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KEY PERFORMANCE OF

HEALTHY GUT IN EARLY LIFE:


Dynamic Function of
Digestive System
UKK GASTRO-HEPATOLOGI

Unit Kerja Kegiatan (UKK) Gastrohepatologi


Pengurus Pusat Ikatan Dokter Anak Indonesia
2016

BRAI
N
MAKER

THE POWER OF GUT


MICROBES
TO HEAL AND PROTECT
YOUR
BRAIN
- FOR LIFE
"The gut
microbiota
influences
blood-brain barrier permeability in
mice"

"a true second brain is


in our gut, and its
neural function is very
similar to that of the
brain in our head"

Absence of
GI
complaints

Gut health
in
early life
Optimal
nutritional
status and
development

Wellbeing and
strong parental
bonding

The impact of gut health in early life

Optimal Gut Function


70 - 80% of the
body's immune
cells
(gut-specific
immune system)
100 million
neurons : producen
neurotransmiter
(Mood and satiety)
95% body's total
serotonin
100 trillion
bacteria
Reza Ranuh,
2016

Serotoni
Gastrointestin
n
al health

95 % produce in the gut

Neurotransmitters for nerve cells


communication

Brain gut connection regulator

The most important for wellbeing

Changes levels of serotonin, can


change bowel works.
Reza Ranuh,
2016

BREASTFEEDING
provides the foundation
for
lifelong health and
breast milk-fed infant microbiota
wellbeing

is composed by an increased
number of bifidobacteria and
lactobacilli ; formula-fed infant
microbiota has more enterococci
and enterobacteria

Gut microbiota
distribution

Immunologi
c

Nutritional

. Nutrient bioavailability
and digestion
. Production of SCFAs
. Production of essential
nutrients
e.g. vitamin B12,
vitamin K, colic acid

. Guides development of infant


Immunity system
. Contributes to development of
appropiate oral tolerance
. Protects against development of
inflammatory, atopic, and autoimmune
disease

Key
functions
of the gut
microbiota
Physiologic

. Influences gut development


. Provides defence against
pathogen
colonization (competitive
inhibition,
antimicrobial production)
. Influences development and
function
of intestinal mucosal/epithelial
barrier

. Helps regulate energy


Metabolic
and others
homeostasis
. Production of metabolites
. Contributes to development
and
maintenance of gut
sensory/motor
function
. Contributes to feeling of
general
wellbeing

The power of the gut microbiota

Beneficial Functions of Intestinal


Microbiota in Infants

Guarner F, Malagelada JRLancet.


2003;361:512-519.

Intestinal Vili Development

Walker

Leaky Gut
bloating, gas,
Syndrome

cramps,
food sensitivities,
aches, pains

Unsolved mystery

Intestinal
permeability
Reza Ranuh,
2016

Gastrointestinal Tract Health

Impact of the gut microbiota on the


gutbrain axis in health and disease

1
6

The Important of
Intestinal Microflora Balances

Unplanned
reactions
COLI

Gastrointestinal
development
Immature digestion process
GI surface << in VLBW and
IUGR
Intrinsic immaturity of the
enteric nervous system
Food sensitive and allergies
Not properly sucking
Lactose >>
Over feeding
Transient lactase deficiency
Immune system immaturity
Microbial imbalance
Reza Ranuh,
2015

Abdominal discomfort
managements

Infantile
managemen
colic ts
Confirm :
history
Reassure
Suppor
t

Reza Ranuh,
2015

Lactose intolerance is NOT a milk


allergy...
Milk allergy is related to the protein
than lactose....
Human breast milk contain 7%
lactose; cow's milk 4.7%....

Reza Ranuh,
2015

Intestinal Microbial
Imbalance

Natural evolution of
Regurgitation in healthy
infants

Prevalece of daily regurgitation during the first year of life

Functional
constipation

Common complaint (first


year)

The pathogensis not


completely understood.

Tend to be benign in
nature and self-limiting
in the majority of
infants.

Behavioural
interventions General
advice for digestive
problem
reassurance for the
parents
self-limiting condition
teaching more
appropriate responses
less overstimulation.

more appropriate
responses
Breastfeeding
Low lactose
formula
Hydrolized
formula
Paediatr Child Health Vol 16 No 1 January
2011

Zinc

The essential

Important formineral
the functioning of the
enzyme, hormone, and immune
systems.

Maintain tight junctions in the


intestine.

Regulation of endothelial cells in the


gut.

Glutamine

Glutamine is an amino acid important for the growth


of enterocytes.

Important energy source for cells of the intestinal


mucosa (essential for normal mucosal structure and
function).

Required for normal production of secretory


immunoglobulin A (IgA) in the intestine.

Prebiotic

Prebiotic plays an important role in


maintaining normal gastrointestinal function
and health.

Helps maintain normal barrier function of the


intestinal mucosa.

Promoting the growth of beneficial


Bifidobacteria.

lcFOS/scGOS (1:9) impact the


Gut Microbiota Composition

12
11
10
9

Bifidus
Breast-fed infants
*

8
7
6
5
4
3
2

group difference:
p<0.05
*vs. 0, # vs. 0.4

0
0.4
0.8
(n=33) (n=30) (n=27)

log 10 of CFU/g wet faeces (median, IQR)

log 10 of CFU/g wet faeces (median, IQR)

more like breast-fed infants


10
9

Lactobacillus

8
7
6

Breast-fed infants
*

5
4
3
2
1
0

group difference:
p<0.05 *vs. 0

0
0.4
0.8
(n=33) (n=30) (n=27)

Supplementation levels of a unique mixture of Prebiotics [g/100ml]

Moro et al 2002

lcFOS/scGOS vs other Prebiotics:


Review of the clinical outcomes of INTERVENTION TRIALS (randomized and quasirandomized controlled
trials) during INFANCY published until December 2011 using nondigestible carbohydrates as prebiotics

(except pAOS)

lcFOS/scGOS
the most extensively studied prebiotics
Highest number of studies
Highest number of infants involved

Guido E. Moro, Gunther Boehm

Prebiotics in early life


nutrition
Oligosaccharides in human breast milk promote

healthy microbiota.

Infant formula supplemented with GOS and fructans,


stimulate the bifidobacteria.

Infants fed formula with oligosaccharides have


microbiota, a stool pH and a SCFA pattern similar to
those of breast-fed infants (stool consistency and
stool frequency).

Prebiotic-fed infants (softer stool and more frequent)


closer to that seen for breast-fed infants than for
those fed standard formula and safe.

Gastrointestinal Health

SelfCare
2012;3(S1):1-68

The infant digestive system and its dynamic


functions

Thank You

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