Advances in infant nutrition: In search of a gut friendly formula

As well as containing antibodies that protect against infection it provides baby with all the nutrients they need for the first six months, is naturally sterile and is always at the right temperature. Another reason that breastmilk is important is that it promotes good digestion.

It contains complex carbohydrates known as prebiotic oligosaccharides. These prebiotic oligosaccharides cannot be digested in the upper gastrointestinal tract, allowing them to pass into the colon where they fuel the growth of gut-friendly bacteria such as lactobacilli and bifidobacteria¹.

The presence of these friendly bacteria stimulates the immune system, helps metabolise dietary residues and inhibits the growth of unfriendly bacteria such as E. Coli, Clostridia and Eubacteria².

While bottle-fed babies tend to develop a diverse gut micro-flora, breastfed babies typically have a gut microflora dominated by bifidobacteria and lactobacilli.

They suffer from fewer infections³, allergies and other immune-mediated diseases⁴ and their stools also appear to be softer and more frequent than those of bottle-fed infants. Indeed, stool consistency is one of the most common reasons for bottle-feeding mothers to seek professional advice on their baby’s diet⁵.

Helping women make an informed choice

Offering advice and information on the benefits of breastfeeding is a key part of the Midwife’s role in helping women make an informed choice about feeding their new baby.

Advice can also be offered to those mothers who cannot or have chosen not to breastfeed. A good source of information for this is the UNICEF Baby Friendly Initiative (BFI) which has published a care pathway for women who choose to bottle feed⁶. This explains the importance of showing women how to make up a feed safely, sterilise equipment and choose the appropriate milk for their newborn baby.

Choosing a formula milk

Formula milks vary in terms of nutritional value. So it is important for Midwives to be aware of the nutritional content of the various formula milks that are available.

Nutritional factors to consider include the carbohydrate and protein content; the ratio of calcium to phosphorus; and the presence of nucleotides and long chain polyunsaturated fatty acids (LCPs). The formula should also support the child’s digestive system, and this is one of the areas where formulas differ.

Innovation offers health benefits

The addition of a patented blend of galacto- and fructooligosaccharides (GOS/FOS) to formula feeds has been an exciting development for health professionals who offer advice to new mothers.

The GOS/FOS blend has been shown to increase friendly bacteria in the gut^7-12, and to inhibit the growth of pathogens^13,14. It has also been shown to improve both stool consistency and frequency⁹. Other clinically proven health benefits include:

• Reduced episodes of infection^13,15
• Reduced upper respiratory tract infections (URTI)¹³
• Reduced incidence of diarrhoea¹³
• Reduced need for antibiotics^13,15

While no formula feed can ever replace the full benefits of breast milk, the addition of GOS/FOS to formula feeds will help to advance the nutrition of bottle-fed babies.

Innovations such as this mean that it is now possible to ensure formula-fed babies receive the benefits of prebiotic oligosaccharides. Midwives supporting women who choose not to breastfeed can be confident that the advice they give is helping mothers make fully informed choices on what is best for their baby.


References:
1. McVeagh P, Miller JB. Human milk oligosaccharides: only the breast. J Paediatr Child Health 1997;33:281-6.
2. Orrhage K, Nord CE. Bifidobacteria and lactobacilli in human health. Drugs Exp Clin Res 2000;26:95-111.
3. Howie PW et al. Protective effect of breastfeeding against infection. BMJ
1990;300:11-16.
4. van Odijk J et al. Breastfeeding and allergic disease: a multidisciplinary review of the literature (1966-2001) on the mode of early feeding in infancy and its impact on later atopic manifestations. Allergy 2003;58:833-43.
5. Morley R. Infant feeding and maternal concerns about stool hardness. Child care and development 1997;23:475-8.
6. UNICEF. Bottle feeding: A mother’s journey [Online]. Available at: http://live.
unicef.org.uk/BabyFriendly/Health-Professionals/Care-Pathways/Bottle_feeding/ [Accessed September 2011].
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8. Boehm G et al. Supplementation of an oligosaccharide mixture to a bovine milk formula increases counts of faecal bifidobacteria in preterm infants. Arch Dis Child 2002;86:F178-81.
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10. Schmelzle H et al. Randomised double-blind study of the nutritional efficacy and bifidogenicity of a new infant formula containing partially hydrolyzed protein, a high ß-palmitic acid level, and non digestible oligosaccharides. J Pediatr Gastroenterol Nutr 2003;36:343-51.
11. Rinne M et al. Similar bifidogenic effects of prebiotic-supplemented partially hydrolyzed infant formula and breastfeeding on infant gut microbiota. FEMS Immunol Med Microbial 2005;43:59-65.
12. Knol et al. An infant formula containing prebiotics changes the intestinal
microbiota of term infants. J Pediatr Gastroenterol Nutr 2003;36:566.
13. Bruzzese E et al. A formula containing galacto- and fructo-oligosaccharides
prevents intestinal and extra-intestinal infections: an observational study. Clinical Nutrition 2009;28:156-61.
14. van Limpt C et al. Effect of colonic short chain fatty acids, lactate and pH on the growth of common pathogens. Pediatr Res 2004;56:487.
15. Arslanoglu S et al. Early dietary intervention with a mixture of prebiotic
oligosaccharides reduces the incidence of allergic manifestations and infections during the first 2 years of life. J Nutr 2008;138:1091-5.