1. نقش پره بیوتیک و پروبیوتیک ها در دوران شیردهی
دکتر آزاده نجارزاده، متخصص تغذیه

2. human breast milk contains over 700 different types of bacteria.
The most common strains include Lactobacillus, Streptococcus, Staphylococcus, Enterococcus and Bifidobacterium.

4. In addition, breast milk contains types of prebiotics known as human
milk oligosaccharides (HMOs), which are non-digestible food
components used by bacteria to stimulate their growth and activity.

5. Prebiotics
Human milk contains more then 130 different oligosaccharides that are fermented in part in the infant’s colon.
• The concentration changes with the duration of lactation:
‐ Highest in colostrum at 20 to 23 g/L,
‐ about 20 g/L on day 4 of lactation,
‐ 9 g/L on day 120 of lactation

6. شیر مادر مهمترین منبع مواد مغذی
نقش شیر مادر در پیشگیری از آلرژی
وجود ترکیبات immunoactive در شیر مادر
نقش پروبیوتیک ها در افزایش CD14 (آنتی آلرژیک)، IgA، TGF-β

7. Importance of Human Breast Milk
Optimal nutrient levels
Appropriate amounts of Carbohydrate, Protein, and Fats
Vitamins
Hormones
Perfect source of nutrition
Minerals
Digestive proteins
Available Online [ accessed on 15/03/09 7

8. Importance of Human Breast Milk
Optimal nutrient levels
Milk leukocytes
Secretory IgA
Lactoferrin
Bifidus factor
Human Milk Oligosaccharides
(HMOS)
Lysozyme
Milk lipids
M. Nathaniel Mead, Environ Health Perspect October; 116(10): A426–A434.
Wagner CL, Anderson DM, Pittard WB Special properties of human milk. Clin Pediatr (Phila) 35(6):283–293. 8

9. Importance of Human Breast Milk
Prebiotics e.g. Human Milk oligosaccharides
Kelly M. Jackson; Andrea M. Nazar, JAOA • Vol 106 • No 4 • April 2006 •

10. Colonic Fermentation of
Effects of Prebiotics
Oligosaccharides
Colonic Fermentation of
Oligosaccharides
Since the lack of gut flora can have such harmful health effects, the use of probiotics has anti-inflammatory effects in the gut and may be useful for improving health.
Prebiotics are dietary components that can help foster the growth of microorganisms in the gut, which may lead to better health.
Guarner F and Malagelada JR Role of bacteria in experimental colitis. Best Practice & Research Clinical Gastroenterology, Volume 17, Issue 5, October 2003, Pages PMID Accessed September 15, 2007
Guarner F et al, Best Practice & Research Clinical Gastroenterology, Volume 17, Issue 5, October 2003,

11. Acquisition of gut flora in human infants
“The infant tends to acquire the flora swallowed from the vaginal fluid at the time of delivery”1
Colonization
“Infants delivered by cesarean section are colonized with more anaerobic bacteria, especially Bacteroides, than vaginally delivered infants ”2
GUT is sterile
Suhali Al-Shammri et al., Journal of the Neurological Sciences 15 July 2004 (Vol. 222, Issue 1, Pages 21-27) 1- Vanderhoof, Jon A.Journal of Pediatric Gastroenterology & Nutrition. 30 Supplement 2:S34-S38, March Adlerberth I. et al , The Ontogony of Intestinal Flora, 1999, p 11

12. Development of the gut flora
Every individual has a particular combination of predominant and subdominant species that is distinct from that found in other individuals
Bifidobacteria
Bacteriods fragilis
The intestinal habitat of an adult individual contains 300–500 different species of bacteria, with 30–40 species comprising up to 99% of the total population.
Conventional bacteriological analysis of the faecal flora by isolation of bacteria on selective growth media shows that strict anaerobic bacteria outnumber aerobes by a factor of 100 to 1,000.
The dominant genera are Bacteroides, Bifidobacterium, Eubacterium, Clostridium, Lactobacillus, Fusobacterium and various anaerobic Gram-positivecocci. Bacteria present in lower numbers include Enterococcus, and Enterobacteriaceae .
Every individual has a particular combination of predominant and subdominant species that is distinct from that found in other individuals. However, over 50% of bacteria cells that are observed by microscopic examination of faecal specimens cannot be grown in culture media
Clostridium
Lactobacillus acidophilus
Francisco Guarner (Spain), Digestion 2006;73(suppl 1):5–12

13. The Prebiotics concept
Prebiotics must “survive” acidic conditions
Must stimulate one or a limited number of beneficial bacteria
Prebiotics must be selectively fermented in the colon
Prebiotics must evade digestion in the small intestine
Fuller & Gibson, 1997, Scand J Gastroenterology Suppl (222):32-40

14. Therapeutic Manipulation of the Intestinal Flora (Probiotics)
“live microorganisms which confer health benefits on the host”, when administered in adequate amounts.
Acute diarrhea in infants
Antibiotic-associated diarrhea
A consensus definition of the term ‘probiotic’ was issued a few years ago and states that oral probiotics are living microorganisms that upon ingestion in certain numbers, exert health benefits beyond those of inherent basic nutrition.
Two meta-analyses concluded that probiotics can be used to prevent antibiotic-associated diarrhea in children and adults. Prophylactic use of probiotics has proven useful for the prevention of acute diarrhea in infants admitted into hospital wards for a chronic disease condition. Probiotics may also be useful in the prevention of community-acquired diarrhea. Several studies have investigated the efficacy of probiotics in the prevention of travelers’ diarrhea in adults,
Needs research to prove safety & efficacy
Francisco Guarner (Spain), Digestion 2006;73(suppl 1):5–12

15. Acquisition of gut flora in human infants
Breast-fed babies
Formula-fed infants
During the first week of life, these bacteria create a reducing environment favorable for the subsequent bacterial succession of strict anaerobic species mainly belonging to the genera Bifidobacterium, Bacteroides, Clostridium, and Ruminococcus.
Breast-fed babies become dominated by bifidobacteria, possibly due to the contents of bifidobacterial growth factors in breast milk.
In contrast, the microflora of formula-fed infants is more diverse with high numbers of Enterobacteriaceae, enterococci, bifidobacteria, Bacteroides, and clostridia.
After the introduction of solid food and weaning, the microflora of breast-fed infants becomes similar to that of formula-fed infants. By the second year of life the fecal microflora resembles that of adults.
Bifidobacteria
Enterobacteriaceae, enterococci, bifidobacteria, Bacteroides, and clostridia
Suhali Al-Shammri et al., Journal of the Neurological Sciences 15 July 2004 (Vol. 222, Issue 1, Pages 21-27)

16. Acquisition of gut flora in human infants
Differences in Development of Microbiota in Breast- and Formula-fed Babies
Bifidobacteria Bacteroides E. coli
Harmsen et al. (2000) JPGN 30:61-67

17. Balance of the Gut flora
In the colon, however, transit time is slow and microorganisms have the opportunity to proliferate by fermenting available substrates derived from either the diet or endogenous secretions.
Generalised scheme of predominant groups of colonic bacteria, indicating how the genera may exhibit potentially harmful and benefi cial functions
Francisco Guarner (Spain), Digestion 2006;73(suppl 1):5–12

18. The gut flora as a forgotten organ
Bacteria in the gut fulfills a host of useful functions for humans, including digestion of unutilized energy substrates.
Stimulating cell growth
Repressing the growth of harmful microorganisms
Training the immune system to respond only to pathogens
Defending against some diseases
Available online [ accessed online on 12th of October 2008
IEC: intestinal epithelial cell
Ann M.O’Hara & Fergus Shanahan, EMBO reports VOL 7, NO 7, 2006

19. Increase growth of human gut cells
Carbohydrate fermentation and absorption
Increase growth of human gut cells
Reduce counts of damaging bacteria
Bacteria turn carbohydrates they ferment into short chain fatty acids, or SCFAs. These materials can be used by host cells: Providing a major source of useful energy and nutrients for humans.
They increase the gut's absorption of water
Reduce counts of damaging bacteria
Increase growth of human gut cells
Growth of indigenous bacteria.
The SCFAs are produced by a form of fermentation called saccharolytic fermentation and include acetic acid, propionic acid, and butyric acid. Gases and organic acids like lactic acid are also produced by saccahrolytic fermentation. Acetic acid is used by muscle, propionic acid helps the liver produce ATP, and butyric acid provides energy to gut cells and may prevent cancer.
Growth of indigenous bacteria.
They increase the gut's absorption of water

20. Healthy gut microbiota similar to breast-fed infants, resulting
Patented Prebiotics
Combination of short-chain Galacto-Oligosaccharides (GOS) and long-chain Fructo-Oligosaccharides (FOS)
Amounts and molecular size and distribution similar to HMOS (0.8 g/100 ml, GOS:FOS 9:1)
Made from natural ingredients (lactose and chicory)
Aim:
Healthy gut microbiota similar to breast-fed infants, resulting
in health benefits

21. تاثیر مصرف پروبیوتیک ها در دوران بارداری و شیردهی بر درماتیت آتوپیک

23. . Experimental design. Trial compound (4 g) was administered twice daily from 26 weeks of gestation to 1 month after delivery. FOS, fructo-oligosaccharides.

24. Comparison of the concentrations of IL-27 in (a) colostrum samples and (b) 1- month milk samples obtained from the placebo and fructooligosaccharide (FOS) groups. The Mann–Whitney U- test was used to analyse differences between the experimental groups (bar, median) ((a) P<0·027; (b) P<0·040)

25. IL-27, together with IL-12, IL-23 and IL-35, belongs to the family of cytokines associated with T- cell differentiation.
IL-27 induces the differentiation of T helper (Th)1 cells, regulates the induction of Th17 cells, increases the production of IL- 10, and induces type 1 regulatory T cells (Tr1)

26. In contrast to the demonstrated effects of probiotics, no significant
difference in colostrum TGF-b, total IgA and soluble CD14
concentrations between the FOS and control groups was observed in
the present study. These data suggest that prebiotics may act
differently when compared with probiotics.

27. Probiotics and mastitis
In some cases, new mums can develop a painful inflammation of the breasts called mastitis. It usually occurs when milk ducts become blocked due to ineffective emptying of the breasts during breastfeeding. The trapped milk can quickly become infected with bacteria entering the breast through sore or cracked nipples leading to an infection that might require antibiotic treatment.

28. Studies have shown that an oral supplement with lactobacilli strains can reduce the number of pathogenic bacteria and lead to a faster recovery.
Probiotics have also been recommended to prevent thrush episodes following the antibiotic treatment.

29. ایمنی مصرف پروبیوتیک ها در شیردهی
Probiotics do not appear to pose any safety concerns for pregnant and lactating women.
current literature does not indicate an increase in adverse pregnancy outcomes.

31. پودر شیر غنی شده ببمام برای حمایت از شیردهی مادران
نوشیدن یک لیوان ببمام در روز 50% از نیازهای تغذیه ای مادر را تأمین می کند.
DHA
کلسیم
آهن
فسفر
روی ید
ویتامینهای
A,D,B2,B12&B5
حاوی DHA که موجب تکامل مغزی و بینایی نوزاد می شود.
پودر شیر غنی شده ببمام برای حمایت از شیردهی مادران

33. THANKS FOR YOUR ATTENTION33