During the 6th World Congress of Paediatric Gastroenterology, Hepatology and Nutrition, Professor Yvan Vandenplas presented at FrieslandCampina Institute’s breakfast symposium. This is a write-up of his presentation.
Prof Vandenplas reviewed the definition, diagnosis and prevalence of functional constipation in infants. Functional constipation is defined as constipation without an organic cause and is described most accurately by stool scales, particularly the Brussels Infant and Toddler Stool Scale, which has been specifically developed for infants and toddlers.
The significance of the latest functional ingredients such as probiotics, prebiotics and milk fat in the management of constipation in infants was also discussed. Appropriate infant nutrition may alleviate the symptoms of functional constipation in infants. Probiotics such as Bifidobacterium lactis HN019 are effective in managing functional constipation in infants.
Similarly, prebiotics such as inulin, galacto- oligosaccharides (GOS) and carob bean gum (CBG) are also useful in relieving digestive issues. Inulin is a nonviscous soluble fiber that improves stool consistency by stimulating the growth of probiotics such as Bifidobacterium and Lactobacillus. GOS can also stimulate the growth and metabolism of intestinal Bifidobacterium to improve stool consistency, stool frequency, as well as relieve defecation straining. CBG is a soluble, viscous, fermentable but indigestible fiber that thickens IFs and stimulates Lactobacillus and Bacteroides growth, hence supporting gut motility and promoting diversity in gut microbiota.
Bovine milk fat comprises high levels of sn-2 palmitic acid, which promotes optimal digestion and absorption of fatty acids. A recent study showed that consumption of milk fat-based IF reduces the excretion of fecal fatty acid soap and calcium and improves stool consistency, compared with vegetable fat-based IF (Figure 2).
Figure 2. Effect of milk fat-based IF and vegetable fat-based IF on stool consistency in infants.
Hydrolyzed IF contributes to softer stools and more frequent defecations than IF with intact proteins. Cow’s milk protein allergy (CMPA) is also frequently associated with infant constipation. Hence, switching to an IF that contains higher amounts of prebiotics, probiotics and milk fat, or to a partially hydrolyzed IF, may be considered for treating functional constipation in infants.
In summary, the addition of prebiotics, probiotics and milk fat in IF can help to improve stool consistency in infants.
Breastfeeding is the best nutrition for healthy growth and development of babies. Exclusive breastfeeding for six months is the optimal way of feeding infants. Thereafter infants should receive complementary foods with continued breastfeeding up to two years or beyond. Mothers should receive guidance on proper maternal nutrition in order to help sustain an adequate supply and quality of breast milk. Unnecessary introduction of bottle-feeding, partially or fully, or of other complementary foods and drinks may have a negative impact on breastfeeding, which may be irreversible. Mothers should consult their doctor and consider the social and financial implications before deciding to use breast milk substitutes or if they have difficulty breastfeeding. Usage, preparation and storage instructions of breast milk substitutes or of other complementary foods and drinks should be followed carefully as improper or unnecessary use may pose a health hazard.