Post on 08-Jul-2020
transcript
Carl Seashore, MD Professor of Pediatrics, UNC School of Medicine
Breastfeeding and the Microbiome “It’s complicated”
Disclosures
• I have no financial disclosures or conflicts to resolve
• I will not discuss off-label use of medications
• I am a general pediatrician, not a microbiome-ologist
Learning Objectives
• Describe the current understanding of the human microbiome and its relationship to health and disease
• Describe the role the breastfeeding plays in the development of the human microbiome
• Determine practices you can adopt do to support breastfeeding mother-baby dyads-and their microbiomes
Why breastfeeding 🤱?
• Improved maternal health outcomes
• Improved child health outcomes
• Immense cost savings
• It is the biological norm for our species
• And sometimes it just doesn’t work for some dyads, and that is OK too.
Components of the Human Microbiome
• Bacterial colonization/symbiosis in:
– Gastrointestinal tract
– Skin and mucous membranes
– Respiratory tract and nasopharynx
– Genitourinary tract (particularly in females)
– Human Milk!
The microbiome and human health
• https://doi.org/10.1016/J.ENG.2017.01.008
• 100 Trillion organisms identified in the human body
• 150 times as much DNA as the human genome
• Complex interactions between environment, host, and the microbiome
The microbiome and human health
The microbiome and human health
– Mental health
– Infectious diseases
– Obesity
– CVD
– Diabetes
– Autoimmune diseases
– Inflammatory conditions
– Cancers
– Liver disease
– Allergy
Understanding the Human Microbiome
• It’s complicated
• Adult ≠ Child
• Dynamic in life
• Delivery route
• Feeding method
• Antibiotics
• Infections
Dynamics and Stabilization of the Human Gut Microbiome during the First Year of Life
Bäckhed, Fredrik et al. Cell Host & Microbe , Volume 17 , Issue 5 , 690 - 703
Impact of breastfeeding on the microbiome
• Respiratory disease in breast vs formula fed infants
– 101 each breast and formula fed infants
– Colonization at 6 weeks of age
– Significantly different colonization patterns
– BF infants had Dolosigranulum abundance
– Dolosigranulum abundance associated with less future wheezing and less severe respiratory infections
https://doi.org/10.1164/rccm.201401-0073OC
• Gastrointestinal disease and infections
• Necrotizing enterocolitis in premature infants
• Earlier recovery of microbiome following infection
• Lower susceptibility to GI pathogens
• Future development of inflammatory bowel disease
• Liver diseases such as cirrhosis, NAFLD
Impact of breastfeeding on the microbiome
• Enhanced recovery of the microbiome after infection
• Exclusively breastfed infants show faster recovery of their microbiome following infection, which may lend to less morbidity and even mortality after common childhood infections
• Unclear if this is due to composition of the microbiome prior to infection or ongoing breastfeeding
Impact of breastfeeding on the microbiome
• Microbiome of Human Milk
• 200 phylotypes have been identified
• Composition of microbes changes with gestational age of the infant and as they grow
• Rich in bifodobacteria and lactobaccilus spp.
• These aid in digestion of milk oligosaccharides
• Truly tailor made for each baby
Impact of breastfeeding on the microbiome
• Later life outcomes?
• Heart and Cardiovascular diseases
• Diabetes and Obesity
• Inflammatory Bowel Disease
• Mental Health conditions
Impact of breastfeeding on the microbiome
Ways you can support the breastfeeding dyad
• What is your work environment?
• What about traveling?
• Is your office breastfeeding friendly?
• How about your own experiences?
Ways you can support the breastfeeding dyad
• What more can be done to support breastfeeding in the work environment?
Discussion and Questions
• How do you interact with pregnant or new mothers
• What do you do to support breastfeeding dyads
• Are there research questions that you can answer
• Who knew 💩 was so complicated?
References
• https://doi.org/10.1016/J.ENG.2017.01.008
• https://doi.org/10.3945/ajcn.112.037382
• https://doi.org/10.1164/rccm.201401-0073OC
• https://doi.org/10.1016/j.chom.2015.04.004
• https://www.sciencedirect.com/topics/medicine-and-dentistry/gut-microbiome
• https://doi.org/10.1016/j.jped.2017.05.013
• https://doi.org/10.1016/j.jpedp.2017.11.003
• https://www.ncbi.nlm.nih.gov/pubmed/29868719
• https://www.ncbi.nlm.nih.gov/pubmed/29519955
• https://www.ncbi.nlm.nih.gov/pubmed/29550235
• https://medlineplus.gov/breastfeeding.html\
Thank you!! Discussion and Questions
seashore@unc.edu