1. Prebiotics &probiotics
Infants formula

2. prebiotics
“non-digestible food ingredients that beneficially affect the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon, and thus improve host health

3. Breast milk composition
Prebiotics:
the third most prevalent
component of breast milk
galacto-oligosaccharides (GOS), fructo-oligosaccharides (FOS), polydextrose (PDX) promoting
bifidobacteria and lactobacilli)

4. Breast milk composition
Human milk contains 8–13 g/L of a complex mixture of oligosaccharides which is about 20-fold higher than those of bovine milk

5. Bacterial roles
Commensal bacteria confer metabolic, protective, and trophic functions to the host through fermentation of non-digestible carbohydrates, vitamin production, bile acids biotransformation, barrier protection against opportunistic pathogens, control against gut epithelial cell proliferation and maturation and stimulation of both local and systemic immunity

6. Interaction of pre &pro
(SCFA) acetate (mainly produced by bifidobacteria), butyrate (mainly produced by Lachnospiraceae and Ruminococcaceae) and propionate (produced by propionibacteria and Bacteroidetes) [
Acetate is metabolized in muscles, kidney, heart and brain;
propionate is cleared by liver and suppresses the cholesterol .synthesis; whereas butyrate acts at the colon
In addition to increased short-chain fatty production prebiotic fermentation leads to reduced fecal pH and
reduced production of putrefactive compounds, such as ammonia, phenol,
indole and branched chain fatty acids

7. Diet and microbes
the enterotypes are associated with long-term dietary patterns, particularly
protein and animal fat (Bacteroides) versus carbohydrates intake (Prevotella)

8. prebiotics
Direct anti inflammatory effect in GI Recently it was shown that non-digestible oligosaccharides (FOS and GOS) act as Toll-like Receptor
4 (TLR4) ligands both in epithelial cells and monocytes, thus up regulating cytokine secretion SYSTEM

9. dysbiosis role of antibiotics
Gut microbiota-derived metabolites may also be involved in disease pathogenesis as shown for CVD and non-alcoholic fatty liver diseases through the production of trimethylamine (TMA
trimethylamine N-oxide (TMAO) production by liver
Reduced diversity is the main event
role of antibiotics

10. Adding prebiotics to formula
produces changes in the short chain fatty acids, making the profile of these acids closer to that observed in breast-fed infants (Knol et al., 2005),
improves the stool characteristics (frequency, pH and softening) (Ben et al., 2008; Fanaro et al., 2005; Moro et al., 2002) and
reduces the incidence of allergic manifestations and infections during the first two years of life (Arslanoglu et al., 2008).

11. PREBIOTICS IN MILK
better weight gain and softer stools, and a significant reduction in stool pH for infants who received prebiotic supplementation

12. prebiotics
, in a systematic review , the authors reported that prebiotic infant formula increased stool frequency and weight gain, however, it failed to increase bifidobacteria, lactobacillus or to decrease levels of pathogens(Bacteriodes, E. coli).
One RCT reported a significant reduction in overall infection and antibiotic use among infants provided prebiotic supplemented formula

13. PREBIOTICS IN FORMULA
One systematic review of 12 RCTs evaluating prebiotic formula and growth and clinical outcomes in full-term infants concluded that prebiotics added to infant formula significantly increased weight gain but had no significant effect on length and head circumference

14. Prebiotics in formula
Prebiotic supplementation increased stool frequency but had no impact on stool consistency, the incidence of colic, spitting up/regurgitation, crying, restlessness or vomiting

15. Randomized, double-blind, placebo-controlled study of synbiotic yogurt effect on the health of children
A synbiotic yogurt with the probiotic bacteria Bifidobacterium animalis subspecies lactis (BB-12) and the prebiotic inulin significantly reduced days of fever, improved social and school functioning and increased frequency of bowel movements in child care centers healthy children attending
j.pediatrcs201

16. prebiotics :Premature baby
Pammi et al. reviewed four RCTs and concluded that there is evidence to suggest that oral lactoferrin used as prophylaxis with or without probiotics decreases late-onset sepsis and NEC stage II or greater

17. Side effects
Overall, 23 of the 24 RCTs reviewed by Rao et al. [45] reported that prebiotic supplementation was well-
tolerated

18. متشکرم