A systematic review of breast milk microbiota composition and the evidence for transfer to and colonisation of the infant gut
Christine A. EdwardsC.A. BouwmanJanna A. van DiepenMarieke H. SchoemakerSusan E. OzanneKoen VenemaCatherine StantonV. MarinelloRicardo RuedaMatthieu FlourakisÁngel GilEline M. van der Beek
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Abstract:
The intestinal microbiota plays a major role in infant health and development. However, the role of the breastmilk microbiota in infant gut colonisation remains unclear. A systematic review was performed to evaluate the composition of the breastmilk microbiota and evidence for transfer to/colonisation of the infant gut. Searches were performed using PUBMED, OVID, LILACS and PROQUEST from inception until 18th March 2020 with a PUBMED update to December 2021. 88 full texts were evaluated before final critique based on study power, sample contamination avoidance, storage, purification process, DNA extraction/analysis, and consideration of maternal health and other potential confounders. Risk of skin contamination was reduced mainly by breast cleaning and rejecting the first milk drops. Sample storage, DNA extraction and bioinformatics varied. Several studies stored samples under conditions that may selectively impact bacterial DNA preservation, others used preculture reducing reliability. Only 15 studies, with acceptable sample size, handling, extraction, and bacterial analysis, considered transfer of bacteria to the infant. Three reported bacterial transfer from infant to breastmilk. Despite consistent evidence for the breastmilk microbiota, and recent studies using improved methods to investigate factors affecting its composition, few studies adequately considered transfer to the infant gut providing very little evidence for effective impact on gut colonisation.Keywords:
Colonisation
Dysbiosis
Infant feeding
Since ancient times, breastfeeding has been the fundamental way of nurturing the newborn. The benefits of breast milk are widely known, as it is a source of essential nutrients and provides immunological protection, as well as developmental benefits, among others. However, when breastfeeding is not possible, infant formula is the most appropriate alternative. Its composition meets the nutritional requirements of the infant, and its quality is subject to strict control by the authorities. Nonetheless, the presence of different pollutants has been detected in both matrices. Thus, the aim of the present review is to make a comparison between the findings in both breast milk and infant formula in terms of contaminants in the last decade, in order to choose the most convenient option depending on the environmental conditions. For that, the emerging pollutants including metals, chemical compounds derived from heat treatment, pharmaceutical drugs, mycotoxins, pesticides, packaging materials, and other contaminants were described. While in breast milk the most concerning contaminants found were metals and pesticides, in infant formula pollutants such as metals, mycotoxins, and packaging materials were the most outstanding. In conclusion, the convenience of using a feeding diet based on breast milk or either infant formula depends on the maternal environmental circumstances. However, it is important to take into account the immunological benefits of the breast milk compared to the infant formula, and the possibility of using breast milk in combination with infant formula when the nutritional requirements are not fulfilled only with the intake of breast milk. Therefore, more attention should be paid in terms of analyzing these conditions in each case to be able to make a proper decision, as it will vary depending on the maternal and newborn environment.
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Mothers' own milk is the best source of nutrition for nearly all infants. Beyond somatic growth, breast milk as a biologic fluid has a variety of other benefits, including modulation of postnatal intestinal function, immune ontogeny, and brain development. Although breastfeeding is highly recommended, breastfeeding may not always be possible, suitable or solely adequate. Infant formula is an industrially produced substitute for infant consumption. Infant formula attempts to mimic the nutritional composition of breast milk as closely as possible, and is based on cow's milk or soymilk. A number of alternatives to cow's milk-based formula also exist. In this article, we review the nutritional information of breast milk and infant formulas for better understanding of the importance of breastfeeding and the uses of infant formula from birth to 12 months of age when a substitute form of nutrition is required.
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Breast milk is the best source of nutrition for infant growth and development. Breast feeding an infant is not always possible because have insufficient in quantity of breast milk or social conditions. In such a case, infant formula sufficient for growth and development must be used. Large amounts of polyunsaturated fatty acids (PUFA), i.e., linoleic acid, arachidonic acid, alfa-liolenic acid, eicosapentaenoic acid and docosahexaenoic acid (DHA) are present in breast milk. Infant formula well-balanced in essential fatty acids was produced subsequent to demonstrating the need for alfa-liolenic acid. DHA-fortified infant formula was recently been developed to provide DHA equivalent to that in Japanese human milk, because DHA is essential to development of the neonatal brain and retina. Visual acuity and/or visual evoked potential assessed the significance of PUFA for term infants. The results were compared with the learning ability of rats.
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Human breast milk is generally and universally recognized as the optimal choice for nutrition during the first year of life. In certain cases in which it is not feasible to breast-feed the infant or the breast milk is not sufficient, especially in the case of preterm infants, infant formula is the next best alternative to provide nutrition to nurture the infant. Therefore, it is highly important that the nutrient composition of the infant formula is as close to breast milk as possible for proper growth and development of the infant. However, human milk is a complex dynamic matrix, and therefore significant research has been done and is still ongoing to fully understand and mimic human breast milk, particularly its fat composition. Lipids play a critical role in infant nutrition. A number of advances have been made in infant formula lipid content and composition so that formula can better simulate or mimic the nutritional functions of human maternal milk.
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Breast feeding is a rule rather than exception in most parts of India. It is now established that examining not only if an infant was breast fed but also how (in terms of duration and exclusivily) is essential to our understanding of the impact of breast feeding on human health (1) . Infants partially breast fed (breast milk along with animal milk or infant formula) or not breast fed have a significantly higher risk of hospitalization and death as compared to infants predominantly breast fed (breast milk and water) or exclusively breast fed (2) . Data from India states that only ��% of children less than 4 months of age are exclusively breast fed, 23% predominantly breast fed and 20% receive supplements along with breast milk. Powdered milk is given infrequently to young children at any age, but other milk (such as cow's / buffalo's milk) is given more often. Around 10% of breast fed infants less than 6 months receive powdered milk. This figure increases considerably with increasing age and also among non breast feeding children (3) . Enterobacter sakazakii in powdered infant formula has been implicated in outbreaks causing sepsis, meningitis or IBFAN - the International Baby Food Action Network -consists of more than 200 public interest groups working around the world to promote the health and well-being of infants, young children and their mothers through the protection, promotion and support of optimal infant and young child feeding practices. IBFAN works to eliminate the irresponsible marketing of breast milk substitutes and feeding bottles through full and universal implementation of the International Code of Marketing of Breast milk Substitutes and subsequent, relevant World Health Assembly Resolutions. In 1998, IBFAN was a recipient of the Right Livelihood Award.
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Global guidelines for infant formula say the ingredients are supposed to be those “which have been proved to be suitable for infant feeding.” “Proven” has not been defined, so there has not been any authoritative proof of suitability.
Assessment of infant formula has focused on its ingredients. Globally, the Codex Alimentarius Commission has set out a list of ingredients that should be in all infant formula, while also giving national governments the option to introduce some variations within that framework. As illustrated by the practice in the United States, infant formula that includes the ingredients specified in the global guidelines and in national law is described as nutritionally adequate.
This is not good enough. The gold standard against which infant formula should be compared is optimal breastfeeding. The comparison should be based not on examination of formula’s ingredients but on examination of its performance. Does infant formula do what it is supposed to do? Does feeding with any particular type of infant formula protect the health of infants and their mothers as well as breastfeeding? If not, it is not functionally adequate.
Some might argue that while infant formula is not quite as good as breastfeeding for protecting infants’ health, it is not much worse. Families might have their own reasons for feeding their infants with formula. There is a need for serious discussion of the gap between breastfeeding and feeding with formula and about the degree to which considerations other than the infant’s health might play a role. New parents should be supported in making wise, well-informed choices about how they will feed their infants.
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Formula-based animal milk is an alternative source of infant nutrition in many cases when breastfeeding is unacceptable or inaccessible; however, these replacements often have low selenium levels. The composition of infant formula milk should be as close as possible to that of human breast milk, both in content and chemical speciation. Selenium is an essential trace element for infants. Generally, human breast milk is the ideal food to ensure adequate infant Se intake. However, to date, sodium selenite or sodium selenate has been used as selenium supplementation in infant formula milk in most countries. This inorganic Se, which is not a natural component of food, may not be the optimal speciation for Se supplementation in infant formula milk. Advances in speciation in foods, especially in animal milk, suggest that future proposals for selenium speciation in human breast milk can lead to discussions regarding the most favorable methods of selenium supplementation in infant formula milk.
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Human breast milk (HBM) is the finest source of nutrition for almost all infants. Breast milk as a bodily fluid has many benefits beyond somatic cell growth, including regulation of postnatal intestinal function, immune ontogeny, and brain development. However, breastfeeding is strongly recommended, breastfeeding may not always be possible, suitable or solely adequate1. Hence, Infant formula is often an alternative source of infant nutrition when breastfeeding is unacceptable or impossible. The composition of infant formula should be as close as possible to the composition of human breast milk, both in terms of content and chemical specification2. Infant formulas try to mimic the nutritional composition of breast milk as closely as possible. A number of substitutes to milk-based formula also exist. In this article, we review nutritional information for breast milk and infant formulas to help you better understand the importance of breastfeeding and the use of infant formulas up to 24 months of age when alternative feeding is required. In general, breast milk is the ideal food to ensure that an infant's nutritional needs are met.
Keywords: breast milk; infant formula; type of infant formula; benefits
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Infant nutrition
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