Department of Pediatric Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
Department of Oral Microbiology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
Caries Res. 2024;58(5):478-487. doi: 10.1159/000538882. Epub 2024 Apr 18.
When infants cannot consume breast milk, the most commonly available alternative milk formula is cow milk-based. Due to a rise in the prevalence of cow milk protein allergy (CMPA) among children, this study aimed to assess the biofilm formation and acidogenicity of cow milk-based formulas as well as milk formulas suggested for children with CMPA.
Cow milk-based formulas with 0%, 10%, or 18% sucrose added, partially hydrolyzed formula (pHF), extensively hydrolyzed formula (eHF), amino acid-based formula (AAF), and soy-based formulas with 0%, or 11% sucrose added were evaluated. Streptococcus mutans was used as a representative microorganism associated with caries. The acidogenicity after 24-h incubation was assessed by the pH of the formed biofilm and lactic acid formation. Biofilm formation was quantified using crystal violet staining. Additionally, the biofilm characteristics were determined using confocal laser scanning microscopy (CLSM). Comparisons were made among formulas without added sucrose to observe protein-based differences. Furthermore, formulas with different sucrose percentages were compared to explore the impact of sucrose content.
When comparing the formulas without added sucrose, the biofilm formation in the cow milk-based formula and pHF were significantly greater than the soy-based formula, eHF, and AAF. In the presence of S. mutans, all formulas reduced the biofilm pH below the critical enamel pH. The cow milk-based formula and AAF showed a significantly lower biofilm pH than the pHF, soy-based, and eHF groups, while the lactic acid production was markedly higher in the cow milk-based formula, pHF and AAF, compared with the eHF and soy-based formula. Adding sucrose into the cow milk-based and soy-based formulas substantially increased biofilm mass. The biofilm pH of the cow milk-based formulas, with or without sucrose, was significantly lower than that of the soy-based formulas. The CLSM indicated distinct biofilm characteristics among the different protein-based formulas, with sucrose supplementation promoting S. mutans aggregation in cow milk-based formula biofilm and increased density and intact biofilm in the soy-based formula.
All assessed milk formulas had caries-inducing factors, including those without supplemental sucrose. Among them, the eHF demonstrated the least caries-inducing factors, attributed to its minimal biofilm formation and the highest biofilm pH.
当婴儿无法食用母乳时，最常用的替代奶是牛奶基配方奶。由于儿童中牛奶蛋白过敏（CMPA）的患病率上升，本研究旨在评估牛奶基配方奶以及推荐用于 CMPA 儿童的配方奶的生物膜形成和产酸能力。
评估了添加 0%、10%或 18%蔗糖的牛奶基配方奶、部分水解配方（pHF）、深度水解配方（eHF）、氨基酸配方（AAF）和添加 0%或 11%蔗糖的大豆配方奶。变形链球菌被用作与龋齿相关的代表性微生物。通过形成的生物膜的 pH 和乳酸形成来评估 24 小时孵育后的产酸能力。使用结晶紫染色定量生物膜形成。此外，使用共聚焦激光扫描显微镜（CLSM）确定生物膜特征。比较未添加蔗糖的配方以观察基于蛋白质的差异。此外，还比较了不同蔗糖百分比的配方，以探讨蔗糖含量的影响。
在比较未添加蔗糖的配方时，牛奶基配方和 pHF 的生物膜形成明显大于大豆配方、eHF 和 AAF。在存在变形链球菌的情况下，所有配方均将生物膜 pH 降低至临界釉质 pH 以下。与 pHF、大豆基和 eHF 组相比，牛奶基配方和 AAF 的生物膜 pH 明显较低，而牛奶基配方、pHF 和 AAF 的乳酸产量明显高于 eHF 和大豆基配方。在牛奶基和大豆基配方中添加蔗糖会显著增加生物膜质量。添加蔗糖的牛奶基配方的生物膜 pH 明显低于未添加蔗糖的大豆基配方。CLSM 表明不同基于蛋白质的配方之间存在明显不同的生物膜特征，添加蔗糖会促进牛奶基配方生物膜中变形链球菌的聚集，并增加大豆基配方中生物膜的密度和完整性。
所有评估的配方奶都具有致龋因素，包括没有添加蔗糖的配方奶。其中，eHF 显示出最少的致龋因素，这归因于其最小的生物膜形成和最高的生物膜 pH。
