Gut wall integrity in exclusively breastfed vs. formula-fed infants
Abstract: Breast milk has
bioactive substances that modulate gastrointestinal maturation and maintain
mucosal integrity of the gut in infants. Markers that are both non-invasive and
reliable, such as fecal alpha-1 antitrypsin (AAT), calprotectin, and secretory
immunoglobulin A (sIgA) have been used to assess gut integrity in adults.
Higher AAT levels may imply greater enteric protein loss due to increase
intestinal permeability of immaturity gut.
Objective To assess and compare gut integrity of exclusively breastfed
(BF) and exclusively formula fed (FF) infants aged 4-6 months.
Methods Subjects were 80 healthy infants (BF=40; FF=40), aged 4-6 months
who visited the Pediatric Polyclinic at St. Carolus Hospital, and lived in
Pasar Minggu or Cempaka Putih Districts, Jakarta. The fecal AAT was analyzed by
an ELISA method. Mann-Whitney and unpaired T-test were used to analyze possible
correlations between feeding type and gut integrity.
Results The BF group had significantly higher mean fecal AAT than the FF
group (P=0.02). Median sIgA levels were not significantly different between
groups (P=0.104). The FF group had a higher mean fecal calprotectin level but
this difference was also not significant (P=0.443). There was a significant
correlation between breastfeeding and mean fecal AAT level (P=0.02), but no
significant correlation with calprotectin (P=0.65) or sIgA (P=0.26).
Conclusion The breastfed group shows better mucosal integrity compared to
the formula fed group. Higher mean fecal AAT level in the BF group is related
to the AAT content of breast milk. Therefore AAT content of BF group is
actually lower than formula fed group which shows greater mucosal integrity in
BF group.
Keywords: infants;
breastfeeding; markers; gut wall integrity; fecal; alpha-1 antitrypsin;
calprotectin; secretory IgA
Author: Nur Hayati, Muzal
Kadim, Irawan Mangunatmadja, Soepardi Soedibyo, Evita Bermansyah Ifran, Hikari
Ambara Sjakti
Journal Code: jpkedokterangg160112
