Smith M M, Kuhn L
Gertrude H. Sergievsky Center, Columbia University and Joseph L. Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
Nutr Rev. 2000 Nov;58(11):333-40. doi: 10.1111/j.1753-4887.2000.tb01830.x.
Exclusive breast-feeding is unambiguously the optimal infant feeding practice and is universally promoted in the absence of human immunodeficiency virus (HIV-1). It is associated with reduced morbidity and mortality from diarrheal and respiratory diseases. Recent findings suggest that exclusive breast-feeding may pose less risk of HIV-1 transmission than the more common practice of mixed feeding (i.e., breast-feeding concurrent with the feeding of water, other fluids, and foods), which has important infant feeding policy implications for low-resource settings. This paper reviews the biologic mechanisms associated with exclusive breast-feeding that provide protection against gastrointestinal, respiratory, and atopic diseases, and evaluates the relevance of these mechanisms for HIV-1 transmission. Potential mechanisms include reduction in dietary antigens and enteric pathogens that may maintain integrity of the intestinal mucosal barrier and limit inflammatory responses of the gut mucosa; promotion of beneficial intestinal microflora that may increase resistance to infection and modulate the infant's immune response; alteration in specific antiviral or anti-inflammatory factors in human milk that may modulate maternal hormonal or immunologic status; and maintenance of mammary epithelial integrity that may reduce viral load in breast milk.
纯母乳喂养无疑是最佳的婴儿喂养方式，在没有人类免疫缺陷病毒（HIV-1）的情况下得到普遍推广。它与腹泻和呼吸道疾病导致的发病率和死亡率降低有关。最近的研究结果表明，与更常见的混合喂养方式（即母乳喂养同时喂水、其他液体和食物）相比，纯母乳喂养可能降低HIV-1传播风险，这对资源匮乏地区的婴儿喂养政策具有重要意义。本文综述了与纯母乳喂养相关的生物学机制，这些机制可预防胃肠道、呼吸道和过敏性疾病，并评估了这些机制与HIV-1传播的相关性。潜在机制包括减少饮食抗原和肠道病原体，这可能维持肠道黏膜屏障的完整性并限制肠道黏膜的炎症反应；促进有益的肠道微生物群，这可能增加对感染的抵抗力并调节婴儿的免疫反应；人乳中特定抗病毒或抗炎因子的改变，这可能调节母体激素或免疫状态；以及维持乳腺上皮完整性，这可能降低母乳中的病毒载量。
