KidZ Health Castle, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Department of Paediatrics, Imperial College, London, UK.
Clin Nutr. 2021 Feb;40(2):358-371. doi: 10.1016/j.clnu.2020.10.025. Epub 2020 Oct 20.
Exclusive breastfeeding ideally up to 6 months of life is the feed of choice for infants and should be promoted by healthcare professionals. However, when human milk is not sufficient or not available, infant formula, generally cow's milk-based, meeting strictly regulated nutritional and safety requirements, are recommended. Human breastmilk feeding has a positive health impact for both mother and child, but there is limited evidence that it has a long-term protective effect on the development of allergic disease. Some studies have found an association of an increased risk to develop cow's milk allergy with early exposure to cow's milk protein in formula milk. As a result, over the last 30 years, partially hydrolyzed formulas (pHF) have gained popularity and, more recently, become embroiled in a debate about their role in the primary prevention of allergic outcomes. Similar debates exist in regards to the potential preventative effects of pre-, pro- and synbiotics as well as nutritional factors, notably vitamin D and omega-3 fatty acids. This paper aims to critically address these aspects, drawing information from published data interpreted by an international expert group in paediatrics, allergy, gastro-intestinal diseases and nutrition. This group of experts emphasize that human milk is the optimal source of infant nutrition. With regards to pHFs, whilst no harm has been shown with their use and some studies have suggested potential benefit preventing atopic dermatitis in at risk infants, there is insufficient evidence for or against their routine recommendation for primary allergy prevention. The method of hydrolysation differs for every formula. There is insufficient evidence to recommend supplementation with vitamin D, omega-3 LCPUFA, specific prebiotic oligosaccharides or specific probiotic strains during pregnancy, lactation and early life to prevent the development of allergic disease in children. There remains a need for well-designed trials with the currently commercialised pHFs and supplements to allow for better clarity and evidence-based recommendations.
纯母乳喂养至 6 个月是婴儿的首选喂养方式，应得到医疗保健专业人员的推广。然而，当母乳不足或无法提供时，应推荐使用符合严格营养和安全要求的婴儿配方奶粉，通常为牛奶基配方奶粉。母乳喂养对母婴健康都有积极影响，但有限的证据表明它对预防过敏性疾病有长期保护作用。一些研究发现，配方奶中早期暴露于牛奶蛋白与增加患牛奶过敏的风险有关。因此，在过去 30 年中，部分水解配方（pHF）越来越受欢迎，最近，它们在预防过敏结局方面的作用引发了争议。关于益生菌、益生元和合生元以及营养因素（特别是维生素 D 和 ω-3 脂肪酸）的潜在预防作用也存在类似的争论。本文旨在批判性地探讨这些方面，从发表的数据中提取信息，并由儿科、过敏、胃肠疾病和营养领域的国际专家组进行解读。专家组强调，母乳是婴儿营养的最佳来源。关于 pHF，虽然使用它们没有显示出任何危害，并且一些研究表明它们具有预防高危婴儿特应性皮炎的潜在益处，但没有足够的证据支持或反对常规推荐它们用于预防原发性过敏。每种配方的水解方法都不同。没有足够的证据推荐在妊娠、哺乳期和婴儿期补充维生素 D、ω-3 LCPUFA、特定的益生元低聚糖或特定的益生菌菌株，以预防儿童过敏疾病的发生。仍然需要对目前商业化的 pHF 和补充剂进行精心设计的试验，以提供更好的清晰度和基于证据的建议。
