The role of probiotics, prebiotics, and human milk oligosaccharides in infant formulae

Background: Addition of probiotics to infant formula may positively affect immune function in non-exclusively breastfed infants. This study aimed to investigate the effect of infant starter formula containing the probiotic Bifidobacterium animalis subspecies lactis (B. lactis) on intestinal immunity and inflammation. Methods: Six-week-old healthy, full-term infants (n=172) were enrolled in a prospective, randomized, double-blind, controlled clinical trial with 2 groups studied in parallel to a breastfed comparison group. Formula-fed (FF) infants were randomized to partially hydrolyzed whey formula (CON), or the same formula containing 10 6 CFU B. lactis/g (PRO) for 6 weeks. Fecal secretory IgA (sIgA), calprotectin, lactate, and stool pH were assessed at baseline, 2, and 6 weeks. Anti-poliovirus-specific IgA and anti-rotavirus-specific IgA were assessed at 2 and 6 weeks. Results: Among vaginally-delivered FF infants, PRO consumption increased (p<0.05) fecal sIgA, compared to CON. Anti-poliovirus-specific IgA concentration increased (p<0.05) in all infants consuming PRO; whereas anti-rotavirus-specific IgA tended to increase (p=0.056) with PRO consumption in cesarean-delivered infants. Anthropometrics and tolerance did not differ significantly between FF infants. Conclusions: Infants consuming formula with B. lactis produced feces with detectable presence of B. lactis 1 The final, definitive version of this paper has been published in the Journal of Parenteral and Enteral Nutrition, 36, Supplement 1, January 2012 by SAGE Publications, Inc., All rights reserved. © 2012 A.S. P.E. N. Holscher, H.D. , Czerkies, L.A. , Cekola, P., Litov, R. , Benbow, M. , Santema, S. , Alexander, D.D. , Perez, V. , Sun, S. & Saavedra, J.M. , & Tappenden, K.A. 2012a, "Bifidobacterium lactis Bb12 Enhances Intestinal Antibody Response in FormulaFed Infants", Journal of Parenteral and Enteral Nutrition, vol. 36, no. 1 suppl, pp. 106S-117S. DOI: 10.1177/0148607111430817 33 and augmented sIgA concentration. Further, cesarean-delivered infants consuming B. lactis had heightened immune response, as evidenced by increased anti-rotavirusand anti-poliovirusspecific IgA following immunization. These results demonstrate that negative immune-related effects of not breast feeding and cesarean delivery can be mitigated by including Bb12 in infant formula and thereby providing infants a safe, dietary, immune-modulating bacterial introduction. CLINICAL RELEVANCY STATEMENT Breast milk, the ideal source of nutrition for infants, is also a source of secretory immunoglobulin (Ig) A, as well as bacteria, which enhance both passive and active infant immunity. These benefits are not provided by routine use infant formula. The addition of probiotics to infant formula is reported to increase fecal secretory IgA. This study demonstrates that supplementation of infant formula with Bifidobacterium animalis subspecies lactis (B. lactis) results in detectable fecal levels of B. lactis and increased concentrations of secretory-, anti-rotavirus-specific, and anti-poliovirus-specific IgA. Therefore, including B. lactis in infant formula provides infants a safe, dietary, immune-modulating bacterial experience.