Dr.

MOTHER'S MILK IS BEST FOR THE BABY

• Breast-feeding is the best option for infants

• I support the WHO’s global public health recommendation calling for exclusive breast-feeding for
the first 6 months of life and adhere to the
 KEY ISSUES DURING INFANCY

Growth
Faltering

Poor
Immunity

Poor Brain
Development
INFANTS HAVE IMMATURE IMMUNE SYSTEM AT BIRTH

Immature Developing Mature

MOST COMMON ILLNESSES OBSERVED IN INFANCY

Fever Diarrhea Require

Antibiotics

Gastroenteritis May or May Not

Common Sore
Cold Throat
DISADVANTAGES OF ANTIBIOTIC USAGE

• Disrupts gut microflora

• Impairs diversity and stability of gut microflora
• May increase the risk of immune system diseases such as inflammatory
bowel disease, obesity, diabetes, asthma and allergies
• Gut microbiota may carry antibiotic resistant genes
 WHY IS THE
GUT SO
IMPORTANT?
GUT AND THE MICROBIOTA

Gut is body’s largest immune organ

and hosts about 70-80% of the
immune cell

Microbiota in the gut influences the

maturation and functional
development of intestinal immune
system

Gut plays a vital role in normal

immune function and maintenance of
health
A HEALTHY GUT MICROBIOTA IS LINKED TO
IMMUNE RESILIENCE
MICROBES PRESENT IN THE GUT AND
COLONIZATION PATTERN
 HOW CAN THE
GUT MICROBIOTA
BE MAINTAINED?
HOW CAN WE MAINTAIN THE GUT MICROBIOTA?
Providing food for
Adding newer
the healthy
healthy microbiota
microbiota
(Probiotics)
(Prebiotics)
NOT ALL CARBOHYDRATES ARE PREBIOTICS
NUTRITION IS CRUCIAL FOR IMMUNE AND
GUT DEVELOPMENT IN EARLY LIFE

The right nutrition

• Ensures healthy development and
establishment of a balanced gut
microbiota

• Positively influences and trains the

immune system
 The Gold
Standard

Breast milk is
the best for the
infant!
HUMAN MILK IS TAILORED* TO SUPPORT IMMUNE SYSTEM
THROUGH GUT FUNCTIONING AND DEVELOPMENT
DRY MATTER IN HUMAN MILK
Main components of human milk
include:
Lactose
Lipids
Prebiotic Oligosaccharides
Proteins
Bacteria
 OLIGOSACCHARIDES IN HUMAN MILK AND FORMULA MILK

 Oligosaccharides found in
breast milk have a
complex structure making
it difficult to replicate
them

 Formula milks have

always used breast milk as
inspiration
BLEND OF SHORT CHAIN GALACTOOLIGOSACCHARIDE (GOS):
LONG CHAIN FRUCTOOLIGOSACCHARIDE (FOS)

This specific mixture of scGOS : lcFOS (9:1) mimics size, linkage,

and prebiotic functions of oligosaccharides in breast milk.
MECHANISM OF ACTION GOS:FOS

GOS:FOS
Act as decoy
Direct Mechanism
receptors
Indirect Production of
mechanism SCFAs
 INDIRECT GOS:FOS MOA
Oligosaccharide mixture passes through stomach and intestine undigested

Lactobacilli and bifidobacteria metabolize OS in large intestine to produce SCFAs

SCFA promotes thicker mucus layer in the

Lower pH (acidic) in the intestine intestine

↑ growth of good ↓ growth of Stimulates bowel movement &

bacteria pathogenic bacteria ↑ water content of stools Prevents pathogens from
attaching to the intestinal lining
and entering the blood stream
Supports a good intestinal
environment

Promotes softer stools for easy Helps reduce the risk of infection
Supports the function of immune
bowel movement and diarrhea
system as a major component of
immune system lies in GI tract
BENEFICIAL ROLE OF
GOS:FOS :
CLINICAL EVIDENCE
 Trial 1
GOS:FOS SUPPLEMENTED FORMULA INCREASES
BIFIDOBACTERIA AND LACTOBACILLI
COUNTS IN INFANTS

Ref: G. Moro, I. Minoli, M. Mosca, S. Fanaro, J. Jelinek, B. Stahl, and G. Boehm. Dosage-related bifidogenic effects of galacto- and
fructooligosaccharides in formula-fed term infants. Journal of Pediatric Gastroenterology and Nutrition 2002;34:291-295
 Trial 2
GOS:FOS MIXTURE INCREASES THE
BIFIDOBACTERIAL COUNT SIMILAR TO THAT SEEN FOR
BREAST FED INFANTS

Ref: Jan Knol, Petra Scholtens, Corinna Kafka, Jochem Steenbakkers, Sabine Groß, Klaus Helm, Malte Klarczyk, Helmut Schopfer, Heinz-Michael Bockler, and John
Wells. Colon microflora in infants fed formula with galacto- and fructooligosaccharides: more like breast-fed infants. Journal of Pediatric Gastroenterology and
Nutrition 2005;40:36-42.
 Trial 3
GOS:FOS MIXTURE RESULTS IN
LOW STOOL pH AND HIGH ACETATE LEVELS
SIMILAR TO BREAST FED INFANTS
P<0.001 P<0.001

Ref: Jan Knol, Petra Scholtens, Corinna Kafka, Jochem Steenbakkers, Sabine Groß, Klaus Helm, Malte Klarczyk, Helmut Schopfer, Heinz-Michael Bockler, and John
Wells. Colon microflora in infants fed formula with galacto- and fructooligosaccharides: more like breast-fed infants. Journal of Pediatric Gastroenterology and
Nutrition 2005;40:36-42.
Trial 4
GOS:FOS MIXTURE PROMOTES
SOFTER STOOLS
IN INFANTS

Ref: G. Moro, I. Minoli, M. Mosca, S. Fanaro, J. Jelinek, B. Stahl, and G. Boehm. Dosage-related bifidogenic effects of galacto- and fructooligosaccharides in
formula-fed term infants. Journal of Pediatric Gastroenterology and Nutrition 2002;34:291-295
Trial 5
INFANTS FED GOS:FOS SUPPLEMENTED FORMULA
SHOWED
LOWER EPISODES OF GASTROENTERITIS

P = 0.01
P = 0.01

No. of infants with atleast one % of children with

episode of acute diarrhea acute diarrhea

Ref: Eugenia Bruzzese, Monica Volpicelli, Veronica Squeglia, Dario Bruzzese, Filippo Salvini, Massimo Bisceglia, Paolo Lionetti, Mario Cinquetti, Giuseppe Iacono, Sergio Amarri, Alfredo Guarino. A
formula containing galacto- and fructo-oligosaccharides prevents intestinal and extra-intestinal infections. Clinical Nutrition 2009;28:156-161
 Trial 6
GOS:FOS SUPPLEMENTED FORMULA SHOW
HIGHER FECAL SIgA RESPONSE
AS COMPARED TO CONTROL FORMULA

Ref: Petra A. M. J. Scholtens, Philippe Alliet, Marc Raes, Martine S. Alles, Hilde Kroes, Guenther Boehm, Leon M. J. Knippels, Jan Knol, and Yvan Vandenplas. Fecal secretory immunoglobulin A is increased
in healthy infants who receive a formula with short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides. Journal of Nutrition 2008;138:1141-1147
Trial 7
INFANTS FED GOS:FOS SUPPLEMENTED FORMULA HAD
LOWER INCIDENCE OF INFECTION IN THE FIRST 6 mo
OF LIFE
P<0.05

P<0.01
P<0.05

Ref: Sertac Arslanoglu, Guido E. Moro, and Gunther Boehm. Early supplementation of prebiotic oligosaccharides protects formula-fed infants against infections
during the first 6 months of life. Journal of Nutrition 2007;137:2420-2424
 Trial 8
GOS:FOS SUPPLEMENTED FORMULA
REDUCED ANTIBIOTIC REQUIREMENT
IN AN INFANT

Mean rate of antibiotic

prescription was
significantly lower in
GOS/FOS group as
compared to the control
group (p = 0.038)

Ref: Arslanoglu et al (2008). Early Dietary Intervention with a Mixture of Prebiotic Oligosaccharides Reduces the Incidence of Allergic Manifestations and Infections
during the First Two Years of Life. The Journal of Nutrition; 138: 1091–1095
 KEY TAKE-AWAY

1. scGOS : lcFOS in the ratio of 9:1 mimic

about 100 oligosaccharide structure
found in breast milk
2. It promotes immunity through gut
3. Increases Bifidobacterium and
Lactobacilli counts
4. Reduces the incidence of URTI,
diarrhea and other infection in infants
5. Reduces the overall antibiotic usage
in infants
 ROLE OF DHA IN INFANTS

• Optimizes fluidity of photoreceptor membranes1

Supports
Eye Health
• Improves retinal integrity1

• Promotes visual function1

• Boosts cognitive development2

Supports
• Enhances physical growth2 Physical Development

Ref - 1. Querques G., Forte R., et al. Retina and Omega-3. J Nutr Metab. 2011; 2011: 748361. • 2. Birch, E. E., Carlson, S. E., The DIAMOND (DHA Intake and Measurement of Neural Development) Study: A double
masked, randomized controlled clinical trial of the maturation of infant visual acuity as a function of the dietary level of docosahexaenoic acid. American Journal of Clinical Nutrition, 91(4), 848–859. :
 0.32% DHA OF TOTAL FATTY ACID

• 0.32% is an appropriate reference point for fortification of infant formulas 1

• Worldwide average of breast milk DHA is 0.32% 2

• Meta-analysis of RCTs - trials that used doses <0.32% of DHA showed a non-significant effect on
visual acuity3

• According to ESPGHAN RECOMMENDED STANDARDS FOR THE COMPOSITION OF

INFANT FORMULA: The concentrations of DHA and AA should be almost similar and closer to
breast milk 4

Ref:1. Lien EL., Richard C., et al. DHA and ARA addition to infant formula: Current status and future research directions. Prostaglandins, Leukotrienes and Essential Fatty Acids 128 (2018) 26–40. • 2. Brenna JT.,
Varamini B., et al. Docosahexaenoic and arachidonic acid concentrations in human breast milk worldwide. Am J Clin Nutr 2007;85:1457– 64. • 3. Qawasmi A., Landeros-Weisenberger A., et al. Meta-analysis of
LCPUFA Supplementation of Infant Formula and Visual Acuity. Pediatrics. 2013 Jan; 131(1): e262–e272 4. Koletzko B, Baker S, Cleghorn G, Neto UF, Gopalan S et al. "Global standard for the composition of infant
formula: recommendations of an ESPGHAN coordinated international expert group." J Pediatr Gastroenterol Nutr. 2005;41(5):584-99.
 PRETERM INFANTS HAVE A POOR IMMUNE SYSTEM
WHY?

Due early birth and Use of medical The bacterial colonization

incomplete intrauterine
growth preterm infants
are born with an
immature innate
immune system.
intervention post birth
interferes with body’s
protective mucosal and
epithelial barriers leading
to an increased
vulnerability to infections
patterns of preterm and
term infants is very different
and is disrupted frequently
due to the usage of
antibiotics leading to
intestinal dysbacteriosis.

Early gut microbiome dysbiosis is one of the major contributing factor to the
development of Necrotizing enterocolitis (NEC).
 A META-ANALYSIS OF 18 RCTS INVOLVING 1322 PRETERM INFANTS
REPORTED THE FOLLOWING BENEFITS OF PREBIOTIC
SUPPLEMENTATION:

1. Reduction in the incidence

of sepsis (p<0.001)
2. Reduction in mortality
(p<0.001)
3. Reduction in the length of
hospital stay (p=0.007)
4. Reduction in the time
taken to full enteral feeds
(p<0.001)
Ref: Chi et al (2019). Effects of prebiotics on sepsis, necrotizing enterocolitis, mortality, feeding intolerance, time to full enteral feeding, length of hospital stay, and stool frequency in preterm infants: a meta-analysis.
European Journal of Clinical Nutrition; 73:657–670
 BENEFICIAL EFFECTS OF GOS:FOS

1. Higher colony counts of bifidobacteria

2. Reduction in the number of

pathogenic organisms

3. Better stool consistency (softer and

frequent stools)

4. Higher stool pH

5. Accelerated GI transport

Ref: Srinivasjois et al (2013). Prebiotic supplementation in preterm neonates: Updated systematic review and meta-analysis of randomised controlled trials. Clinical Nutrition; 32 958-965
 GOS:FOS ADDITION TO PRETERM FORMULA
INCREASES BIFIDOBACTERIUM COUNTS & PROMOTES SOFTER
STOOLS

P = 0.0008

Ref: Boehm, G., Lidestri, M., Casetta, P. et al. (2002). Supplementation of a bovine milk formula with an oligosaccharide mixture increases counts of faecal Bifidobacteria in preterm infants. Arch Dis Child
Fetal Neonatal Ed, 86: F178–181
 Trial 2

GOS:FOS SUPPLEMENTED FORMULA HELPS REDUCE

STOOL VISCOSITY IN PRETERM INFANTS

Ref: Mihatsh et al Acta Pædiatrica, 2006; 95: 843848

 GOS:FOS SUPPLEMENTED PRETERM FORMULA
Trial 3 IMPROVES GUT MOTILITY & STOOL FREQUENCY

Significantly increases
motilin secretion in the
as compared to control
group (p=0.001)

Proportion of neonates
with more frequent
stools was 72.5% in the
control group and 91.1%
in the intervention group
(p = 0.002)

Ref: Dasopoulou et al (2015), Journal of Parenteral and Enteral Nutrition, 39(3):359-368

 KEY TAKE-AWAY

1. scGOS : lcFOS in the ratio of 9:1 mimic about 100 oligosaccharide

structure found in breast milk
2. Promotes Bifidobacterium counts
3. Improves gut motility and time required to reach full feeds
4. Promotes softer stools
 LEAVING THOUGHTS..

DIFFERENCE BETWEEN
PREBIOTICS AND PROBIOTICS

Prebiotics
Nondigestible dietary fibres that
stimulate the growth of healthy
bacteria in the colon.
e.g. Fructooligosaccharides,
Galactooligosaccharides
Probiotics
Live microorganisms that, when
administered in adequate amounts,
confer a health benefit to the host.
e.g. Lactobacilli, Bifidobacteria
TO SUMMARIZE

Power
of
DHA