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The effect of enteral supplementation of a prebiotic mixture of neutral and acidic oligosaccharides on immunoglobulin free light chains in preterm infants

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Conference Journal of Pediatric Gastroenterology and Nutrition
Year 2011
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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The effect of enteral supplementation of a prebiotic mixture of non-human milk galacto-, fructo- and acidic oligosaccharides on intestinal permeability in preterm infants.

Journal The British journal of nutrition
Year 2011
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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Preterm infants have an impaired gut barrier function. We aimed to determine the effects of enteral supplementation of a prebiotic mixture consisting of neutral oligosaccharides (short-chain galacto-oligosaccharides (SCGOS)/long-chain fructo-oligosaccharides (LCFOS)) and acidic oligosaccharides (AOS) on intestinal permeability of preterm infants as measured by the sugar absorption test in the first week of life. Furthermore, we determined host- and treatment-related factors associated with intestinal permeability. In a randomised controlled trial, preterm infants with a gestational age < 32 weeks and/or birth weight (BW) < 1500 g received enteral supplementation of SCGOS/LCFOS/AOS or placebo (maltodextrin) between days 3 and 30 of life. Intestinal permeability, reflected by the urinary lactulose/mannitol (L/M) ratio after oral ingestion of lactulose and mannitol, was assessed at three time points: before the start of the study (t = 0), at day 4 (t = 1) and at day 7 (t = 2) of life. Data were analysed by generalised estimating equations. In total, 113 infants were included. Baseline patient and nutritional characteristics were not different between the SCGOS/LCFOS/AOS (n 55) and the placebo groups (n 58). SCGOS/LCFOS/AOS had no effect on the L/M ratio between t = 0 and t = 2. In both the groups, the L/M ratio decreased from t = 0 to t = 2 (P < 0·001). Low BW increased the L/M ratio (P = 0·002). Exclusive breast milk feeding and mixed breast milk/formula feeding during the first week of life decreased the L/M ratio (P < 0·001 and P < 0·05, respectively). In conclusion, enteral supplementation of a prebiotic mixture does not enhance the postnatal decrease in intestinal permeability in preterm infants in the first week of life.

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Non-digestible oligosaccharides reduce immunoglobulin free light-chain concentrations in infants at risk for allergy.

Journal Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology
Year 2011
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Prebiotic oligosaccharides influence the intestinal microbiota and can positively modulate the infant's immune system. It was demonstrated that a special prebiotic mixture (Immunofortis(®)) of short-chain galacto-oligosaccharides (scGOS) and long-chain fructo-oligosaccharides (lcFOS) can reduce the cumulative incidence of atopic dermatitis (AD) in infants at risk for allergy as determined using the AD symptom score (SCORAD). Additionally, it was shown very recently that immunoglobulin free light-chain (Ig-fLC) might be involved in the pathophysiology of allergic disease. Increased Ig-fLC concentrations were found in patients suffering from AD, cow's milk allergy, allergic rhinitis, or asthma. In this study, the effect of supplementation of scGOS/lcFOS on the Ig-fLC plasma concentrations in infants at risk for allergy was assessed. The plasma kappa and lambda Ig-fLC concentrations were measured in a double-blind, placebo-controlled, randomized trial, in which infants at risk for developing allergic disease received a hypoallergenic whey formula containing 8 g/l of the scGOS/lcFOS mixture (n = 34) or maltodextrin as a placebo (n=40) for 6 months. After intervention, plasma samples were collected, and total plasma concentrations of lambda and kappa Ig-fLC were analyzed using ELISA. Total kappa and lambda Ig-fLC plasma concentrations were higher in infants suffering from AD when compared to infants without any sign of AD. In infants receiving the prebiotic mixture, the Ig-fLC levels were significantly lower compared to the placebo-fed infants (p<0.001). Interestingly, lambda Ig-fLC concentrations were positively correlated with total IgE (p<0.05). These data demonstrate for the first time that the specific scGOS/lcFOS mixture lowered kappa and lambda Ig-fLC plasma concentrations in infants at high risk for allergies when compared to infants receiving placebo formula. Because Ig-fLC concentrations were increased in infants suffering from AD, this may have contributed, at least in part, to the reduced incidence in AD as described previously. This suggests a possible role for Ig-fLC in the pathophysiology of AD in infants at risk for allergy development.

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The effect of neutral and acidic oligosaccharides on stool viscosity, stool frequency and stool pH in preterm infants.

Journal Acta paediatrica (Oslo, Norway : 1992)
Year 2011
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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AIM: To determine the effect of neutral oligosaccharides [small-chain galacto-oligosaccharides/long-chain fructo-oligosaccharides (scGOS/lcFOS)] in combination with acidic oligosaccharides (pAOS) on stool viscosity, stool frequency and stool pH in preterm infants. METHODS: In this explorative RCT, preterm infants with gestational age <32 weeks and/or birth weight <1500 g received enteral supplementation with scGOS/lcFOS/pAOS or placebo (maltodextrin) between days 3 and 30 of life. Stool samples were collected at day 30 after birth. RESULTS: In total, 113 infants were included. Baseline and nutritional characteristics were not different between both groups. Stool viscosity at day 30 was lower in the prebiotics group (16.8N) (3.9-67.8) compared with the placebo group (26.3N) (1.3-148.0) (p = 0.03; 95% CI -0.80 to 0.03). There was a trend towards higher stool frequency in the prebiotics group (3.1 ± 0.8) compared with the placebo group (2.8 ± 0.7) (p = 0.15; 95% CI -0.08 to 0.52). Stool pH at day 30 was lower in the in the prebiotics group (5.9 ± 0.6) compared with the placebo group (6.2 ± 0.3) (p = 0.009; 95% CI 0.08 to 0.53). CONCLUSIONS: Enteral supplementation of a prebiotic mixture consisting of neutral (scGOS/lcFOS) and acidic oligosaccharides (pAOS) decreases stool viscosity and stool pH with a trend towards increased stool frequency in preterm infants. The inclusion of pAOS in a formula containing a mixture of scGOS/lcFOS does not add specific advantages to the formula in terms of stool viscosity, frequency, pH as well as feeding tolerance.

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Effect of enteral supplementation of neutral and acidic oligosaccharides in preterm infants on allergic diseases during the first year of life

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Conference European Journal of Pharmacology
Year 2011
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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Aim: Enteral administration of a prebiotic mixture of neutral and acidic oligosaccharides during the neonatal period in preterm infantsmay positively affect the Th2 response. Aim was to determine the effect of enteral supplementation of neutral and acidic (scGOS/ lcFOS/AOS) oligosaccharides during the neonatal period in preterm infants on the incidence of allergic diseases during the first year of life. Methods: In a randomised controlled trial, preterm infants (GA<32 weeks and/or BW<1500 g) were allocated to receive enteral scGOS/lcFOS/AOS supplementation or placebo (maltodextrin) between days 3 and 30 of life. Incidence of allergic disease (atopic dermatitis, bronchial hyperreactivity) was assessed by validated questionnaire. Both atopic dermatitis and bronchial hyperreactivity needed to be physician- diagnosed. Data were analysed by logistic regression analysis. Results: In total, 113 preterm infants were enrolled in the initial study. Of these 113, 99 were eligible for follow-up (11 died, 3 were excluded). To date, 92/99 (93%) infants participated in our follow-up study. Incidence of atopic dermatitis was not different in scGOS/lcFOS/ AOS- and placebo group (8/48 (17%)) versus (7/44 (16%)) respectively (p=0.92, OR 1.1 (0.35-3.20)) Incidence of bronchial hyperreactivity was not different between scGOS/lcFOS/AOS- or placebo group (14/48 (29%) versus 12/44 (27%)) respectively (p=0.84, OR 1.1 (0.44-2.73)). Adjustments for confounding factors (maternal education, parental history of atopy, smoking, and presence of pets at home) did not change the results of the primary analysis. Conclusion: Enteral administration of a prebiotic mixture of acidic and neutral oligosaccharides during the neonatal period in preterm infants does not decrease the risk of atopic dermatitis or bronchial hyperreactivity during the first year of life.

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Effect of neutral and acidic oligosaccharides on fecal IL-8 and fecal calprotectin in preterm infants.

Journal Pediatric research
Year 2011
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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The gastrointestinal inflammatory response may play a role in the susceptibility of preterm infants for infections. We previously reported a trend toward lower endogenous infection morbidity after enteral supplementation of neutral and acidic oligosaccharides (SC GOS/LC FOS/AOS). We hypothesize that enteral supplementation of prebiotics may decrease infectious morbidity by reducing intestinal inflammation. Therefore, we aimed to determine the effect of enteral supplementation of prebiotics on intestinal inflammation, as measured by fecal IL-8 (f-IL-8) and calprotectin (f-calprotectin), in preterm infants. In a randomized controlled trial, infants with a GA <32 wk and/or birth weight <1,500 g received enteral supplementation of prebiotics or placebo (maltodextrin) between d 3 and 30 of life. F-IL-8 and f-calprotectin was assessed at baseline, d 7, 14, and 30 of life. In total, 113 infants were included. Baseline patient and nutritional characteristics were not different in the SC GOS/LC FOS/AOS (n = 55) and the placebo group (n = 58). Enteral supplementation of prebiotics had no effect on f-IL-8 and f-calprotectin. F-IL-8 and f-calprotectin were strongly correlated at all time points (p < 0.001). In conclusion, enteral supplementation of prebiotics (SC GOS/LC FOS/AOS) does not affect f-IL-8 and f-calprotectin levels in preterm infants.

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The effect of enteral supplementation of neutral and acidic oligosaccharides on immunoglobulin free light chains in preterm infants

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Conference European Journal of Pharmacology
Year 2011
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Introduction: Immunoglobulin free light chains (Igflc) may play a role in the pathogenesis of atopy. Prebiotics may decrease the risk to develop atopy.We hypothesise that prebiotics may decrease the serum concentration of Igflc. Therefore, we aimed to determine the effect of enteral supplementation of a prebiotic mixture consisting of neutral and acidic oligosaccharides (SCGOS/LCFOS/AOS) on Igflc in preterm infants. Methods: In a randomised controlled trial, preterm infants with a gestational age <32 weeks and/or birth weight <1500 g received enteral supplementation of SCGOS/LCFOS/AOS or placebo (maltodexe46 trin) between days 3-30 of life in a max dose 1.5 g/kg/day. Serum samples were taken at 12 months of age. Kappa and Labda Igflc were analysed by ELISA. Data were analysed by logistic regression analysis. Results: In total, 42 infants in the prebiotics and 41 infants in the placebo group were included. Baseline patient and nutritional characteristics were not different between both groups. There was no difference in both the Kappa and Labda Igflc between the prebiotics and placebo group (Beta 0.09, 95%CI - 0.16-0.40; p=0.41 and Beta 0.04, 95%CI - 0.22-0.30, respectively). Correction for possible confounding factors did not change the results. Conclusions: Enteral supplementation with a prebiotic mixture consisting of neutral and acidic oligosaccharides does not influence Igflc in preterm infants. If there is a correlation between Igflc and atopy in preterm infants will be further evaluated.

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A mixture of three prebiotics does not affect vaccine specific antibody responses in healthy term infants in the first year of life.

Journal Vaccine
Year 2011
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BACKGROUND: Previous studies have shown, that prebiotics can modulate the immune response in infants at risk for allergy, leading to a lower incidence of atopic dermatitis. Few studies have evaluated the effect of prebiotic carbohydrates alone on the vaccine-specific antibody response as a marker for the development of the immune system in healthy infants not at risk for allergy. AIM: This study evaluates the effect of adding a specific prebiotic mixture of short chain galacto-oligosaccharides (scGOS)/long chain fructo-oligosaccharides (lcFOS) ratio 9:1 and pectin-derived acidic oligosaccharides (pAOS) to formula feeding on the specific immunoglobulin responses to Haemophilus influenza type b (Hib) and tetanus immunization in healthy non-atopic infants during the first year of life. METHODS: This substudy has been embedded in a multinational multicenter RCT (n=1130 children) to evaluate the effect of study prebiotics on the incidence of fever episodes during the first year of life. The study prebiotics were administered throughout the first year of life. This is a substudy on the vaccine-specific immunoglobulin responses to Hib and tetanus immunizations. Only data of the Dutch children, 80 in the prebiotics group and 84 in the control group, were used for this substudy. They all followed the national vaccination schedule leading to a homogeneous group. Blood was sampled at 6 and 12 months of age. RESULTS: Hib immunizations: median values did not differ between groups at the age of 6 and 12 months. At the age of 12 months, 34 out of 37 (91.9%) infants in the prebiotics group and 31 out of 34 infants (91.2%) in the control group had Hib antibody levels >1.0 μg/ml. Tetanus immunizations: median values did not differ between groups at the age of 6 and 12 months and were above the cut-off value of 0.1 IU/ml in all infants in both the prebiotics and the control group. CONCLUSION: No effect of prebiotics supplementation on vaccination specific antibody levels was found in children up to the age of 12 months; the vaccine specific antibody levels in infants fed the study prebiotics or a control diet were similar during the first year of life. We hypothesize that this specific prebiotic mixture, which resembles the composition of oligosaccharides in human milk, mainly promotes Th1 and Treg dependent immune responses and induces a down regulation of IgE-mediated allergic responses, while the desired vaccine-specific serum antibody responses remain intact.

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Effect of enteral supplementation of neutral and acidic oligosaccharides in preterm infants on allergic and infectious diseases during the first year of life

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Conference Journal of Pediatric Gastroenterology and Nutrition
Year 2011
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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Tolerance and safety evaluation in a large cohort of healthy infants fed an innovative prebiotic formula: a randomized controlled trial.

Journal PloS one
Year 2011
Links Pubmed DOI PubMed Central

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND: the addition of oligosaccharides to infant formula has been shown to mimic some of the beneficial effects of human milk. The aim of the study was to assess the tolerance and safety of a formula containing an innovative mixture of oligosaccharides in early infancy. METHODOLOGY/PRINCIPAL FINDINGS: this study was performed as a multi-center, randomized, double-blind, placebo-controlled trial including healthy term infants. Infants were recruited before the age of 8 weeks, either having started with formula feeding or being fully breast-fed (breastfeeding group). Formula-fed infants were randomized to feeding with a regular formula containing a mixture of neutral oligosaccharides and pectin-derived acidic oligosaccharides (prebiotic formula group) or regular formula without oligosaccharides (control formula group). Growth, tolerance and adverse events were assessed at 8, 16, 24 and 52 weeks of age. The prebiotic and control groups showed similar mean weight, length and head circumference, skin fold thicknesses, arm circumference gains and stool frequency at each study point. As far as the anthropometric parameters are concerned, the prebiotic group and the control group did not attain the values shown by the breastfeeding group at any study point. The skin fold thicknesses assessed in the breastfeeding group at 8 weeks were strikingly larger than those in formula fed infants, whereas at 52 weeks were strikingly smaller. The stool consistency in the prebiotic group was softer than in the control group at 8, 16 and 24 weeks (p<0.001) and closer to that of the breastfeeding group. There was no difference in the incidence of adverse events between the two formula groups. CONCLUSIONS: our findings demonstrate the tolerability and the long term safety of a formula containing an innovative mixture of oligosaccharides in a large cohort of healthy infants. TRIAL REGISTRATION: drks-neu.uniklinik-freiburg.de DRKS 00000201.