Abstract
Breastfeeding is the best source of nutrition during infancy and is associated with a broad range of health benefits. However, there remains a significant and persistent need for innovations in infant formula that will allow infants to access a wider spectrum of benefits available to breastfed infants. The addition of human milk oligosaccharides (HMOs) to infant formulas represents the most significant innovation in infant nutrition in recent years. Although not a direct source of calories in milk, HMOs serve as potent prebiotics, versatile anti-infective agents, and key support for neurocognitive development. Continuing improvements in food science will facilitate production of a wide range of HMO structures in the years to come. In this review, we evaluate the relationship between HMO structure and functional benefits. We propose that infant formula fortification strategies should aim to recapitulate a broad range of benefits to support digestive health, immunity, and cognitive development associated with HMOs in breastmilk. We conclude that acetylated, fucosylated, and sialylated HMOs likely confer important health benefits through multiple complementary mechanisms of action.
Highlights
IntroductionDecades of scientific evidence demonstrates that breastfeeding provides the best source of nutrition for infants
There may be sufficient tolerance and redundancy that has evolved within the mother–infant feeding dynamic such that as long as a diverse pool of human milk oligosaccharides (HMOs) structures are present in the diet, a stable microbial and immunological phenotype is likely to develop in early life
Perhaps the best example of the potential of HMOs as systemic immune mediators comes from studies examining the use of HMOs as therapeutic nutrients in models of necrotizing enterocolitis
Summary
Decades of scientific evidence demonstrates that breastfeeding provides the best source of nutrition for infants. Breastfed infants generally exhibit improved cognitive development and may score higher in standardized testing during childhood in comparison to formula-fed infants [7]. These benefits extend well into adulthood, with individuals who were breastfed as infants having generally lower rates of metabolic syndrome and inflammatory disease [5,6]. The addition of human milk oligosaccharides (HMO), structurally and functionally identical to those occurring naturally in human breast milk, represents the most significant innovation in infant formula technology of the past decade. We summarize the scientific literature demonstrating that these HMOs serve critical functions in supporting the developing immune system, promoting digestive health and development of the gut microbiome, and supporting cognitive function
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