SMA® ADVANCED RANGEHUMAN MILK OLIGOSACCHARIDES (HMOs):

THE LATEST BREAKTHROUGH IN INFANT NUTRITION

S C I E N C E I N S P I R E D B Y N A T U R E

INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY BREASTFEEDING IS BEST FOR BABIES

Breastfeeding is best for babies Breastfeeding is universally recognised as the optimal nutrition for babies, and is associated with many nutritive and non-nutritive benefits.1–4

WHO guidelines recommend exclusive breastfeeding for the first 6 months of an infant’s life, and breastfeeding in combination with balanced, complementary foods thereafter.1–3

Research suggests that breastfed babies have fewer infections and may have a stronger immune system,3 which in part may be due to the presence of human milk oligosaccharides.5,6

What are human milk oligosaccharides (HMOs)? Human milk contains bioactive components that confer protective effects on the newborn. These include complex carbohydrates called human milk oligosaccharides (HMOs).

HMOs are the third most abundant solid component in human milk and have a very unique structure. This unique structure results in specific functions within the human body.5,6,9,10

HMOs are unique to human breast milk and are not found in significant amounts in any other mammalian milk.5,6,9,10

INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY BREASTFEEDING IS BEST FOR BABIES

INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY BREASTFEEDING IS BEST FOR BABIES

GI: gastrointestinal. WHO: World Health Organisation.

Breastfed babies have fewer infections and may have a stronger immune system7,8

Immune and nutritive components in breast milk11–14

Up to

50% lessrespiratory infections7

59% lessgastrointestinal infections7

THESE BENEFITS MAY BE PARTLY DUE TO THE EFFECT OF BREAST MILK ON THE INTESTINAL MICROBIOTA8

EXAMPLES KEY FEATURES KEY FUNCTION

SUPPORTIMMUNE

FUNCTIONS

SUPPORTHEALTHY

GROWTH ANDDEVELOPMENT

Human MilkOligosaccharides

(HMOs)11

Majority not absorbedin the Gl tract,11

i.e. have nonutritive value12

Proteins,carbohydrates,

fats13

Majority absorbedin the Gl tract14

IMMUNECOMPONENTS

NUTRITIVECOMPONENTS

What do HMOs do in breast milk? Research suggests that HMOs support the developing infant’s immune system in four main ways:5,6,9,10

HMOs offer specific benefits compared with GOS/FOS The structure of HMOs is unique and fundamentally different to GOS/FOS (which are not present in human milk).

This unique structure of HMOs allows them to have targeted benefits that are not present with GOS/FOS.6,9,10

HMOs GOS/FOS

INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY BREASTFEEDING IS BEST FOR BABIES

INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY BREASTFEEDING IS BEST FOR BABIES

GOS/FOS: Galacto-oligosaccharides/fructo-oligosaccharides; HMO: Human Milk Oligosaccharide.HMOs: Human Milk Oligosaccharides.

PRESENT IN HUMAN MILK

Blocks pathogens (bacteria, viruses and their toxins) through a specific decoy function6,9,10

Highly effective in increasing systemic and gastrointestinal immune cell populations15,16

NOT PRESENT IN HUMAN MILK(Plant sourced)

Does not reduce potentially pathogenic bacteria in the gastrointestinal tract17

Less effective in increasing systemic and gastrointestinal immune cell populations15

Blocking bad bacteria from attaching to the gut and doing harm 6,9,10

Helping to balance the immune system 6,9

Strengthening the developing gut barrier 6,9,10

Selectively feeding good bacteria within the gut, where 70–80% of the human body’s immune cells live 6,970%

INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY BREASTFEEDING IS BEST FOR BABIES

INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY BREASTFEEDING IS BEST FOR BABIES

SMA® Nutrition have been researching HMOs for 30 years At SMA® Nutrition, we have been leading research in baby nutrition for over 100 years and are dedicated to learning more about breast milk. Our research into HMOs in breast milk started in the 1980s and we have been pioneering HMO research for 30 years.

SMA® Nutrition the Pioneer in HMOs30 years HMO research

LEADING

For over100 years

baby nutritionresearch

Latest research on infant formula supplemented with HMOs*18 A 2017 clinical trial evaluated the effects of First Infant Milk containing two HMOs* (2’FL & LNnT) on growth, tolerance and morbidity in infants.18

INTERVENTION GROUP

‘80sNestlé’s first exploratoryresearch with HMOs

‘90s3 Nestlé publicationson HMOs

2006Nestlé partnership with Glycom to develop HMOs

2016Nestlé’s 2 HMOs (2’FL & LNnT)

Until 201717 Nestlé publications

on HMOs

2019Launch of the SMA® ADVANCED

Range with HMOs*

2007First production of Nestlé’s HMOs at lab scale

2012First Infant Formula Clinical Study with Nestlé's HMOs

Infants who received the test First Infant Milk vs control:

First Infant Milk with HMOs* 2’FL & LNnT is safe, well tolerated, and supports age-appropriate growth

Recruitment age of 14 days or less; 6-month intervention period.

First Infant Milk with 2’FL and LNnT (n=88)

Primary outcome

Secondary outcome

1.2 g/100 mL, intact protein formula

without HMOs (n=87)

lower risk of parent-reported bronchitis

No significant difference in weight gain

70%lower risk of parent-reported LRTIs55%lower use of antipyretics and antibiotics>50%

CONTROL GROUP

*HMOs: structurally identical Human Milk Oligosaccharides, not sourced from breast milk. 2’FL: 2’fucosyllactose; LNnT: lacto-N-neotetraose; LRTI: Lower Respiratory Tract Infection.

*HMOs: structurally identical Human Milk Oligosaccharides, not sourced from breast milk.

Aptamil ProfuturaFirst Infant Milk20

Contains latest breakthrough in infant nutrition – HMOs* (2’FL & LNnT) 4 7

Easy to digest, 100% whey, partially hydrolysed protein 4 7

60:40 whey:casein ratio

Lowest protein infant formula in UK and Ireland19,22–25 4 7

Contains DHA (Omega 3) 4 4

Nutritionally complete 4 4

INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY BREASTFEEDING IS BEST FOR BABIES

INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY BREASTFEEDING IS BEST FOR BABIES

SMA® ADVANCED First Infant Milk From birth

How does SMA® ADVANCED First Infant Milk compare?

The 1st infant milk in the UK & Ireland to contain HMOs* (2’FL & LNnT)19–23

The lowest protein infant formula in the UK and Ireland19–23

Easy to digest (100% whey, partially hydrolysed protein)

Zinc and Vitamins A, C & D to help support the normal function of baby’s immune system24,25

SMA® ADVANCEDFirst Infant Milk19

*HMOs: structurally identical Human Milk Oligosaccharides, not sourced from breast milk.2’FL: 2’fucosyllactose; LNnT: lacto-N-neotetraose. DHA: docosahexaenoic acid.

SMA® ADVANCED Follow-on Milk From 6 months

The 1st Follow-on Milk in the UK & Ireland with HMOs* (2’FL & LNnT)23–30

Iron to help support normal cognitive development in baby’s brain

Zinc and Vitamins A, C & D to help support the normal function of baby’s immune system

Easy to digest (100% whey, partially hydrolysed protein)

SMA® ADVANCED Growing Up Milk From the 12th month onwards

The 1st Growing up Milk in the UK & Ireland with HMOs* (2’FL & LNnT)31–35

Easy to digest (100% whey, partially hydrolysed protein)

Vitamin D and calcium to support the normal growth and development of bones

Zinc and Vitamins A, C & D to help support the normal function of baby’s immune system

*HMOs: structurally identical Human Milk Oligosaccharides, not sourced from breast milk.

INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY BREASTFEEDING IS BEST FOR BABIES

INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY BREASTFEEDING IS BEST FOR BABIES

Introducing SMA® ADVANCEDThe 1st formula range in the UK & Ireland with HMOs*19–23,26–35

LEADING

For over100 years

baby nutritionresearch

SMA Nutrition have been researching HMOs for 30 years

The SMA® ADVANCED range, containing the latest breakthrough in infant nutrition – human milk oligosaccharides – represents our most advanced formulas yet.

*HMOs: structurally identical Human Milk Oligosaccharides, not sourced from breast milk.

References:1. World Health Organisation (2002). Infant and young child nutrition: Global strategy on infant and young child feeding. Available at: http://apps.who.int/ gb/archive/pdf_files/WHA55/ea5515.pdf (accessed February 2019). 2. Unicef (2015). Improving breastfeeding, complementary foods and feeding practices. Available at: http://www.unicef.org/nutrition/index_breastfeeding.html (accessed February 2019). 3. Victora CG, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387: 475–90. 4. Horta B, et al (2007). Evidence on the long-term effects of breastfeeding: systematic review and meta-analyses. World Health Organization, Geneva. 5. Kunz C. Historical aspects of human milk oligosaccharides. Adv Nutr 2012; 3(3): 430S–9S. 6. Bode L. Human milk oligosaccharides: every baby needs a sugar mama. Glycobiology 2012; 22(9): 1147–62. 7. Duijts L et al. Pediatrics 2010; 126: e18–25. 8. Donovan SM, Comstock SS. Ann Nutr Metab 2016; 69(Suppl 2): 42–51. 9. Jantscher-Krenn E, Bode L. Human milk oligosaccharides and their potential benefits for the breast-fed neonate. Minerva Pediatr 2012; 64(1): 83–99. 10. Smilowitz JT, et al. Breast milk oligosaccharides: structure-function relationships in the neonate. Annu Rev Nutr 2014; 34: 143–69. 11. Rudloff S, Kunz C. Milk oligosaccharides and metabolism in infants. Adv Nutr 2012; 3: 398S–405S. 12. Hennet T, et al. Decoding breast milk oligosaccharides. Swiss Med Wkly 2014; 144: w13927. 13. Ballard O, Morrow AL. Human milk composition: nutrients and bioactive factors. Pediatr Clin North Am 2013; 60(1): 49–74. 14. Borgström B, et al. Studies of intestinal digestion and absorption in the human. J Clin Invest 1957; 36: 1521–36. 15. Comstock SS, et al. Dietary human milk oligosaccharides but not prebiotic oligosaccharides increase circulating natural killer cell and mesenteric lymph node memory T cell populations in noninfected and rotavirus-infected neonatal piglets. J Nutr 2017; 147(6): 1041–7. 16. Hoeflinger JL, et al. In vitro impact of human milk oligosaccharides on Enterobacteriaceae growth. J Agric Food Chem 2015; 63(12): 3295–302. 17. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on the substantiation of a health claim related Immunofortis® and strengthening of the baby's immune system pursuant to Article 14 of Regulation (EC) No 1924/2006. EFSA Journal 2010; 8: 1430. 18. Puccio G, et al. Effects of infant formula with human milk oligosaccharides on growth and morbidity: A randomized multicenter trial. J Pediatr Gastroenterol Nutr 2017; 64: 624–31. 19. SMA® ADVANCED First Infant Milk datacard. Available at: http://smahcp.co.uk (accessed February 2019). 20. Aptamil Profutura First Infant Milk datacard. Available at: https://eln.nutricia.co.uk/media/4349/datacard_aptamil_profutura_first.pdf (accessed February 2019). 21. Aptamil Pronutra First Infant Milk datacard. Available at: https://eln.nutricia.co.uk/media/4349/datacard_aptamil_profutura_first.pdf (accessed February 2019). 22. Cow & Gate First Infant Milk datacard. Available at: https://eln.nutricia.co.uk/media/4333/datacard_cow__gate_first_milk. pdf (accessed February 2019). 23. HiPP Organic First Infant Milk datacard. Available at: https://www.hipp4hcps.co.uk/fileadmin/media_hcp/pdf/HiPP_ first_infant_milk_powder_datacard_050117.pdf (accessed February 2019). 24. Mora J, et al. Vitamin effects on the immune system: vitamins A and D take centre stage. Nat Rev Immunol 2008; 8(9): 685–98. 25. EFSA Journal 2014; 12(5):3653. 26. SMA® ADVANCED Follow-on Milk datacard. Available at: http://smahcp.co.uk (accessed February 2019). 27. Aptamil Pronutra Follow-on Milk datacard. Available at: https://eln.nutricia. co.uk/media/4339/datacard_aptamil_follow_on.pdf (accessed February 2019). 28. Aptamil Profutura Follow-on Milk datacard. Available at: https://eln. nutricia.co.uk/media/4351/datacard_aptamil_profutura_follow_on.pdf (accessed February 2019). 29. Cow & Gate Follow-on Milk datacard. Available at: https://eln.nutricia.co.uk/media/4335/datacard_cow__gate_follow_on.pdf (accessed February 2019). 30. HiPP Organic Follow-on Milk datacard. Available at: https://www.hipp4hcps.co.uk/fileadmin/media_hcp/pdf/HiPP_follow_on_milk_powder_data_card_241018.pdf (accessed February 2019). 31. SMA® ADVANCED Growing Up Milk datacard. Available at: http://smahcp.co.uk (accessed February 2019). 32. Aptamil Pronutra Growing up Milk datacard. Available at: https://eln.nutricia.co.uk/media/4347/datacard_aptamil_gum1-2.pdf (accessed February 2019). 33. Aptamil Profutura Growing up Milk datacard. Available at: https://www.eln.nutricia.co.uk/media/4350/datacard_aptamil_profutura_gum.pdf (accessed February 2019). 34. Cow & Gate Growing up Milk datacard. Available at: https://www.eln.nutricia.co.uk/media/4334/datacard_cow__gate_ gum1-2.pdf (accessed February 2019 17). 35. HiPP Organic Growing up Milk datacard. Available at: https://www.hipp4hcps.co.uk/fileadmin/media_hcp/ pdf/HiPPgrowing_up_milk_3_powder_data_card_050117.pdf (accessed February 2019).

NWHP315 F, NWHP315 G, NWHP315 H.

IMPORTANT NOTICE: The World Health Organisation (WHO) has recommended that pregnant women and new mothers be informed on the benefits and superiority of breastfeeding – in particular the fact that it provides the best nutrition and protection from illness for babies. Mothers should be given guidance on the preparation for, and maintenance of, lactation, with special emphasis on the importance of a well-balanced diet both during pregnancy and after delivery. Unnecessary introduction of partial bottle-feeding or other foods and drinks should be discouraged since it will have a negative effect on breastfeeding. Similarly, mothers should be warned of the difficulty of reversing a decision not to breastfeed. Before advising a mother to use an infant formula, she should be advised of the social and financial implications of her decision: for example, if a baby is exclusively bottle-fed, more than one can (400 g) per week will be needed, so the family circumstances and costs should be kept in mind. Mothers should be reminded that breast milk is not only the best, but also the most economical food for babies. If a decision to use an infant formula is taken, it is important to give instructions on correct preparation methods, emphasising that unboiled water, unsterilised bottles or incorrect dilution can all lead to illness. SMA® ADVANCED Follow-on Milk is only suitable for babies over 6 months as part of a mixed diet. It should not be used as a substitute for breast milk during the first 6 months of life. The decision to start weaning or to use this product before 6 months, should be made only on the advice of a doctor, midwife, health visitor, public health nurse, dietitian or pharmacist, based on baby’s individual needs. SMA® ADVANDED Growing Up Milk is suitable for young children from the 12th month, as part of a healthy balanced diet and it is not a breast milk substitute.

ZTC4205/03/19SMA® Nutrition UK and Ireland®Reg. Trademark of Société des Produits Nestlé S.A.

Learn more:

UK 0800 081 81 80www.smahcp.co.uk

ROI 1800 931 832www.smahcp.ie

SMA Nutrition, 1 City Place, Gatwick, RH6 0PA In the Republic of Ireland: SMA Nutrition, 3030 Lake Drive, Citywest Business Campus, Dublin 24, Ireland