Background:The efficiency with which breast- and formula-fed infants utilize dietary nutrients is likely to provide insight into their relative requirements for the growth process.Methods:We measured longitudinal changes in growth, body composition, and dietary intakes in breast- and formula-fed infants and estimated the gross efficiency with which dietary nitrogen and energy were used for lean body mass and body fat deposition. Lean body mass and body fat were determined in 10 breast-fed and 10 formula-fed infants at 6-week intervals during the first 24 weeks of life by the18O dilution technique. Dietary nitrogen and energy intakes were determined from the amount of milk and food consumed and the nutrient content of the feedings. The gross efficiency of nutrient utilization was calculated for each infant from the cumulative dietary intake and the change in body composition with time.Results:Length and weight gains and lean body mass and body fat accretion during the first 24 weeks of life were similar between breast- and formula-fed infants despite significantly higher nitrogen and energy intakes of the formula-fed group. The gross efficiency of dietary nitrogen utilization for lean body mass deposition was almost two-fold lower in formula- than in breast-fed infants, whereas the efficiency of dietary energy utilization for lean body mass and body fat deposition was similar between groups. Despite apparent differences in the efficiency of nitrogen utilization, there was no association between lean body mass deposition and dietary protein intake, implying that human milk protein does not limit growth quantitatively in breast-fed infants.Conclusions:These differences in nutrient utilization illustrate the biologic adaptability of human infants who are quipped with mechanisms that promote normal growth despite the variability of their nutrient intake.