1
|
Liu S, Mao Y, Wang J, Tian F, Hill DR, Xiong X, Li X, Zhao Y, Wang S. Lactational and geographical variation in the concentration of six oligosaccharides in Chinese breast milk: a multicenter study over 13 months postpartum. Front Nutr 2023; 10:1267287. [PMID: 37731395 PMCID: PMC10508235 DOI: 10.3389/fnut.2023.1267287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/23/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction Understanding the variations of oligosaccharide in breast milk contribute to better study how human milk oligosaccharides (HMOs) play a role in health-promoting benefits in infants. Methods Six abundant HMOs, 2'-fucosyllactose (2'-FL), 3-fucosyllactose (3-FL), Lacto-N-tetraose (LNT), Lacto-N-neotetraose (LNnT), 3'-sialyllactose (3'-SL) and 6'-sialyllactose (6'-SL), in breast milk collected at 0-5 days, 10-15 days, 40-45 days, 200-240 days, and 300-400 days postpartum from six locations across China were analyzed using high-performance anion-exchange chromatography-pulsed amperometric detector. Results The concentration of individual HMO fluctuated dynamically during lactational stages. The median ranges of 2'-FL, 3-FL, LNT, LNnT, 3'-SL, and 6'-SL across the five lactational stages were 935-2865 mg/L, 206-1325 mg/L, 300-1473 mg/L, 32-317 mg/L, 106-228 mg/L, and 20-616 mg/L, respectively. The prominent variation was observed in the content of 6'-SL, which demonstrates a pattern of initial increase followed by a subsequent decrease. Among the five lactational stages, the transitional milk has the highest concentration, which was 31 times greater than the concentration in mature milk at 300-400 days postpartum, where the content is the lowest. Geographical location also influenced the content of HMOs. LNT and LNnT were the highest in mature milk of mothers from Lanzhou among the six sites at 40-240 days postpartum. Breast milks were categorized into two groups base on the abundance of 2'-FL (high and low). There was no significant difference in the proportions of high and low 2'-FL phenotypes among the six sites, and the percentages of high and low 2'-FL phenotypes were 79% and 21%, respectively, across all sites in China. Discussion This study provided a comprehensive dataset on 6 HMOs concentrations in Chinese breast milk during the extended postpartum period across a wide geographic range and stratified by high and low 2'-FL phenotypes.
Collapse
Affiliation(s)
- Shuang Liu
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin, China
| | - Yingyi Mao
- Abbott Nutrition Research & Development Center, Shanghai, China
| | - Jin Wang
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin, China
| | - Fang Tian
- Abbott Nutrition Research & Development Center, Shanghai, China
| | - David R. Hill
- Abbott Nutrition Research & Development Center, Columbus, OH, United States
| | - Xiaoying Xiong
- Abbott Nutrition Research & Development Center, Shanghai, China
| | - Xiang Li
- Abbott Nutrition Research & Development Center, Shanghai, China
| | - Yanrong Zhao
- Abbott Nutrition Research & Development Center, Shanghai, China
| | - Shuo Wang
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin, China
| |
Collapse
|
2
|
Schönknecht YB, Moreno Tovar MV, Jensen SR, Parschat K. Clinical Studies on the Supplementation of Manufactured Human Milk Oligosaccharides: A Systematic Review. Nutrients 2023; 15:3622. [PMID: 37630811 PMCID: PMC10458772 DOI: 10.3390/nu15163622] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Human milk oligosaccharides (HMOs) are a major component of human milk. They are associated with multiple health benefits and are manufactured on a large scale for their addition to different food products. In this systematic review, we evaluate the health outcomes of published clinical trials involving the supplementation of manufactured HMOs. We screened the PubMed database and Cochrane Library, identifying 26 relevant clinical trials and five publications describing follow-up studies. The clinical trials varied in study populations, including healthy term infants, infants with medical indications, children, and adults. They tested eight different HMO structures individually or as blends in varying doses. All trials included safety and tolerance assessments, and some also assessed growth, stool characteristics, infections, gut microbiome composition, microbial metabolites, and biomarkers. The studies consistently found that HMO supplementation was safe and well tolerated. Infant studies reported a shift in outcomes towards those observed in breastfed infants, including stool characteristics, gut microbiome composition, and intestinal immune markers. Beneficial gut health and immune system effects have also been observed in other populations following HMO supplementation. Further clinical trials are needed to substantiate the effects of HMO supplementation on human health and to understand their structure and dose dependency.
Collapse
|
3
|
Bosheva M, Tokodi I, Krasnow A, Pedersen HK, Lukjancenko O, Eklund AC, Grathwohl D, Sprenger N, Berger B, Cercamondi CI. Infant Formula With a Specific Blend of Five Human Milk Oligosaccharides Drives the Gut Microbiota Development and Improves Gut Maturation Markers: A Randomized Controlled Trial. Front Nutr 2022; 9:920362. [PMID: 35873420 PMCID: PMC9298649 DOI: 10.3389/fnut.2022.920362] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Human milk oligosaccharides (HMOs) have important biological functions for a healthy development in early life. Objective This study aimed to investigate gut maturation effects of an infant formula containing five HMOs (2′-fucosyllactose, 2′,3-di-fucosyllactose, lacto-N-tetraose, 3′-sialyllactose, and 6′-sialyllactose). Methods In a multicenter study, healthy infants (7–21 days old) were randomly assigned to a standard cow’s milk-based infant formula (control group, CG); the same formula with 1.5 g/L HMOs (test group 1, TG1); or with 2.5 g/L HMOs (test group 2, TG2). A human milk-fed group (HMG) was enrolled as a reference. Fecal samples collected at baseline (n∼150/formula group; HMG n = 60), age 3 (n∼140/formula group; HMG n = 65) and 6 (n∼115/formula group; HMG n = 60) months were analyzed for microbiome (shotgun metagenomics), metabolism, and biomarkers. Results At both post-baseline visits, weighted UniFrac analysis indicated different microbiota compositions in the two test groups (TGs) compared to CG (P < 0.01) with coordinates closer to that of HMG. The relative abundance of Bifidobacterium longum subsp. infantis (B. infantis) was higher in TGs vs. CG (P < 0.05; except at 6 months: TG2 vs. CG P = 0.083). Bifidobacterium abundance was higher by ∼45% in TGs vs. CG at 6-month approaching HMG. At both post-baseline visits, toxigenic Clostridioides difficile abundance was 75–85% lower in TGs vs. CG (P < 0.05) and comparable with HMG. Fecal pH was significantly lower in TGs vs. CG, and the overall organic acid profile was different in TGs vs. CG, approaching HMG. At 3 months, TGs (vs. CG) had higher secretory immunoglobulin A (sIgA) and lower alpha-1-antitrypsin (P < 0.05). At 6 months, sIgA in TG2 vs. CG remained higher (P < 0.05), and calprotectin was lower in TG1 (P < 0.05) vs. CG. Conclusion Infant formula with a specific blend of five HMOs supports the development of the intestinal immune system and gut barrier function and shifts the gut microbiome closer to that of breastfed infants with higher bifidobacteria, particularly B. infantis, and lower toxigenic Clostridioides difficile. Clinical Trial Registration [https://clinicaltrials.gov/ct2/show/], identifier [NCT03722550].
Collapse
Affiliation(s)
- Miroslava Bosheva
- University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria
| | - Istvan Tokodi
- Infant and Children’s Department, St. George’s Hospital, Székesfehérvár, Hungary
| | | | | | | | | | | | - Norbert Sprenger
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Bernard Berger
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
- *Correspondence: Bernard Berger,
| | - Colin I. Cercamondi
- Nestlé Product Technology Center – Nutrition, Société des Produits Nestlé S.A., Vevey, Switzerland
| | - 5 HMO Study Investigator ConsortiumBauerViktorArciszewskaMalgorzataTarnevaMariaPopovaIrinaDosevSvilenDimitrovaSirmaNikolovaOlgaNowakMarzenaSzuflinska-SidorowiczMagdalenaKorczowskiBartoszKarcheva-BeloevaRositsaBanovStefanCimoszkoBoguslawaOlechowskiWieslawSimkoRobertTengelyiZsuzsannaKorbalPiotrZolnowskaMartaBilevAntonVasilopoulosGeorgiosKorzynskaSylwiaLakiIstvánKoleva-SyarovaMargaritaGrigorovToniKraevaSteliyanaKovácsÉvaMarkovaRadaJasieniak-PinisGrazynaFisterKatalinStoevaTatyanaDr. Kenessey Albert Hospital and Clinic, Balassagyarmat, Hungary; Polyclinic of Gynecology and Obstetrics Arciszewscy, Bialystok, Poland; University Multiprofile Hospital for Active Treatment Deva Mariya—Neonatology, Burgas, Bulgaria; Medical Center Prolet—Pediatrics department, Ruse, Bulgaria; Medical Center Excelsior, Sofia, Bulgaria; Multiprofile Hospital for Active Treatment Sveti Ivan Rilski, Kozloduy, Bulgaria; Medical Center PROMED, Krakow, Poland; Medical Center Pratia Warszawa, Warszawa, Poland; College of Medical Sciences, University of Rzeszów, Rzeszów, Poland; Medical Center-1, Sevlievo, Bulgaria; Individual Practice for Specialized Medical Assistance, Stara Zagora, Bulgaria; Primary Health Care Clinic Clinical Vitae, Gdansk, Poland; ALERGO-MED Specialist Medical Clinic, Tarnow, Poland; Futurenest Clinical Research, Miskolc, Hungary; Medical Center Clinexpert, Budapest, Hungary; Dr. Jan Biziel’s University Hospital No. 2, Bydgoszcz, Poland; Plejady Medical Center, Krakow, Poland; Medical Center Sveti Ivan Rilski Chudotvorets, Blagoevgrad, Bulgaria; Center of Innovative Therapies, Piaseczno, Poland; Medical Center Pratia Ostroleka, Ostroleka, Poland; Kanizsai Dorottya Hospital, Nagykanizsa, Hungary; Diagnostic Consultative Center Ritam, Stara Zagora, Bulgaria; Multiprofile Hospital for Active Treatment Sveti Georgi, Montana, Bulgaria; Alitera Medical Centre, Sofia, Bulgaria; Family Pediatric Surgery/Babadoki Ltd., Szeged, Hungary; Policlinic Bulgaria—Department of pediatrics; Sofia, Bulgaria; Non-public Health Care Institution Specialist Clinics ATOPIA, Krakow, Poland; Bugát Pál Hospital—Department of Pediatrics, Gyöngyös, Hungary; Medical Center—Izgrev Ltd., Sofia, Bulgaria.
| |
Collapse
|
4
|
Alliet P, Vandenplas Y, Roggero P, Jespers SNJ, Peeters S, Stalens JP, Kortman GAM, Amico M, Berger B, Sprenger N, Cercamondi CI, Corsello G. Safety and efficacy of a probiotic-containing infant formula supplemented with 2'-fucosyllactose: a double-blind randomized controlled trial. Nutr J 2022; 21:11. [PMID: 35193609 PMCID: PMC8862345 DOI: 10.1186/s12937-022-00764-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human milk oligosaccharides (HMOs) have important and diverse biological functions in early life. This study tested the safety and efficacy of a starter infant formula containing Limosilactobacillus (L.) reuteri DSM 17938 and supplemented with 2'-fucosyllactose (2'FL). METHODS Healthy infants < 14 days old (n = 289) were randomly assigned to a bovine milk-based formula containing L. reuteri DSM 17938 at 1 × 107 CFU/g (control group; CG) or the same formula with added 1.0 g/L 2'FL (experimental group; EG) until 6 months of age. A non-randomized breastfed group served as reference (BF; n = 60). The primary endpoint was weight gain through 4 months of age in the formula-fed infants. Secondary endpoints included additional anthropometric measures, gastrointestinal tolerance, stooling characteristics, adverse events (AEs), fecal microbiota and metabolism, and gut immunity and health biomarkers in all feeding groups. RESULTS Weight gain in EG was non-inferior to CG as shown by a mean difference [95% CI] of 0.26 [-1.26, 1.79] g/day with the lower bound of the 95% CI above the non-inferiority margin (-3 g/day). Anthropometric Z-scores, parent-reported stooling characteristics, gastrointestinal symptoms and associated behaviors, and AEs were comparable between formula groups. Redundancy analysis indicated that the microbiota composition in EG was different from CG at age 2 (p = 0.050) and 3 months (p = 0.052), approaching BF. Similarly, between sample phylogenetic distance (weighted UniFrac) for BF vs EG was smaller than for BF vs CG at 3-month age (p = 0.045). At age 1 month, Clostridioides difficile counts were significantly lower in EG than CG. Bifidobacterium relative abundance in EG tracked towards that in BF. Fecal biomarkers and metabolic profile were comparable between CG and EG. CONCLUSION L. reuteri-containing infant formula with 2'FL supports age-appropriate growth, is well-tolerated and may play a role in shifting the gut microbial pattern towards that of breastfed infants. TRIAL REGISTRATION The trial was registered on ClinicalTrials.gov ( NCT03090360 ) on 24/03/2017.
Collapse
Affiliation(s)
| | - Yvan Vandenplas
- KidZ Health Castle, Vrije Universiteit Brussel, UZ Brussel, Brussels, Belgium
| | - Paola Roggero
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | | | | | - Mailis Amico
- Biostatistics & Data, Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Bernard Berger
- Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Norbert Sprenger
- Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Colin I Cercamondi
- Nestlé Product Technology Center - Nutrition, Société des Produits Nestlé S.A., Vevey, Switzerland.
| | - Giovanni Corsello
- Department of Health Promotion Sciences Maternal and Infant Care, University of Palermo, Palermo, Italy
| |
Collapse
|
5
|
Sekerel BE, Bingol G, Cullu Cokugras F, Cokugras H, Kansu A, Ozen H, Tamay Z. An Expert Panel Statement on the Beneficial Effects of Human Milk Oligosaccharides (HMOs) in Early Life and Potential Utility of HMO-Supplemented Infant Formula in Cow's Milk Protein Allergy. J Asthma Allergy 2021; 14:1147-1164. [PMID: 34594114 PMCID: PMC8478436 DOI: 10.2147/jaa.s323734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/23/2021] [Indexed: 12/12/2022] Open
Abstract
This review by pediatric gastroenterology and allergy-immunology experts aimed to address the biological roles of human milk oligosaccharides (HMOs) and the potential utility of HMOs in prevention of allergy with particular emphasis on cow’s milk protein allergy (CMPA). The participating experts consider HMOs amongst the most critical bioactive components of human milk, which act as antimicrobials and antivirals by preventing pathogen adhesion to epithelial cells, as intestinal epithelial cell modulators by enhancing maturation of intestinal mucosa and intestinal epithelial barrier function, as prebiotics by promoting healthy microbiota composition and as immunomodulators by modulating immune cells indirectly and directly. Accordingly, the participating experts consider the proposed link between HMOs and prevention of allergy to be primarily based on the impact of HMO on gut microbiota, intestinal mucosal barrier, immunomodulation and immune maturation. Along with the lower risk of respiratory and gastrointestinal infections, HMO-supplemented formulas seem to be promising alternatives in the management of CMPA. Nonetheless, the effects of individual as well as complex mixtures of HMO in terms of clear clinical and immunological effects and tolerance development need to be further explored to fully realize the immunomodulatory mechanisms and the potential for HMOs in prevention of allergic diseases and CMPA.
Collapse
Affiliation(s)
- Bulent Enis Sekerel
- Division of Pediatric Allergy, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gulbin Bingol
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Fugen Cullu Cokugras
- Division of Pediatric Gastroenterology, Department of Pediatrics, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Haluk Cokugras
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Aydan Kansu
- Division of Pediatric Gastroenterology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Hasan Ozen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Tamay
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|
6
|
Parschat K, Melsaether C, Jäpelt KR, Jennewein S. Clinical Evaluation of 16-Week Supplementation with 5HMO-Mix in Healthy-Term Human Infants to Determine Tolerability, Safety, and Effect on Growth. Nutrients 2021; 13:nu13082871. [PMID: 34445031 PMCID: PMC8401119 DOI: 10.3390/nu13082871] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 12/23/2022] Open
Abstract
Human milk oligosaccharides (HMOs) are complex sugars that occur naturally in human breast milk and provide many beneficial functions. Most formula products lack HMOs or contain only the most abundant HMO, 2′-fucosyllactose; however, benefits of HMOs come from multiple sugars. We therefore developed a mixture of five HMOs (5HMO-Mix) mimicking the natural concentrations of the top five HMOs (5.75 g/L total, comprising 52% 2′-fucosyllactose, 13% 3-fucosyllactose, 26% lacto-N-tetraose, 4% 3′-sialyllactose, and 5% 6′-sialyllactose) representing the groups of neutral, neutral-fucosylated, and sialylated HMOs. We conducted the first multicenter, randomized, controlled, parallel-group clinical study assessing the safety, tolerability, and effect on growth of formula containing the 5HMO-Mix in healthy infants. We enrolled 341 subjects aged ≤14 days; 225 were randomized into groups fed either with infant formula containing 5HMO-Mix (5HMO-Mix) or infant formula without HMOs (IF) for 4 months, with the others exclusively breastfed. There were no differences in weight, length, or head circumference gain between the two formula groups. The 5HMO-Mix was well tolerated, with 5HMO-Mix and breastfed infants producing softer stools at a higher stool frequency than the control formula group. Adverse events were equivalent in all groups. We conclude that the 5HMO-Mix at 5.75 g/L in infant formula is safe and well tolerated by healthy term infants during the first months of life.
Collapse
Affiliation(s)
- Katja Parschat
- Chr. Hansen HMO GmbH, 53619 Rheinbreitbach, Germany
- Correspondence: ; Tel.: +49-2224-98810400
| | | | | | - Stefan Jennewein
- Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), 52074 Aachen, Germany;
| |
Collapse
|