Whole goat milk formula may be protective against AD in infants.The results from the GIraFFE* study shed light on the potential protective effect of whole goat milk formula (WGF) against the development of atopic dermatitis (AD) in infants, compared with cow milk formula (CF).
“The incidence of AD based on the United Kingdom Working Party (UKWP) criteria (ADUKWP) was not reduced by WGF,” said Dr Laura Schlosser from LMU University Hospital, Munich, Germany, at ESPGHAN 2026. “[However,] WGF significantly reduced the risk of AD development in children with a parental history of AD, which could be a huge advantage for this subgroup.”
ADUKWP was measured via face-to-face visits at 4, 6, and 12 months (ADPrimary) and telephone interviews at 8 and 10 months. Doctors’ diagnosis (ADDoctor) and ADUKWP comprised the overall AD outcome (ADAny). [ESPGHAN 2026, abstract OP077]
There were no significant differences in incidence rates (IR) between WGF and CF for ADPrimary (adjusted IR ratio [aIRR], 1.00; p=0.999) and ADUKWP (aIRR, 1.01; p=0.949) in the intention-to-treat (ITT) population. [Clin Nutr 2026:63:106707]
However, there were significant protective effects with WGF vs CF in ADDoctor, both in the ITT (aIRR, 0.78; p=0.06) and per-protocol (PP) cohorts (aIRR, 0.67; p=0.011). A similar effect was observed in ADAny (ITT: aIRR, 0.83; p=0.091; PP: aIRR, 0.75; p=0.030).
Subgroup analysis
The effects were even more pronounced in infants with a parental history of AD in the ITT cohort, with risk reductions of 64 percent in ADDoctor (aIRR, 0.36) and 61 percent in ADAny (aIRR, 0.39) in the first year of life (p for interaction<0.01 for both).
“This means that out of 100 WGF-fed infants with parental history of AD … 28 were protected from developing AD over 1 year,” Schlosser said.
Of note, a larger effect was observed in the PP cohort (aIRRs, 0.21 and 0.25 for ADDoctor and ADAny, respectively; p for interaction<0.01 for both), suggesting that better adherence to WGF was associated with greater risk reduction.
Different compositions, structures
WGF and CF contain milk allergens, but they differ in their protein and lipid composition and structure, which could lead to immunomodulatory effects. [J Invest Dermatol 2022;142:2541-2543]
A study evaluating the suitability and safety of WGF in infants found a lower incidence of AD among infants fed WGF compared with those fed CF. [British J Nut 2014;111:1641-1651] “Although the difference was not statistically significant … the potential protective effect of WGF was considered plausible,” Schlosser noted.
To further examine the role of WGF and CF in AD development in infants, the team evaluated 2,132 healthy term infants (52.5 percent male) up to age 3 months from four Polish and six Spanish centres. The infants were randomized 1:1 to receive iso-energetic infant WGF or CF until 6 months of age, and follow-on formula from 6 to 12 months.
A total of 268 infants dropped out until the end of the intervention phase, which ran until 12 months of age; follow-up was up to 5 years of age. The majority of dropouts occurred in the first 4 months of the intervention phase, with more dropouts in the WGF than the CF group (15 percent vs 10 percent). The investigators analysed data from 1,927 infants.
WGF consisted of 49 percent goat milk fat and 51 percent vegetable oils, with a whey:casein ratio of 20:80. CF was 5 percent milk fat and 95 percent vegetable oils, with a whey:casein ratio of 60:40.
There were no differences in the incidence of overall adverse events (AEs). When examining AE categories, Schlosser noted a higher incidence of constipation in the WGF group than in the CF group (46 percent vs 39 percent).