scFOS supplemented follow-on formula in healthy infants: Impact on vaccine specific faecal secretory IGA response, faecal bifidobacteria, growth and digestive tolerance

Effect of prebiotics on growth metrics in infants: A GRADE approach systematic review and meta-analysis of randomized clinical trials

Breastfeeding is often not feasible for all mothers, making infant formula a critical alternative for ensuring infant safety and nutrition. We hypothesized that the inclusion of prebiotics in infant formula significantly affects growth metrics in infants compared to standard formula. This study aims to fill a knowledge gap regarding the effects of prebiotics in infant formula on infant growth and development, particularly given the varying compositions and durations of prebiotic supplementation. A systematic review was conducted following PRISMA guidelines, analyzing 24 studies sourced from databases such as PubMed and Cochrane, with risk of bias assessed using RoB-2 for randomized controlled trials (RCTs). The findings revealed no significant differences in weight gain (WG), height gain (HG), or head circumference gain (HCG) between prebiotic-fed infants and control groups overall. However, infants receiving prebiotics for 3 or more months exhibited a significant decrease in WG compared to controls (SMD -0.479, P < .05). Notably, those fed formulas containing fructo-oligosaccharides/galacto-oligosaccharides and a combination of polydextrose/galacto-oligosaccharides/lactulose demonstrated improved WG (SMDs of 0.214 and 0.184, P < .05 respectively). Conversely, infants on formulas with inulin-enriched oligo-fructose (IOF) experienced reduced WG and HG. In conclusion, while prebiotics did not consistently enhance growth metrics, specific combinations showed potential benefits, emphasizing the need for tailored approaches in infant formula design to optimize growth without compromising health.

Effects of Infant Formula Supplemented With Prebiotics on the Gut Microbiome, Gut Environment, Growth Parameters, and Safety and Tolerance: A Systematic Review and Meta-Analysis

CONTEXT

Prebiotics are often added to infant formulas to mimic the benefits of oligosaccharides found in human milk.

OBJECTIVE

This systematic review and meta-analysis evaluated the effects of prebiotic-supplemented cow's milk-based formula on the gut microbiota, gut environment, growth parameters, and safety and tolerance in infants ≤6 months old, compared with a standard formula or human milk comparator.

DATA SOURCES

Searches were performed in the PubMed, Embase, Cochrane Central Register of Controlled Trials, and ProQuest Dissertations & Theses databases. Articles were included that reported on randomized controlled trials, were published from inception until April 2024, and met prespecified inclusion and exclusion criteria.

DATA EXTRACTION

Outcomes included gut microbiota (eg, diversity; taxa at phylum, family, genus and species levels), gut environment (eg, pH, secretory immunoglobulin A, fecal calprotectin, fecal metabolites), growth parameters (eg, z scores), and safety and tolerance. Fixed or random effects models were used and mean differences (MDs) with 95% CIs were calculated to assess pooled effects. Risk of bias was assessed using the Cochrane Collaboration Tool (RoB 2).

DATA ANALYSIS

A total of 30 articles met inclusion criteria, with 5290 infants included. Whereas effects on Lactobacillus were inconsistent, prebiotic formula supplementation increased Bifidobacterium counts (k = 7 [MD: 0.49; 95% CI, 0.27-0.71]; I2 = 13%; P < .00001) and decreased fecal pH (k = 7 [MD: -0.39; 95% CI, -0.57 to -0.20]; I2 = 0%; P < .0001) compared with standard formula. Prebiotic formula supplementation increased total bacteria compared with human milk (MD: 0.41 [95% CI, 0.17-0.65]; I2 = 8%; P = .0006). In terms of growth parameters, weight-for-age z scores favored the prebiotic formula group compared with the human milk group (k = 2 [MD: 0.23; 95% CI, 0.04-0.42]; I2 = 7%; P = .02).

CONCLUSIONS

Prebiotic supplementation in infant formula can positively alter the gut microbiota, particularly Bifidobacterium, without negative impacts on growth. Standardized, high-quality research is needed to confirm the study findings and inform guidelines for prebiotic use in infant nutrition.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42021253589.

Regular Consumption of Fortified Growing-up Milk Attenuates Upper Respiratory Tract Infection among Young Children in Indonesia: A Retrospective Cohort Study

Introduction

A Growing-up Milk (GUM) supplemented with short-chain Galacto-oligosaccharides (scGOS), long-chain Fructo-oligosaccharides (lcFOS), and omega-3 Long-chain Polyunsaturated Fatty Acids (n-3 LCPUFAs) could support the development of the immune system to prevent the Upper Respiratory Tract Infection (URTI) and associated morbidities. It is of interest to assess whether a daily consumption of scGOS/lcFOS/n-3 LCPUFAs-fortified GUM for a minimum of 6 months reduces URTI incidences within the subsequent 3 months among young children in Indonesia.

Methods

A total of 154 children aged 18 to 36 months were recruited in this retrospective cohort study and categorized into exposed and non-exposed groups (78 and 76 children, respectively). A guided interview was conducted with each subject’s parent. Demographic and clinical information was collected, including incidence of URTI within the past three months, duration of URTI, as well as the frequency of medical visits when contracting URTI. The bivariate analysis via chi-square test as well as the multivariate analysis via binary logistic regression were performed.

Results

The overall characteristics were similar between groups with certain distinctions. The bivariate analysis indicated the exposed group to have better protection against URTI within the past 3 months as compared to the non-exposed group (RR=0.62; 95% CI=0.41-0.92; P<0.05). The multivariate analysis reinforced the finding by reporting that the exposed group was indeed protected against URTI (adjusted RR=0.42; 95% CI=0.21-0.85; P<0.05).

Conclusion

A routine consumption of scGOS/lcFOS/n-3 LCPUFAs-fortified GUM for a minimum of 6 months among Indonesian young children protected against URTI up to 58%, suggesting that fortified GUM consumption supports proper development of the immune system.

Term Infant Formulas Influencing Gut Microbiota: An Overview

Intestinal colonization of the neonate is highly dependent on the term of pregnancy, the mode of delivery, the type of feeding [breast feeding or formula feeding]. Postnatal immune maturation is dependent on the intestinal microbiome implementation and composition and type of feeding is a key issue in the human gut development, the diversity of microbiome, and the intestinal function. It is well established that exclusive breastfeeding for 6 months or more has several benefits with respect to formula feeding. The composition of the new generation of infant formulas aims in mimicking HM by reproducing its beneficial effects on intestinal microbiome and on the gut associated immune system (GAIS). Several approaches have been developed currently for designing new infant formulas by the addition of bioactive ingredients such as human milk oligosaccharides (HMOs), probiotics, prebiotics [fructo-oligosaccharides (FOSs) and galacto-oligosaccharides (GOSs)], or by obtaining the so-called post-biotics also known as milk fermentation products. The aim of this article is to guide the practitioner in the understanding of these different types of Microbiota Influencing Formulas by listing and summarizing the main concepts and characteristics of these different models of enriched IFs with bioactive ingredients.

A prebiotic-enhanced lipid-based nutrient supplement (LNSp) increases Bifidobacterium relative abundance and enhances short-chain fatty acid production in simulated colonic microbiota from undernourished infants

Undernutrition remains a public health problem in the developing world with an attributable under-five death proportion of 45%. Lower gut microbiota diversity and poor metabolic output are associated with undernutrition and new therapeutic paths may come from steering gut microbiota composition and functionality. Using a dynamic gut model, the Simulator of Human Intestinal Microbial Ecosystem (SHIME®), we investigated the effect of a lipid-based nutrient supplement enriched with prebiotics (LNSp), compared to LNS alone and control treatment, on the composition and metabolic functionality of fecal microbiota from three infants suffering from undernutrition. LNS elicited a significant increase in acetate and branched-chain fatty acid production, and a higher relative abundance of the genera Prevotella, Megasphaera, Acinetobacter, Acidaminococcus and Pseudomonas. In contrast, LNSp treatment resulted in a significant 9-fold increase in Bifidobacterium relative abundance and a decrease in that of potential pathogens and detrimental bacteria such as Enterobacteriaceae spp. and Bilophila sp. Moreover, the LNSp treatment resulted in a significantly higher production of acetate, butyrate and propionate, as compared to control and LNS. Our results suggest that provision of prebiotic-enhanced LNS to undernourished children could be a possible strategy to steer the microbiota toward a more beneficial composition and metabolic activity. Further in vivo investigations are needed to assess these effects and their repercussion on nutritional status.

Prebiotics for the prevention of allergies: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Prevalence of allergic diseases in infants is approximately 10% reaching 20 to 30% in those with an allergic first-degree relative. Prebiotics are selectively fermented food ingredients that allow specific changes in composition/activity of the gastrointestinal microflora. They modulate immune responses, and their supplementation has been proposed as an intervention to prevent allergies.

OBJECTIVE

To assess in pregnant women, breastfeeding mothers, and infants (populations) the effect of supplementing prebiotics (intervention) versus no prebiotics (comparison) on the development of allergic diseases and to inform the World Allergy Organization guidelines.

METHODS

We performed a systematic review of studies assessing the effects of prebiotic supplementation with an intention to prevent the development of allergies.

RESULTS

Of 446 unique records published until November 2016 in Cochrane, MEDLINE, and EMBASE, 22 studies fulfilled a priori specified criteria. We did not find any studies of prebiotics given to pregnant women or breastfeeding mothers. Prebiotic supplementation in infants, compared to placebo, had the following effects: risk of developing eczema (RR: 0.68, 95% CI: 0.40 to 1.15), wheezing/asthma (RR, 0.37; 95% CI: 0.17 to 0.80), and food allergy (RR: 0.28, 95% CI: 0.08 to 1.00). There was no evidence of an increased risk of any adverse effects (RR: 1.01, 95% CI: 0.92 to 1.10). Prebiotic supplementation had little influence growth rate (MD: 0.92 g per day faster with prebiotics, 95% CI: 0 to 1.84) and the final infant weight (MD: 0.10 kg higher with prebiotics, 95% CI: -0.09 to 0.29). The certainty of these estimates is very low due to risk of bias and imprecision of the results.

CONCLUSIONS

Currently available evidence on prebiotic supplementation to reduce the risk of developing allergies is very uncertain.

Infant formulae supplemented with prebiotics: Are they better than unsupplemented formulae? An updated systematic review

In 2011, the Committee on Nutrition of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition systematically reviewed published evidence related to the safety and health effects of the administration of formulae supplemented with pro- and/or prebiotics compared with unsupplemented formulae. We updated evidence on the effects of the administration of prebiotic-supplemented infant formulae (IF) compared with unsupplemented IF. Five databases were searched up to March 2017 for randomised controlled trials. In all, forty-one publications were identified, including twenty-five new publications. The administration of currently evaluated prebiotic-supplemented formulae to healthy infants does not raise safety concerns with regard to growth and adverse effects. Some favourable clinical effects are possible, primarily stool softening, which may be beneficial in some infants. Currently, there is no existing robust evidence to recommend the routine use of prebiotic-supplemented formulae. The latter conclusion may reflect the small amount of data on specific prebiotics and outcomes, rather than a genuine lack of an effect. The efficacy and safety should be considered for each prebiotic(s)-supplemented formula.