasaradnam R, et al. Fecal calprotectin testing for differentiating amongst inflammatory and non- inflammatory bowel diseases: systematic review and economic evaluation. Health Technol Assess 2013;17:1-211.

Erbayrak M, Turkay C, Eraslan E, Cetinkaya H, Kasapoglu B, Bektas M. The role of fecal calprotectin in investigating inflammatory bowel diseases. Clinics 2009;64:421-5.

Tibble JA, Bjarnason I. Non-invasive investigation of inflammatory bowel disease. World J Gastroenterol 2001;7:460-5.

Savino F, Castagno E, Calabrese R, Viola S, Oggero R, Miniero R. High fecal calprotectin levels in healthy, exclusively breast-fed infants. Neonatology 2010;97:299-304.

Rosti L, Braga M, Fulcieri C, Sammarco G, Manenti B, Costa E. Formula milk feeding does not increase the release of the inflammatory marker calprotectin, compared to human milk. Pediatr Med Chir 2011;33:178-81.

Debes AK, Kohli A, Walker N, Edmond K, Mullany LC.Time to initiation of breastfeeding and neonatal mortality and morbidity: a systematic review. BMC Public Health 2013;13:S19.

WHO collaborative study team. Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet 20005;355:451-5.

Liu JR, Sheng XY, Hu YQ, Yu XG, Westcott JE, Miller LV, et al. Fecal calprotectin levels are higher in rural than urban Chinese infants and negatively associated with growth. BMC Pediatrics 2012;12:129.

Urwin HJ, Miles EA, Noakes PS, Kremmyda LS, Vlachava M, Diaper ND, et al. Effect of salmon consumption during pregnancy on maternal and infant faecal microbiota, secretory IgA and calprotectin. Br J Nutr 2014;111:773-84.

Urban CF, Ermert D, Schmid M, Abu-Abed U, Goosmann C, Nacken W, et al. Neutrophil extracellular traps contain calprotectin, a cytosolic protein complex involved in host defense against candida albicans. PloS Pathog 2009;5:e1000639.

Li R, Dee D, Li CM, Hoffman HJ, Grummer-Strawn LM.Breastfeeding and risk of infections at 6 years. Pediatrics 2014;134:S13-20.

Rouge C, Butel MJ, Piloquet H, Ferraris L, Legrand A, Vodova M, et al. Fecal calprotectin excretion in preterm infants during the neonatal period. PloS One2010;5:e11083.

Canani R, Rapacciuolo L, Romano MT, Tanturri de Horatio L, Terrin G, Manguso F, et al. Diagnostic value of fecal calprotectin in pediatric gastroenterology clinical practice. Dig Liver Dis 2004;36:467-70.

Rhoads JM, Fatheree NY, Norori J, Liu Y, Lucke JF, Tyson JE, Ferris MJ. Altered fecal microflora and increased fecal calprotectin in infants with colic. J Pediatr 2009;155:823-8.

How to Cite
Asgarshirazi M, Shariat M, Nayeri F, Dalili H, Abdollahi A. Comparison of Fecal Calprotectin in Exclusively Breastfed and Formula or Mixed Fed Infants in the First Six Months of Life. Acta Med Iran. 55(1):53-58.