What are the differences in gut physiology between formula and breastfed infants? Does the addition of

prebiotics and probiotics in formula mimic the effects of breast milk?

Sahira Copenhaver

Nutrition 490W

Dr. Patterson

Spring 2011

April 22, 2011

Outline• Definitions• Intestinal microflora of breastfed vs. formula fed infants• Studies evaluating formulas with prebiotics and probiotics– Pre-term

• Westerbeek et al (2010)

– Term• Rinne et al (2005)• Bakker-Zierikzee et al (2005)

• Where is research heading?• Dietitian’s role• Conclusions

Definitions

• Human Milk Oligosaccharides (HMOs)• Functional Food Components– Probiotics• Bifidobacteria and lactobacilli

– Prebiotics • Galacto-oligosaccharides (GOS)• Fructo-oligosaccharides (FOS)

Thomas et al Pediatrics 2010;126:1217-1231.

1

Intestinal Microflora of Breastfed vs. Formula Fed Infants

• Breastfed– Dominated by populations of Bifidobacteria

• Formula fed–More complex microflora with Bifidobacteria,

facultative anaerobes, bacteroides, and clostridia

Mountzouris et al British Journal of Nutrition 2002;87:405-420.

2

Enteral Supplementation of Prebiotic Mixture on Intestinal Permeability in Preterm Infants

• Subjects– 113 infants, gestational age <32 weeks and/or birth

weight <1500g

• Methods– Randomly allocated • Prebiotic mixture of 80% GOS/FOS + 20% AOS• Placebo mixture (maltodextrin)

– Intestinal Permeability

Westerbeek et al British Journal of Nutrition 2011;105:268-274. 3

4

0 1 2 Time point

Westerbeek et al British Journal of Nutrition 2011;105:268-274.

L/M

R

atio

0.5

0.4

0.3

0.2

0.1

0.0

No Effect on L/M Ratio in Both Groups

Enteral Supplementation of Prebiotic Mixture not Correlated with Intestinal Permeability in Preterm Infants

• Results– Baseline patient and nutritional characteristics

were not different between groups– LBW increased the L/M ratio

• Limitations– Timing

Westerbeek et al British Journal of Nutrition 2011;105:268-274.

5

Similar Bifidogenic Effects on Infant Gut Microflora

• Subjects– 32 infants, born between 36 and 42 weeks of

gestation

• Study Design (Four Groups)– Formula (n=8)*– Pre + Formula – Breast milk – Pro + Breast milk

Rinne et al FEMS 2005;43:59-65. 6

Similar Bifidogenic Effects on Infant Gut Microflora

• Methods– Fluorescent in situ hybridization (FISH)– Bifidobacterium species characterization

• Results– Bifidobacteria lower among formula group

(P=0.044)– Bifidobacterium composition achieved in infants

receiving prebiotic supplemented formula

Rinne et al FEMS 2005;43:59-65.

7

Bifidobacterium Composition Achieved

8Rinne et al FEMS 2005;43:59-65.

Infant Formula Containing a Mixture of GOS/FOS or Bb-12 Compared to Standard

• Subjects– 63 pregnant women breastfeeding, 57 not

breastfeeding

• Feeding Groups–Mothers who decided not to breastfeed• Standard formula (n=19)• Prebiotic formula; GOS/FOS (n-19)• Probiotic formula; Bb-12 (n=19)

– BreastfeedingBakker-Zierikzee et al BJN 2005;94:783-

790.9

Infant Formula Containing a Mixture of GOS and FOS Results in Higher Bifidobacteria

• Methods– Questionnaires– FISH• Fecal samples

• Results

Bakker-Zierikzee et al BJN 2005;94:783-790.

10

GOS/FOS Formula has a Higher Percentage of Bifidobacteria in the Total Bacterial Count

11

Breast milkStandard formulaBb-12GOS/FOS

Where is Research Heading?

• Development of new prebiotic blend formula

• Microflora modulation can occur through diets– Is the effect long lasting?– Optimal composition and dosage

• Clarify specific effects: understand HMO’s benefit for the breastfed infant

12

Dietitian’s Role

• Encouragement of breastfeeding is the first choice

• Whenever breastfeeding is not possible– Supplemented infant formula provides safe, nutritious,

and healthy food for growth and development

• Keep abreast with the latest research

Huerou-Luron et al Nutrition Research Reviews 2010;23:23-36.

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Conclusions• Enteral supplementation of a prebiotic mixture does not

enhance postnatal decrease in intestinal permeability in preterm infants in the first week of life

• Infants given partially hydrolyzed formula supplemented with prebiotics had identical levels of Bifidobacteria in feces, exceeding formula fed infants

• With the aim of stimulating the typical intestinal microflora of breastfed infants in formula fed infants, the effects of adding pre or probiotics to infant formula was compared to a standard formula. Although not statistically significant, GOS/FOS group had higher percentage of Bifidobacteria

14

The field is still in its infancy and it has to grow with care …

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References1. Thomas DW, Greer FR, et al. Probiotics and prebiotics in pediatrics. Pediatrics

2010;126:1217-1231.

2. Mountzouris KC, McCartney AL, Gibson GR. Intestinal microflora of human infants and current trends for tis nutritional modulation. British Journal of Nutrition 2002;87:405-420.

3. Westerbeek EAM,van den Berg A, Lafeber HN, Fetter WPF, van Elburg RM. The effect of enteral supplementation of a prebiotic mixture of non-human milk galacto-, fructo- and acidic oligosaccharides on intestinal permeability in preterm infants. British Journal of Nutrition 2011;105:268-274.

4. Rinne MM, Gueimonde M, Kalliomaki M, Hoppu U, Salminen SJ, Isolauri E. Similar bifidogenic effects of prebiotic-supplemented partially hydrolyzed infant formula and breastfeeding on infant gut microbiota. FEMS 2005;43:59-65.

5. Bakker-Zierikzee AM, Alles MS, Knol J, et al. Effects of infant formula containing a mixture of galacto- and fructo- oligosaccharides or viable Bifidobacterium animalis on the intestinal microflora during the first 4 months of life. BJN 2005;94:783-790.

6. Huerou-Luron IL, Blat S, Boudry G. Breast v. formula-feeding: impacts on the digestive tract and immediate and long term health effects. Nutrition Research Reviews 2010;23:23-36.