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Mullaney JA, Roy NC, Halliday C, Young W, Altermann E, Kruger MC, Dilger RN, McNabb WC. Effects of early postnatal life nutritional interventions on immune-microbiome interactions in the gastrointestinal tract and implications for brain development and function. Front Microbiol 2022; 13:960492. [PMID: 36504799 PMCID: PMC9726769 DOI: 10.3389/fmicb.2022.960492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022] Open
Abstract
The gastrointestinal (GI) microbiota has co-evolved with the host in an intricate relationship for mutual benefit, however, inappropriate development of this relationship can have detrimental effects. The developing GI microbiota plays a vital role during the first 1,000 days of postnatal life, during which occurs parallel development and maturation of the GI tract, immune system, and brain. Several factors such as mode of delivery, gestational age at birth, exposure to antibiotics, host genetics, and nutrition affect the establishment and resultant composition of the GI microbiota, and therefore play a role in shaping host development. Nutrition during the first 1,000 days is considered to have the most potential in shaping microbiota structure and function, influencing its interactions with the immune system in the GI tract and consequent impact on brain development. The importance of the microbiota-GI-brain (MGB) axis is also increasingly recognized for its importance in these developmental changes. This narrative review focuses on the importance of the GI microbiota and the impact of nutrition on MGB axis during the immune system and brain developmental period in early postnatal life of infants.
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Affiliation(s)
- Jane A. Mullaney
- Riddet Institute, Massey University, Palmerston North, New Zealand,AgResearch, Palmerston North, New Zealand,High-Value Nutrition National Science Challenge, Auckland, New Zealand
| | - Nicole C. Roy
- Riddet Institute, Massey University, Palmerston North, New Zealand,High-Value Nutrition National Science Challenge, Auckland, New Zealand,Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Christine Halliday
- Riddet Institute, Massey University, Palmerston North, New Zealand,AgResearch, Palmerston North, New Zealand,School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North, New Zealand
| | - Wayne Young
- Riddet Institute, Massey University, Palmerston North, New Zealand,AgResearch, Palmerston North, New Zealand,High-Value Nutrition National Science Challenge, Auckland, New Zealand
| | - Eric Altermann
- Riddet Institute, Massey University, Palmerston North, New Zealand,High-Value Nutrition National Science Challenge, Auckland, New Zealand,School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Marlena C. Kruger
- School of Health Sciences, College of Health, Massey University, Palmerston North, New Zealand
| | - Ryan N. Dilger
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Warren C. McNabb
- Riddet Institute, Massey University, Palmerston North, New Zealand,High-Value Nutrition National Science Challenge, Auckland, New Zealand,*Correspondence: Warren C. McNabb,
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2
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Fuertes M, Gonçalves JL, Faria A, Lopes-Dos-Santos P, Conceição IC, Dionisio F. Maternal sensitivity and mother-infant attachment are associated with antibiotic uptake in infancy. J Health Psychol 2020; 27:2197-2210. [PMID: 32660278 DOI: 10.1177/1359105320941245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Attachment security has been associated with health status and symptom reporting. In this longitudinal study, we investigated the association between antibiotics uptake by infants at 9-months and mother-infant attachment at 12-months. Logistic regression analyses indicated that lower maternal sensitivity was associated with increased odds of antibiotic uptake. Furthermore, 89.7% of insecure-ambivalent infants consumed antibiotics, which contrasted with 32.5% of avoidant infants and 21.5% of secure infants. This study suggests that maternal behavior and mother-infant attachment impact on antibiotic consumption, which is worrying because antibiotics may lead to several health problems later in life and antibiotic-resistance.
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Affiliation(s)
- Marina Fuertes
- Centro de Psicologia, University of Porto, Portugal.,Escola Superior de Educação de Lisboa, Portugal
| | | | - Anabela Faria
- Hospital de Santo Espírito, Terceira, Azores, Portugal
| | | | - Inês C Conceição
- Serviço de Patologia Clínica, Hospital Nossa Senhora do Rosário, Barreiro, Setúbal, Portugal
| | - Francisco Dionisio
- cE3c -Centre for Ecology, Evolution and Environmental Changes, and Departamento de Biologia Vegetal, Faculdade de Ciências, Universidade de Lisboa, Portugal
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3
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Lagström H, Rautava S, Ollila H, Kaljonen A, Turta O, Mäkelä J, Yonemitsu C, Gupta J, Bode L. Associations between human milk oligosaccharides and growth in infancy and early childhood. Am J Clin Nutr 2020; 111:769-778. [PMID: 32068776 PMCID: PMC7138667 DOI: 10.1093/ajcn/nqaa010] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/21/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Breastfeeding modulates infant growth and protects against the development of obesity. However, whether or not maternal variation in human milk components, such as human milk oligosaccharides (HMOs), is associated with programming of child growth remains unknown. OBJECTIVE Our objective was to determine the association between maternal HMO composition and child growth during the first 5 y of life. In addition, the association between maternal prepregnancy BMI and HMO composition was assessed. METHODS Human milk samples from 802 mothers were obtained from a prospective population-based birth cohort study, Steps to healthy development of Children (STEPS), conducted in Turku, Finland. HMO composition in these milk samples was analyzed by HPLC. Child growth data from 3 mo to 5 y were collected from municipal well-baby clinics and linked to maternal HMO composition data to test for associations. RESULTS Maternal HMO composition 3 mo after delivery was associated with height and weight during the first 5 y of life in children of secretor mothers. Specifically, HMO diversity and the concentration of lacto-N-neo-tetraose (LNnT) were inversely associated and that of 2'-fucosyllactose (2'FL) was directly associated with child height and weight z scores in a model adjusted for maternal prepregnancy BMI, mode of delivery, birthweight z score, sex, and time. Maternal prepregnancy BMI was associated with HMO composition. CONCLUSIONS The association between maternal HMO composition and childhood growth may imply a causal relation, which warrants additional testing in preclinical and clinical studies, especially since 2'FL and LNnT are among the HMOs now being added to infant formula. Furthermore, altered HMO composition may mediate the impact of maternal prepregnancy BMI on childhood obesity, which warrants further investigation to establish the cause-and-effect relation.
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Affiliation(s)
- Hanna Lagström
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland,Centre for Population Health Research, University of Turku, Turku, Finland
| | - Samuli Rautava
- Department of Pediatrics, University of Turku & Turku University Hospital, Turku, Finland
| | - Helena Ollila
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Anne Kaljonen
- Department of Biostatistics, Faculty of Medicine, University of Turku, Turku, Finland
| | - Olli Turta
- Department of Pediatrics, University of Turku & Turku University Hospital, Turku, Finland
| | - Johanna Mäkelä
- Finnish Clinical Biobank Tampere, Tampere University Hospital, Tampere, Finland
| | - Chloe Yonemitsu
- Department of Pediatrics and Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence (MOMI CORE), University of California San Diego, La Jolla, CA, USA
| | - Julia Gupta
- Department of Pediatrics and Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence (MOMI CORE), University of California San Diego, La Jolla, CA, USA
| | - Lars Bode
- Department of Pediatrics and Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence (MOMI CORE), University of California San Diego, La Jolla, CA, USA,Address correspondence to LB (e-mail: )
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4
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Moore RE, Townsend SD. Temporal development of the infant gut microbiome. Open Biol 2019; 9:190128. [PMID: 31506017 PMCID: PMC6769289 DOI: 10.1098/rsob.190128] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/15/2019] [Indexed: 12/21/2022] Open
Abstract
The majority of organisms that inhabit the human body reside in the gut. Since babies are born with an immature immune system, they depend on a highly synchronized microbial colonization process to ensure the correct microbes are present for optimal immune function and development. In a balanced microbiome, symbiotic and commensal species outcompete pathogens for resources. They also provide a protective barrier against chemical signals and toxic metabolites. In this targeted review we will describe factors that influence the temporal development of the infant microbiome, including the mode of delivery and gestational age at birth, maternal and infant perinatal antibiotic infusions, and feeding method-breastfeeding versus formula feeding. We will close by discussing wider environmental pressures and early intimate contact, particularly between mother and child, as they play a pivotal role in early microbial acquisition and community succession in the infant.
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Affiliation(s)
| | - Steven D. Townsend
- Department of Chemistry, Vanderbilt University, Nashville, TN 37235, USA
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5
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Cow's Milk Allergy: Immunomodulation by Dietary Intervention. Nutrients 2019; 11:nu11061399. [PMID: 31234330 PMCID: PMC6627562 DOI: 10.3390/nu11061399] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 12/26/2022] Open
Abstract
Cow’s milk proteins cause allergic symptoms in 2% to 3% of all infants. In these individuals, the physiological mechanism of tolerance is broken with subsequent possible sensitization to antigens, which can lead eventually to allergic responses. The present review aims to provide an overview of different aspects of immune modulation by dietary intervention in cow’s milk allergy (CMA). It focuses on pathogenetic mechanisms of different CMA related disorders, e.g., gastroesophageal reflux and eosinophilic esophagitis, highlighting the role of dietary management on innate and adaptive immune systems. The traditional dietary management of CMA has greatly changed in the last years, moving from a passive approach, consisting of an elimination diet to relieve symptoms, to a “proactive” one, meaning the possibility to actively modulate the immune system. Thus, new insights into the role of hydrolysates and baked milk in immunomodulation are addressed here. Additionally, nutritional components, such as pre- and probiotics, may target the immune system via microbiota, offering a possible road map for new CMA prevention and treatment strategies.
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Huang T, Yue Y, Wang H, Zheng J, Chen Z, Chen T, Zhang M, Wang S. Infant Breastfeeding and Behavioral Disorders in School-Age Children. Breastfeed Med 2019; 14:115-120. [PMID: 30570349 DOI: 10.1089/bfm.2018.0151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To explore the effects of breastfeeding on behavioral disorders of school-age children. MATERIALS AND METHODS Totally 1,979 children of 6-11 years old from three primary schools in Xiamen, China, were assessed and included for further analysis. The Pearson chi-square test and multivariable logistic regression model were used to analyze the effects of breastfeeding on internalizing behaviors such as depression, withdrawn, and somatic complaints, and externalizing behaviors such as aggression and rule-breaking behavior. RESULTS The Pearson chi-square test revealed that the percentages in internalizing behavioral problems (χ2 = 21.693, p < 0.001), depression (χ2 = 12.713, p = 0.002), and somatic complains (χ2 = 12.850, p = 0.002) were significantly lower with the decrease of the duration of breastfeeding. However, there were no statistically significant differences in externalizing behavioral problems. After adjusting the potential covariates, children who were breastfed for >6 months were significantly associated with the reduced risk of internalizing behavioral problems (Odds ratio = 0.446, 95%CI: 0.228-0.873) and depression (Odds ratio = 0.452, 95% CI: 0.225-0.906) compared with those who were never breastfed, whereas differences were not found in externalizing behavioral problems. CONCLUSION Increased duration of breastfeeding (≥6 months) could help lower internalizing behavioral problems, particularly depression, in school-age children. Breastfeeding with longer duration will play an important role to prevent and reduce children's internalizing behavioral disorders.
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Affiliation(s)
- Tingting Huang
- 1 Xiamen Mental Health Center (Xiamen Xianyue Hospital) , Xiamen, China
| | - Yihuan Yue
- 2 Children's Hospital of Fudan University Xiamen Branch (Xiamen Children's Hospital) , Xiamen, China
| | - Hui Wang
- 2 Children's Hospital of Fudan University Xiamen Branch (Xiamen Children's Hospital) , Xiamen, China
| | - Jianshan Zheng
- 2 Children's Hospital of Fudan University Xiamen Branch (Xiamen Children's Hospital) , Xiamen, China
| | - Zhijian Chen
- 2 Children's Hospital of Fudan University Xiamen Branch (Xiamen Children's Hospital) , Xiamen, China
| | - Tianyi Chen
- 2 Children's Hospital of Fudan University Xiamen Branch (Xiamen Children's Hospital) , Xiamen, China
| | - Min Zhang
- 2 Children's Hospital of Fudan University Xiamen Branch (Xiamen Children's Hospital) , Xiamen, China
| | - Shunqin Wang
- 2 Children's Hospital of Fudan University Xiamen Branch (Xiamen Children's Hospital) , Xiamen, China
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7
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Kozik AJ, Huang YJ. The microbiome in asthma: Role in pathogenesis, phenotype, and response to treatment. Ann Allergy Asthma Immunol 2018; 122:270-275. [PMID: 30552986 DOI: 10.1016/j.anai.2018.12.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To synthesize evidence on the role of microbiota in asthma pathogenesis, phenotype, and treatment outcomes, and to provide perspective on future research directions and challenges. DATA SOURCES Studies identified from a PubMed search, including all or some of the terms "asthma," "microbiome," "microbiota," "gut," "airway," "respiratory," "lung," "viral," and "fungal". STUDY SELECTIONS Studies included and referenced based on the authors' opinion of the study design and methods, value of the research questions, and the relevance of the results to the objective of the article. RESULTS Many studies have demonstrated an important role for intestinal or upper airway microbiota in mediating the pathogenesis of childhood asthma. Fewer but robust studies have implicated a role for lower respiratory tract microbiota in adult asthma phenotype, including effects of treatments. Bacterial and fungal members of the respiratory microbiota are associated with and may drive specific molecular phenotypes of asthma in adults. CONCLUSION Current evidence supports the role of human microbiota changes in shaping asthma risk, pathogenesis, and clinical presentation. Further understanding of how microbiota functionally mediate these aspects in clinically relevant contexts will require better integration of advanced scientific tools, analytic methods, and well-designed clinical studies. These efforts should be pursued with a systems-level perspective of the complex interactions between human hosts and their microbiomes, and the impact on these interactions of changes in environmental and lifestyle factors across the lifespan.
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Affiliation(s)
- Ariangela J Kozik
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Yvonne J Huang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
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8
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Abbring S, Hols G, Garssen J, van Esch BCAM. Raw cow's milk consumption and allergic diseases - The potential role of bioactive whey proteins. Eur J Pharmacol 2018; 843:55-65. [PMID: 30439365 DOI: 10.1016/j.ejphar.2018.11.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/06/2018] [Accepted: 11/09/2018] [Indexed: 12/18/2022]
Abstract
The prevalence of allergic diseases has increased significantly in Western countries in the last decades. This increase is often explained by the loss of rural living conditions and associated changes in diet and lifestyle. In line with this 'hygiene hypothesis', several epidemiological studies have shown that growing up on a farm lowers the risk of developing allergic diseases. The consumption of raw, unprocessed, cow's milk seems to be one of the factors contributing to this protective effect. Recent evidence indeed shows an inverse relation between raw cow's milk consumption and the development of asthma and allergies. However, the consumption of raw milk is not recommended due to the possible contamination with pathogens. Cow's milk used for commercial purposes is therefore processed, but this milk processing is shown to abolish the allergy-protective effects of raw milk. This emphasizes the importance of understanding the components and mechanisms underlying the allergy-protective capacity of raw cow's milk. Only then, ways to produce a safe and protective milk can be developed. Since mainly heat treatment is shown to abolish the allergy-protective effects of raw cow's milk, the heat-sensitive whey protein fraction of raw milk is an often-mentioned source of the protective components. In this review, several of these whey proteins, their potential contribution to the allergy-protective effects of raw cow's milk and the consequences of heat treatment will be discussed. A better understanding of these bioactive whey proteins might eventually contribute to the development of new nutritional approaches for allergy management.
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Affiliation(s)
- Suzanne Abbring
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Gert Hols
- Danone Nutricia Research, Utrecht, the Netherlands
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands; Danone Nutricia Research, Utrecht, the Netherlands
| | - Betty C A M van Esch
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands; Danone Nutricia Research, Utrecht, the Netherlands.
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9
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Rationale of Probiotic Supplementation during Pregnancy and Neonatal Period. Nutrients 2018; 10:nu10111693. [PMID: 30404227 PMCID: PMC6267579 DOI: 10.3390/nu10111693] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/31/2018] [Accepted: 11/03/2018] [Indexed: 02/07/2023] Open
Abstract
Probiotics are living microorganisms that confer a health benefit when administered in adequate amounts. It has been speculated that probiotics supplementation during pregnancy and in the neonatal period might reduce some maternal and neonatal adverse outcomes. In this narrative review, we describe the rationale behind probiotic supplementation and its possible role in preventing preterm delivery, perinatal infections, functional gastrointestinal diseases, and atopic disorders during early life.
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10
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Kennedy HP, Cheyney M, Dahlen HG, Downe S, Foureur MJ, Homer CSE, Jefford E, McFadden A, Michel-Schuldt M, Sandall J, Soltani H, Speciale AM, Stevens J, Vedam S, Renfrew MJ. Asking different questions: A call to action for research to improve the quality of care for every woman, every child. Birth 2018; 45:222-231. [PMID: 29926965 DOI: 10.1111/birt.12361] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 05/10/2018] [Accepted: 05/10/2018] [Indexed: 11/26/2022]
Abstract
Despite decades of considerable economic investment in improving the health of families and newborns world-wide, aspirations for maternal and newborn health have yet to be attained in many regions. The global turn toward recognizing the importance of positive experiences of pregnancy, intrapartum and postnatal care, and care in the first weeks of life, while continuing to work to minimize adverse outcomes, signals a critical change in the maternal and newborn health care conversation and research prioritization. This paper presents "different research questions" drawing on evidence presented in the 2014 Lancet Series on Midwifery and a research prioritization study conducted with the World Health Organization. The results indicated that future research investment in maternal and newborn health should be on "right care," which is quality care that is tailored to individuals, weighs benefits and harms, is person-centered, works across the whole continuum of care, advances equity, and is informed by evidence, including cost-effectiveness. Three inter-related research themes were identified: examination and implementation of models of care that enhance both well-being and safety; investigating and optimizing physiological, psychological, and social processes in pregnancy, childbirth, and the postnatal period; and development and validation of outcome measures that capture short and longer term well-being. New, transformative research approaches should account for the underlying social and political-economic mechanisms that enhance or constrain the well-being of women, newborns, families, and societies. Investment in research capacity and capability building across all settings is critical, but especially in those countries that bear the greatest burden of poor outcomes. We believe this call to action for investment in the three research priorities identified in this paper has the potential to achieve these benefits and to realize the ambitions of Sustainable Development Goal Three of good health and well-being for all.
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Affiliation(s)
- Holly P Kennedy
- Yale School of Nursing, Yale University, West Haven, CT, USA
| | | | | | - Soo Downe
- University of Central Lancashire, Preston, England
| | | | | | | | | | | | - Jane Sandall
- University of Technology Sydney, Sydney, NSW, Australia.,Kings College London, London, England
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11
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Abstract
NEC is a multifactorial disease that occurs when multiple risk factors and/or stressors overlap, leading to profound inflammation and intestinal injury. Human milk feedings, both from the infant's mother and donor human milk, have been associated with reductions in NEC in preterm infants. This article will review the protective factors in human milk, clinical studies of human milk and NEC, and practices to enhance human milk use in neonatal intensive care units.
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Affiliation(s)
- Aloka L Patel
- Section of Neonatology, Rush University Children's Hospital, 1653 W. Congress Pkwy, Pavilion 353, Chicago, Illinois 60612.
| | - Jae H Kim
- Divisions of Neonatology & Pediatric Gastroenterology, Hepatology and Nutrition, University of California San Diego, Rady Children's Hospital of San Diego, San Diego, California
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12
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Choi YS, Song IG. Fetal and preterm infant microbiomes: a new perspective of necrotizing enterocolitis. KOREAN JOURNAL OF PEDIATRICS 2017; 60:307-311. [PMID: 29158764 PMCID: PMC5687977 DOI: 10.3345/kjp.2017.60.10.307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/13/2017] [Accepted: 09/17/2017] [Indexed: 12/19/2022]
Abstract
Necrotizing enterocolitis (NEC) is a devastating condition of hospitalized preterm infants. Numerous studies have attempted to identify the cause of NEC by examining the immunological features associated with pathogenic microorganisms. No single organism has proven responsible for the disease; however, immunological studies are now focused on the microbiome. Recent research has investigated the numerous bacterial species residing in the body and their role in diseases in preterm infants. The timing of initial microbial colonization is a subject of interest. The microbiome appears to transfer from the mother to the newborn, as well as to the fetus. Cross-talk between the fetus and fetal microbiome takes place continuously to generate a unique immune system. This review examined the transfer of the microbiome to the human fetus, and its potential relationship with NEC.
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Affiliation(s)
- Yong-Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - In Gyu Song
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
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13
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The importance of appropriate initial bacterial colonization of the intestine in newborn, child, and adult health. Pediatr Res 2017; 82:387-395. [PMID: 28426649 PMCID: PMC5570628 DOI: 10.1038/pr.2017.111] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/29/2017] [Indexed: 12/11/2022]
Abstract
The fetus does not reside in a sterile intrauterine environment and is exposed to commensal bacteria from the maternal gut/blood stream that cross the placenta and enter the amniotic fluid. This intestinal exposure to colonizing bacteria continues at birth and during the first year of life and has a profound influence on lifelong health. Why is this important? Intestinal crosstalk with colonizing bacteria in the developing intestine affects the infant's adaptation to extrauterine life (immune homeostasis) and provides protection against disease expression (allergy, autoimmune disease, obesity, etc.) later in life. Colonizing intestinal bacteria are critical to the normal development of host defense. Disrupted colonization (dysbiosis) due to maternal dysbiosis, cesarean section delivery, use of perinatal antibiotics, or premature delivery may adversely affect the gut development of host defense and predispose to inflammation rather than to homeostasis, leading to increased susceptibility to disease later in life. Babies born by cesarean section have a higher incidence of allergy, type 1 diabetes, and obesity. Infants given repeated antibiotic regimens during the first year of life are more likely to have asthma as adolescents. This research breakthrough helps to explain the shift in disease paradigms from infections to immune-mediated in children from developed countries. This review will develop this research breakthrough.
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14
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Amenyogbe N, Kollmann TR, Ben-Othman R. Early-Life Host-Microbiome Interphase: The Key Frontier for Immune Development. Front Pediatr 2017; 5:111. [PMID: 28596951 PMCID: PMC5442244 DOI: 10.3389/fped.2017.00111] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/28/2017] [Indexed: 12/14/2022] Open
Abstract
Human existence can be viewed as an "animal in a microbial world." A healthy interaction of the human host with the microbes in and around us heavily relies on a well-functioning immune system. As development of both the microbiota and the host immune system undergo rapid changes in early life, it is not surprising that even minor alterations during this co-development can have profound consequences. Scrutiny of existing data regarding pre-, peri-, as well as early postnatal modulators of newborn microbiota indeed suggest strong associations with several immune-mediated diseases with onset far beyond the newborn period. We here summarize these data and extract overarching themes. This same effort in turn sets the stage to guide effective countermeasures, such as probiotic administration. The objective of our review is to highlight the interaction of host immune ontogeny with the developing microbiome in early life as a critical window of susceptibility for lifelong disease, as well as to identify the enormous potential to protect and promote lifelong health by specifically targeting this window of opportunity.
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Affiliation(s)
- Nelly Amenyogbe
- Department of Experimental Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tobias R. Kollmann
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Rym Ben-Othman
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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15
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Sardecka I, Krogulska A, Toporowska-Kowalska E. The influence of dietary immunomodulatory factors on development of food allergy in children. Postepy Dermatol Alergol 2017; 34:89-96. [PMID: 28507485 PMCID: PMC5420598 DOI: 10.5114/pdia.2016.63955] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/20/2016] [Indexed: 02/08/2023] Open
Abstract
In the last few years many studies have been conducted on the role of dietary and environmental factors in the prevention of allergic diseases among children. Many studies have shown that the diet of pregnant women and children in their early postnatal life, rich in antioxidants, vitamin D, and fatty acids is beneficial as it reduces the risk of allergy in their future life. Moreover, there are many reports about the main role of gut microbiota and probiotics in the allergy prevention, what can indicate new ways of procedures in allergic diseases.
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Affiliation(s)
- Izabela Sardecka
- Department of Paediatric Allergology, Gastroenterology and Nutrition, 3 Chair of Paediatrics, Medical University of Lodz, Lodz, Poland
| | - Aneta Krogulska
- Department of Paediatry, Allergology and Gastroenterology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Ewa Toporowska-Kowalska
- Department of Paediatric Allergology, Gastroenterology and Nutrition, 3 Chair of Paediatrics, Medical University of Lodz, Lodz, Poland
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Gregory KE, Samuel BS, Houghteling P, Shan G, Ausubel FM, Sadreyev RI, Walker WA. Influence of maternal breast milk ingestion on acquisition of the intestinal microbiome in preterm infants. MICROBIOME 2016; 4:68. [PMID: 28034306 PMCID: PMC5200970 DOI: 10.1186/s40168-016-0214-x] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 11/29/2016] [Indexed: 05/14/2023]
Abstract
BACKGROUND The initial acquisition and early development of the intestinal microbiome during infancy are important to human health across the lifespan. Mode of birth, antibiotic administration, environment of care, and nutrition have all been shown to play a role in the assembly of the intestinal microbiome during early life. For preterm infants, who are disproportionately at risk of inflammatory intestinal disease (i.e., necrotizing enterocolitis), a unique set of clinical factors influence the establishment of the microbiome. The purpose of this study was to establish the influence of nutritional exposures on the intestinal microbiome in a cohort of preterm infants early in life. RESULTS Principal component analysis of 199 samples from 30 preterm infants (<32 weeks) over the first 60 days following birth showed that the intestinal microbiome was influenced by postnatal time (p < 0.001, R 2 = 0.13), birth weight (p < 0.001, R 2 = 0.08), and nutrition (p < 0.001, R 2 = 0.21). Infants who were fed breast milk had a greater initial bacterial diversity and a more gradual acquisition of diversity compared to infants who were fed infant formula. The microbiome of infants fed breast milk were more similar regardless of birth weight (p = 0.049), in contrast to the microbiome of infants fed infant formula, which clustered differently based on birth weight (p < 0.001). By adjusting for differences in gut maturity, an ordered succession of microbial phylotypes was observed in breast milk-fed infants, which appeared to be disrupted in those fed infant formula. Supplementation with pasteurized donor human milk was partially successful in promoting a microbiome more similar to breast milk-fed infants and moderating rapid increases in bacterial diversity. CONCLUSIONS The preterm infant intestinal microbiome is influenced by postnatal time, birth weight, gestational age, and nutrition. Feeding with breast milk appears to mask the influence of birth weight, suggesting a protective effect against gut immaturity in the preterm infant. These findings suggest not only a microbial mechanism underpinning the body of evidence showing that breast milk promotes intestinal health in the preterm infant but also a dynamic interplay of host and dietary factors that facilitate the colonization of and enrichment for specific microbes during establishment of the preterm infant microbiota.
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Affiliation(s)
- Katherine E. Gregory
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Buck S. Samuel
- Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030 USA
| | - Pearl Houghteling
- Department of Pediatrics, Yale School of Medicine, New Haven, CT USA
| | - Guru Shan
- Cooper Medical School, Camden, NJ USA
| | - Frederick M. Ausubel
- Department of Molecular Biology, Massachusetts General Hospital, Department of Genetics, Harvard Medical School, Boston, MA USA
| | - Ruslan I. Sadreyev
- Department of Molecular Biology, Massachusetts General Hospital, Department of Pathology, Harvard Medical School, Boston, MA USA
| | - W. Allan Walker
- Department of Pediatrics, Mucosal Immunology and Biology Research Center, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA USA
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Vajpayee S, Sharma SD, Gupta R, Goyal A, Sharma A. Early Infant Feeding Practices May Influence the Onset of Symptomatic Celiac Disease. Pediatr Gastroenterol Hepatol Nutr 2016; 19:229-235. [PMID: 28090467 PMCID: PMC5234418 DOI: 10.5223/pghn.2016.19.4.229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/17/2016] [Accepted: 10/01/2016] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To study whether breastfeeding and breastfeeding status during gluten introduction influences the age at diagnosis of celiac disease (CD). In addition to study, whether the timing of gluten introduction influences the age at diagnosis of CD. METHODS It was a hospital based observational study. Total 198 patients diagnosed with CD as per modified European Society of Pediatric Gastroenterology, Hepatology and Nutrition (2012) criteria, aged between 6 months to 6 years were included. Detail history taken with special emphasis on breastfeeding and age of gluten introduction. Standard statistical methods used to analyze the data. RESULTS Mean±standard deviation age of onset and diagnosis of CD in breastfed cases was 2.81±1.42 years and 3.68 ±1.55 years respectively as compared to 1.84±1.36 years and 2.70±1.65 years respectively in not breastfed cases (p<0.05). Those who had continued breastfeeding during gluten introduction and of longer duration had significantly delayed onset of disease. The age at onset of CD was under one year in 40.42% of the cases, who had started gluten before 6 months of age compared to only 12.58% of those who had started gluten later (p<0.001). The proposed statistical model showed that two variables, i.e., breast feeding status during gluten introduction and age at gluten introduction positively influencing the age at diagnosis of CD. CONCLUSION Delayed gluten introduction to infant's diet along with continuing breastfeeding, delays symptomatic CD. However, it is not clear from our study that these infant feeding practices provide permanent protection against the disease or merely delays the symptoms.
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Affiliation(s)
- Shailja Vajpayee
- Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College, Jaipur, India
| | - Shiv Dayal Sharma
- Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College, Jaipur, India
| | - Rajkumar Gupta
- Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College, Jaipur, India
| | - Alok Goyal
- Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College, Jaipur, India
| | - Aakash Sharma
- Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College, Jaipur, India
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Reid G, Kumar H, Khan AI, Rautava S, Tobin J, Salminen S. The case in favour of probiotics before, during and after pregnancy: insights from the first 1,500 days. Benef Microbes 2016; 7:353-62. [PMID: 26839074 DOI: 10.3920/bm2015.0140] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Successful human reproduction requires microbial homeostasis in the female reproductive tract, and colonisation of the newborn with beneficial microbes. In order to prevent several complications associated with dysbiosis, the administration of probiotics is more often being considered. The objective of the enclosed review was to examine the rationale for probiotic utility before and during pregnancy and in the early phase of infant life. The conclusions emerged from a panel of researchers who met during the International Scientific Association for Probiotics and Prebiotics (ISAPP) workshop held in Washington, DC, USA in 2015. The group concluded based upon the current literature, that a case can be made for the use of a specific sets of probiotic organisms during the first 1,500 days of life, with the goal of a healthy pregnancy to term, and a healthy start to life with lowered risk of infections and inflammatory events. The key to successfully translating these recommendations to practice is that products be made available and affordable to women in developed and developing countries.
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Affiliation(s)
- G Reid
- 1 Centre for Human Microbiome and Probiotic Research, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada.,2 Department of Microbiology and Immunology, University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - H Kumar
- 3 Functional Foods Forum, University of Turku, Itäinenpitkäkatu 4 A, 20014 Turku, Finland
| | - A I Khan
- 4 Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh, P.O. Box 128, Dhaka 1000, Bangladesh
| | - S Rautava
- 5 Department of Pediatrics, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - J Tobin
- 6 Melbourne Medical School Centre for Indigenous Health Equity, 207 Bouverie St, Parkville, Melbourne 3010, Victoria, Australia
| | - S Salminen
- 3 Functional Foods Forum, University of Turku, Itäinenpitkäkatu 4 A, 20014 Turku, Finland
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19
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Rodriguez NA, Vento M, Claud EC, Wang CE, Caplan MS. Oropharyngeal administration of mother's colostrum, health outcomes of premature infants: study protocol for a randomized controlled trial. Trials 2015; 16:453. [PMID: 26458907 PMCID: PMC4603349 DOI: 10.1186/s13063-015-0969-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 09/21/2015] [Indexed: 12/03/2022] Open
Abstract
Background Extremely premature (birth weight < 1250 g) infants are at high risk for acquiring late-onset sepsis and necrotizing enterocolitis, which are associated with significant mortality and morbidity. Own mother's milk contains protective (immune and trophic) biofactors which provide antimicrobial, anti-inflammatory, antioxidant, and immunomodulatory functions, enhance intestinal microbiota, and promote intestinal maturation. Many of these biofactors are most highly concentrated in the milk expressed by mothers of extremely premature infants. However, since extremely premature infants do not receive oral milk feeds until 32 weeks post-conceptional age, they lack the potential benefit provided by milk (biofactor) exposure to oropharyngeal immunocompetent cells, and this deficiency could contribute to late-onset sepsis and necrotizing enterocolitis. Therefore, oropharyngeal administration of own mother's milk may improve the health outcomes of these infants. Objectives To compare the effects of oropharyngeal administration of mother’s milk to a placebo, for important clinical outcomes, including (1A) reducing the incidence of late-onset sepsis (primary outcome) and (1B) necrotizing enterocolitis and death (secondary outcomes). To identify the biomechanisms responsible for the beneficial effects of oropharyngeal mother’s milk for extremely premature infants, including; (2A) enhancement of gastrointestinal (fecal) microbiota (2B) improvement in antioxidant defense maturation or reduction of pro-oxidant status, and (2C) maturation of immunostimulatory effects as measured by changes in urinary lactoferrin. Methods/Design A 5-year, multi-center, double-blind, randomized controlled trial designed to evaluate the safety and efficacy of oropharyngeal mother’s milk to reduce the incidence of (1A) late-onset sepsis and (1B) necrotizing enterocolitis and death in a large cohort of extremely premature infants (n = 622; total patients enrolled). Enrolled infants are randomly assigned to one of 2 groups: Group A infants receive 0.2 mL of own mother's milk, via oropharyngeal administration, every 2 hours for 48 hours, then every 3 hours until 32 weeks corrected-gestational age. Group B infants receive a placebo (0.2 mL sterile water) following the same protocol. Milk, urine, oral mucosal swab, and stool samples are collected at various time points, before, during and after the treatment periods. Health outcome and safety data are collected throughout the infant’s stay. Trial registration ClinicalTrials.gov identifier: NCT02116699 on 11 April 2014. Last updated: 26 May 2015
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Affiliation(s)
- Nancy A Rodriguez
- NorthShore University HealthSystem, Evanston, IL, USA. .,University of Chicago Pritzker School of Medicine, Chicago, IL, USA. .,Clinician Researcher, Pritzker School of Medicine, Neonatal Nurse Practitioner, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA.
| | - Maximo Vento
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain.
| | - Erika C Claud
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
| | | | - Michael S Caplan
- NorthShore University HealthSystem, Evanston, IL, USA. .,University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
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Dixon DL. The Role of Human Milk Immunomodulators in Protecting Against Viral Bronchiolitis and Development of Chronic Wheezing Illness. CHILDREN (BASEL, SWITZERLAND) 2015; 2:289-304. [PMID: 27417364 PMCID: PMC4928768 DOI: 10.3390/children2030289] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 06/21/2015] [Accepted: 06/29/2015] [Indexed: 12/26/2022]
Abstract
Infants who are breastfed are at an immunological advantage when compared with formula fed infants, evidenced by decreased incidence of infections and diminished propensity for long term conditions, including chronic wheeze and/or asthma. Exclusive breastfeeding reduces the duration of hospital admission, risk of respiratory failure and requirement for supplemental oxygen in infants hospitalised with bronchiolitis suggesting a potentially protective mechanism. This review examines the evidence and potential pathways for protection by immunomodulatory factors in human milk against the most common viral cause of bronchiolitis, respiratory syncytial virus (RSV), and subsequent recurrent wheeze in infants. Further investigations into the interplay between respiratory virus infections such as RSV and how they affect, and are affected by, human milk immunomodulators is necessary if we are to gain a true understanding of how breastfeeding protects many infants but not all against infections, and how this relates to long-term protection against conditions such as chronic wheezing illness or asthma.
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Affiliation(s)
- Dani-Louise Dixon
- Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide 5042, Australia.
- Department of Critical Care Medicine, Flinders University, Adelaide 5001, Australia .
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21
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Abstract
The significance of contact with microbes in early life for subsequent health has been the subject of intense research during the last 2 decades. Disturbances in the establishment of the indigenous intestinal microbiome caused by cesarean section delivery or antibiotic exposure in early life have been linked to the risk of immune-mediated and inflammatory conditions such as atopic disorders, inflammatory bowel disease and obesity later in life. Distinct microbial populations have recently been discovered at maternal sites including the amniotic cavity and breast milk, as well as meconium, which have previously been thought to be sterile. Our understanding of the impact of fetal microbial contact on health outcomes is still rudimentary. Breast milk is known to modulate immune and metabolic programming. The breast milk microbiome is hypothesized to guide infant gut colonization and is affected by maternal health status and mode of delivery. Immunomodulatory factors in breast milk interact with the maternal and infant gut microbiome and may mediate some of the health benefits associated with breastfeeding. The intimate connection between the mother and the fetus or the infant is a potential target for microbial therapeutic interventions aiming to support healthy microbial contact and protect against disease.
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The Interaction among Microbiota, Immunity, and Genetic and Dietary Factors Is the Condicio Sine Qua Non Celiac Disease Can Develop. J Immunol Res 2015; 2015:123653. [PMID: 26090475 PMCID: PMC4451297 DOI: 10.1155/2015/123653] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 10/14/2014] [Indexed: 12/24/2022] Open
Abstract
Celiac disease (CD) is an immune-mediated enteropathy, triggered by dietary wheat gluten and similar proteins of barley and rye in genetically susceptible individuals. This is a complex disorder involving both environmental and immune-genetic factors. The major genetic risk factor for CD is determined by HLA-DQ genes. Dysfunction of the innate and adaptive immune systems can conceivably cause impairment of mucosal barrier function and development of localized or systemic inflammatory and autoimmune processes. Exposure to gluten is the main environmental trigger responsible for the signs and symptoms of the disease, but exposure to gluten does not fully explain the manifestation of CD. Thus, both genetic determination and environmental exposure to gluten are necessary for the full manifestation of CD; neither of them is sufficient alone. Epidemiological and clinical data suggest that other environmental factors, including infections, alterations in the intestinal microbiota composition, and early feeding practices, might also play a role in disease development. Thus, this interaction is the condicio sine qua non celiac disease can develop. The breakdown of the interaction among microbiota, innate immunity, and genetic and dietary factors leads to disruption of homeostasis and inflammation; and tissue damage occurs. Focusing attention on this interaction and its breakdown may allow a better understanding of the CD pathogenesis and lead to novel translational avenues for preventing and treating this widespread disease.
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23
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Dalal PG. The Need to Treat Maternal Pain in the Breastfeeding Mother: Are Opioids Safe? PAIN MEDICINE 2015; 16:630-1. [DOI: 10.1111/pme.12718_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Takahashi N, Takahashi K, Kobayashi M, Yada Y, Koike Y, Kono Y. Constitutively high-level expression of TGFβ isoforms in cord blood and its relationship to perinatal findings. Cytokine 2015; 73:101-7. [PMID: 25743244 DOI: 10.1016/j.cyto.2015.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 01/17/2015] [Accepted: 01/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The clinical significance of TGFβ isoforms in cord blood is not well understood. METHODS We obtained cord blood samples from 37 term infants and 85 preterm infants who were born in several clinical settings. The serum levels of 3 TGFβ isoforms and of the other 17 cytokines in cord blood were investigated using cytometric bead array technology. RESULTS Very high levels of TGFβ1 and TGFβ2 isoforms compared to the level of other cytokines were found; mean levels were 44,180 and 1871pg/mL, respectively. The levels of all 3 isoforms of TGFβ were significantly correlated with birth weight, and the levels of TGFβ1 and TGFβ3 were correlated with gestational age. The levels of TGFβ1 and β2 isoforms were strongly correlated with each other, but not with levels of other cytokines. The levels of TGFβ1 and TGFβ2 were significantly higher in male infants and significantly lower in infants with fetal growth restriction. The prevalence of chronic lung disease was related to a low level of TGFβ1, and that of patent ductus arteriosus was related to a high level of TGFβ1 in preterm infants. CONCLUSIONS TGFβ1 and TGFβ2 appeared to play a significant role in physiological and pathological conditions in the fetus. TGFβ isoform levels appear to be regulated independently of those of other cytokines and do not appear to be influenced by inflammation in the fetal period. The role of TGFβ3 in cord blood and the postnatal chronological changes of the TGFβ isoforms should be investigated in the future.
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Affiliation(s)
- Naoto Takahashi
- Department of Pediatrics, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Pediatrics, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi-ken 329-0498, Japan.
| | - Kayo Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi-ken 329-0498, Japan
| | - Mami Kobayashi
- Department of Pediatrics, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi-ken 329-0498, Japan
| | - Yukari Yada
- Department of Pediatrics, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi-ken 329-0498, Japan
| | - Yasunori Koike
- Department of Pediatrics, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi-ken 329-0498, Japan
| | - Yumi Kono
- Department of Pediatrics, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi-ken 329-0498, Japan
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25
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Walker WA, Iyengar RS. Breast milk, microbiota, and intestinal immune homeostasis. Pediatr Res 2015; 77:220-8. [PMID: 25310762 DOI: 10.1038/pr.2014.160] [Citation(s) in RCA: 189] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/22/2014] [Indexed: 12/22/2022]
Abstract
Newborns adjust to the extrauterine environment by developing intestinal immune homeostasis. Appropriate initial bacterial colonization is necessary for adequate intestinal immune development. An environmental determinant of adequate colonization is breast milk. Although the full-term infant is developmentally capable of mounting an immune response, the effector immune component requires bacterial stimulation. Breast milk stimulates the proliferation of a well-balanced and diverse microbiota, which initially influences a switch from an intrauterine TH2 predominant to a TH1/TH2 balanced response and with activation of T-regulatory cells by breast milk-stimulated specific organisms (Bifidobacteria, Lactobacillus, and Bacteroides). As an example of its effect, oligosaccharides in breast milk are fermented by colonic bacteria producing an acid milieu for bacterial proliferation. In addition, short-chain fatty acids in breast milk activate receptors on T-reg cells and bacterial genes, which preferentially mediate intestinal tight junction expression and anti-inflammation. Other components of breast milk (defensins, lactoferrin, etc.) inhibit pathogens and further contribute to microbiota composition. The breast milk influence on initial intestinal microbiota also prevents expression of immune-mediated diseases (asthma, inflammatory bowel disease, type 1 diabetes) later in life through a balanced initial immune response, underscoring the necessity of breastfeeding as the first source of nutrition.
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Affiliation(s)
- W Allan Walker
- Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Rajashri Shuba Iyengar
- Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts
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Abstract
The prevalence of reported cases of asthma and allergic disease has seen a marked increase throughout the world since the 1960s, particularly in more developed, westernised countries. A key focus of research in this area has been the possible adverse effects of foetal and infant exposure to food allergens. There is some evidence that foetal and infant exposure to a range of allergens via the mother and her breast milk is important in the development of normal immune tolerance. Current advice is that pregnant and breastfeeding women do not need to avoid potential food allergens unless they are allergic themselves, or are advised to modify their diet by a health professional. Delaying the introduction of common food allergies beyond 6 months is unlikely to reduce the likelihood of food allergy and allergic disease. The findings of current ongoing trials investigating the potential benefits of early introduction on allergenic foods into the diet of children-as well as the comprehensive review of complementary and young-child feeding advice currently being conducted by the Scientific Advisory Committee on Nutrition-will help inform guidance in this area.
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Affiliation(s)
- Laura Wyness
- Senior Research Fellow, School of Health Sciences, Dietetics, Nutrition & Biological Sciences, Queen Margaret University, Edinburgh
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27
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Baldassarre ME, Bellantuono L, Mastromarino P, Miccheli A, Fanelli M, Laforgia N. Gut and Breast Milk Microbiota and Their Role in the Development of the Immune Function. CURRENT PEDIATRICS REPORTS 2014. [DOI: 10.1007/s40124-014-0051-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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29
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Dalal PG, Bosak J, Berlin C. Safety of the breast-feeding infant after maternal anesthesia. Paediatr Anaesth 2014; 24:359-71. [PMID: 24372776 DOI: 10.1111/pan.12331] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2013] [Indexed: 12/30/2022]
Abstract
There has been an increase in breast-feeding supported by the recommendations of the American Academy of Pediatrics and the World Health Organization. An anesthesiologist may be presented with a well-motivated breast-feeding mother who wishes to breast-feed her infant in the perioperative period. Administration of anesthesia entails acute administration of drugs with potential for sedation and respiratory effects on the nursing infant. The short-term use of these drugs minimizes the possibility of these effects. The aim should be to minimize the use of narcotics and benzodiazepines, use shorter acting agents, use regional anesthesia where possible and avoid agents with active metabolites. Frequent clinical assessments of the nursing infant are important. Available literature does suggest that although the currently available anesthetic and analgesic drugs are transferred in the breast milk, the amounts transferred are almost always clinically insignificant and pose little or no risk to the nursing infant.
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Affiliation(s)
- Priti G Dalal
- Department of Anesthesiology, Penn State University College of Medicine, Milton S Hershey Medical Center, Hershey, PA, USA
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30
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Liu J, Leung P, Yang A. Breastfeeding and active bonding protects against children's internalizing behavior problems. Nutrients 2013; 6:76-89. [PMID: 24368674 PMCID: PMC3916850 DOI: 10.3390/nu6010076] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 12/04/2013] [Accepted: 12/10/2013] [Indexed: 02/04/2023] Open
Abstract
Breastfeeding is associated with numerous health benefits to offspring and mothers and may improve maternal-infant bonding. Ample evidence suggests breastfeeding can improve child neurodevelopment, but more research is needed to establish whether breastfeeding is linked to the development of child psychopathology. This paper aims to explore the effects of both breastfeeding and mother-child interactions on child behavioral outcomes at a later age. Children from the China Jintan Child Cohort Study (N = 1267), at age six years old were assessed, along with their parents. Children who were breastfed exclusively for a period of time in the presence of active bonding were compared to those who were breastfed in the absence of active bonding as well as to children who were not exclusively breastfed, with or without active bonding. Results from ANOVA and GLM, using SPSS20, indicate that children who were breastfed and whose mothers actively engaged with them displayed the lowest risk of internalizing problems (mean = 10.01, SD = 7.21), while those who were neither exclusively breastfed nor exposed to active bonding had the least protection against later internalizing problems (mean = 12.79, SD = 8.14). The effect of breastfeeding on internalizing pathology likely represents a biosocial and holistic effect of physiological, and nutritive, and maternal-infant bonding benefits.
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Affiliation(s)
- Jianghong Liu
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-215-898-8293
| | - Patrick Leung
- Department of Psychology, Chinese University of Hong Kong, Hong Kong, China; E-Mail:
| | - Amy Yang
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA 19104, USA; E-Mail:
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Power ML, Schulkin J. Maternal regulation of offspring development in mammals is an ancient adaptation tied to lactation. Appl Transl Genom 2013; 2:55-63. [PMID: 27896056 PMCID: PMC5121250 DOI: 10.1016/j.atg.2013.06.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/10/2013] [Accepted: 06/11/2013] [Indexed: 06/06/2023]
Abstract
The developmental origins of health and disease (DOHaD) is a paradigm for understanding metabolic diseases of modern humans. Vulnerability to disease is linked to perturbations in development during critical time periods in fetal and neonatal life. These perturbations are caused by environmental signals, often generated or transduced by the mother. The regulation of mammalian development depends to a large extent on maternal biochemical signals to her offspring. We argue that this adaptation is ancient, and originated with the evolution of lactation. Lactation evolved earlier than live birth and before the extensive placental development of modern eutherian mammals. Milk contains a host of signaling molecules including nutrients, immunoglobulins, growth factors and metabolic hormones. As evidenced by marsupials, lactation originally served to supply the biochemical factors for growth and development for what is essentially a fetus to a weanling transitioning to independent existence. In placental mammals maternal signaling in earliest life is accomplished through the maternal-placental-fetal connection, with more of development shifted to in utero life. However, significant development occurs postpartum, supported by milk. Mothers of all taxa provide biochemical signals to their offspring, but for non-mammalian mothers the time window is short. Developing mammals receive maternal biochemical signals over an extended period. These signals serve to guide normal development, but also can vary in response to environmental conditions. The ancient adaptation of lactation resulted in a lineage (mammals) in which maternal regulation of offspring development evolved to a heightened degree, with the ability to modify development at multiple time points. Modern metabolic diseases may arise due to a mismatch between maternal regulation and eventual circumstances of the offspring, and due to a large proportion of mothers that exceed past evolutionary norms in body fat and pregnancy weight gain such that maternal signals may no longer be within the adaptive range.
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Affiliation(s)
- Michael L. Power
- Research Department, American College of Obstetricians and Gynecologists, Washington, DC, United States
- Smithsonian Conservation Biology Institute, Conservation Ecology Center, Washington, DC, United States
| | - Jay Schulkin
- Research Department, American College of Obstetricians and Gynecologists, Washington, DC, United States
- Department of Neuroscience, Georgetown University, Washington, DC, United States
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
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Lanari M, Prinelli F, Adorni F, Di Santo S, Faldella G, Silvestri M, Musicco M. Maternal milk protects infants against bronchiolitis during the first year of life. Results from an Italian cohort of newborns. Early Hum Dev 2013; 89 Suppl 1:S51-7. [PMID: 23809352 DOI: 10.1016/s0378-3782(13)70016-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Bronchiolitis is one of the primary causes of hospitalization in infancy. We evaluated the effect of breastfeeding on the occurrence of hospitalization for bronchiolitis in the first year of life. METHODS In a prospective cohort study, 1,814 newborns of =33 weeks of gestational age (wGA) were enrolled in 30 Italian Neonatology Units and followed-up for 1 year to assess hospitalizations for bronchiolitis. Children were grouped as 'never breastfed' and 'ever breastfed'; these latter were further divided into those 'exclusively breastfed' and 'breastfed associated with milk formula'. The risk of hospitalization for bronchiolitis was evaluated with survival analysis, and hazard ratios (HR) with 95% confidence interval [95% CI] were calculated. RESULTS Among enrolled newborns 22.9% were 'never breastfed'; in the breastfed group, 65% were 'exclusively breastfed' and 35% were 'breastfed with associated milk formula'. At 12 months of age, the risk of hospitalization for bronchiolitis was significantly higher in the 'never breastfed' group (HR: 1.57; 95% CI: 1.00-2.48). 'Breastfed associated with formula milk' and 'exclusively breastfed' groups were at similar risk of hospitalization for bronchiolitis. This observed protective effect of maternal milk was not explained by the higher prevalence of conditions able to increase the risk of bronchiolitis among 'never breastfed newborns'. CONCLUSIONS Breastfeeding, even in association with formula milk, reduces the risk of hospitalization for bronchiolitis during the first year of life. Encouraging breastfeeding might be an effective/inexpensive measure of prevention of lower respiratory tract infections in infancy.
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Affiliation(s)
- Marcello Lanari
- Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy
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Bernstein RM, Dominy NJ. Mount Pinatubo, Inflammatory Cytokines, and the Immunological Ecology of Aeta Hunter-Gatherers. Hum Biol 2013; 85:231-50. [DOI: 10.3378/027.085.0312] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2013] [Indexed: 11/05/2022]
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Chattha KS, Vlasova AN, Kandasamy S, Esseili MA, Siegismund C, Rajashekara G, Saif LJ. Probiotics and colostrum/milk differentially affect neonatal humoral immune responses to oral rotavirus vaccine. Vaccine 2013; 31:1916-23. [PMID: 23453730 DOI: 10.1016/j.vaccine.2013.02.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 02/05/2013] [Accepted: 02/08/2013] [Indexed: 02/04/2023]
Abstract
Breast milk (colostrum [col]/milk) components and gut commensals play important roles in neonatal immune maturation, establishment of gut homeostasis and immune responses to enteric pathogens and oral vaccines. We investigated the impact of colonization by probiotics, Lactobacillus rhamnosus GG (LGG) and Bifidobacterium lactis Bb12 (Bb12) with/without col/milk (mimicking breast/formula fed infants) on B lymphocyte responses to an attenuated (Att) human rotavirus (HRV) Wa strain vaccine in a neonatal gnotobiotic pig model. Col/milk did not affect probiotic colonization in AttHRV vaccinated pigs. However, unvaccinated pigs fed col/milk shed higher numbers of probiotic bacteria in feces than non-col/milk fed colonized controls. In AttHRV vaccinated pigs, col/milk feeding with probiotic treatment resulted in higher mean serum IgA HRV antibody titers and intestinal IgA antibody secreting cell (ASC) numbers compared to col/milk fed, non-colonized vaccinated pigs. In vaccinated pigs without col/milk, probiotic colonization did not affect IgA HRV antibody titers, but serum IgG HRV antibody titers and gut IgG ASC numbers were lower, suggesting that certain probiotics differentially impact HRV vaccine responses. Our findings suggest that col/milk components (soluble mediators) affect initial probiotic colonization, and together, they modulate neonatal antibody responses to oral AttHRV vaccine in complex ways.
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Affiliation(s)
- Kuldeep S Chattha
- Food Animal Health Research Program, Department of Veterinary Preventive Medicine, Ohio Agricultural Research and Development Center, The Ohio State University, 1680 Madison Avenue, Wooster, OH 44691-4096, USA.
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Al-Makoshi A, Al-Frayh A, Turner S, Devereux G. Breastfeeding practice and its association with respiratory symptoms and atopic disease in 1-3-year-old children in the city of Riyadh, central Saudi Arabia. Breastfeed Med 2013; 8:127-33. [PMID: 23039399 DOI: 10.1089/bfm.2011.0137] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Saudi Arabia has a declining rate of breastfeeding and increasing levels of childhood asthma and atopic disease. In highly economically developed countries, breastfeeding of children at high risk of atopic disease reduces the likelihood of atopic dermatitis, wheezing associated with respiratory infections, and possibly asthma. This study investigated the prevalence of breastfeeding and its association with wheezing/asthma and atopic disease in 1-3-year-old children in Riyadh, Saudi Arabia. SUBJECTS AND METHODS A cross-sectional study of children attending routine "well-baby" clinics in three Saudi State Hospitals in Riyadh. An interviewer administered a questionnaire to collect data on sociodemographics, breastfeeding, wheezing symptoms, asthma, and atopic disease. RESULTS In total, 622 children 1-3 years old were recruited. Of these, 75% of children were ever breastfed, and 36% of children were fully breastfed, with 20% of children being fully breastfed for ≥ 3 months. Increasing duration of full breastfeeding was associated with a reduced likelihood of maternal reporting of her child having "ever wheezed," "wheezed' in the last 12 months," and "ever having asthma," with adjusted odds ratio for full breastfeeding ≥ 12 months versus never breastfed of 0.51 (95% confidence interval 0.29-0.90), 0.48 (0.26-0.88), and 0.46 (0.22-0.94), respectively. No associations were demonstrable between full or ever breastfeeding and atopic dermatitis/eczema, irrespective of family history of atopic disease. CONCLUSIONS Although breastfeeding does not protect children from developing eczema in Riyadh, full breastfeeding is associated with reduced childhood wheezing and possibly asthma. Further efforts should be made to promote breastfeeding in Saudi Arabia.
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Affiliation(s)
- Amel Al-Makoshi
- Department of Child Health, University of Aberdeen, Aberdeen, United Kingdom.
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Immunological programming by breast milk creates an anti-inflammatory cytokine milieu in breast-fed infants compared to formula-fed infants. Br J Nutr 2012; 109:1962-70. [PMID: 23110822 DOI: 10.1017/s0007114512004229] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Breast milk provides important maturational stimuli to an infant's developing immune system. However, data concerning the role of breast-feeding in reducing the risk of allergic disease remain contradictory. Previous studies have centred on comparative analyses of breast milk and formula compositions. We chose a slightly different angle, whereby we focused on the effects of the chosen diet on the infant himself, comparing the immune development of formula-fed and breast-fed children. The objective of the present study was to determine how the mode of feeding affects infant immunology. Altogether, eighteen formula-fed infants with limited breast-feeding for ,3 months and twenty-nine infants who were exclusively breast-fed for .3 months were included in the study. Concentrations of interferon g, TNF-a IL-10, IL-5, IL-4 and IL-2 were measured simultaneously from the same serum sample through use of a multiplexed flow cytometric assay at the ages of 1, 3, 6 and 12 months. Transforming growth factor β2 (TGF-β2) was measured using ELISA at the same time points. Serum TNF-a and IL-2 concentrations were significantly higher in formula-fed than in breast-fed infants during the first year of life (ANOVA, P=0·002). The serum concentrations of TGF-b were significantly lower in formula-fed than in breast-fed infants throughout the first year of life (ANOVA, P≤0·0001). Exclusive breast-feeding promotes an anti-inflammatory cytokine milieu, which is maintained throughout infancy. Such an immunological environment limits hyper-responsiveness and promotes tolerisation, possibly prohibiting the onset of allergic disease.
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Abstract
Interaction with colonizing intestinal bacteria is essential for healthy intestinal and immunological development in infancy. Advances in understanding early host-microbe interactions indicate that this early microbial programming begins in utero and is substantially modulated by mode of birth, perinatal antibiotics and breastfeeding. Furthermore, it has become evident that this stepwise microbial colonization process, as well as immune and metabolic programming by the microbiota, might have a long-lasting influence on the risk of not only gastrointestinal disease, but also allergic, autoimmune and metabolic disease, in later life. Modulating early host-microbe interaction by maternal probiotic intervention during pregnancy and breastfeeding offers a promising novel tool to reduce the risk of disease. In this Review, we describe the current body of knowledge regarding perinatal microbial contact, initial intestinal colonization and its association with human disease, as well as means of modulating early host-microbe interaction to reduce the risk of disease in the child.
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Immune development and intestinal microbiota in celiac disease. Clin Dev Immunol 2012; 2012:654143. [PMID: 23008734 PMCID: PMC3447214 DOI: 10.1155/2012/654143] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 08/06/2012] [Accepted: 08/13/2012] [Indexed: 01/06/2023]
Abstract
Celiac disease (CD) is an immune-mediated enteropathy, triggered by dietary wheat gluten and similar proteins of barley and rye in genetically susceptible individuals. The etiology of this disorder is complex, involving both environmental and genetic factors. The major genetic risk factor for CD is represented by HLA-DQ genes, which account for approximately 40% of the genetic risk; however, only a small percentage of carriers develop the disease. Gluten is the main environmental factor responsible for the signs and symptoms of the disease, but exposure to gluten does not fully explain the manifestation of CD. Epidemiological and clinical data suggest that environmental factors other than gluten might play a role in disease development, including early feeding practices (e.g., breast milk versus formula and duration of breastfeeding), infections, and alterations in the intestinal microbiota composition. Herein, we review what is known about the influence of dietary factors, exposure to infectious agents, and intestinal microbiota composition, particularly in early life, on the risk of developing CD, as well as the possible dietary strategies to induce or increase gluten tolerance.
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Luoto R, Laitinen K, Nermes M, Isolauri E. Impact of maternal probiotic-supplemented dietary counseling during pregnancy on colostrum adiponectin concentration: a prospective, randomized, placebo-controlled study. Early Hum Dev 2012; 88:339-44. [PMID: 21945174 DOI: 10.1016/j.earlhumdev.2011.09.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Revised: 09/05/2011] [Accepted: 09/06/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND The breast milk bioactive substances such as adiponectin, have a presumably long-term impact upon the health and well-being of a child. AIM To determine the impact of probiotic-supplemented dietary counseling during pregnancy on colostrum adiponectin concentration. STUDY DESIGN AND SUBJECTS Altogether 256 pregnant women were randomized into three study groups: dietary intervention with probiotics (diet/probiotics) or with placebo (diet/placebo) and a control group (control/placebo). The intervention group received dietary counseling provided by a nutritionist, the main focus being the amount and the type of dietary fat. The probiotics used were Lactobacillus rhamnosus GG and Bifidobacterium lactis in combination. Dietary intake was evaluated by food records at every trimester of pregnancy. Breast milk samples were collected after birth (colostrum) for adiponectin concentration analysis (n=181). RESULTS The dietary intervention increased the colostrum adiponectin concentration (ng/mL, geometric mean [95% CI]), the difference being significant when comparing to the control group; 12.7 [10.6-29.7] vs. 10.2 [9.9-13.2], P=0.024. Maternal weight gain during pregnancy (kg) correlated inversely with colostrum adiponectin concentration; β (SE)=-1.7 (0.1), P=0.020, and gestational diabetes mellitus was associated with the likelihood of adiponectin concentration falling into the lowest quartile; OR 2.36, 95% CI 1.1-3.2, P=0.028. CONCLUSIONS In showing that the colostrum adiponectin concentration is markedly dependent on maternal diet and nutritional status during pregnancy, and considering that colostrum adiponectin has potential effects on metabolism, nutrition, and immune function in the neonates, the results of this study underscore the importance of the metabolic homeostasis of the mother for the child's initial nutritional environment.
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Affiliation(s)
- Raakel Luoto
- Department of Paediatrics, Turku University Hospital, Turku, Finland.
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TGF-β2 induces maturation of immature human intestinal epithelial cells and inhibits inflammatory cytokine responses induced via the NF-κB pathway. J Pediatr Gastroenterol Nutr 2012; 54:630-8. [PMID: 22067113 PMCID: PMC3319014 DOI: 10.1097/mpg.0b013e31823e7c29] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Breast milk transforming growth factor (TGF)-β2 is associated with healthy immune maturation and reduced risk of immune-mediated disease in infants. We sought to investigate whether conditioning with TGF-β2 may result in a more mature immune responder phenotype in immature human intestinal epithelial cells (IECs). METHODS Primary human fetal IECs (hFIECs) and the human fetal small intestinal epithelial cell line (H4 cells) were conditioned with breast milk levels of TGF-β2, and an inflammatory response was subsequently induced. Inflammatory cytokine secretion and mRNA expression were measured by enzyme-linked immunosorbent assay and quantitative real-time polymerase chain reaction, respectively. Alterations in activation of inflammatory signaling pathways were detected from IECs by immunoblotting and immunofluorescence. The effects of TGF-β2 conditioning on gene expression patterns in hFIECs were assessed by cDNA microarray analysis and quantitative PCR. RESULTS Conditioning with TGF-β2 significantly attenuated subsequent interleukin (IL)-1β-, TNF-α-, and poly I:C-induced IL-8 and IL-6 responses in immature human IECs. Conditioning with TGF-β2 inhibited IL-1β-induced IκB-α degradation and NF-κB p65 nuclear translocation, which may partially result from TGF-β2-induced changes in the expression of genes in the NF-κB signaling pathway detected by cDNA microarray and qPCR. CONCLUSIONS Conditioning with TGF-β2 attenuates the subsequent inflammatory cytokine response in immature human IECs by inhibiting signaling in the NF-κB pathway. The immunomodulatory potential of breast milk may in part be mediated by TGF-β2, which may provide a novel means of supporting intestinal immune maturation in neonates.
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Abstract
PURPOSE To study the clinical spectrum and etiopathogenesis of keratomalacia in infants younger than 6 months. METHODS Case records of children younger than 6 months presenting with keratomalacia to cornea services of a tertiary care ophthalmic center in India from June 2007 through April 2010 were reviewed. The parameters evaluated were age, sex, anthropometry, nutritional status, socioeconomic status, antenatal history, maternal nutrition, systemic associations, immunization, and dietary history. Comprehensive ocular examination with emphasis on ocular adnexa, conjunctiva, cornea, and anterior chamber was performed. RESULTS Overall, 33 infants (24 male and 9 female) with mean age of 2.8 ± 1.3 months (range = 1-6 months) were included. Eighty-eight percent (29 of 33) had associated protein energy malnutrition. A total of 31 of 33 children (94%) belonged to poor families, and nearly, three fourth of the children were not fully immunized as recommended for their age. Inadequate breastfeeding was the precipitating cause in 100%. Maternal nutritional status was poor in 82% of the cases. The reason for not breastfeeding the infant was inadequate milk production in 89.4% of mothers, 64.7% were ill informed, and 1 mother had adopted a child. Feeding practices included diluted cow's milk (1:1-1:5) in 21 infants (63.6%), toned dairy milk in 9 infants (27.3%), infant lactogen in 2 infants (6.1%), and skimmed milk powder in 1 infant (3.0%). CONCLUSION Keratomalacia in early infancy can be attributed to inadequate breastfeeding. Important contributory risk factors include lower socioeconomic status, poor maternal nutrition, and lack of knowledge about recommended feeding guidelines.
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Sensibilisation et allergie aux protéines du lait de vache chez l’enfant allaité. Arch Pediatr 2012; 19:305-12. [DOI: 10.1016/j.arcped.2011.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 11/20/2011] [Accepted: 12/02/2011] [Indexed: 02/03/2023]
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Prescott S, Nowak-Węgrzyn A. Strategies to prevent or reduce allergic disease. ANNALS OF NUTRITION AND METABOLISM 2011; 59 Suppl 1:28-42. [PMID: 22189254 DOI: 10.1159/000334150] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The need for allergy prevention strategies has never been greater. Surging rates of food allergy and eczema are now adding to the already substantial burden of asthma and respiratory allergic diseases. The parallel rise in many other immune diseases suggests that the developing immune system is highly vulnerable to modern environmental changes. These strong environmental pressures may be one reason why simple allergen avoidance strategies have not been successful. Another more recent strategy to curtail the allergy epidemic has been to identify factors associated with modern lifestyle that may be causally linked with allergic disease, in an attempt to restore more favourable conditions for immune tolerance during early development. More hygienic conditions and disruption of microbial exposure have prompted strategies to restore this balance using probiotic and prebiotic supplements. Modern dietary changes linked with allergic diseases have prompted supplementation studies to assess the preventive merits of specific immunomodulatory dietary nutrients such as polyunsaturated fatty acids. Other nutrients such as antioxidants, folate, and vitamin D are also currently under investigation. Modern environmental pollutants have also been associated with adverse effects on immune development and the risk of disease. While many of these avenues have provided some promise, they have not yet translated into specific recommendations. Current evidence-based guidelines for allergy prevention remain limited to avoidance of cigarette smoke, promotion of breastfeeding and the use of hydrolysed formula when breastfeeding is not possible. Allergen avoidance strategies have been largely removed from most guidelines. It is hoped that a number of ongoing studies will help provide clearer recommendations around the use of probiotics, prebiotics, specific dietary nutrients and the role of early introduction of allergenic foods for the promotion of tolerance. Despite the current uncertainties, prevention remains the best long-term strategy to reduce the growing burden of allergic disease.
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Affiliation(s)
- Susan Prescott
- School of Paediatrics and Child Health Research, University of Western Australia, Perth, WA 6840, Australia.
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West CE, D'Vaz N, Prescott SL. Dietary immunomodulatory factors in the development of immune tolerance. Curr Allergy Asthma Rep 2011; 11:325-33. [PMID: 21538229 DOI: 10.1007/s11882-011-0200-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Emerging evidence suggests that exposures during pregnancy and the early postnatal period can modify gene expression and disease propensity. Diet is a major environmental exposure, and dietary factors, including polyunsaturated fatty acids, probiotics, oligosaccharides, antioxidants, folate, and other vitamins, have effects on immune function. Some also have been implicated in reduced risk of allergy in observational studies. Intervention trials with polyunsaturated fatty acids, probiotics, and oligosaccharides suggest preliminary but as-of-yet-unconfirmed benefits. Food allergen avoidance during pregnancy, lactation, or infancy has provided no consistent evidence in allergy prevention and is no longer recommended. Rather, there is now a focus on food allergens in tolerance induction. Specific nutrients can induce changes in gene expression during early development and have been implicated in potentially heritable "epigenetic" changes in disease predisposition. Collectively, these observations emphasize that early exposures may modify tolerance development and that further research on these exposures should remain a priority.
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Affiliation(s)
- Christina E West
- Department of Clinical Sciences, Pediatrics, Umeå University, SE-901 87, Umeå, Sweden.
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Sun Y, Vestergaard M, Christensen J, Olsen J. Breastfeeding and risk of epilepsy in childhood: a birth cohort study. J Pediatr 2011; 158:924-9. [PMID: 21232762 DOI: 10.1016/j.jpeds.2010.11.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 08/25/2010] [Accepted: 11/15/2010] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We asked whether breastfeeding reduces the risk of epilepsy in childhood. STUDY DESIGN We included 69 750 singletons born between September 1997 and June 2003 in the Danish National Birth Cohort and observed them to August 2008. Information on breastfeeding was reported by mothers in two computer-assisted telephone interviews at 6 and 18 months after birth. Information on epilepsy (inpatients and outpatients) was retrieved from the Danish National Hospital Register. Cox proportional hazards regression models were used to estimate incidence rate ratios and 95% CIs. RESULTS Breastfeeding was associated with a decreased risk of epilepsy, with a dose-response like pattern. For example, children breastfed for 3 to 5, 6 to 8, 9 to 12, and ≥ 13 months had a 26%, 39%, 50%, and 59% lower risk of epilepsy after the first year of life, respectively, compared with children who were breastfed for <1 month. The association remained when we excluded children who had adverse neonatal conditions or children who were exposed to adverse maternal conditions during pregnancy. CONCLUSIONS The observed protective effect of breastfeeding may be causal. Breastfeeding may decrease epilepsy in childhood, thereby adding another reason for breastfeeding.
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Affiliation(s)
- Yuelian Sun
- Department of Epidemiology, School of Public Health, University of Aarhus, Aarhus, Denmark.
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Radlovic NP, Mladenovic MM, Lekovic ZM, Stojsic ZM, Radlovic VN. Influence of early feeding practices on celiac disease in infants. Croat Med J 2011; 51:417-22. [PMID: 20960591 DOI: 10.3325/cmj.2010.51.417] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
AIM To investigate whether duration of breastfeeding and timing of gluten introduction influence the age at diagnosis and severity of celiac disease. METHODS Medical records of 89 infants (59 girls and 30 boys; mean age of 14.2 months, standard deviation 4.80) diagnosed with classic celiac disease at the University Children's Hospital in Belgrade from 2000 to 2008 were retrospectively analyzed to determine the duration of breastfeeding and timing of gluten introduction. The severity of celiac disease was assessed based on weight loss, longitudinal growth retardation, anemia, and secondary lactose intolerance. RESULTS Longer breastfeeding significantly reduced the risk that celiac disease would manifest in the first year of life (odds ratio, 0.655; 95% confidence interval, 0.481-0.891; P=0.007), and duration of breastfeeding was the most significant predictor of developing celiac disease (B=0.49; 95% confidence interval, 0.131-0.768; P=0.007). There were no significant differences in age at diagnosis between infants who had started consuming gluten before the fourth month and those who had started between the fourth and sixth month. Neither breastfeeding nor timing of gluten introduction affected the severity of the disease. CONCLUSION Longer breastfeeding and continuation of breastfeeding after gluten introduction delay the onset of classic celiac disease. On the other hand, neither breastfeeding nor the timing of gluten introduction affects the severity of celiac disease.
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Affiliation(s)
- Nedeljko P Radlovic
- Department of Gastroenterology and Nutrition, University Children’s Hospital, Belgrade, Serbia.
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Rautava S, Nanthakumar NN, Dubert-Ferrandon A, Lu L, Rautava J, Walker WA. Breast milk-transforming growth factor-β₂ specifically attenuates IL-1β-induced inflammatory responses in the immature human intestine via an SMAD6- and ERK-dependent mechanism. Neonatology 2011; 99:192-201. [PMID: 20881435 PMCID: PMC3214931 DOI: 10.1159/000314109] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 04/20/2010] [Indexed: 01/26/2023]
Abstract
BACKGROUND Breast milk is known to protect the infant against infectious and immuno-inflammatory diseases, but the mechanisms of this protection are poorly understood. OBJECTIVES We hypothesized that transforming growth factor-β₂ (TGF-β₂), an immunoregulatory cytokine abundant in breast milk, may have a direct anti-inflammatory effect on immature human intestinal epithelial cells (IECs). METHODS Human fetal ileal organ culture, primary human fetal IECs, and the human fetal small intestinal epithelial cell line H4 were stimulated with interleukin 1β (IL-1β) with or without TGF-β₂. Pro-inflammatory cytokine secretion and mRNA expression were measured by ELISA and quantitative real-time polymerase chain reaction, respectively. Alterations in ERK signalling were detected from IECs by immunoblotting and in fetal ileal tissue culture by immunohistochemistry. SMAD6 knockdown was performed by transfecting the cells with SMAD6 siRNA. RESULTS TGF-β₂ significantly attenuated IL-1β-induced pro-inflammatory cytokine production in fetal intestinal organ culture and the cell culture models. In addition, TGF-β₂ reduced the IL-1β-induced IL-8 and IL-6 mRNA response in H4 cells. TGF-β₂ markedly inhibited IL-1β-induced phosphorylation of ERK, which was necessary for the cytokine response. The inhibitory effect of TGF-β₂ on IL-1β-induced cytokine production was completely abrogated by SMAD6 siRNA knockdown. CONCLUSIONS TGF-β₂ attenuates IL-1β-induced pro-inflammatory cytokine production in immature human IECs by inhibiting ERK signalling. The anti-inflammatory effect of TGF-β₂ is dependent on SMAD6. Breast milk TGF-β₂ may provide the neonate with important immunoregulatory support. TGF-β₂ might provide a novel means to improve intestinal immunophysiology in premature neonates.
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Affiliation(s)
- Samuli Rautava
- Developmental Gastroenterology Laboratory, Division of Pediatric Gastroenterology, Massachusetts General Hospital for Children, Charlestown, Mass., USA.
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Abstract
PURPOSE OF REVIEW Diet is arguably one of the most significant environmental exposures during early development. Here, we explore the effects of key perinatal dietary exposures on immune development and susceptibility to allergic disease. RECENT FINDINGS Dietary changes are at the centre of the emerging epigenetic paradigms that underpin the rise in many modern diseases. There is growing evidence that exposures in pregnancy and the early postnatal period can modify gene expression and disease susceptibility. Specific nutrients, including antioxidants, oligosaccharides, polyunsaturated fatty acids, folate and other vitamins, have documented effects on immune function. Some have also been implicated in modified risk of allergic disease in observational studies. Intervention studies are largely limited to trials with polyunsaturated fatty acids and oligosaccharides, showing preliminary but yet unconfirmed benefits in allergy prevention. Avoidance of food allergens in pregnancy, lactation or infancy has provided no clear evidence in allergy prevention and is no longer recommended. Rather there is focus on their role in tolerance induction. SUMMARY Modern dietary changes are clearly implicated in the rising propensity for inflammatory immune responses. These dietary changes, which appear to be providing less tolerogenic conditions during early immune programming, may provide important avenues for preventing disease.
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Fujimura KE, Slusher NA, Cabana MD, Lynch SV. Role of the gut microbiota in defining human health. Expert Rev Anti Infect Ther 2010; 8:435-54. [PMID: 20377338 DOI: 10.1586/eri.10.14] [Citation(s) in RCA: 271] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The human superorganism is a conglomerate of mammalian and microbial cells, with the latter estimated to outnumber the former by ten to one and the microbial genetic repertoire (microbiome) to be approximately 100-times greater than that of the human host. Given the ability of the immune response to rapidly counter infectious agents, it is striking that such a large density of microbes can exist in a state of synergy within the human host. This is particularly true of the distal gastrointestinal (GI) tract, which houses up to 1000 distinct bacterial species and an estimated excess of 1 x 10(14) microorganisms. An ever-increasing body of evidence implicates the GI microbiota in defining states of health and disease. Here, we review the literature in adult and pediatric GI microbiome studies, the emerging links between microbial community structure, function, infection and disease, and the approaches to manipulate this crucial ecosystem to improve host health.
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Affiliation(s)
- Kei E Fujimura
- Colitis and Crohn's Disease Center, Gastroenterology Division, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
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Hunter S, Myers S, Radmacher P, Eno C. Detection of Polycyclic Aromatic Hydrocarbons (PAHs) in Human Breast Milk. Polycycl Aromat Compd 2010. [DOI: 10.1080/10406638.2010.483629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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