de Oliveira Samira C, Bellanger Amandine, Ménard Olivia, Pladys Patrick, Le Gouar Yann, Dirson Emelyne, Kroell Florian, Dupont Didier, Deglaire Amélie, Bourlieu Claire
Science and Technology of Milk and Eggs, Agrocampus West, French National Institute for Agricultural Research, Rennes, France.
Department of Pediatrics, Rennes University Hospital, Rennes, France; and.
Am J Clin Nutr. 2017 Feb;105(2):379-390. doi: 10.3945/ajcn.116.142539. Epub 2017 Jan 4.
Holder pasteurization has been reported to modify human milk composition and structure by inactivating bile salt-stimulated lipase (BSSL) and partially denaturing some of its proteins, potentially affecting its subsequent digestion.
We sought to determine the impact of human milk pasteurization on gastric digestion (particularly for proteins and lipids) in preterm infants who were fed their mothers' own milk either raw or pasteurized.
In a randomized controlled trial, 12 hospitalized tube-fed preterm infants were their own control group in comparing the gastric digestion of raw human milk (RHM) with pasteurized human milk (PHM). Over a 6-d sequence, gastric aspirates were collected 2 times/d before and after RHM or PHM ingestion. The impact of milk pasteurization digestive kinetics and disintegration was tested with the use of a general linear mixed model.
Despite inactivating BSSL, instantaneous lipolysis was not affected by pasteurization (mean ± SD at 90 min: 12.6% ± 4.7%; P > 0.05). Lipolysis occurred in milk before digestion and was higher for PHM than for RHM (mean ± SD: 3.2% ± 0.6% and 2.2% ± 0.8%, respectively; P < 0.001). Pasteurization enhanced the proteolysis of lactoferrin (P < 0.01) and reduced that of α-lactalbumin (only at 90 min) (P < 0.05). Strong emulsion destabilization was observed, with smaller aggregates and a higher specific surface for PHM (P < 0.05). Pasteurization did not affect gastric emptying (∼30-min half time) or pH (mean ± SD: 4.4 ± 0.8) at 90 min.
Overall, pasteurization had no impact on the gastric digestion of lipids and some proteins from human milk but did affect lactoferrin and α-lactalbumin proteolysis and emulsion disintegration. Freeze-thawing and pasteurization increased the milk lipolysis before digestion but did not affect gastric lipolysis. Possible consequences on intestinal digestion and associated nutritional outcomes were not considered in this study. This trial was registered at clinicaltrials.gov as NCT02112331.
据报道，保持式巴氏杀菌通过使胆盐刺激脂肪酶（BSSL）失活并使部分蛋白质发生变性，改变了母乳的成分和结构，这可能会影响其后续消化。
我们试图确定母乳巴氏杀菌对食用生母乳或巴氏杀菌母乳的早产儿胃消化（特别是蛋白质和脂质消化）的影响。
在一项随机对照试验中，12名住院的经鼻胃管喂养的早产儿在比较生母乳（RHM）和巴氏杀菌母乳（PHM）的胃消化情况时作为自身对照组。在6天的时间段内，每天在摄入RHM或PHM之前和之后采集2次胃吸出物。使用一般线性混合模型测试了母乳巴氏杀菌对消化动力学和分解的影响。
尽管BSSL失活，但瞬时脂解不受巴氏杀菌的影响（90分钟时平均值±标准差：12.6%±4.7%；P>0.05）。脂解在消化前就已在母乳中发生，且PHM的脂解高于RHM（平均值±标准差分别为：3.2%±0.6%和2.2%±0.8%；P<0.001）。巴氏杀菌增强了乳铁蛋白的蛋白水解作用（P<0.01），并降低了α-乳白蛋白的蛋白水解作用（仅在90分钟时）（P<0.05）。观察到强烈的乳剂失稳现象，PHM的聚集体更小且比表面积更高（P<0.05）。巴氏杀菌在90分钟时不影响胃排空（半衰期约30分钟）或pH值（平均值±标准差：4.4±0.8）。
总体而言，巴氏杀菌对母乳中脂质和部分蛋白质的胃消化没有影响，但确实影响了乳铁蛋白和α-乳白蛋白的蛋白水解作用以及乳剂分解。冻融和巴氏杀菌增加了消化前母乳的脂解，但不影响胃脂解。本研究未考虑对肠道消化及相关营养结果的可能影响。该试验已在clinicaltrials.gov上注册，注册号为NCT02112331。
