Abstract
The authors reviewed the published evidence on the presence of oligosaccharides in human milk (HMO) and their benefits in in vitro and in vivo studies. The still limited data of trials evaluating the effect of mainly 2′-fucosyllactose (2′-FL) on the addition of some of HMOs to infant formula were also reviewed. PubMed was searched from January 1990 to April 2018. The amount of HMOs in mother’s milk is a dynamic process as it changes over time. Many factors, such as duration of lactation, environmental, and genetic factors, influence the amount of HMOs. HMOs may support immune function development and provide protection against infectious diseases directly through the interaction of the gut epithelial cells or indirectly through the modulation of the gut microbiota, including the stimulation of the bifidobacteria. The limited clinical data suggest that the addition of HMOs to infant formula seems to be safe and well tolerated, inducing a normal growth and suggesting a trend towards health benefits. HMOs are one of the major differences between cow’s milk and human milk, and available evidence indicates that these components do have a health promoting benefit. The addition of one or two of these components to infant formula is safe, and brings infant formula closer to human milk. More prospective, randomized trials in infants are need to evaluate the clinical benefit of supplementing infant formula with HMOs.
Highlights
Breast milk is the natural and ideal food for infants, providing the energy and nutrients that every infant needs during the first four to six months of life in the correct quality and amount
Authority (EFSA), based on the scientific and technical information provided, concluded that 20 -fucosyllactose (20 -FL) is safe for infants up to one year of age when added to infant and follow-on formulae, in combination with LNnT, at concentrations up to 1.2 gram per liter (g/L) of 20 -FL and up to 0.6 g/L of LNnT, at a ratio of 2:1 in the reconstituted formulae. 20 -FL is safe for young children when added to follow-on and young-child formulae, at concentrations up to 1.2 g/L of 20 -FL (EFSA-Q-2015-00052, EFSA Journal 2015)
These findings indicate that supplementation of infant formula with 20 -FL supports aspects of immune development and regulation similar to that of breastfed infants; while supplementation with galacto-oligosachairdes alone does not [73]
Summary
Breast milk is the natural and ideal food for infants, providing the energy and nutrients that every infant needs during the first four to six months of life in the correct quality and amount. HMOs are non-digestible carbohydrates [6] They have little nutritional value for the infant, HMOs are the third largest solid component in human milk after lactose and lipids [7,8]. Oligosaccharide concentrations in the milk of farm animals, such as cows, goats, and sheep are 100–1000-fold lower. These unique complex carbohydrate structures in human milk are virtually absent in cow’s milk or any other farmed animal milk, and their variety is much lower [10]. The difference in oligosaccharide content on human milk and cow milk, and, cow milk-based infant formula, is likely to explain, at least in part, the differences in health outcomes between formula and breastfed infants
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