Kebbe Maryam, Leung Kennedy, Perrett Ben, Reimer Raylene A, Adamo Kristi, Redman Leanne M
Faculty of Kinesiology, University of New Brunswick, Fredericton, NB E3B 5A3, Canada.
Department of Microbiology and Immunology, McGill University, Montréal, QC H3A 2B4, Canada.
Nutr Rev. 2025 Mar 1;83(3):422-447. doi: 10.1093/nutrit/nuae184.
Prebiotics are often added to infant formulas to mimic the benefits of oligosaccharides found in human milk.
This systematic review and meta-analysis evaluated the effects of prebiotic-supplemented cow's milk-based formula on the gut microbiota, gut environment, growth parameters, and safety and tolerance in infants ≤6 months old, compared with a standard formula or human milk comparator.
Searches were performed in the PubMed, Embase, Cochrane Central Register of Controlled Trials, and ProQuest Dissertations & Theses databases. Articles were included that reported on randomized controlled trials, were published from inception until April 2024, and met prespecified inclusion and exclusion criteria.
Outcomes included gut microbiota (eg, diversity; taxa at phylum, family, genus and species levels), gut environment (eg, pH, secretory immunoglobulin A, fecal calprotectin, fecal metabolites), growth parameters (eg, z scores), and safety and tolerance. Fixed or random effects models were used and mean differences (MDs) with 95% CIs were calculated to assess pooled effects. Risk of bias was assessed using the Cochrane Collaboration Tool (RoB 2).
A total of 30 articles met inclusion criteria, with 5290 infants included. Whereas effects on Lactobacillus were inconsistent, prebiotic formula supplementation increased Bifidobacterium counts (k = 7 [MD: 0.49; 95% CI, 0.27-0.71]; I2 = 13%; P < .00001) and decreased fecal pH (k = 7 [MD: -0.39; 95% CI, -0.57 to -0.20]; I2 = 0%; P < .0001) compared with standard formula. Prebiotic formula supplementation increased total bacteria compared with human milk (MD: 0.41 [95% CI, 0.17-0.65]; I2 = 8%; P = .0006). In terms of growth parameters, weight-for-age z scores favored the prebiotic formula group compared with the human milk group (k = 2 [MD: 0.23; 95% CI, 0.04-0.42]; I2 = 7%; P = .02).
Prebiotic supplementation in infant formula can positively alter the gut microbiota, particularly Bifidobacterium, without negative impacts on growth. Standardized, high-quality research is needed to confirm the study findings and inform guidelines for prebiotic use in infant nutrition.
PROSPERO registration no. CRD42021253589.
益生元常被添加到婴儿配方奶粉中，以模拟母乳中低聚糖的益处。
本系统评价和荟萃分析评估了添加益生元的牛乳基配方奶粉与标准配方奶粉或母乳对照相比，对6个月及以下婴儿肠道微生物群、肠道环境、生长参数以及安全性和耐受性的影响。
在PubMed、Embase、Cochrane对照试验中心注册库和ProQuest学位论文数据库中进行检索。纳入自数据库建立至2024年4月发表的、报告随机对照试验且符合预先设定的纳入和排除标准的文章。
结局指标包括肠道微生物群（如多样性；门、科、属和种水平的分类群）、肠道环境（如pH值、分泌型免疫球蛋白A、粪便钙卫蛋白、粪便代谢产物）、生长参数（如z评分）以及安全性和耐受性。使用固定效应或随机效应模型，并计算95%置信区间的平均差（MD）以评估合并效应。使用Cochrane协作工具（RoB 2）评估偏倚风险。
共有30篇文章符合纳入标准，纳入5290名婴儿。虽然对乳酸杆菌的影响不一致，但与标准配方奶粉相比，添加益生元的配方奶粉可增加双歧杆菌数量（k = 7 [MD：0.49；95%CI，0.27 - 0.71]；I² = 13%；P <.00001）并降低粪便pH值（k = 7 [MD：-0.39；95%CI，-0.57至-0.20]；I² = 0%；P <.0001）。与母乳相比，添加益生元的配方奶粉可增加总细菌数量（MD：0.41 [95%CI，0.17 - 0.65]；I² = 8%；P =.0006）。在生长参数方面，与母乳组相比，年龄别体重z评分更有利于益生元配方奶粉组（k = 2 [MD：0.23；95%CI，0.04 - 0.42]；I² = 7%；P =.02）。
婴儿配方奶粉中添加益生元可对肠道微生物群，尤其是双歧杆菌产生积极影响，且对生长无负面影响。需要开展标准化、高质量的研究来证实本研究结果，并为婴儿营养中益生元的使用提供指导。
PROSPERO注册号CRD42021253589。
