Infant nutrition expert Prof. Szajewska: Why HMOs are essential in Infant Health
By: Talking Nutrition Editors
Professor Hania Szajewska, MD presented a thorough overview of HMOs and their role in infant nutrition
- DSM sponsored a webinar with the world-renowned scientist and physician – Prof. Hania Szajewska. Professor Szajewska provided an evidence based approach to describe how HMOs can impact infant health.
- Prof. Szajewska summarized how the structure of an HMO dictates its function in the body, as well as the growing evidence that highlights the potential benefits of HMOs in infant nutrition.
- Information presented in this webinar is particularly relevant to managers in sales, marketing, innovation, R&D, or business development, as well as academic researchers interested in the latest on HMOs in infant health.
HMOs: Why all the interest?
Prof. Hania Szajewska recently presented an intriguing webinar on Human Milk Oligosaccharides (HMOs) that described what they are and what the research tells us about their role in the infant diet, which was followed by a Q&A with Prof. Szajewska and Dr. Louise Vigsnæs, Head of HMO Biology at DSM.
Prof. Szajewska described why there is such a high level of interest in HMOs. Advances in HMO analytics and biotechnology now make it possible to manufacture HMOs. In addition, there are regulatory approvals for the use of certain HMOs in infant, follow-on, and young child formulas from authorities such as the European Commission and the United States Food and Drug Administration (FDA). She noted that currently, the HMOs 2’FL (2 -Fucosyllactose) and Lacto-N-Neotetraose (LNnT) are approved for use, however other HMOs are being evaluated and will soon receive approval. In addition, during the Q&A it was acknowledged that both parents and clinicians have an increasing awareness of HMOs.
The presentation focused on three main points:
- HMOs are complex carbohydrates that are abundant in breastmilk.
- Specific HMOs in breastmilk and formula may contribute to health outcomes in infancy and beyond.
- Clinical research has determined that HMOs are safe and well-tolerated in infant formula. Future studies are needed to help us gain a further understanding of the additional functional benefits HMOs could provide.
HMOs Structure Impacts Function
Around 200 different HMOs have been identified, with their unique structures being associated with their functions. As Prof. Szajewska explained, the basic structure of all HMOs begins with various combinations of 5 different monosaccharide building blocks and these structures always contain lactose. Interestingly, Dr. Vigsanaes noted in the Q&A that although HMOs contain lactose, they do not appear to cause issues for individuals with lactose intolerance based on a study in adults with irritable bowel syndrome (IBS).1 HMOs are created via a process of structural elongation and branching of the lactose molecule, followed often by fucosylation or sialyation. These HMOs fall within three main categories based on their structure - fucosylated, sialylated, and non-fucosylated neutral HMOs. Differences in these groups, and even in individual HMOs within the groups, determines how they function in the body and what health outcomes they might affect. Prof. Szajewska stated that while bovine milk does contain some milk oligosaccharides, they are at much lower levels and far less diverse structurally. Thus, we should not assume that HMOs and bovine oligosaccharides have equal functionality.
Just as our fingerprints are unique, each mother produces a unique HMO profile and that profile varies over time. Factors that may influence her HMO profile include genetics, lactation status (early versus later lactation), and potentially, time of delivery (term versus preterm), maternal diet, infant gender, and maternal microbiota. Prof. Szajewska noted research in these areas is sometimes conflicting due to the lack of a standardized methodology for HMO assessment. During the Q&A, Dr. Vigsnæs agreed that while different institutions measure HMOs differently, most consistently find that the type and amount of HMOs vary over the course of lactation.
The State of HMO Research
Preclinical and Observational Research
Prof. Szajewska stated that we are at the beginning of a “fascinating journey” in HMO research.
As a clinician, Prof. Szajewska noted that her interest in HMOs is centered around the growing body of research in infants and children. However, she acknowledged the importance of preclinical work in understanding HMO mechanisms of action and informing potential benefits for HMOs in humans.
HMOs have been well-researched for their function as a prebiotic, promoting the growth of bifidobacteria and other potentially beneficial gut microbes. Other areas of investigation include their potential for antiadhesive/antimicrobial effects, modulation of intestinal epithelial cell surfaces, which serve to restrict pathogen adhesion, and immune cell regulation.2 Observational research on HMOs in breastmilk is motivating further study to better understand how they might impact other areas including gastrointestinal health, the immune system, and brain health and development.3-7 During the Q&A, Dr. Vigsnæs noted that an observational study has found sialic acid8 at higher levels in the brains of infants fed breastmilk compared to formula. Studies in neonatal piglets show that dietary 3´Sialyllactose Sodium Salt (3’SL) and 6´Sialyllactose Sodium Salt (6’SL) contribute to the sialic acid content of the brain, suggesting these HMOs may play a role in cognition and brain development.9
Certain HMOs, including 2’FL and LNnT, are currently included in infant formulas based on research demonstrating that these formulas are both safe and supportive of normal growth.9-11 Prof. Szajewska reviewed potential benefits associated with infant formulas supplemented with these HMOs, such as helping shift the microbiota of formula-fed infants closer to that of breastfed infants, immune benefits, and reduced respiratory illness and antibiotic use (based on parent reports).10-13 She emphasized the need for evidence-based strategies that reduce the over prescription of antibiotics in infants, as antibiotic use in early life has been associated with later allergy and obesity.14-16 She noted that future studies are needed to further explore potential benefits of infant formulas with HMOs, yet existing data are encouraging.
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- Palsson OS, Peery A, Seitzberg D, Amundsen ID, McConnell B, Simrén M. 467 Human Milk Oligosaccharides Improve All the Central Symptoms of Irritable Bowel Syndrome: A Multi-Center, Open Label Trial. Official journal of the American College of Gastroenterology | ACG. 2019;114:S272-S273. doi:10.14309/01.ajg.0000591400.15886.60
- Bode L, Kuhn L, Kim HY, et al. Human milk oligosaccharide concentration and risk of postnatal transmission of HIV through breastfeeding. Am J Clin Nutr. Oct 2012;96(4):831-9. doi:10.3945/ajcn.112.039503
- Morrow AL, Ruiz-Palacios GM, Jiang X, Newburg DS. Human-milk glycans that inhibit pathogen binding protect breast-feeding infants against infectious diarrhea. J Nutr. May 2005;135(5):1304-7. doi:10.1093/jn/135.5.1304
- Wejryd E, Martí M, Marchini G, et al. Low diversity of human milk oligosaccharides is associated with necrotising enterocolitis in extremely low birth weight infants. Nutrients. 2018;10(10)doi:10.3390/nu10101556
- Sprenger N, Odenwald H, Kukkonen A, Kuitunen M, Savilahti E, Kunz C. FUT2-dependent breast milk oligosaccharides and allergy at 2 and 5 years of age in infants with high hereditary allergy risk. European Journal of Nutrition. 2017;56(3):1293-1301. doi:10.1007/s00394-016-1180-6
- Lodge CJ, Lowe AJ, Milanzi E, et al. Human milk oligosaccharide profiles and allergic disease up to 18 years. J Allergy Clin Immunol. Jul 7 2020;doi:10.1016/j.jaci.2020.06.027
- Berger PK, Plows JF, Jones RB, et al. Human milk oligosaccharide 2’-fucosyllactose links feedings at 1 month to cognitive development at 24 months in infants of normal and overweight mothers. PLoS ONE. 2020;15(2)doi:10.1371/journal.pone.0228323
- Mudd AT, Fleming SA, Labhart B, Chichlowski M, Berg BM, Donovan SM, Dilger RN.Nutrients. 2017 Nov 28;9(12):1297. doi: 10.3390/nu9121297
- Wang B, McVeagh P, Petocz P, Brand-Miller J. Brain ganglioside and glycoprotein sialic acid in breastfed compared with formula-fed infants. The American Journal of Clinical Nutrition. 2003;78(5):1024-1029. doi:10.1093/ajcn/78.5.1024
- Storm HM, Shepard J, Czerkies LM, et al. 2'-Fucosyllactose Is Well Tolerated in a 100% Whey, Partially Hydrolyzed Infant Formula With Bifidobacterium lactis: A Randomized Controlled Trial. Glob Pediatr Health. 2019;6:2333794x19833995. doi:10.1177/2333794x19833995
- Puccio G, Alliet P, Cajozzo C, et al. Effects of Infant Formula With Human Milk Oligosaccharides on Growth and Morbidity: A Randomized Multicenter Trial. J Pediatr Gastroenterol Nutr. Apr 2017;64(4):624-631. doi:10.1097/mpg.0000000000001520
- Marriage BJ, Buck RH, Goehring KC, Oliver JS, Williams JA. Infants Fed a Lower Calorie Formula with 2 ′ FL Show Growth and 2 ′ FL Uptake Like Breast-Fed Infants. Journal of Pediatric Gastroenterology and Nutrition. 2015;61(6):649-658. doi:10.1097/MPG.0000000000000889
- Goehring KC, Marriage BJ, Oliver JS, Wilder JA, Barrett EG, Buck RH. Similar to Those Who Are Breastfed, Infants Fed a Formula Containing 2'-Fucosyllactose Have Lower Inflammatory Cytokines in a Randomized Controlled Trial. J Nutr. Dec 2016;146(12):2559-2566. doi:10.3945/jn.116.236919
- Chelimo C, Camargo CA, Jr, Morton SMB, Grant CC. Association of Repeated Antibiotic Exposure Up to Age 4 Years With Body Mass at Age 4.5 Years. JAMA Network Open. 2020;3(1):e1917577-e1917577. doi:10.1001/jamanetworkopen.2019.17577
- Leong KSW, McLay J, Derraik JGB, et al. Associations of Prenatal and Childhood Antibiotic Exposure With Obesity at Age 4 Years. JAMA Network Open. 2020;3(1):e1919681-e1919681. doi:10.1001/jamanetworkopen.2019.19681
- Zou Z, Liu W, Huang C, Sun C, Zhang J. First-Year Antibiotics Exposure in Relation to Childhood Asthma, Allergies, and Airway Illnesses. Int J Environ Res Public Health. Aug 7 2020;17(16)doi:10.3390/ijerph17165700
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