Doherty Alice M, Lodge Caroline J, Dharmage Shyamali C, Dai Xin, Bode Lars, Lowe Adrian J
Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Front Pediatr. 2018 Apr 20;6:91. doi: 10.3389/fped.2018.00091. eCollection 2018.
Complex sugars found in breastmilk, human milk oligosaccharides (HMOs), may assist in early-life immune programming and prevention against infectious diseases. This study aimed to systematically review the associations between maternal levels of HMOs and development of immune-mediated or infectious diseases in the offspring. PubMed and EMBASE databases were searched (last search on 22 February 2018) according to a predetermined search strategy. Original studies published in English examining the effect of HMOs on immune-mediated and infectious disease were eligible for inclusion. Of 847 identified records, 10 articles from 6 original studies were included, with study quality ranging from low to high. Of three studies to examine allergic disease outcomes, one reported a protective effect against cow's milk allergy (CMA) by 18 months of age associated with lower lacto--fucopentaose (LNFP) III concentrations (OR: 6.7, 95% CI 2.0-22). Another study found higher relative abundance of fucosyloligosaccharides was associated with reduced diarrhea incidence by 2 years, due to (i) stable toxin- infection ( = 0.04) and (ii) "all causes" ( = 0.042). Higher LNFP-II concentrations were associated with (i) reduced cases of gastroenteritis and respiratory tract infections at 6 weeks ( = 0.004, = 0.010) and 12 weeks ( = 0.038, = 0.038) and (ii) reduced HIV transmission (OR: 0.45; 95% CI: 0.21-0.97) and mortality risk among HIV-exposed, uninfected infants (HR: 0.33; 95% CI: 0.14-0.74) by 24 months. Due to heterogeneity of the outcomes reported, pooling of results was not possible. There was limited evidence that low concentrations of LNFP-III are associated with CMA and that higher fucosyloligosaccharide levels protect infants against infectious disease. Further research is needed.
母乳中含有的复合糖，即人乳寡糖（HMOs），可能有助于早期免疫编程以及预防传染病。本研究旨在系统评价母体HMOs水平与子代免疫介导性疾病或传染病发生之间的关联。根据预先确定的检索策略，对PubMed和EMBASE数据库进行了检索（最后一次检索时间为2018年2月22日）。以英文发表的关于HMOs对免疫介导性疾病和传染病影响的原始研究符合纳入标准。在847条检索到的记录中，纳入了来自6项原始研究的10篇文章，研究质量从低到高不等。在三项研究过敏性疾病结局的研究中，一项研究报告称，18个月大时，低乳糖岩藻五糖（LNFP）III浓度与预防牛奶过敏（CMA）具有保护作用（OR：6.7，95%CI 2.0 - 22）。另一项研究发现，岩藻糖基寡糖的相对丰度较高与2岁时腹泻发病率降低有关，原因如下：（i）稳定毒素感染（P = 0.04）和（ii）“所有原因”（P = 0.042）。较高的LNFP-II浓度与以下情况有关：（i）6周（P = 0.004，P = 0.010）和12周（P = 0.038，P = 0.038）时胃肠炎和呼吸道感染病例减少，以及（ii）24个月时HIV传播减少（OR：0.45；95%CI：0.21 - 0.97），且HIV暴露未感染婴儿的死亡风险降低（HR：0.33；95%CI：0.14 - 0.74）。由于所报告结局的异质性，无法进行结果合并。有有限的证据表明，低浓度的LNFP-III与CMA有关，且较高的岩藻糖基寡糖水平可保护婴儿免受传染病侵害。需要进一步的研究。
