Современные возможности диетической коррекции минимальных пищеварительных дисфункций у младенцев, находящихся на искусственном вскармливании

Захарова И.Н., Дмитриева Ю.А. Современные возможности диетической коррекции минимальных пищеварительных дисфункций у младенцев, находящихся на искусственном вскармливании. Consilum Medicum. Педиатрия (Прил.). 2015; 4: 11–16.

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Zakharova I.N., Dmitriyeva Yu.A. Modern possibilities of correcting the minimum dietary digestive dysfunctions in infants who are bottle-fed. Consilum Medicum. Pediatrics (Suppl.). 2015; 4: 11–16.

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Аннотация

Преимуществом естественного вскармливания является обеспечение комфортного пищеварения младенцев в условиях транзиторной незрелости механизмов регуляции моторики и ферментативных систем желудочно-кишечного тракта (ЖКТ). Дети, находящиеся на искусственном вскармливании, составляют группу риска по развитию функциональных расстройств ЖКТ. Современной тенденцией производства молочных смесей, предназначенных для профилактики или купирования минимальных пищеварительных дисфункций у младенцев, является обогащение их определенными функциональными ингредиентами, способными оказывать положительное влияние на процессы созревания функциональных структур ЖКТ ребенка и становление кишечной микробиоты. Примером подобных продуктов, обеспечивающих комфортное пищеварение для младенцев, являются смеси серии «Комфорт», содержащие частично гидролизованный белок, минимальное количество лактозы, без пальмового масла, а также имеющие в составе олигосахариды, нуклеотиды и пробиотики, что способствует поддержанию нормальной консистенции стула, адекватной моторике ЖКТ, росту и дифференцировке клеток кишечного эпителия и становлению ферментативной активности пищеварительной системы.

Ключевые слова: младенцы, кишечные колики, морфофункциональная незрелость, искусственное вскармливание, комфортное пищеварение, регуляция моторики, функциональные нарушения желудочно-кишечного тракта, гастроинтестинальные гормоны, желудочно-ингибирующий пептид, панкреатический полипептид и нейропептид Y, соматостатин, мотилин, нейротензин.

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The advantage of breastfeeding is to ensure comfortable digestion of babies under transient immaturity of the mechanisms of regulation of motility and enzyme systems of the gastrointestinal tract (GIT). Children who are bottle-fed, are at risk for the development of functional disorders of the gastrointestinal tract. The current trend of dairy mixtures intended for the prevention or relief of minimal digestive dysfunctions in infants is the enrichment of specific functional ingredients capable of exerting a positive influence on the process of maturation of the functional structures of the gastrointestinal tract of the child and the establishment of the intestinal microbiota. Examples of such products providing comfortable digestion Baby are mixtures of a series of "comfort", containing partially hydrolyzed protein, the minimum amount of lactose, without palm oil, and having a composition of oligosaccharides, nucleotides and probiotics, which helps to maintain normal stool consistency, an adequate motility gastrointestinal tract, growth and differentiation of intestinal epithelial cells and the formation of the enzymatic activity of the digestive system.

Key words: babies, intestinal colic, morphofunctional immaturity, artificial feeding, comfortable digestion, motor control, functional disorders of the gastrointestinal tract, gastrointestinal hormones, gastrointestinal inhibitory peptide, pancreatic polypeptide and neuropeptide Y, somatostatin, motilin, neurotensin.

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Список литературы

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18. Tabbers MM, DiLorenzo C, Berger MY et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014; 58 (2): 258–74.
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23. Mountzouris KC, McCartney AL, Gibson GR. Intestinal microflora of human infants and current trends for its nutritional modulation. Br J Nutr 2002; 87: 405–20.
24. Morrow AL, Ruiz-Palacios GM, Altaye M et al. Human milk oligosaccharides are associated with protection against diarrhea in breastfed infants. J Pediatr 2004; 145: 297–303.
25. Moro G, Minoli I, Mosca M et al. Dosage related bifidogenic effects of galacto- and fructo-oligosaccharides in formula fed term infants. J Pediatr Gastroenterol Nutr 2002; 34: 291–5.
26. Yu ZB, Han SP, Zhu C et al. Effects of infant formula containing palm oil on the nutrient absorption and defecation in infants: a meta-analysis. Zhonghua Er Ke Za Zhi 2009; 47 (12): 904–10.
27. Alarcon PA, Tressler RL, Mulvaney A et al. Gastrointestinal tolerance of a new infant milk formula in healthy babies: an international study conducted in 17 countries. Nutrition 2002; 18 (6): 484–9.
28. Nevo N, Rubin L, Tamir A et al. Infant feeding patterns in the first 6 months: an assessment in full-term infants. J Pediatr Gastroenterol Nutr 2007; 45 (2): 234–9.

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1. Hyman PE, Milla PJ, Bennig MA et al. Childhood functional gastrointestinal disorders: neonate/toddler. Am J Gastroenterol 2006; 130 (5): 1519–26.
2. Zakharova I.N., Sugian N.G., Andriukhina E.N., Dmitrieva Iu.A. Taktika pediatra pri mladencheskikh kishechnykh kolikakh. Rus. med. zhurn. 2010; 18 (1): 11–5. [in Russian]
3. Zakharova I.N., Sugian N.G., Andriukhina E.N., Dmitrieva Iu.A. Taktika pediatra pri mladencheskikh kishechnykh kolikakh. Rus. med. zhurn. 2010; 18 (1): 11–5. [in Russian]
4. Huhtala V, Lehtonen L, Uvnäs-Moberg K et al. Low plasma cholecystokinin levels in colicky infants. J Pediatr Gastroenterol Nutr 2003; 37 (1): 42–6.
5. Lot L, Ivarsson S, Lindberg T. Motilin, vasoactive intestinal peptide and gastrin in infantile colic. Acta Paediatr Scand 1987; 76: 316–20.
6. Savino F, Grassino EC, Guidi C et al. Ghrelin and motilin concentration in colicky infants. Acta Paediatr 2006, 95; 738–41.
7. Savino F, Bailo E, Oggero R et al. Bacterial counts of intestinal Lactobacillus species in infants with colic. Pediatr Allergy Immunol 2005; 16 (1): 72–5.
8. Savino F, Cordisco L, Tarasco V et al. Molecular identification of coliform bacteria from colicky breastfed infants. Acta Paediatr 2009; 98 (10): 1582–8.
9. Mukhina Iu.G., Chubarova A.I., Geras'kina V.P. Sovremennye aspekty problemy laktaznoi nedostatochnosti u detei rannego vozrasta. Vopr. detskoi dietologii. 2003; 1 (1): 50–6. [in Russian]
10. Lowe AJ, Dharmage SC, Allen KJ et al. The role of partially hydrolyzed whey formula for the prevention of allergic disease: evidence and gaps. Expert Rev Clin Immunol 2013; 9 (1): 31–41.
11. Osborn DA, Sinn J. Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev 2006; 4: CD003664;
12. Von Berg A, Filipiak-Pittroff B, Krämer U et al. Allergies in high-risk schoolchildren after early intervention with cow's milk protein hydrolysates: 10-year results from the German Infant Nutritional Intervention (GINI) study. J Allergy Clin Immunol. 2013; 131 (6): 1565–73
13. Greer FR, Sicherer SH, Burks AW; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics 2008; 121 (1): 183–91.
14. Vandenplas Y, Cruchet S, Faure C et al. When should we use partially hydrolysed formulae for frequent gastrointestinal symptoms and allergy prevention? Acta Paediatr. 2014; 103 (7): 689–95.
15. Staelens S, Van den Driessche M, Barclay D et al. Gastric emptying in healthy newborns fed an intact protein formula, a partially and an extensively hydrolysed formula. Clin Nutr 2008; 27 (2): 264–8.
16. Savino F, Cresi F, Maccario S et al. "Minor" feeding problems during the first months of life: effect of a partially hydrolysed milk formula containing fructo- and galacto-oligosaccharides. Acta Paediatr Suppl 2003; 91 (441): 86–90.
17. Vandenplas Y, Leluyer B, Cazaubiel M. Double-blind comparative trial with 2 antiregurgitation formulae. J Pediatr Gastroenterol Nutr 2013; 57 (3): 389–93.
18. Tabbers MM, DiLorenzo C, Berger MY et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014; 58 (2): 258–74.
19. Mihatsch WA, Högel J, Pohlandt F. Hydrolysed protein accelerates the gastrointestinal transport of formula in preterm infants. Acta Paediatr 2001; 90 (2): 196–8.
20. Uauy R. Dietary nucleotides and requirements in early life. In: Textbook of Gastroenterology and Nutrition in Infancy. 2nd ed. (Lebenthal E, ed.). Raven Press, New York, NY. 1989; p. 265–80.
21. LeLeiko NS, Walsh MJ, Abraham S. Gene expression in the intestine: the effect of dietary nucleotides. In: Barness L, DeVivo D, Kaback M et al, eds. Advances in pediatrics. St Louis: Mosby-Year Book, Inc, 1995; p. 145–69.
22. Cosgrove M, Davies DP, Jenkins HR. Nucleotide supplementation and the growth of term small for gestational age infants. Arch Dis Child 1996; 74: F122–F125.
23. Mountzouris KC, McCartney AL, Gibson GR. Intestinal microflora of human infants and current trends for its nutritional modulation. Br J Nutr 2002; 87: 405–20.
24. Morrow AL, Ruiz-Palacios GM, Altaye M et al. Human milk oligosaccharides are associated with protection against diarrhea in breastfed infants. J Pediatr 2004; 145: 297–303.
25. Moro G, Minoli I, Mosca M et al. Dosage related bifidogenic effects of galacto- and fructo-oligosaccharides in formula fed term infants. J Pediatr Gastroenterol Nutr 2002; 34: 291–5.
26. Yu ZB, Han SP, Zhu C et al. Effects of infant formula containing palm oil on the nutrient absorption and defecation in infants: a meta-analysis. Zhonghua Er Ke Za Zhi 2009; 47 (12): 904–10.
27. Alarcon PA, Tressler RL, Mulvaney A et al. Gastrointestinal tolerance of a new infant milk formula in healthy babies: an international study conducted in 17 countries. Nutrition 2002; 18 (6): 484–9.
28. Nevo N, Rubin L, Tamir A et al. Infant feeding patterns in the first 6 months: an assessment in full-term infants. J Pediatr Gastroenterol Nutr 2007; 45 (2): 234–9.

Авторы

И.Н.Захарова*1, Ю.А.Дмитриева1, 2

1 ГБОУ ДПО Российская медицинская академия последипломного образования Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1;
2 ФГБУ Федеральный научно-клинический центр детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева Минздрава России. 117997, Россия, Москва, ул. Саморы Машела, д. 1, ГСП-7
*zakharova-rmapo@yandex.ru

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I.N.Zakharova*1, Yu.A.Dmitriyeva1, 2

1 Russian Medical Academy of Postgraduate Education of the Ministry of Health of the Russian Federation. 125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1;
2 Dmitriy Rogachev Federal Research Center of Pediatric Hematology, Oncology and Immunology of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Samory Mashela, d. 1, GSP-7
*zakharova-rmapo@yandex.ru

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