نقش پره بیوتیک و پروبیوتیک ها در دوران شیردهی دکتر آزاده نجارزاده، متخصص تغذیه azadehnajarzadeh@gmail.com

human breast milk contains over 700 different types of bacteria. The most common strains include Lactobacillus, Streptococcus, Staphylococcus, Enterococcus and Bifidobacterium.

In addition, breast milk contains types of prebiotics known as human milk oligosaccharides (HMOs), which are non-digestible food components used by bacteria to stimulate their growth and activity.

Prebiotics Human milk contains more then 130 different oligosaccharides that are fermented in part in the infant’s colon. • The concentration changes with the duration of lactation: ‐ Highest in colostrum at 20 to 23 g/L, ‐ about 20 g/L on day 4 of lactation, ‐ 9 g/L on day 120 of lactation

شیر مادر مهمترین منبع مواد مغذی نقش شیر مادر در پیشگیری از آلرژی وجود ترکیبات immunoactive در شیر مادر نقش پروبیوتیک ها در افزایش CD14 (آنتی آلرژیک)، IgA، TGF-β

Importance of Human Breast Milk Optimal nutrient levels Appropriate amounts of Carbohydrate, Protein, and Fats Vitamins Hormones Perfect source of nutrition Minerals Digestive proteins Available Online [http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/002451.htm] accessed on 15/03/09 7

Importance of Human Breast Milk Optimal nutrient levels Milk leukocytes Secretory IgA Lactoferrin Bifidus factor Human Milk Oligosaccharides (HMOS) Lysozyme Milk lipids M. Nathaniel Mead, Environ Health Perspect. 2008 October; 116(10): A426–A434. Wagner CL, Anderson DM, Pittard WB. 1996. Special properties of human milk. Clin Pediatr (Phila) 35(6):283–293. 8

Importance of Human Breast Milk Prebiotics e.g. Human Milk oligosaccharides Kelly M. Jackson; Andrea M. Nazar, JAOA • Vol 106 • No 4 • April 2006 • 203-207

Colonic Fermentation of Effects of Prebiotics Oligosaccharides Colonic Fermentation of Oligosaccharides Since the lack of gut flora can have such harmful health effects, the use of probiotics has anti-inflammatory effects in the gut and may be useful for improving health. Prebiotics are dietary components that can help foster the growth of microorganisms in the gut, which may lead to better health. Guarner F and Malagelada JR. 2003. Role of bacteria in experimental colitis. Best Practice & Research Clinical Gastroenterology, Volume 17, Issue 5, October 2003, Pages 793-804. PMID 14507589. Accessed September 15, 2007 Guarner F et al, Best Practice & Research Clinical Gastroenterology, Volume 17, Issue 5, October 2003,

Acquisition of gut flora in human infants “The infant tends to acquire the flora swallowed from the vaginal fluid at the time of delivery”1 Colonization “Infants delivered by cesarean section are colonized with more anaerobic bacteria, especially Bacteroides, than vaginally delivered infants ”2 GUT is sterile Suhali Al-Shammri et al., Journal of the Neurological Sciences 15 July 2004 (Vol. 222, Issue 1, Pages 21-27) 1- Vanderhoof, Jon A.Journal of Pediatric Gastroenterology & Nutrition. 30 Supplement 2:S34-S38, March 2000. 2- Adlerberth I. et al , The Ontogony of Intestinal Flora, 1999, p 279-292 11

Development of the gut flora Every individual has a particular combination of predominant and subdominant species that is distinct from that found in other individuals Bifidobacteria Bacteriods fragilis The intestinal habitat of an adult individual contains 300–500 different species of bacteria, with 30–40 species comprising up to 99% of the total population. Conventional bacteriological analysis of the faecal flora by isolation of bacteria on selective growth media shows that strict anaerobic bacteria outnumber aerobes by a factor of 100 to 1,000. The dominant genera are Bacteroides, Bifidobacterium, Eubacterium, Clostridium, Lactobacillus, Fusobacterium and various anaerobic Gram-positivecocci. Bacteria present in lower numbers include Enterococcus, and Enterobacteriaceae . Every individual has a particular combination of predominant and subdominant species that is distinct from that found in other individuals. However, over 50% of bacteria cells that are observed by microscopic examination of faecal specimens cannot be grown in culture media Clostridium Lactobacillus acidophilus Francisco Guarner (Spain), Digestion 2006;73(suppl 1):5–12

The Prebiotics concept Prebiotics must “survive” acidic conditions Must stimulate one or a limited number of beneficial bacteria Prebiotics must be selectively fermented in the colon Prebiotics must evade digestion in the small intestine Fuller & Gibson, 1997, Scand J Gastroenterology Suppl (222):32-40

Therapeutic Manipulation of the Intestinal Flora (Probiotics) “live microorganisms which confer health benefits on the host”, when administered in adequate amounts. Acute diarrhea in infants Antibiotic-associated diarrhea A consensus definition of the term ‘probiotic’ was issued a few years ago and states that oral probiotics are living microorganisms that upon ingestion in certain numbers, exert health benefits beyond those of inherent basic nutrition. Two meta-analyses concluded that probiotics can be used to prevent antibiotic-associated diarrhea in children and adults. Prophylactic use of probiotics has proven useful for the prevention of acute diarrhea in infants admitted into hospital wards for a chronic disease condition. Probiotics may also be useful in the prevention of community-acquired diarrhea. Several studies have investigated the efficacy of probiotics in the prevention of travelers’ diarrhea in adults, Needs research to prove safety & efficacy Francisco Guarner (Spain), Digestion 2006;73(suppl 1):5–12

Acquisition of gut flora in human infants Breast-fed babies Formula-fed infants During the first week of life, these bacteria create a reducing environment favorable for the subsequent bacterial succession of strict anaerobic species mainly belonging to the genera Bifidobacterium, Bacteroides, Clostridium, and Ruminococcus. Breast-fed babies become dominated by bifidobacteria, possibly due to the contents of bifidobacterial growth factors in breast milk. In contrast, the microflora of formula-fed infants is more diverse with high numbers of Enterobacteriaceae, enterococci, bifidobacteria, Bacteroides, and clostridia. After the introduction of solid food and weaning, the microflora of breast-fed infants becomes similar to that of formula-fed infants. By the second year of life the fecal microflora resembles that of adults. Bifidobacteria Enterobacteriaceae, enterococci, bifidobacteria, Bacteroides, and clostridia Suhali Al-Shammri et al., Journal of the Neurological Sciences 15 July 2004 (Vol. 222, Issue 1, Pages 21-27)

Acquisition of gut flora in human infants Differences in Development of Microbiota in Breast- and Formula-fed Babies Bifidobacteria Bacteroides E. coli Harmsen et al. (2000) JPGN 30:61-67

Balance of the Gut flora In the colon, however, transit time is slow and microorganisms have the opportunity to proliferate by fermenting available substrates derived from either the diet or endogenous secretions. Generalised scheme of predominant groups of colonic bacteria, indicating how the genera may exhibit potentially harmful and benefi cial functions Francisco Guarner (Spain), Digestion 2006;73(suppl 1):5–12

The gut flora as a forgotten organ Bacteria in the gut fulfills a host of useful functions for humans, including digestion of unutilized energy substrates. Stimulating cell growth Repressing the growth of harmful microorganisms Training the immune system to respond only to pathogens Defending against some diseases Available online [http://www.nature.com/embor/journal/v7/n7/images/7400731-f1.jpg] accessed online on 12th of October 2008 IEC: intestinal epithelial cell Ann M.O’Hara & Fergus Shanahan, EMBO reports VOL 7, NO 7, 2006

Increase growth of human gut cells Carbohydrate fermentation and absorption Increase growth of human gut cells Reduce counts of damaging bacteria Bacteria turn carbohydrates they ferment into short chain fatty acids, or SCFAs. These materials can be used by host cells: Providing a major source of useful energy and nutrients for humans. They increase the gut's absorption of water Reduce counts of damaging bacteria Increase growth of human gut cells Growth of indigenous bacteria. The SCFAs are produced by a form of fermentation called saccharolytic fermentation and include acetic acid, propionic acid, and butyric acid. Gases and organic acids like lactic acid are also produced by saccahrolytic fermentation. Acetic acid is used by muscle, propionic acid helps the liver produce ATP, and butyric acid provides energy to gut cells and may prevent cancer. Growth of indigenous bacteria. They increase the gut's absorption of water

Healthy gut microbiota similar to breast-fed infants, resulting Patented Prebiotics Combination of short-chain Galacto-Oligosaccharides (GOS) and long-chain Fructo-Oligosaccharides (FOS) Amounts and molecular size and distribution similar to HMOS (0.8 g/100 ml, GOS:FOS 9:1) Made from natural ingredients (lactose and chicory) Aim: Healthy gut microbiota similar to breast-fed infants, resulting in health benefits

تاثیر مصرف پروبیوتیک ها در دوران بارداری و شیردهی بر درماتیت آتوپیک

. Experimental design. Trial compound (4 g) was administered twice daily from 26 weeks of gestation to 1 month after delivery. FOS, fructo-oligosaccharides.

Comparison of the concentrations of IL-27 in (a) colostrum samples and (b) 1- month milk samples obtained from the placebo and fructooligosaccharide (FOS) groups. The Mann–Whitney U- test was used to analyse differences between the experimental groups (bar, median) ((a) P<0·027; (b) P<0·040)

IL-27, together with IL-12, IL-23 and IL-35, belongs to the family of cytokines associated with T- cell differentiation. IL-27 induces the differentiation of T helper (Th)1 cells, regulates the induction of Th17 cells, increases the production of IL- 10, and induces type 1 regulatory T cells (Tr1)

In contrast to the demonstrated effects of probiotics, no significant difference in colostrum TGF-b, total IgA and soluble CD14 concentrations between the FOS and control groups was observed in the present study. These data suggest that prebiotics may act differently when compared with probiotics.

Probiotics and mastitis In some cases, new mums can develop a painful inflammation of the breasts called mastitis. It usually occurs when milk ducts become blocked due to ineffective emptying of the breasts during breastfeeding. The trapped milk can quickly become infected with bacteria entering the breast through sore or cracked nipples leading to an infection that might require antibiotic treatment.

Studies have shown that an oral supplement with lactobacilli strains can reduce the number of pathogenic bacteria and lead to a faster recovery. Probiotics have also been recommended to prevent thrush episodes following the antibiotic treatment.

ایمنی مصرف پروبیوتیک ها در شیردهی Probiotics do not appear to pose any safety concerns for pregnant and lactating women. current literature does not indicate an increase in adverse pregnancy outcomes.

پودر شیر غنی شده ببمام برای حمایت از شیردهی مادران نوشیدن یک لیوان ببمام در روز 50% از نیازهای تغذیه ای مادر را تأمین می کند. DHA کلسیم آهن فسفر روی ید ویتامینهای A,D,B2,B12&B5 حاوی DHA که موجب تکامل مغزی و بینایی نوزاد می شود. پودر شیر غنی شده ببمام برای حمایت از شیردهی مادران

THANKS FOR YOUR ATTENTION 33