母乳低聚糖与婴幼儿代谢性疾病的相关性研究进展

母乳是婴幼儿摄取营养的最佳来源,世界卫生组织建议纯母乳喂养至婴幼儿6个月,并持续母乳喂养至婴幼儿两岁及以上。母乳中含有多种营养物质满足婴幼儿生长发育的需求,其中母乳低聚糖(human milk oligosaccharides,HMOs)是一类结构复杂的功能性低聚糖,含量在母乳中位于第三位,仅次于脂肪和乳糖^([1])。HMOs不能被婴幼儿胃肠道上部消化,会直接到达小肠及结肠。     

人乳、牛乳和配方奶粉中脂肪酸组成随泌乳期及婴幼儿不同阶段的变化

目的分析不同泌乳期与婴幼儿阶段配方奶粉、牛乳与人乳中的脂肪酸组成情况。方法选择50例健康产妇提供的人乳、35份荷斯坦牛牛乳与30份配方奶粉开展临床检验,以气相色谱法检测不同样本的脂肪酸组成情况。结果配方奶粉中检测出28种脂肪酸,牛乳中检测出30种脂肪酸,人乳中检测出27种脂肪酸。在所有配方奶粉中棕榈酸、油酸与亚油酸的占比较高。人乳中各阶段均以油酸、亚油酸与棕榈酸为最常见脂肪酸类型。伴随泌乳期阶段变化,牛乳中γ-亚麻酸与亚油酸的占比明显下降(P<0.05),但花生四烯酸占比显著升高(P<0.05);人乳中棕榈酸、顺-11-二十烯酸、芥酸与神经酸均明显下降(P<0.05)。伴随婴幼儿年龄增加其配方奶粉亚油酸、花生四烯酸、α-亚油酸与顺式-4,7,10,13,16,19-二十二碳六烯酸的占比明显下降。结论在生产配方奶粉时需参照人乳中脂肪酸组成进行合理配置,着重调整亚油酸、亚麻酸、二十二碳六烯酸与花生四烯酸等重要脂肪酸含量,以促使婴幼儿获得最佳营养供给。     

母乳营养成分研究的新进展

<正> 母乳是健康新生儿、婴幼儿理想的营养物质,母乳喂养最初是研究其主要成份的蛋白质、脂肪、乳糖等问题,后来集中研究微量元素、感染防御因子.近年来对生长因子的研究引人注目.现已知母乳中有100多种以上的化学成分.本文就母乳营养成份研究的新进展作一概述. 一、氨基酸众所周知用人乳喂养能提供优质蛋白,人乳胱氨酸和牛磺酸等必需氨基酸含量较高.据研究早产母乳尤其是泌乳的前1个月,所含蛋白质、非蛋白氮、钠、氯和钙均较成熟人乳     

母乳喂养与儿童健康

母乳喂养对婴幼儿早期以及远期的健康均有促进作用,是因为母乳中独一无二且至今无法模拟与替代的营养成分。特别是随着母乳库捐赠人乳的临床应用,国内外开展了大量对母乳成分的相关研究,发现母乳中存在成百上千的蛋白质以及大量的生物活性因子,如生长因子和免疫因子以及寡糖和有益菌群等。这些活性成分有不同的生理功能,涉及到机体代谢以及免疫的各个环节。在婴幼儿早期发挥着促进肠道黏膜的成熟与发育、提高免疫功能、减少炎症反应,并对过敏性疾病的发生起到一定的预防作用。     

2’-岩藻糖基乳糖的功能及其应用现状

2’-岩藻糖基乳糖是母乳中最主要的低聚糖之一,近年来大量实验研究了2’-岩藻糖基乳糖在调节肠道菌群及免疫系统方面的作用,随着2’-岩藻糖基乳糖在体外合成的实现,临床研究也表明2’-岩藻糖基乳糖添加奶粉促进了婴幼儿免疫发育且耐受性良好。本文综述了2’-岩藻糖基乳糖在母乳中的含量、变化趋势及其健康益处,总结了现阶段2’-岩藻糖基乳糖添加奶粉的临床研究结果和当前添加到婴幼儿配方产品中的2’-岩藻糖基乳糖的生产工艺和特性,可为优化婴幼儿配方食品提供参考。[营养学报,2020,42(2):187-192]     

人乳、牛乳及婴儿奶方中脂肪酸组成比较

进一步提倡母乳喂养.方法 采用气相色谱法测定了人乳、牛乳和婴儿奶方中脂肪酸的含量.结果 显示婴儿奶方和半乳中总饱和脂肪酸(sfA)、C8:0、C14:0C16:0 、和C18:0含量都显著高于人乳,而总不饱和脂肪酸(TUFA)、总多价不饱和脂肪酸(PUFA)、亚油酸(C18:2,LA),α-亚麻酸(C18:3,LNA)和花生四烯酸(C20:4,AA)含量都显著低于人乳.人乳中可测得二十二碳六烯酸(C22:6DHA),而在婴儿奶方和年乳中都未测得DHA .结论 婴儿奶方中脂肪酸组成较牛光更接近于人乳,但不能完全替代人乳.人乳是婴儿理想的食物选择.婴儿奶方中应强化DHA.     

母乳喂养，让职场妈妈温柔有力量

<正>母乳喂养在预防儿童疾病方面起到了关键的作用。母乳不仅是智能化的食物,也是母婴情感联结的重要纽带。母乳的成分随着婴幼儿生长发育而变化,当婴儿食用固体食物之后,母乳中的免疫因子持续增加,产后第二年的人乳含有较高浓度的总蛋白、乳铁蛋白、浴菌酶和免疫球蛋白,脂肪含量也在增加,还提供了大量的维生素。     

人乳中酶的作用和意义

人乳在促进新生儿的健康与营养上有其生理上的适应性。与经加工的牛乳相比人乳含有活性酶、各种激素和必需营养素,是一种适合于婴儿的有活力的分泌物。虽然人乳的酶含量比牛乳高得多,但关于这些酶的作用和意义的资料却极少。Shahani等综述牛乳中的酶,认为该类酶可能是分泌型上皮细胞的正常成份,并在此参与细胞代谢与牛乳成份的生物合成。在挤奶过程中细胞挤裂,酶流出到乳中,有些酶可直接分泌到乳中,这有益于消化系统尚未发育完全的新生儿。本文将综述人乳中的某些酶的生理意义,并提出这些酶起到近似于牛奶中酶作用的证据。从大体上看,人乳中酶的水平均高于牛乳。授乳阶段对人乳中酶浓度影响明显。一般情况,大多数酶在分娩后的早期浓度明显增高,尔后逐渐下降。另外授乳期妇女营养摄入的形式和方式及取样时间均可影响人乳中酶的水平。     

人乳中部分激素的生理功能研究进展

人乳是儿童生命早期最佳的营养物质,人乳喂养是最利于婴儿生长发育的喂养方式。人乳喂养不仅能够满足婴儿的营养需要,增强婴儿的抗病能力,而且有利于婴儿的心理发展。近年来在人乳中相继检测出多种激素,这些激素包括瘦素、脑肠肽、脂联素、抵抗素和肥胖抑制素等。它们与生命早期营养素摄取和能量平衡调节有关,可能程序化地影响远期的代谢平衡。随着代谢性疾病发生率的上升和发病的低龄化趋势,寻求早期预防代谢性疾病的措施成为人们关注的问题。人乳中的激素成分对生命早期营养及代谢的调控机制虽未完全阐明,但现有研究表明这些激素成分的功能与远期的代谢调节及健康密切相关。     

提倡母乳喂养绝非老生常谈

近二三十年来,儿童发育不良者相应增多,这与母乳喂养渐少有密切关系,需要向准妈妈宣传母乳喂养的好处。 母乳中有丰富的适于婴儿生长发育的营养素 人乳是一种高度复杂的生化物,它所含的各种营养成分是相互关联的。例如,牛乳内的钙含量比人乳高,但喂人乳的婴儿很少出现低血钙和佝偻病,就是由于人乳含有优良蛋白质,能促进钙的吸收。人乳还可提供牛乳所不具备的长碳键脂肪,含碳键长,双键多,富有多种不饱和脂肪酸的成分,正是婴儿大脑发育需要的营养物质。人乳中的脂肪含油酸量比牛乳为高,较容易消化吸收。人乳中含有较丰富的溶菌酶,与蛋白质作用形成易于消化的酪蛋白,人乳与牛乳的酪蛋白,有物理化学上的区别。人乳酪蛋白形成的乳凝块较小而软,易为     

Human Milk Microbiota and Oligosaccharides: A Glimpse into Benefits,Diversity, and Correlations

Human milk represents a cornerstone for growth and development of infants, with extensive array of benefits. In addition to exceptionally nutritive and bioactive components, human milk encompasses a complex community of signature bacteria that helps establish infant gut microbiota, contributes to maturation of infant immune system, and competitively interferes with pathogens. Among bioactive constituents of milk, human milk oligosaccharides (HMOs) are particularly significant. These are non-digestible carbohydrates forming the third largest solid component in human milk. Valuable effects of HMOs include shaping intestinal microbiota, imparting antimicrobial effects, developing intestinal barrier, and modulating immune response. Moreover, recent investigations suggest correlations between HMOs and milk microbiota, with complex links possibly existing with environmental factors, genetics, geographical location, and other factors. In this review, and from a physiological and health implications perspective, milk benefits for newborns and mothers are highlighted. From a microbiological perspective, a focused insight into milk microbiota, including origins, diversity, benefits, and effect of maternal diet is presented. From a metabolic perspective, biochemical, physiological, and genetic significance of HMOs, and their probable relations to milk microbiota, are addressed. Ongoing research into mechanistic processes through which the rich biological assets of milk promote development, shaping of microbiota, and immunity is tackled.     

Human milk oligosaccharides are resistant to enzymatic hydrolysis in the upper gastrointestinal tract

BACKGROUND: Human milk oligosaccharides (HMOs) show a complexity and variety not found in milk of any other species. Although progress has been made in the past 3 decades with regard to identification and structural characterization of HMOs, not much is known about the physiologic functions of HMOs. OBJECTIVE: As a prerequisite for biological activity in infant metabolism, HMOs have to resist enzymatic hydrolysis in the gastrointestinal tract. To assess the extent to which selected HMOs are hydrolyzed, we carried out in vitro digestion studies using enzyme preparations of human and porcine pancreas and intestinal brush border membranes (BBMs). DESIGN: Fractions of HMOs, including structurally defined isolated oligosaccharides, were digested for up to 20 h with human pancreatic juice and BBMs prepared from human or porcine intestinal tissue samples. HMOs were incubated by using a porcine pancreatic homogenate and BBMs as enzyme sources. HMOs and digestion products were identified by mass spectrometry and anion-exchange chromatography. Additionally, free D-glucose, L-fucose, and N-acetylneuraminic acid were determined enzymatically. RESULTS: Whereas maltodextrin (control) was rapidly and completely hydrolyzed, neutral and acidic HMOs showed a profound resistance against pancreatic juice and BBM hydrolases. However, cleavage of most of the HMOs was achieved by using a pancreatic homogenate containing intracellular, including lysosomal, enzymes in addition to secreted enzymes. CONCLUSIONS: The results of this study strongly suggest that HMOs are not hydrolyzed by enzymes in the upper small intestine. Although intact HMOs may be absorbed, we postulate that a majority of HMOs reach the large intestine, where they serve as substrates for bacterial metabolism. Therefore, HMOs might be considered the soluble fiber fraction of human milk.     

Milk Exosomes Transfer Oligosaccharides into Macrophages to Modulate Immunity and Attenuate Adherent-Invasive E. coli (AIEC) Infection

Exosomes are abundance in human body fluids like urine, milk and blood. They act a critical role in extracellular and intracellular communication, intracellular trafficking and physiological regulation. Multiple immune-modulatory components, such as proteins, RNAs and carbohydrates (glycoproteins), have been found in human milk exosomes, which play immune-regulatory functions. However, little is known about oligosaccharides in milk exosomes, the “free sugars”, which act critical roles in the development of infant’s immature mucosal immune system. In this study, the profile of milk exosomes encapsulated human milk oligosaccharides (HMOs) was calibrated with characteristic oligosaccharides in colostrum and mature milk, respectively. The exosomes containing human milk oligosaccharides were uptaken by macrophages, which were responsible for the establishment of intestinal immunity. Furthermore, mice pretreated with exosome encapsulated HMOs were protected from AIEC infection and had significantly less LPS-induced inflammation and intestinal damage. Exosome encapsulated milk oligosaccharides are regarded to provide a natural manner for milk oligosaccharides to accomplish their critical functions in modifying newborn innate immunity. The understanding of the interaction between a mother’s breastfeeding and the development of an infant’s mucosal immune system would be advantageous. The transport of milk oligosaccharides to its target via exosome-like particles appears to be promising.     

Determinants of information technology outsourcing among health maintenance organizations

We analyze the determinants of HMO information technology outsourcing using two studies. Study 1 examines the effect of asset specificity on outsourcing for development and operation activities, using HMO specific fixed effects to control for differences between HMOs. Study 2 regresses the HMO specific fixed effects from Study 1, which measure an HMO's propensity to outsource, on HMO characteristics. The data comes from a 1995 InterStudy survey about information technology organization of HMOs. While HMOs split roughly equally in outsourcing information technology development activities, they are extremely unlikely to outsource the day-to-day operation of information systems. The greater an HMO's information technology capability and the complexity of information systems supported, the less likely is an HMO to outsource. While HMOs less than two years old, for-profit HMOs, local or Blue Cross-affiliated HMOs, and mixed HMOs are more likely to outsource, federally qualified HMOs are less likely to outsource. Policy and managerial implications for the adoption and diffusion of new ways of organizing information technology, such as application service providers (ASPs), are discussed.     

Hospital and health maintenance organization financial agreements for inpatient services: a case study of the Minneapolis/St. Paul area.

With nearly a quarter of the population enrolled in Health Maintenance Organizations (HMOs) the Mineapolis/St. Paul metropolitan area provides a unique opportunity for studies dealing with the effects of prepaid health plans on the health care marketplace. This study explores one aspect of that market; discounts obtained by HMOs for hospital inpatient service. Using information gathered from structured interviews with the 7 HMOs and 30 hospitals in the Twin Cities area, the study addressed three areas of inquiry: (1) the nature of discount contracts between hospitals and HMOs, (2) the roles played by each party in initiating the contracts, and (3) factors influencing the establishment of the contracts. While each of the HMOs was found to have at least one hospital contract under which they received inpatient services for other than full-billed charges, the amount of the discount was not substantial in the majority of cases. Other factors such as hospital location and ability to provide a full range of services appear to be as important as financial discounts when HMOs select a hospital for inpatient services. It appears that hospitals played the lead role in initiating hospital/HMO contracts during the formative HMO years, but this initiative shifted to the HMOs as they gained market shares and bargaining power. Hospitals and HMOs agree that the most important factor influencing hospital willingness to consider discount contracts was and still is the surplus bed availability in the area. This surplus of beds has been exacerbated by a continued decline in hospital utilization. These conditions coupled with increased HMO market shares has recently resulted in intensified contract negotiations and further discounts for inpatient services.     

Physicians' perspectives of HMOs and marketing: implications and recommendations

The authors compare physicians in HMOs and those not in HMOs in order to determine how HMOs have affected their practices. Physicians in HMOs see more patients per day, but receive less income per patient than physicians not in HMOs; however, both groups of physicians agree that HMOs have not changed marketing practices. In fact, both groups report uncertainty as to the best way to market their practice, and in their understanding of marketing. The physicians do agree that patient referrals are the most important means of patient acquisition; however, both groups report a surprisingly low use of patient questionnaires. Implications and recommendations for HMOs, physicians, and health care marketing researchers are discussed.     

Physicians' Perspectives of HMOs and Marketing

The authors compare physicians in HMOs and those not in HMOs in order to determine how HMOs have affected their practices. Physicians in HMOs see more patients per day, but recieve less income per patient than physicians not in HMOs; however, both groups of physicians agree that HMOs have not changed marketing practices. In fact, both groups report uncertainty as to the best way to market their practice, and in their understanding of marketing. The physicians do agree that patient referrals are the most important means of patient acquisition; however, both groups report a surprisngly low use of patient questionnaires. Implications and recommendations for HMOs, physicians, and health care marketing researchers are discussed.     

The diffusion of information technology among health maintenance organizations

This article examines the information technology functions, staffing and cost, services provided, and advanced technologies among health maintenance organizations (HMOs) using a national sample of HMOs from mid-1995. HMOs have a well-developed capability to use data from administrative functions, such as claims processing. Nationally affiliated HMOs and HMOs in markets with greater HMO penetration support more IT functions. Relatively little work has been completed integrating clinical with administrative systems.     

Estimating the budget impact of new technologies added to the National List of Health Services in Israel: stakeholders' incentives for adopting a financial risk-sharing mechanism

BACKGROUND: The Israeli National List of Health Services (NLHS) is updated annually according to a government allocated budget. The estimated annual cost of each new technology added to this list is based on budget-impact estimations provided by the HMOs and the manufacturers. The HMOs argue that once a new technology is reimbursed, extensive marketing efforts by industry expands demand and renders the allocated budget insufficient. Industry claims that HMOs, in order to secure a sufficient budget, tend to over-estimate the number of target patients. We provide a framework for a financial risk-sharing mechanism between HMOs and the industry, which may be able to balance these incentives and result in more accurate early budget-impact estimates. OBJECTIVES: To explore the current stakeholders' incentives and behaviors under the existing process of updating the NLHS, and to examine the possible incentives for adopting a financial risk-sharing mechanism on early budget-impact estimations. RESULTS AND CONCLUSIONS: According to the financial risk-sharing mechanism, HMOs will be partially compensated by the industry if actual use of a technology is substantially higher than what was projected. HMOs will partially refund the government for a budget that was not fully used. To maintain profits, we assume that the industry will present a more realistic budget-impact analysis. HMOs will be less apprehensive of technology promotion, as they would be compensated in case of budget under-estimation. In case of over-estimation of technology use, the budget re-allocated will be used to enlarge the NLHS which is in the best interest of the health technology industry. Our proposed risk-sharing mechanism is expected to counter balance incentives and disincentives that currently exist in adopting new health technologies in the Israeli healthcare system.     

A descriptive analysis of average productivity among health maintenance organizations, 1985 to 2001

This paper examines the evolution of average productivity among HMOs for 4,419 Health Maintenance Organizations (HMOs) from 1985 to 2001. For both IPA and non-IPA HMOs, HMO productivity increased from 1990 to 1996 and rapidly decreased from 1997 to 2001. In contrast to cost functions that show scale economies for IPA and non-IPA HMOs, production functions showed scale economies for IPA HMOs were constant and non-IPA HMOs having only slight scale economies. This suggests that much of the scale economies observed in cost functions are due to lower prices for resources used rather than improvements in production organization. Non-IPA HMOs and non-profit HMOs are more productive than IPA HMOs and for profit HMOs. Production organization for non-IPA HMOs appears to have improved over time, resulting in non-IPA HMOs being able to produce more member months of coverage with their production organization in 1997 to 2001 than they would have with their production organization in 1985 to 1990. Regulations requiring consumer involvement in HMO governance reduce productivity.