Impact of human milk pasteurization on gastric digestion in preterm infants: a randomized controlled trial
Impact of human milk pasteurization on gastric digestion in preterm infants: a randomized controlled trial
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DOI：
10.3945/ajcn.116.142539
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发表时间：
2017-02-01
影响因子：
7.1
通讯作者：
Bourlieu, Claire
中科院分区：
文献类型：
--
作者：
de Oliveira, Samira C.;Bellanger, Amandine;Bourlieu, Claire
背景：据报道，持有人巴氏灭菌可通过灭活胆盐刺激脂肪酶 (BSSL) 并使其部分蛋白质部分变性，从而改变母乳成分和结构，从而可能影响其随后的消化。目的：我们试图确定母乳巴氏灭菌对用母亲自己的母乳（生奶或巴氏灭菌奶）喂养的早产儿胃消化（特别是蛋白质和脂质）的影响。设计：在一项随机对照试验中，12 名住院的早产儿接受管饲婴儿作为自己的对照组，比较生母乳（RHM）和巴氏灭菌母乳（PHM）的胃消化情况。在 6 天的序列中，在 RHM 或 PHM 摄入之前和之后每天收集胃吸出物 2 次。使用一般线性混合模型测试了牛奶巴氏灭菌消化动力学和崩解的影响。结果：尽管 BSSL 失活，瞬时脂肪分解并未受到巴氏灭菌的影响（90 分钟时的平均值 +/- SD：12.6% +/- 4.7%；P > 0.05）。消化前牛奶中发生脂肪分解，PHM 的脂肪分解高于 RHM（平均 SD：分别为 3.2% +/- 0.6% 和 2.2% +/- 0.8%；P < 0.001）。巴氏灭菌增强了乳铁蛋白的蛋白水解作用（P < 0.01），并降低了α-乳清蛋白的蛋白水解作用（仅在 90 分钟时）（P < 0.05）。观察到强烈的乳液不稳定，具有较小的聚集体和较高的 PHM 比表面（P < 0.05）。巴氏灭菌不影响 90 分钟时的胃排空（类似于 30 分钟半时间）或 pH（平均 SD：4.4 +/- 0.8）。结论：总体而言，巴氏灭菌对人乳中脂质和某些蛋白质的胃消化没有影响，但确实影响乳铁蛋白和 α-乳白蛋白的蛋白水解和乳液崩解。冻融和巴氏灭菌增加了消化前的牛奶脂肪分解，但不影响胃脂肪分解。本研究没有考虑对肠道消化和相关营养结果可能产生的后果。
Background: Holder pasteurization has been reported to modify human milk composition and structure by inactivating bile salt stimulated lipase (BSSL) and partially denaturing some of its proteins, potentially affecting its subsequent digestion.Objective: We sought to determine the impact of human milk pasteurization on gastric digestion (particularly for proteins and lipids) in preterm infants who were fed their mothers' own milk either raw or pasteurized.Design: In a randomized controlled trial, 12 hospitalized tube-fed preterm infants were their own control group in comparing the gastric digestion of raw human milk (RHM) with pasteurized human milk (PHM). Over a 6-d sequence, gastric aspirates were collected 2 times/d before and after RHM or PHM ingestion. The impact of milk pasteurization digestive kinetics and disintegration was tested with the use of a general linear mixed model.Results: Despite inactivating BSSL, instantaneous lipolysis was not affected by pasteurization (mean +/- SD at 90 min: 12.6% +/- 4.7%; P > 0.05). Lipolysis occurred in milk before digestion and was higher for PHM than for RHM (mean SD: 3.2% +/- 0.6% and 2.2% +/- 0.8%, respectively; P < 0.001). Pasteurization enhanced the proteolysis of lactoferrin (P < 0.01) and reduced that of a-lactalbumin (only at 90 min) (P < 0.05). Strong emulsion destabilization was observed, with smaller aggregates and a higher specific surface for PHM (P < 0.05). Pasteurization did not affect gastric emptying (similar to 30-min half time) or pH (mean SD: 4.4 +/- 0.8) at 90 min.Conclusions: Overall, pasteurization had no impact on the gastric digestion of lipids and some proteins from human milk but did affect lactoferrin and a-lactalbumin proteolysis and emulsion disintegration. Freeze-thawing and pasteurization increased the milk lipolysis before digestion but did not affect gastric lipolysis. Possible consequences on intestinal digestion and associated nutritional outcomes were not considered in this study.