The Role of Fiber and Prebiotics - Oligosaccharides

on Children’s GI Health and Beyond Andy Darma

Pediatric Gastroenterologist
Dr. Soetomo Hospital – Faculty of Medicine UNIVERSITAS AIRLANGGA
16 October
1 2023
Conflict of Interest Disclosure
Andy Darma, dr., SpA(K)

Has no real or apparent

conflict of interest to report
Definitions

•There is no universally accepted

definitions …….

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FIBERS do importants
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 Definitions
What are considered as fibers?
Historically, the term fiber was loosely defined as
any non-digestible portion of a plant cell wall.
HIPSLEY EH. Dietary "fibre" and pregnancy toxaemia. Br Med J. 1953 Aug 22;2(4833):420-2.

Trowell’s definition ‘that portion of food which is

derived from the cellular walls of plants which is
digested very poorly by human beings’
Trowell H (1972): Dietary fibre and coronary heart disease. Eur. J. Clin.Biol. Res. 17, 345

“Any dietary component that reaches the colon

without being absorbed in a healthy human gut”
©AndyDarma Ha MA, Jarvis MC, Mann JI. A definition for dietary fibre. Eur J Clin Nutr. 2000;54(12):861-4.
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 Codex Alimentarius Commission
a carbohydrate polymer with 10 or more monomeric
units that are not hydrolyzed by the enzymes in the small
intestine of humans.
Carbohydrate polymers that have been obtained from
food’s raw material by physical, enzymatic, or chemical
means and that have been shown to have a physiologic
effect of benefit to health as demonstrated by accepted
scientific evidence to proficient authorities.

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 PHYSIOLOGY OF GI TRACT
3 Main EVENTS
1. Propulsion
2. Digestion
3. Absorption

DIETARY
©AndyDarma FIBERS
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 Health Benefit

The physical effects of fiber in the small intestine drive metabolic

health effects (e.g., cholesterol lowering, improved glycemic control), and
efficacy is a function of the viscosity of gel-forming fibers (e.g.,
psyllium, β-glucan).

In the large intestine, fiber can provide a laxative effect if (a) it resists
fermentation to remain intact throughout the large intestine, and (b) it
increases percentage of water content to soften/bulk stool (e.g., wheat
bran and psyllium)
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 Health Benefit
Laxation and Regularity
• increase stool weight
• increase the ease of defecation
• reduce transit time
Appetite Control
• increased time required to chew
certain fiber-rich foods
• slow gastric emptying
• various satiety-related hormones ➔ Decrease Body Weight
are released ➔ Decrease risk of CRC
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Slavin J. Fiber and prebiotics: mechanisms and health benefits. Nutrients. 2013 Apr 22;5(4):1417-35.
 DIETARY FIBER

PREBIOTICS

“not all DIETARY FIBER are PREBIOTICS …. but

©AndyDarma all PREBIOTICS are DIETARY FIBER”
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 Prebiotics : old concept
“non-digestible food components that benefit the
host by selectively stimulating growth and/or
activity of one/ limited amount of bacteria in
colon, thereby improve host health”

In simple form:
“Good Food for the Good Bacteria”

Diplock AT, Charleux JL, Crozier-Willi G, Kok FJ, Rice-Evans C, Roberfroid M, Stahl W, Viña-Ribes J.
Functional food science and defence against reactive oxidative species. Br J Nutr. 1998 Aug;80
Suppl 1:S77-112.
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 Good Food for the Good Bacteria

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 Prebiotics: new concepts

“a substrate that is selectively utilized by host

microorganisms conferring a health benefit”

Gibson GR, Hutkins R, Sanders ME, Prescott SL, Reimer RA, Salminen SJ, Scott K,
Stanton C, Swanson KS, Cani PD, Verbeke K, Reid G. Expert consensus document:
The International Scientific Association for Probiotics and Prebiotics (ISAPP)
consensus statement on the definition and scope of prebiotics. Nat Rev
Gastroenterol Hepatol. 2017 Aug;14(8):491-502.

Miqdady M, Al Mistarihi J, Azaz A, Rawat D. Prebiotics in the Infant Microbiome:

The Past, Present, and Future. Pediatr Gastroenterol Hepatol Nutr. 2020
©AndyDarma Jan;23(1):1-14.
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 Prebiotics: new concepts
• Include non-carbohydrate substances
• Body sites other than gastrointestinal tract.
• Beneficial health effects must be documented

Gibson GR, Hutkins R, Sanders ME, Prescott SL, Reimer RA, Salminen SJ, Scott K,
Stanton C, Swanson KS, Cani PD, Verbeke K, Reid G. Expert consensus document:
The International Scientific Association for Probiotics and Prebiotics (ISAPP)
consensus statement on the definition and scope of prebiotics. Nat Rev
Gastroenterol Hepatol. 2017 Aug;14(8):491-502.

Miqdady M, Al Mistarihi J, Azaz A, Rawat D. Prebiotics in the Infant Microbiome:

The Past, Present, and Future. Pediatr Gastroenterol Hepatol Nutr. 2020
©AndyDarma Jan;23(1):1-14.
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 Common Prebiotics

GOS

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Miqdady M, Al Mistarihi J, Azaz A, Rawat D. Prebiotics in the Infant Microbiome: The Past, Present, and
16102023 Future. Pediatr Gastroenterol Hepatol Nutr. 2020 Jan;23(1):1-14.
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 Mechanism of Action And Health Benefits

©AndyDarma
Miqdady M, Al Mistarihi J, Azaz A, Rawat D. Prebiotics in the Infant Microbiome: The Past, Present, and
16102023 Future. Pediatr Gastroenterol Hepatol Nutr. 2020 Jan;23(1):1-14.
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 Prebiotics on Immunity

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 Prebiotics on Immunity
1. Indirect Effect
• Effect on Probiotics ➔ Immune System
• Short Chain Fatty Acid
2. Direct Effect
• Innate Immune System
• Intestinal Epithelial Cells

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 Prebiotics on Innate Immunity

Pujari R, Banerjee
G. Impact of
prebiotics on
immune response:
from the bench to
the clinic. Immunol
Cell Biol. 2021
Mar;99(3):255-273.
Effect of prebiotics on the innate immune response. The prebiotics can induce
direct or indirect effect on the gut-associated epithelial and immune cells
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 Prebiotics on GALT
1
3

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Pujari R, Banerjee
G. Impact of
prebiotics on
immune response:
from the bench to
the clinic. Immunol
Cell Biol. 2021
Mar;99(3):255-273.

1. Prebiotic fibers can act as decoy receptors for pathogens and cause elimination
2. Prebiotic fibers support the growth and activity of probiotic bacteria
©AndyDarma 3. Prebiotic fibers are fermented by the microbes to release SCFAs
16102023 4. SCFA also modulates the functionality of intestinal immune cells 21
 Prebiotics on Immune Cells

Pujari R, Banerjee
G. Impact of
prebiotics on
immune response:
from the bench to
the clinic. Immunol
Cell Biol. 2021
Mar;99(3):255-273.

Prebiotic oligosaccharides act as ligands to either TLR-2, TLR-4 or TLR-5 and

induce NF-jB, MAPK or ERK signaling pathways that leads to the secretion of pro-
©AndyDarma and anti-inflammatory cytokines.
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Prebiotics on Gut-Brain-Axis

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Probiotics based modulation
Liu X, Cao S, Zhang X. Modulation of Gut
Microbiota-Brain Axis by Probiotics, Prebiotics,
and Diet. J Agric Food Chem. 2015 Sep
16;63(36):7885-95

Probiotics modulate brain function by altering the

composition of gut microbiota or regulating
multiple signaling pathways including neural
pathways, immune pathways, and metabolic
pathways

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 Prebiotics based modulation
Liu X, Cao S, Zhang X. Modulation of Gut
Microbiota-Brain Axis by Probiotics,
Prebiotics, and Diet. J Agric Food Chem.
2015 Sep 16;63(36):7885-95

Prebiotics modulate brain function by altering

the composition of gut microbiota or
influencing the production of neurochemicals

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Prebiotics Health Benefit –
Clinical Studies

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 Macronutrients

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 Prebiotics in Human Milk
• > 250 components identified in 1 sample
• Extremely high structural diversity: 90% short chain, 10% long
chain
• Complex composition supports HMOs to be multi-functional
• Each HMO may have a special function
• Composition pending on: genetics (Lewis factor) -Epigenetics:Diet
• The added HMO’s are not HMO’s , they are MO’s

Miqdady M, Al Mistarihi J, Azaz A, Rawat D. Prebiotics in the Infant Microbiome:

©Miqdady The Past, Present, and Future. Pediatr Gastroenterol Hepatol Nutr. 2020
Nov2020 Jan;23(1):1-14. 31
Prebiotic - Sources

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 Prebiotics and Atopic Dermatitis – 6 mo
Moro G, Arslanoglu S, Stahl B, Jelinek J,
Wahn U, Boehm G.
A mixture of prebiotic oligosaccharides
reduces the incidence of atopic dermatitis
during the first six months of age.
Arch Dis Child. 2006 Oct;91(10):814-9.

Prebiotic : FOS/GOS
Placebo : Maltodextrin

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 Prebiotics and Immunomodulation – 6 months

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Arslanoglu S, Moro GE, Boehm G. Early supplementation of prebiotic oligosaccharides protects formula-fed infants
against infections during the first 6 months of life. J Nutr. 2007 Nov;137(11):2420-4. 34
 Prebiotics and Immunomodulation – 6 months

Arslanoglu S, Moro GE, Boehm G. Early supplementation of prebiotic oligosaccharides protects formula-fed infants
against infections during the first 6 months of life. J Nutr. 2007 Nov;137(11):2420-4. 35
 Prebiotics on Stool Characteristics

Moro G, Arslanoglu S, Stahl B, Jelinek J, Wahn U, Boehm G.

A mixture of prebiotic oligosaccharides reduces the incidence of atopic dermatitis during the first six months of age.
Arch Dis Child. 2006 Oct;91(10):814-9.
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Prebiotics on Regurgitation and Colic

Moro G, Arslanoglu S, Stahl B,

Jelinek J, Wahn U, Boehm G.
A mixture of prebiotic
oligosaccharides reduces the
incidence of atopic dermatitis
during the first six months of age.
Arch Dis Child. 2006
Oct;91(10):814-9.

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Prebiotics and Immunomodulation – 2 years

Arslanoglu S, Moro GE, Schmitt J, Tandoi L, Rizzardi S, Boehm G. Early dietary intervention with a mixture of
prebiotic oligosaccharides reduces the incidence of allergic manifestations and infections during the first two
years of life. J Nutr. 2008 Jun;138(6):1091-5.

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Prebiotics and Immunomodulation – 2 years

Arslanoglu S, Moro GE, Schmitt J, Tandoi L, Rizzardi S, Boehm G. Early dietary intervention with a mixture of
prebiotic oligosaccharides reduces the incidence of allergic manifestations and infections during the first two
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years of life. J Nutr. 2008 Jun;138(6):1091-5.
©Miqdady
Nov2020
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Take Home Messages
1. Dietary Fiber is important in Human Health
2. Not all Fibers are “Prebiotics”, but all “Prebiotic” are Fibers
3. Prebiotics have a wide health benefit, direct or indirectly via
Probiotics.
4. Prebiotics have the role in immune system, growth and
development.

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 Thank you

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