Prebiotic infant formula aids gut, immunity

The prebiotics studied in this review is a mixture of 90 per cent short-chain galacto-oligosaccharides (scGOS) and 10 per cent long-chain fructo-oligosaccharides (lcF0S).

The nine to one ratio of scGOS and lcF0S is of importance as it is designed to make the infant formula more closely resemble human milk.

The systematic review and meta-analysis were conducted by researchers from the University of Indonesia, Dr. Soetomo General Academic Hospital, Danone Specialized Nutrition, Indonesia, and University of Pelita Harapan.

Findings were published in the journal Pediatric Gastroenteology, Hepatology and Nutrition.

The researchers found a total of 18 clinical trials that studied the effects of scGOS and lcFOS used in the ratio of nine to one for the systematic review, while 11 of these publications were included in the meta-analysis.

Most of these trials (10) used the prebiotics blend in the concentration of 0.8g/dL, while five of them used prebiotics in the concentration of 0.6g/dL, and four at 0.4g/dL.

Effects of the prebiotic blend on gut and immune health were measured based on stool consistency, frequency, pH, and the concentrations faecal short-chain fatty acids, lactate.

The researchers also assessed the effects of prebiotic infant formulas on the babies immune system by assessing the presence of various immune parameters in the blood, such as cytokines and c-reactive protein.

Gut environment resembling breastfed infants

Findings showed significantly higher levels of Bifidobacteria or Lactobacilli in infants who took formulas containing the prebiotic blend in most of the trials – except for two which showed non-significant differences between the prebiotic and control groups.

Bifidobacteria and Lactobacilli are both beneficial bacteria and in particular, Bifidobacteria is the main bacteria colonising the gut of healthy infants.

However, they tend to be less prevalent in the gut microbiota of formula-fed infants as compared to breast-fed infants – which is why it is noteworthy to mention that the prebiotic blend has raised the levels of Bifidobacteria in formula-fed infants significantly in most of the trials studied in this review.

Aside from colonising the gut with good bacteria, prebiotic enriched formulas also helped to lower stool pH.

One of the trials by G Moro et al., in particular, showed that the prebiotic blend when consumed at a concentration of 0.8g/dL, was more effective than the concentration of 0.4g/dL in lowering stool pH.

This was further confirmed by the meta-analysis that the researchers have conducted, which showed a significant difference in mean pH between the groups taking prebiotic-enriched formulas and the standard formula.

In particular, infants who took prebiotic-enriched formulas had a stool pH that was on average 0.75 lower than the control group.

A lower stool pH is of interest as this is one of the features which resembles the gut environment of healthy breastfed infants.

Another point to take note is a reduction in pathogenic bacteria, such as Clostridium species and E. coli, in infants who took the prebiotic-enriched formulas.

A significant reduction in pathogenic bacteria was reported by Scholtens PA et al. in 2008, which showed that the percentages of the pathogen Clostridium spp. were 0.0 in the prebiotic group and 3.27 per cent in control group.

“Other gastrointestinal benefits of GOS/FOS supplementation that were consistently observed in this review included higher stool frequency, softer stool, and lower stool pH.

“As these characteristics were also found among exclusively breastfed infants, these findings reinforce the notion that a mixture of scGOS/lcFOS (9:1) mimics the molecular size and distribution of human milk oligosaccharides in human milk,” said the researchers.

Effects on immune health

In terms of immune health, prebiotic enriched formulas have significantly increased the concentrations of faecal immunoglobulin A (IgA) – an antibody blood protein that plays a role in fighting infections.

Notably, the increase in the antibody was only observed in stools, and not in the serum concentration.

This suggests that “supplementation with GOS/FOS appeared to directly improve mucosal immunity but not systemic immunity, as its administration would modulate the gut microbiome,” said the researchers.

Source: Pediatric Gastroenteology, Hepatology and Nutrition

Gastrointestinal Health and Immunity of Milk Formula Supplemented with a Prebiotic Mixture of Short-Chain Galacto-oligosaccharides and Long-Chain Fructo-Oligosaccharides (9:1) in Healthy Infants and Toddlers: A Systematic Review with Meta-Analysis

DOI: 10.5223/pghn.2025.28.1.1

Authors: Kadim M, Darma A, Kartjito MS, Dilantika C, Basrowi RW, Sungono V, Jo J.