Impact of pasteurization of human milk on preterm newborn in vitro digestion: Gastrointestinal disintegration, lipolysis and proteolysis

Protein and Free Amino Acid Composition of Preterm Human Milk: A Systematic Review and Meta-Analysis

The composition of total protein and free amino acids (FAA) in preterm human milk (HM) is crucial for optimizing infant growth and development. The objective of this systematic review and meta-analysis is to quantify the amount of true, crude, and unspecified protein and FAA in preterm HM. Ebsco, PubMed, and Scopus databases were searched up to July 2023 measuring total protein and FAA in preterm HM. Two reviewers, working independently, screened all titles and abstracts using Covidence software to identify studies meeting inclusion criteria [preterm <37 weeks; Human Development Index >0.8; cross-sectional, case-controlled (n>1), prospective cohort, and randomized clinical trials; English language]. Random effects models were used to estimate mean protein and FAA content across studies. Data were aggregated for studies reporting multiple estimates (e.g., across time). Heterogeneity was estimated using I2 and publication bias using Kendall tau rank correlation coefficient. Of the 884 articles identified, a total of 66 original studies were included for the meta-analysis comprising an estimated 30,421 preterm HM samples. Preterm colostrum (<4 d) contained the highest mean [95% CI] true protein at 2. 32 [1. 96, 2. 68] g/100 mL, followed by transition preterm HM (5-14 d) mean true protein of 1. 77 [1. 60, 1.93] g/100 mL. Mature (>14 d) preterm HM had the lowest mean true protein content at 1.46 [1.34, 1.59] g/100 mL. Glutamate was the most prevalent FAA reported. This systematic review provides updated estimates of protein and FAA concentrations in preterm HM. We found significant variability in the quality of studies, completeness of the reported results, and analytical methodologies across studies. REGISTRY NUMBER IN PROSPERO: CRD42023445191 STATEMENT OF SIGNIFICANCE: The current manuscript advances the field of human milk nutrition by providing up-to-date estimates of protein and/or free amino acids in colostrum, transition, and mature preterm HM. These values fulfill a critical need for practitioners and researchers to more accurately understand the nutritional needs of preterm infants, as well as any supplementary nutrition that may be necessary for appropriate growth and development.

Comparative Study of Human Milk and Infant Formulas at Different Stages Based on Dynamic In Vitro Infant Gastrointestinal Digestion: The Effect of Polar Lipids on Lutein Digestion

The efficiency of the absorption and digestion of lutein in infant formulas (IFs) is remarkably lower than that in human milk. This work compared the simulated in vitro dynamic digestive characteristics of lutein in three stages of human milk and six IFs, with a special emphasis on how polar lipids affect lutein digestion. Compared with colostrum (CM), IF2 had a significantly higher lutein loss rate but significantly lower micellarization and bioaccessibility rates. In CM, the morphology of milk fat globules (MFGs) remained visible after digestion; the phospholipid globular membrane structure can be observed after 180 min of intestinal digestion, and MFGs remained in a spherical form in micelles. Lipidomic analysis precisely quantified 18 significantly different lipids, including cholesterol, phosphatidylcholine, phosphatidylserine, phosphatidylinositol, phosphatidic acid, and phosphatidylglycerol, between CM and IF2 micelles, suggesting that these lipids may influence the micellarization of lutein. In summary, polar lipids play an important role in the protection of lutein and the facilitation of lutein micellarization. These findings also provide a certain reference for the adjustment of IF formulations.

Comparative proteomic analysis of donor human milk treated by high-pressure processing or Holder pasteurization on undigested proteins across dynamic simulated preterm infant digestion

High-pressure processing (HPP) of donor human milk (DM) minimally impacts the concentration and bioactivity of some important bioactive proteins including lactoferrin, and bile salt-stimulated lipase (BSSL) compared to Holder pasteurization (HoP), yet the impact of HPP and subsequent digestion on the full array of proteins detectable by proteomics remains unclear. We investigated how HPP impacts undigested proteins in DM post-processing and across digestion by proteomic analysis. Each pool of milk (n = 3) remained raw, or was treated by HPP (500 MPa, 10 min) or HoP (62.5 °C, 30 min), and underwent dynamic in vitro digestion simulating the preterm infant. In the meal, major proteins were minimally changed post-processing. HPP-treated milk proteins better resisted proximal digestion (except for immunoglobulins, jejunum 180 min) and the extent of undigested proteins after gastric digestion of major proteins in HPP-treated milk was more similar to raw (e.g., BSSL, lactoferrin, macrophage-receptor-1, CD14, complement-c3/c4, xanthine dehydrogenase) than HoP.

Peptidomic profile of human milk as influenced by fortification with different protein sources: An in vitro dynamic digestion simulation

Fortification of human milk (HM) is often necessary to meet the nutritional requirements of preterm infants. The present experiment aimed to establish whether the supplementation of HM with either an experimental donkey milk-derived fortifier containing whole donkey milk proteins, or with a commercial bovine milk-derived fortifier containing hydrolyzed bovine whey proteins, affects peptide release differently during digestion. The experiment was conducted using an in vitro dynamic system designed to simulate the preterm infant's digestion followed by digesta analysis by means of LC-MS-MS. The different fortifiers did not appear to influence the cumulative intensity of HM peptides. Fortification had a differential impact on the release of either donkey or bovine bioactive peptides. Donkey milk peptides showed antioxidant/ACE inhibitory activities, while bovine peptides showed opioid, dipeptil- and propyl endo- peptidase inhibitory and antimicrobial activity. A slight delay in peptide release from human lactoferrin and α-lactalbumin was observed when HM was supplemented with donkey milk-derived fortifier.

A Comparative In Vitro Digestion Study of Three Lipid Delivery Systems for Arachidonic and Docosahexaenoic Acids Intended to Be Used for Preterm Infants

It is well stablished that docosahexaenoic (DHA) and arachidonic (ARA) acids fulfill relevant biological activities, especially in newborns. However, oils containing these fatty acids are not always optimally digestible. To address this, various formulation strategies and lipid delivery systems have been developed. This study compares the following three formulations in an in vitro digestion model to assess bioaccessibility: Enfamil® DHA & ARA (Mead Johnson & Company), an emulsion of FormulaidTM, AquaCelle®, and pasteurized donated human milk, and a previously characterized enzymatic glycerolysis product (GP) of ARA oil and microalgae oil in a 2:1 (w:w) ratio. To evaluate digestibility, parameters such as the percentage of oily phase (OP), micellar phase (MP), free fatty acids, and monoacylglycerols in the digestion product (DP) were considered. Additionally, diacylglycerol content in the MP can be used as an indirect marker of the emulsification capacity of the DP, and consequently, as an indicator of bioaccessibility. The GP demonstrated the highest bioaccessibility, with a DP containing more than 80% MP (<14% OP), rich in free fatty acids (60%) and monoacylglycerols (17%). Furthermore, more than 40% of total diacylglycerols were present in MP, highlighting GPs' potential as a superior delivery system for DHA and ARA in preterm infant formulations.

Preparation of milk fat globule membrane ingredients enriched in polar lipids: Composition characterization and digestive properties

In this study, milk fat globule membrane (MFGM) ingredients enriched in polar lipids were prepared using membrane filtration, including microfiltration, diafiltration, and ultrafiltration from butter serum powder. Polar lipids (phospholipids, sterols, and gangliosides) in prepared MFGM ingredients were analyzed by 31P nuclear magnetic resonance spectroscopy, GC-MS, and ultra-performance liquid chromatography (UPLC)-MS/MS, respectively. The lipolysis degree and microstructure of MFGM ingredient and soybean lecithin (SL) emulsions during in vitro digestion were also analyzed. Microfiltration showed higher concentration efficiency than ultrafiltration, which increased by 2.16% and 2.73% in phospholipids, respectively. Moreover, diafiltration concentrated more polar lipids (6.39% of phospholipids) than microfiltration. Milk fat globule membrane ingredients had high levels of sphingomyelin (1.27%-1.36%) and ratio of GD3 to GM3 is 9.25- to 9.88-fold. The different lipolysis behaviors between MFGM ingredient emulsions and SL emulsions were correlated with their different polar lipid compositions. Phospholipids from both MFGM ingredients and SL could help maintain the initial structure during the gastric digestion. These results could provide a scientific basis for developing high-polar-lipids food, particularly infant formulas and special functional foods.

Reduction of Beany Flavor and Improvement of Nutritional Quality in Fermented Pea Milk: Based on Novel Bifidobacterium animalis subsp. lactis 80

Peas (Pisum sativum L.) serve as a significant source of plant-based protein, garnering consumer attention due to their high nutritional value and non-GMO modified nature; however, the beany flavor limits its applicability. In this study, the effects of Bifidobacterium animalis subsp. Lactis 80 (Bla80) fermentation on the physicochemical characteristics, particle size distribution, rheological properties, and volatile flavor compounds of pea milk was investigated. After fermentation by Bla80, the pH of pea milk decreased from 6.64 ± 0.01 to 5.14 ± 0.01, and the (D4,3) distribution decreased from 142.4 ± 0.47 μm to 122.7 ± 0.55 μm. In addition, Lactic acid bacteria (LAB) fermentation significantly reduced the particle size distribution of pea milk, which was conducive to improving the taste of pea milk and also indicated that Bla80 had the probiotic potential of utilizing pea milk as a fermentation substrate. According to GC-MS analysis, 64 volatile compounds were identified in fermented pea milk and included aldehydes, alcohols, esters, ketones, acids, and furans. Specifically, aldehydes in treated samples decreased by 27.36% compared to untreated samples, while esters, ketones, and alcohols increased by 11.07%, 10.96%, and 5.19%, respectively. These results demonstrated that Bla80 fermentation can significantly decrease the unpleasant beany flavor, such as aldehydes and furans, and increase fruity or floral aromas in treated pea milk. Therefore, Bla80 fermentation provides a new method to improve physicochemical properties and consumer acceptance of fermented pea milk, eliminating undesirable aromas for the application of pea lactic acid bacteria beverage.

The triacylglycerol structures are key factors influencing lipid digestion in preterm formulas during in vitro digestion

Preterm formulas are usually supplemented with medium-chain triacylglycerols (MCT) whereas breast milk contains more medium and long-chain triacylglycerols (MLCT). Different types of triacylglycerol (TAG) containing medium-chain fatty acids may influence lipid digestion. In this study, the digestive characteristics of breast milk and preterm formulas with different MCT contents were evaluated using a dynamic in vitro system simulating the gastrointestinal tract of preterm infants. The lipolysis products, including diacylglycerols, monoacylglycerols (MAGs), free fatty acids, and undigested TAGs, were analyzed. Formulas with MCT addition has significantly (P < 0.05) lower lipolysis degree (LD, 69.35%-71.28%) than breast milk (76.93%). Higher amounts of C8:0 and C10:0 were released in the formulas with MCT addition. Breast milk released more C18:1n-9, C18:2n-6, and MAG containing C16:0, whereas formulas released more free C16:0. The Pearson correlation heatmap showed that the LD value was significantly and positively (P < 0.05) related to the MLCT and sn-2 C16:0 content.

Characterization of protein aggregates in cream and skimmed human milk after heat and high-pressure pasteurization treatments

Preservation processes applied to ensure microbial safety of human milk (HM) can modify the native structure of proteins and their bioactivities. Consequently, this study evaluated the effect of pasteurization methods (Holder pasteurization, high-temperature short-time (HTST), and high hydrostatic pressure (HHP)) of whole human milk (HM) on protein aggregates in skim milk and cream fractions. For heat-treated whole milk, insoluble protein aggregates at milk fat globule membrane (MFGM) were formed by disulfide and non-covalent bonds, but insoluble skim milk protein aggregates were only stabilized by non-covalent interactions. Contrary to heat treatment, the insolubilization of main proteins at the MFGM of HHP-treated HM was only through non-covalent interactions rather than disulfide bonds. Moreover, only heat treatment induced the insoluble aggregation of ⍺-lactalbumin. Overall, compared to heat treatment, HHP produced a milder effect on protein aggregation, validating the use of this process to better preserve the native state of HM bioactive proteins.

Differences in fat digestion from milk of different Species: In vitro gastrointestinal digestion model for infants

The differences in the milk fat digestion from goat milk (GM), camel milk (CM), bovine milk (BM), sheep milk (SM), mare milk (MM) and human milk (HM) using an in vitro gastrointestinal digestion model for simulated infants were investigated. The particle size distributions in goat and mare milk were similar to that of HM after digestion in the small intestine. During in vitro digestion, the zeta-potential change of MM was more consistent with that of HM. After 60 min of gastric digestion, the lipolysis degree (LD) of different milks were<2%, of which the highest LD was MM (1.84%), followed by HM (1.45%). At the end of intestinal digestion, the LD of HM was the highest, reaching 88.47%, and the LD of SM was similar to that of HM, reaching 83.92%, followed by GM (57.00%), BM (40.98%) and MM (39.37%), respectively, the LD of CM was only 29.99%, which was much lower than HM. The results of the glyceride composition hierarchical clustering analysis revealed that MM and HM were clustered into one category at the end of gastric and intestinal digestion. This study provides a scientific basis for the development of lipid ingredients in infant formula.

HAMLET in human milk is resistant to digestion and carries essential free long chain polyunsaturated fatty acids and oleic acid

The oleic acid/alpha-lactalbumin complex HAMLET (human alpha-lactalbumin made lethal to tumors) is cytotoxic to various cancerous cell lines and is assembled from alpha-lactalbumin (ALA) and free oleic acid (OA). HAMLET is also cytotoxic to normal immature intestinal cells. It remains unclear if HAMLET, experimentally assembled with OA and heat, can spontaneously assemble in frozen human milk over time. To approach this issue, we used a set of timed proteolytic experiments to evaluate the digestibility of HAMLET and native ALA. The purity of HAMLET in human milk was confirmed by ultra high performance liquid chromatography coupled to tandem mass spectrometry and western blot to resolve the ALA and OA components. Timed proteolytic experiments were used to identify HAMLET in whole milk samples. Structural characterization of HAMLET was performed by Fournier transformed infrared spectroscopy and indicated a transformation of secondary structure with increased alpha-helical character of ALA upon binding to OA.

Mechanisms for the interaction of the milk fat globule membrane with the plasma membrane of gut epithelial cells

The milk fat globule membrane (MFGM) provides infants and adults with several health benefits. These are not derived solely from its unique composition, but also from arrangement of lipids in the MFGM that, in the case of newborns, could reach the intestine partially intact. Fluorochromes associated with lipid derivatives were used to prove a fusion process between the MFGM and the cellular membrane of differentiated Caco-2 cells. To explore the mechanism of this interaction, incubations of MFGM with Caco-2 cells were carried out in the presence of fusogenic agents or compounds that block other MFGM interaction pathways with cells. Confocal fluorescence microscopy provided visual evidence of the fusion process. Lastly, determination on the lipid profile of cells after their interaction with MFGM indicated a metabolic rearrangement of lipids leading to accumulation of triacylglycerols.

Evaluating human milk as a drug delivery vehicle for clofazimine to premature infants

Human milk is proposed as a drug delivery vehicle suitable for use in neonatal patients. Clofazimine, traditionally used for the treatment of leprosy and tuberculosis, is emerging as a treatment for cryptosporidiosis in infants, however its poor aqueous solubility has led to its commercial formulation as a waxy lipid formulation in a capsule, a format that is not suitable for infants. In this study, the evaluation of pasteurised human milk for the delivery of clofazimine was investigated using an in vitro lipolysis model to simulate gastric and intestinal digestion. The total lipid composition of the human milk was characterised alongside the liberated fatty acid species following digestion for comparison to alternative lipid-based delivery systems. Small-angle X-ray scattering was used to measure the presence of crystalline clofazimine during digestion and hence the extent of drug solubilisation. High-performance liquid chromatography was used to quantify the mass of clofazimine solubilised per gram of human milk fat (drug-to-fat ratio) in digested and undigested human milk. The digestion process was essential for the solubilisation of clofazimine, with digested human milk solubilising a sufficient dose of clofazimine for treatment of a premature infant. Human milk solubilised the clofazimine to a greater extent than bovine milk and infant formula during digestion, most likely as a result of differing lipid composition and increased long-chain fatty acid concentrations. These findings show that human milk enhances the solubility of clofazimine as a model drug and may be a suitable drug delivery vehicle for infant populations requiring therapeutic treatment.

Digestion of human milk processed by high pressure processing and Holder pasteurization using a dynamic in vitro model of the preterm infant

Holder pasteurization (HoP) (62.5 °C, 30 min) of donor human milk is widely used to inactivate potential pathogens but may lead to denaturation and aggregation of bioactive proteins, reducing their functionality. In contrast, high pressure processing (HPP) is a non-thermal technique that minimally affects assessed bioactive components; however, it is unclear how HPP affects protein digestion, and retention of functional bioactive proteins. Raw or processed (HoP; HPP[500 MPa,10 min]) pools of milk (N = 3, from 9 donors) were subjected in triplicate to in vitro digestion simulating the preterm infant gastrointestinal tract. Compared to raw or HPP, HoP increased intestinal proteolysis of lactoferrin and bioactive milk fat globule membrane proteins. Lysozyme activity was impacted by digestion following HoP (72 % to 7 %)-significantly more than HPP (75 % to 34 %) or raw (100 % to 39 %), which did not differ. Proteins in HPP-treated donor milk are digested no different than raw milk, while preserved bioactivity remains functional upon digestion.

Pre-duodenal lipid digestion of emulsions: Relevance, colloidal aspects and mechanistic insight

The digestion of lipids in the human body has several health and nutritional implications. Lipid digestion is an interfacial phenomenon meaning that water-soluble lipases need to first adsorb to the oil-water interface before enzymatic conversions can start. The digestion of lipids mainly occurs on colloidal structures dispersed in water, such as oil-in-water (o/w) emulsions, which can be designed during food formulation/processing or structured during digestion. From a food design perspective, different in vitro studies have demonstrated that the kinetics of lipid digestion can be influenced by emulsion properties. However, most of these studies have been performed with pancreatic enzymes to simulate lipolysis in the small intestine. Only few studies have dealt with lipid digestion in the gastric phase and its subsequent impact on intestinal lipolysis. In this aspect, this review compiles information on the physiological aspects of gastric lipid digestion. In addition, it deals with colloidal and interfacial aspects starting from emulsion design factors and how they evolve during in vitro digestion. Finally, molecular mechanisms describing gastric lipolysis are discussed.

Gastric devolution of transglutaminase-induced acid and rennet-induced casein gels using dynamic DIDGI® and static COST action INFOGEST protocols

Limited studies in the literature have compared in vitro dynamic and in vitro static protocols for modelling the gastric digestive process of food systems. This experiment explores the differences between two different in vitro approaches to the devolution of a transglutaminase-induced acid gel (TG, pH 5.1-5.3) and rennet-induced gel (RG, pH 6.5-6.7). Gels were exposed to a simulated oral phase, followed by either the dynamic DIDGI® or static COST action INFOGEST protocol to simulate gastric conditions. Protein hydrolysis was evident from 15 min onwards for TG exposed to the dynamic protocol where levels continued to increase at a steady rate. In contrast, RG exhibited a notable lag-phase before levels increased from around 60 min onwards. Under the static protocol, protein hydrolysis was observed for both TG and RG upon exposure to the gastric environment which continued to increase over time. Despite these differences, similar levels of protein hydrolysis were found for TG and RG at the gastric endpoint using either protocol demonstrating that both the dynamic DIDGI® and static COST action INFOGEST methods provide a suitable and comparable environment for the in vitro digestion of casein protein under simulated gastric conditions.

Development of a human milk protein concentrate from donor milk: Impact of the pasteurization method on static in vitro digestion in a preterm newborn model

The impact of high temperature short time (HTST, 72 °C, 15 s), Holder pasteurization- (63 °C, 30 min) and high hydrostatic pressure (HHP, 600 MPa-10 min) was evaluated on the digestibility of human milk protein concentrate (HMPC) by using a static in vitro gastrointestinal digestion system. The results showed that the processing steps used to produce the HMPC induced a decrease in readily available nitrogen (non-protein nitrogen and peptides). Overall, digestibility was similar between pasteurized and raw HMPC (degree of hydrolysis ranged from 26 to 34 %). Lactoferrin was more susceptible to gastric and intestinal digestion after thermal pasteurization. Additionally, the resistance of β-casein to digestion increased after HHP and Holder pasteurization due to aggregation and changes in protein structure. During intestinal digestion, Holder pasteurization induced a higher release of arginine, phenylalanine and tyrosine from HMPC compared to raw and HHP-treated HMPC. Overall, protein structural changes induced by human milk (HM) processing (freeze-thawing and filtration) and pasteurization treatments affected HMPC proteolysis during in vitro digestion. However, protein digestion behaviors were quite similar for raw and HHP-treated HMPC compared to the thermal-treated HMPC, with no effect on lactoferrin digestion. Consequently, pasteurization of HMPC by HHP represents an interesting non-thermal process that preserves the HM bioactive proteins during digestion.

Donor human milk processing and its impact on infant digestion: A systematic scoping review of in vitro and in vivo studies

When there is an inadequate supply of mother's milk, pasteurized donor human milk is preferred over formula to supplement feeds for preterm infants. Although providing donor milk helps to improve feeding tolerance and reduce necrotizing enterocolitis, changes to its composition and reductions in bioactivity during processing, are thought to contribute to the slower growth often exhibited by these infants. To improve the clinical outcomes of recipient infants by maximizing the quality of donor milk, research is currently investigating strategies to optimize all aspects of processing, including pooling, pasteurization, and freezing; however, reviews of this literature typically only summarize the impact of a processing technique on composition or bioactivity. Reviews of published research investigating the impact of donor milk processing on infant digestion/absorption are lacking and thus, was the objective for this systematic scoping review, Open Science Framework (https://doi.org/10.17605/OSF.IO/PJTMW). Databases were searched for primary research studies evaluating donor milk processing for pathogen inactivation or other rationale and subsequent effect on infant digestion/absorption. Non-human milk studies or those assessing other outcomes were excluded. Overall, 24 articles from 12,985 records screened were included. Most studied thermal methods to inactivate pathogens, predominantly Holder pasteurization (HoP) (62.5°C, 30 min) and high-temperature short-time. Heating consistently decreased lipolysis and increased proteolysis of lactoferrin and caseins; however, protein hydrolysis was unaffected from in vitro studies. The abundance and diversity of released peptides remain unclear and should be further explored. Greater investigation into less-harsh methods for pasteurization, such as high-pressure processing, is warranted. Only 1 study assessed the impact of this technique and found minimal impact on digestion outcomes compared with HoP. Fat homogenization appeared to positively impact fat digestion (n = 3 studies), and only 1 eligible study investigated freeze-thawing. Identified knowledge gaps regarding optimal methods of processing should be further explored to improve the quality and nutrition of donor milk.

Infant nutrition affects the microbiota-gut-brain axis: Comparison of human milk vs. infant formula feeding in the piglet model

Early nutrition plays a dominant role in infant development and health. It is now understood that the infant diet impacts the gut microbiota and its relationship with gut function and brain development. However, its impact on the microbiota-gut-brain axis has not been studied in an integrative way. The objective here was to evaluate the effects of human milk (HM) or cow’s milk based infant formula (IF) on the relationships between gut microbiota and the collective host intestinal-brain axis. Eighteen 10-day-old Yucatan mini-piglets were fed with HM or IF. Intestinal and fecal microbiota composition, intestinal phenotypic parameters, and the expression of genes involved in several gut and brain functions were determined. Unidimensional analyses were performed, followed by multifactorial analyses to evaluate the relationships among all the variables across the microbiota-gut-brain axis. Compared to IF, HM decreased the α-diversity of colonic and fecal microbiota and modified their composition. Piglets fed HM had a significantly higher ileal and colonic paracellular permeability assessed by ex vivo analysis, a lower expression of genes encoding tight junction proteins, and a higher expression of genes encoding pro-inflammatory and anti-inflammatory immune activity. In addition, the expression of genes involved in endocrine function, tryptophan metabolism and nutrient transport was modified mostly in the colon. These diet-induced intestinal modifications were associated with changes in the brain tissue expression of genes encoding the blood-brain barrier, endocrine function and short chain fatty acid receptors, mostly in hypothalamic and striatal areas. The integrative approach underlined specific groups of bacteria (Veillonellaceae, Enterobacteriaceae, Lachnospiraceae, Rikenellaceae, and Prevotellaceae) associated with changes in the gut-brain axis. There is a clear influence of the infant diet, even over a short dietary intervention period, on establishment of the microbiota-gut-brain axis.

Digestion of Medium- and Long-Chain Triacylglycerol and sn-2 Palmitate in Infant Formula: A Study Based on Dynamic In Vitro Simulation of Infant Gastrointestinal Lipolysis

In this study, lipolysis of triacylglycerols (TAGs) in infant formula (IF) composed of different oils and supplied with different structured TAGs, including medium- and long-chain triacylglycerol (MLCT) and sn-2 palmitate, was studied using a dynamic digestion model simulating the infant gastrointestinal tract. The molecular species of digestion products released during digestion, including diacylglycerols, monoacylglycerols (MAGs), and free fatty acids, as well as undigested TAGs, were identified and quantified using liquid chromatography-mass spectrometry. We observed clearly different lipolysis degrees (LDs), with diversity in digestion products of different IFs. IFs supplied with MLCT showed moderate medium-chain fatty acid release during gastric digestion and higher LD after intestinal digestion. The presence of sn-2 palmitate in IF was associated with higher content of MAG-16:0 in digestion products. The species and contents of digestion products in IF were highly influenced by structured TAGs.

Simulated dynamic digestion reveals different peptide releases from human milk processed by means of holder or high temperature-short time pasteurization

High Temperature-Short Time (HTST) pasteurization was proposed as an alternative to Holder pasteurization (HOP) to increase the retention of specific human milk (HM) bioactive proteins. The present study explored whether HTST and HOP differently affect peptide release during simulated preterm infant gastrointestinal digestion. Raw (RHM), HOP- and HTST- pasteurized HM were digested using an in vitro dynamic system, and the identified peptides were analyzed by mass spectrometry and multivariate statistics. Before digestion, 158 peptides were identified in either RHM, HTST- or HOP- HM, mostly (84.4%) originating from β-casein (CASB). During gastric digestion, HOP-HM presented a greater number and more abundant specific CASB peptides. A delayed release of peptides was observed in RHM during the intestinal phase, with respect to both pasteurized HM. Although limited to gastric digestion, the HM peptidomic profile differed according to the pasteurization type, and the pattern of the HTST peptides showed a greater similarity with RHM.

Comparative Analysis of Lipid Digestion Characteristics in Human, Bovine, and Caprine Milk Based on Simulated In Vitro Infant Gastrointestinal Digestion

Lipid digestion characteristics in human, bovine, and caprine milk were investigated using an infant in vitro digestion model. Our results suggested that particle size in bovine and caprine milk increased initially and then decreased over time, whereas the particle size in human milk continuously decreased. The lipolysis degree of human milk (86.8%) was higher than that in bovine (80.2%) and caprine (82.7%) milk (P < 0.05). Compared to human milk, bovine and caprine milk released higher unsaturated fatty acids and lower SFAs. In addition, 12 and 84 glyceride species were significantly different between bovine and human milk, during gastrointestinal digestion (P < 0.05). Another 13 and 92 glyceride species were found to be significantly different between caprine and human milk. A total of 30 and 31 lipids were screened as biomarkers to further clarify the differences related to lipid digestion properties of human, bovine, and caprine milk.

New Insights Into Microbiota Modulation-Based Nutritional Interventions for Neurodevelopmental Outcomes in Preterm Infants

Gut microbiota and the central nervous system have parallel developmental windows during pre and post-natal life. Increasing evidences suggest that intestinal dysbiosis in preterm infants predisposes the neonate to adverse neurological outcomes later in life. Understanding the link between gut microbiota colonization and brain development to tailor therapies aimed at optimizing initial colonization and microbiota development are promising strategies to warrant adequate brain development and enhance neurological outcomes in preterm infants. Breast-feeding has been associated with both adequate cognitive development and healthy microbiota in preterms. Infant formula are industrially produced substitutes for infant nutrition that do not completely recapitulate breast-feeding benefices and could be largely improved by the understanding of the role of breast milk components upon gut microbiota. In this review, we will first discuss the nutritional and bioactive component information on breast milk composition and its contribution to the assembly of the neonatal gut microbiota in preterms. We will then discuss the emerging pathways connecting the gut microbiota and brain development. Finally, we will discuss the promising microbiota modulation-based nutritional interventions (including probiotic and prebiotic supplementation of infant formula and maternal nutrition) for improving neurodevelopmental outcomes.

An Integrative Approach of an In Vitro Measurement of the Digestibility of Triacylglycerols of Human Milk

Several studies have been published regarding the effect of different factors on the digestion of milk lipids, considering their natural structural arrangement as milk fat globules and the efficiency of the digestive enzymes in the lipolysis of such complex structures. During digestion, the lipolytic products are dispersed in vesicles and micelles, which are the source for absorption of digested lipids. Therefore, it is necessary to consider the isolation of the micellar phase from the digesta to appropriately determine the amounts and classes of lipids which are bioaccessible. This study presents an integrative approach that included an isolation procedure to separate the micellar fraction from undigested and non-micellar parts, and the distribution of digested milk lipids in micelles determined directly through chromatographic techniques. Four groups of five full term mothers donated colostrum or mature milk. Two sets of samples were analyzed directly (raw), and two sets were pasteurized and then analyzed. Our data revealed that the profile of digested milk lipids is different depending on the lactation period and processing stage, while the carbon atom number distribution of the digested triacylglycerols in the micellar fraction provides a substantial information regarding the acylglycerols species that are less available for absorption.

Lecithin alleviates protein flocculation and enhances fat digestion in a model of infant formula emulsion

This study investigates whether lecithin could fasten lipolysis through the alleviation of protein aggregation in an infant formula emulsion model. Our previous study reported low intestinal digestion of infant formula could be due to the aggregation of proteins that slow lipid digestion. The emulsion contained lipids droplets simulating the fatty acid composition in breast milk, different levels of lecithin and milk protein. The interphase proteins were replaced with lecithin in a dose-dependent manner. The results showed the addition of 5% and 7% lecithin improves the physical stability, narrows the range of particle size, reduces the mean particle size and increases the zeta potential. The 5% lecithin emulsion showed the highest rate and extent of lipid and protein digestion. These positive effects were caused by lecithin through stabilizing the emulsion and suppressing droplet flocculation after digestion. Lecithin promotes lipid digestion and may improve the "insufficient fat supply" in infant formula.

Human milk pasteurisation reduces pre-lipolysis but not digestive lipolysis and moderately decreases intestinal lipid uptake in a combination of preterm infant in vitro models

Donor human milk, pasteurised for safety reasons, is the first alternative for feeding preterm infants when mothers' own milk is unavailable. Breastmilk pasteurisation impact on lipid digestion and absorption was evaluated by a static in vitro digestion model for preterm infants coupled with intestinal absorption using Caco-2/TC7 cells. Lipid absorption was quantified by digital image analysis of lipid droplets, by measurement of basolateral triglyceride concentration and by analysing the expression of major genes involved. After in vitro digestion, lipolysis extent was 13% lower in pasteurised human milk (PHM) than in raw human milk (RHM). In Caco-2/TC7 cells, the number of lipid droplets was identical for both milk types, while the mean droplet area was 17% smaller with PHM. Altogether, pasteurisation decreased the pre-lipolysis of human milk. This initial difference in free fatty acid amount was only partially buffered by the subsequent processes of in vitro digestion and cellular lipid absorption.

Current Evidence on the Bioavailability of Food Bioactive Peptides

Food protein-derived bioactive peptides are recognized as valuable ingredients of functional foods and/or nutraceuticals to promote health and reduce the risk of chronic diseases. However, although peptides have been demonstrated to exert multiple benefits by biochemical assays, cell culture, and animal models, the ability to translate the new findings into practical or commercial uses remains delayed. This fact is mainly due to the lack of correlation of in vitro findings with in vivo functions of peptides because of their low bioavailability. Once ingested, peptides need to resist the action of digestive enzymes during their transit through the gastrointestinal tract and cross the intestinal epithelial barrier to reach the target organs in an intact and active form to exert their health-promoting properties. Thus, for a better understanding of the in vivo physiological effects of food bioactive peptides, extensive research studies on their gastrointestinal stability and transport are needed. This review summarizes the most current evidence on those factors affecting the digestive and absorptive processes of food bioactive peptides, the recently designed models mimicking the gastrointestinal environment, as well as the novel strategies developed and currently applied to enhance the absorption and bioavailability of peptides.

Digestion of human milk fat in healthy infants

Lipid digestion is critical for infant development, and yet, the interconnection between lipid digestion and the microbiota is largely understudied. This review focuses on digestion of the human milk fat globule and summarizes the current understanding of the mechanisms underlying this process in infants. We first discuss the partial hydrolysis of milk fat in the stomach, which leads to rearrangement of lipid droplets, creating a lipid-water interface necessary for duodenal lipolysis. In the first few months of life, secretion of pancreatic triglyceride lipase, phospholipase A₂, and bile salts is immature. The dominant lipases aiding fat digestion in the newborn small intestine are therefore pancreatic lipase-related protein 2 and bile salt-stimulated lipase from both the exocrine pancreas and milk. We summarize the interaction between ionic fatty acids and cations to form insoluble fatty acid soaps and how it is influenced by various factors, including cation availability, pH, and bile salt concentration, as well as saturation and chain length of fatty acids. We further argue that the formation of the soap complex does not contribute to lipid bioavailability. Next, the possible roles that the gut microbiota plays in lipid digestion and absorption are discussed. Finally, we provide a perspective on how the manufacturing process of infant formula and dairy products may alter the physical properties and structure of lipid droplets, thereby altering the rate of lipolysis.

Effects of Chemical Composition and Microstructure in Human Milk and Infant Formulas on Lipid Digestion

Infant formula (IF) is an important substitute for infants when human milk (HM) is unavailable; however, it was often observed with "insufficient fat" and showed different metabolic phenotypes, which may affect the growth and brain development of the infant. Considering that the milk fat digestion rate may affect the fat absorption and metabolism and further influence the metabolic phenotype, it is valuable to study the fat digestive behaviors of IF and HM. In the current study, we investigated the in vitro fat digestive properties of HM in comparison to four formulas (IF1, 2, 3, 4) including IFs enriched in OPO lipids (IF1 and IF3) and IFs with common mixed plant oils (IF2 and IF4). Results showed that the extent of eventual lipid hydrolysis of HM (98.9 ± 2.70%) was higher than those of IF1 and IF3 (90.4 ± 3.39 and 91.1 ± 1.67%, respectively) (p < 0.05) and IF2 and IF4 (81.9 ± 1.64 and 79.9 ± 1.05% respectively) (p < 0.01). Native fat globules and protein aggregation were observed at the end of HM gastric digestion, and the aggregates became smaller and then resolved from 60 to 120 min in intestinal digestion, while a large number of aggregates were observed in IF, which may slow the lipid digestion. The absorption differences between HM and IFs in lipid digestion need further study to elucidate the nutritional relevance to infant development and growth.

Triacylglycerol Containing Medium-Chain Fatty Acids: Comparison of Human Milk and Infant Formulas on Lipolysis during In Vitro Digestion

Medium-chain triacylglycerol (MCT) is widely used in infant formulas (IFs) to provide medium-chain fatty acids (MCFAs) for infants with special fat absorption requirements. However, MCFAs naturally present in human milk are medium-and long-chain triacylglycerols (MLCTs). This study investigated the effect of triacylglycerol containing MCFAs (MLCT vs MCT) on lipolysis by comparison of human milk and IFs containing 0, 20, 30, and 55% of MCT (IF 1 to IF 4) using an in vitro digestion model. Rabbit gastric lipase showed an extent of digestion within the expected range, and was selected as the alternative to human gastric lipase. All IFs showed a lower lipolysis degree compared with human milk. There was no significant difference (p = 0.175) among IFs supplemented with MCT at the end of intestinal digestion. In addition, the digestion of IFs with different MCT contents led to different free fatty acid profiles, which may have health effects on infants.

Lipid Profile, Lipase Bioactivity, and Lipophilic Antioxidant Content in High Pressure Processed Donor Human Milk

Human milk fat plays an essential role as the source of energy and cell function regulator; therefore, the preservation of unique human milk donors’ lipid composition is of fundamental importance. To compare the effects of high pressure processing (HPP) and holder pasteurization on lipidome, human milk was processed at 62.5 °C for 30 min and at five variants of HPP from 450 MPa to 600 MPa, respectively. Lipase activity was estimated with QuantiChrom™ assay. Fatty acid composition was determined with the gas chromatographic technique, and free fatty acids content by titration with 0.1 M KOH. The positional distribution of fatty acid in triacylglycerols was performed. The oxidative induction time was obtained from the pressure differential scanning calorimetry. Carotenoids in human milk were measured by liquid chromatography. Bile salt stimulated lipase was completely eliminated by holder pasteurization, decreased at 600 MPa, and remained intact at 200 + 400 MPa; 450 MPa. The fatty acid composition and structure of human milk fat triacylglycerols were unchanged. The lipids of human milk after holder pasteurization had the lowest content of free fatty acids and the shortest induction time compared with samples after HPP. HPP slightly changed the β-carotene and lycopene levels, whereas the lutein level was decreased by 40.0% up to 60.2%, compared with 15.8% after the holder pasteurization.

The relevance of a digestibility evaluation in the allergenicity risk assessment of novel proteins. Opinion of a joint initiative of COST action ImpARAS and COST action INFOGEST

The current allergenicity assessment of novel proteins is based on the EFSA GMO guidance. Recently, EFSA launched a new guidance document on allergenicity assessment of GM plants (2017). This document describes, amongst other topics, the new scientific and regulatory developments on in vitro protein digestibility tests. The EFSA GMO Panel stated that for in vitro protein digestibility tests, additional investigations are needed before any additional recommendation in the form of guidance can be provided. To this end, an interim phase is considered necessary to evaluate the revisions to the in vitro gastrointestinal digestion test, proposed by EFSA. This prompted the establishment of a joint workshop through two COST Action networks: COST Action ImpARAS and COST Acton INFOGEST. In 2017, a workshop was organised to discuss the relevance of digestion in allergenicity risk assessment and how to potentially improve the current methods and readouts. The outcome of the workshop is that there is no rationale for a clear readout that is predictive for allergenicity and we suggest to omit the digestion test from the allergenicity assessment strategy for now, and put an effort into filling the knowledge gaps as summarized in this paper first.

Variations in gastrointestinal lipases, pH and bile acid levels with food intake, age and diseases: Possible impact on oral lipid-based drug delivery systems

The lipids and some surfactants present in oral lipid-based drug delivery systems are potential substrates for the various lipases involved in gastrointestinal (GI) lipolysis. The levels of these enzymes, together with pH and biliairy secretion, are important parameters that condition the fate of lipid-based formulations (LBF) and the dispersion, solubilization and absorption of lipophilic drugs in the GI tract. Since in vitro methods of digestion are now combined with dissolution assays for a better assessment of LBF performance, it is essential to have a basic knowledge on lipase, pH and bile acid (BA) levels in vivo to develop relevant in vitro models. While these parameters and their variations in healthy subjects are today well documented, in vivo data on specific populations (age groups, patients with various diseases, patients with treatment affecting GI tract parameters, …) are scarce and obtaining them from clinical studies is sometimes difficult due to ethical limitations. Here we collected some in vivo data already available on the levels of digestive lipases, gastric and intestinal pH, and BAs at various ages and in patients with exocrine pancreatic insufficiency, a pathological situation that leads to drastic changes in GI tract parameters and impacts pharmacological treatments.

Does lactic fermentation influence soy yogurt protein digestibility: a comparative study between soymilk and soy yogurt at different pH

BACKGROUND

Lactic acid bacteria fermentation allows soymilk to form a yogurt-like product accompanied by protein acidic coagulation. It is not known whether the coagulation of soy protein during fermentation influences protein digestibility when ingested. In the present study, soymilk (pH 6.3) and soy yogurt (SY) at different pH (6.0, 5.7, 5.4 and 5.1) were subjected to in vitro gastrointestinal digestion (GIS) and a comparison study was conducted.

RESULTS

Lactic fermentation allowed the pH of soymilk to reduce gradually to 5.1 in 330.0 min. A decline in pH resulted in the volume-weighted mean diameters D[4,3] and D[v,90] increasing from 0.81 to 97 µm and 1.82 to 273 µm, respectively. Predominant proteins lost their solubility between pH 6.0 and 5.7. Application of GIS allowed SY samples, especially SY-5.7, SY-5.4 and SY-5.1, to reveal particles with a predominant peak at approximately 10 µm and also lower soluble proteins compared to soymilk, with reduction percentages of 18%, 28% and 43%. The cleavage pattern of soy protein during GIS was scarcely affected by the sample pH. However, a lower quantity of the band at 33.9 kDa was found in SY-5.7, SY-5.4 and SY-5.1.

CONCLUSION

The results of the present study demonstrate that lactic fermentation altered soy protein digestibility. With the process of protein coagulation, SY-5.7, 5.4 and 5.1 had a lower bioaccessible protein content compared to that of soymilk. © 2018 Society of Chemical Industry.

Free fatty acid release from vegetable and bovine milk fat-based infant formulas and human milk during two-phase in vitro digestion

The profile of fatty acids released during in vitro digestion of vegetable and bovine milk fat-based infant formula differ.

Advances and challenges in liposome digestion: Surface interaction, biological fate, and GIT modeling

During the past 50 years, there has been increased interest in liposomes as carriers of pharmaceutical, cosmetic, and agricultural products. More recently, much progress has been made in the use of surface-modified formulas in experimental food matrices. However, before the viability and the applications of nutrients in liposomal form in the edible field can be determined, the digestion behavior along the human gastrointestinal tract (GIT) must be clarified. In vitro digestion models, from static models to dynamic mono-/bi-/multi-compartmental models, are increasingly being developed and applied as alternatives to in vivo assays. This review describes the surface interactions of liposomes with their encapsulated ingredients and with external food components and updates the biological fate of liposomes after ingestion. It summarizes current models for the human stomach and intestine that are available and their relevance in nutritional studies. It highlights limitations and challenges in the use of these models for liposomal colloid system digestion and discusses crucial factors, such as enzymes and bile salts, that affect liposomal bilayer degradation.

Impact of human milk pasteurization on the kinetics of peptide release during in vitro dynamic digestion at the preterm newborn stage

Holder pasteurization (62.5 °C, 30 min) of human milk denatures beneficial proteins. The present paper aimed to assess whether this can affect the kinetics of peptide release during digestion at the preterm stage. Raw (RHM) or pasteurized (PHM) human milk were digested in triplicates using an in vitro dynamic system. Mass spectrometry and multivariate statistics were conducted. Pre-proteolysis occurred mostly on β-casein, for which cumulative peptide abundance was significantly greater in PHM over 28% of the hydrolysed sequence. Eight clusters resumed the kinetics of peptide release during digestion, which differed on seven clusters (69% of the 1134 peptides). Clusters associated to the heat-denaturated proteins, lactoferrin and bile salt-stimulated lipase, presented different kinetics of release during digestion, unlike that for β-casein. Some bioactive peptides from β-casein presented significant different abundances between PHM and RHM before digestion (1-18, 185-211) or in during intestinal digestion (154-160, 161-166). Further physiological consequences should be investigated.

Invited review: Dairy proteins and bioactive peptides: Modeling digestion and the intestinal barrier

Dairy products are one of the most important sources of biologically active proteins and peptides. The health-promoting functions of these peptides are related to their primary structure, which depends on the parent protein composition. A crucial issue in this field is the demonstration of a cause-effect relationship from the ingested protein form to the bioactive form in vivo. Intervention studies represent the gold standard in nutritional research; however, attention has increasingly been focused on the development of sophisticated in vitro models of digestion to elucidate the mechanism of action of dairy nutrients in a mechanistic way and significantly reduce the number of in vivo trials. On the other hand, the epithelial intestinal barrier is the first gate that actively interacts with digestion metabolites, making the intestinal cells the first target tissue of dairy nutrients and respective metabolites. An evolution of the in vitro digestion approach in the study of dairy proteins and derived bioactive compounds is the setup of combined in vitro digestion and cell culture models taking into consideration the endpoint to measure the target organism (e.g., animal, human) and the key concepts of bioaccessibility, bioavailability, and bioactivity. This review discusses the relevance and challenges of modeling digestion and the intestinal barrier, focusing on the implications for the modeling of dairy protein digestion for bioactivity evaluation.

Focusing on fatty acid profile in milk from different species after in vitro digestion

We report the fatty acid profile of raw milk and of the corresponding digested milk from different sources (human milk, formula milk and donkey, bovine, ovine and caprine milk) to gain information on the nutritional quality of different milk sources in infant nutrition.Short chain fatty acids (SC-FA) were higher in bovine and caprine milk, intermediate in ovine and donkey and lower in human and formula milk. Medium chain fatty acids (MC-FA) showed the highest values for bovine and caprine milk and the lowest for donkey and formula milk, whereas long chain fatty acids (LC-FA) were the highest in donkey and formula milk and intermediate in human milk.The percentage distribution of fatty acids liberated after in vitro digestion did not reflect the patterns found in the corresponding milk sources. In particular, MC free fatty acids (MC-FFA) showed the highest and the lowest values in donkey and in formula milk, LC-FFA showed the highest value in human milk. The total FFA was highest in human milk, lowest in formula milk and intermediate in donkey, bovine, ovine, and caprine milk.