Nondigestible Carbohydrates in the Diets of Infants and Young Children: A Commentary by the ESPGHAN Committee on Nutrition

Abstract

The consumption of nondigestible carbohydrates is perceived as beneficial by health professionals and the general public, but the translation of this information into dietary practice, public health recommendations, and regulatory policy has proved difficult. Nondigestible carbohydrates are a heterogeneous entity, and their definition is problematic. Without a means to characterize the dietary components associated with particular health benefits, specific attributions of these cannot be made. Food labeling for "fiber" constituents can be given only in a general context, and the development of health policy, dietary advice, and education, and informed public understanding of nondigestible carbohydrates are limited. There have, however, been several important developments in our thinking about nondigestible carbohydrates during the past few years. The concept of fiber has expanded to include a range of nondigestible carbohydrates. Their fermentation, fate, and effects in the colon have become a defining characteristic; human milk, hitherto regarded as devoid of nondigestible carbohydrates, is now recognized as a source for infants, and the inclusion of nondigestible carbohydrates in the diet has been promoted for their "prebiotic" effects. Therefore, a review of the importance of nondigestible carbohydrates in the diets of infants and young children is timely. The aims of this commentary are to clarify the current definitions of nondigestible carbohydrates, to review published evidence for their biochemical, physiologic, nutritional, and clinical effects, and to discuss issues involved in defining dietary guidelines for infants and young children.

Evaluation of dietary fibre intake from infancy to adolescence against various references – results of the DONALD Study

“…The ESPGAN Committee on Nutrition argued that an energy-linked reference value could lead to excess amounts in toddlers (Aggett et al, 2003). In fact, our data showed higher recommended values from the energy-based approach than from the age-or body weight-based approach.…”

“…The 'age þ 5' rule is easy to prescribe and easy to remember even for lay persons (Dwyer, 1995), but it was criticized as being pragmatic and without any firm physiological basis (Aggett et al, 2003). The resulting recommended dietary fibre levels are well below the two other recommendations used here (Figure 1).…”

“…However, a variety of definitions of dietary fibre exist. The ESPGHAN Committee on Nutrition (Aggett et al, 2003) defines dietary fibre as NDC. Using this definition, fructo-and galactooligosaccharides present in breast milk (Kunz et al, 2000) as well as the amount of lactose that is not absorbed and escapes into the large intestine are counted in dietary fibre.…”

“…Whereas breast-fed infants get such NDS, formula-fed infants do not, as long as common formula products are not supplemented with thickening agents and prebiotic compounds. However, until better assessments of their metabolic and clinical effects, the ESPGHAN committee on Nutrition is advised to be cautious concerning such supplementation (Aggett et al, 2003).…”

Dietary fibre in infancy and childhood

“…Thus, human milk could, if the new definitions are accepted, be considered the first source of dietary fibre. Other early sources of non-digestible carbohydrates include thickeners in medicines and anti-regurgitation products (Aggett et al 2003).At weaning new complex carbohydrate foods are included in the diet. For the first time the colonic flora encounter cellwall polysaccharides, and the bacteria must develop the ability to cope with them.…”