Multifunctional Benefits of Prevalent HMOs: Implications for Infant Health

Abstract

Breastfeeding is the best source of nutrition during infancy and is associated with a broad range of health benefits. However, there remains a significant and persistent need for innovations in infant formula that will allow infants to access a wider spectrum of benefits available to breastfed infants. The addition of human milk oligosaccharides (HMOs) to infant formulas represents the most significant innovation in infant nutrition in recent years. Although not a direct source of calories in milk, HMOs serve as potent prebiotics, versatile anti-infective agents, and key support for neurocognitive development. Continuing improvements in food science will facilitate production of a wide range of HMO structures in the years to come. In this review, we evaluate the relationship between HMO structure and functional benefits. We propose that infant formula fortification strategies should aim to recapitulate a broad range of benefits to support digestive health, immunity, and cognitive development associated with HMOs in breastmilk. We conclude that acetylated, fucosylated, and sialylated HMOs likely confer important health benefits through multiple complementary mechanisms of action.

Growth and Gastrointestinal Tolerance in Healthy Term Infants Fed Milk-Based Infant Formula Supplemented with Five Human Milk Oligosaccharides (HMOs): A Randomized Multicenter Trial

“…Human milk oligosaccharides (HMOs) are non-digestible carbohydrates found in human milk. Their importance to infant nutrition is underscored by their position as the third most abundant solid component of human milk, behind lactose and lipids [1]. HMOs can be structurally categorized as (a) fucosylated HMOs such as 2 -and 3-fucosyllactose (2 -FL and 3-FL), (b) acetylated HMOs such as lacto-N-tetraose (LNT) and (c) sialylated HMOs such as 3 -and 6 sialyllactose (3 -SL and 6 -SL) [1].…”

“…Their importance to infant nutrition is underscored by their position as the third most abundant solid component of human milk, behind lactose and lipids [1]. HMOs can be structurally categorized as (a) fucosylated HMOs such as 2 -and 3-fucosyllactose (2 -FL and 3-FL), (b) acetylated HMOs such as lacto-N-tetraose (LNT) and (c) sialylated HMOs such as 3 -and 6 sialyllactose (3 -SL and 6 -SL) [1]. The profiles of HMOs in human milk can vary widely due to various influences such as genetics, stage of lactation and geography [2].…”

“…While most HMO concentrations decrease over the course of lactation, at least two, 3 -SL and 3-FL, have been reported to increase [3]. Structural differences in HMOs facilitate functional synergy between different categories, as different HMOs may work in cumulative and complementary ways to promote digestive health, immune support and cognitive development [1].…”

“…The digestive benefits of HMOs span across three general areas: prebiotic effects, generation of beneficial microbial metabolites and providing gut barrier protection [1].…”

Variations in the Composition of Human Milk Oligosaccharides Correlates with Effects on Both the Intestinal Epithelial Barrier and Host Inflammation: A Pilot Study

“…Unlike plant-derived glycans or animal sources of milk oligosaccharides, HMOs are highly complex oligosaccharides notable for marked variability, with up to 150 structures that differ between lactating individuals [ 8 ]. Structurally, HMOs share a common lactose core, which can be elongated from five individual monosaccharides: glucose, galactose, N-acetylglucosamine, fucose and sialic acid [ 9 ].…”