Prebiotics in infant formula

This summary has been adapted from Prebiotics in infant formula. Gut Microbes (2014) by Vandenplas et al.

Prebiotic oligosaccharides are a major component of human breast milk (1) and have been reported to affect the growth of gastrointestinal microbiota, which can have benefits for the infant’s health. The bacterial profiles of breast-fed babies are known to differ from those of babies fed with standard formulas (2), so as a result, research has investigated the effects of supplementing formulas with different combinations of galacto-oligosaccharides (GOS), fructo-oligosaccharides (FOS) and polydextrose (PDX), to try to emulate the gold standard of breast milk. Researchers in Belgium performed a review of the latest scientific research to highlight the findings related to supplementing infant formulas. 

Effects on gastrointestinal microbiota

Formula with added prebiotics have a greater chance of affecting gut microbes when their administration begins earlier in infancy (3). There is also evidence to suggest that prebiotics can reduce adverse effects of antibiotics on the gastrointestinal microbiota (4). With respect to pre-term babies, formula supplemented with FOS, specifically, can be beneficial for gut microbiota (5). Different studies have investigated various concentrations of prebiotics in formulas and report similar stimulation of intestinal bifido and lacto to breast-fed infants (6-8).

Effects on faecal pH and metabolic activity

The pH levels in the gut effect the bacteria that can grow there, with lower pH values decreasing the amount of pathogenic bacteria (9). Supplementary prebiotics have been reported to decrease intestinal pH levels (19), reduce pH levels lower compared to standard formula (10) and even bring pH levels in-line with those observed in breast-fed infants (8). Metabolic activity in the gut of infants feed with GOS/FOS supplemented formula has been shown to be comparable to that of babies fed with breast milk (11, 12).

Effects on immunity

There is evidence to suggest a potential association between prebiotics and immune system development (13) but other research has found no significant effect (14). One study found prebiotics affected intestinal microbiota after the study intervention, which suggested a modulating effect on the immune system (15). While further investigation is warranted, it is likely that prebiotic oligosaccharides are likely to enhance the immune system.

Effects on stool consistency and frequency

Prebiotics added to formula can bring the frequency of bowel movements in-line with that of breast-fed infants (6, 7, 16). Different supplement mixtures have been shown to soften the consistency of stools (17, 18), bringing it closer to that of breast-fed babies (19), without increasing fussiness or gassiness (18).

Other areas of study

Prebiotic supplements in infant formulas are unlikely to have an effect on growth (16), while the influences on general health (20), infection reduction (8, 21) and atopic dermatitis (22, 23) remain unclear and warrant further examination.


  1. Kunz C, Rudloff S, Baier W, Klein N, Strobel S. Oligosaccharides in human milk: structural, functional, and metabolic aspects. Annu Rev Nutr 2000; 20:699-722
  2. Harmsen HJ, Wildeboer-Veloo AC, Raangs GC, Wagendorp AA, Klijn N, Bindels JG, Welling GW. Analysis of intestinal flora development in breast-fed and formula-fed infants by using molecular identification and detection methods. J Pediatr Gastroenterol Nutr 2000; 30:61-7
  3. 9 Nakamura N, Gaskins HR, Collier CT, Nava GM, Rai D, Petschow B, Russell WM, Harris C, Mackie RI, Wampler JL, et al. Molecular ecological analysis of fecal bacterial populations from term infants fed formula supplemented with selected blends of prebiotics. Appl Environ Microbiol 2009; 75:1121-8
  4. Ladirat SE, Schuren FH, Schoterman MH, Nauta A, Gruppen H, Schols HA. Impact of galacto-oligosaccharides on the gut microbiota composition and metabolic activity upon antibiotic treatment during in vitro fermentation. FEMS Microbiol Ecol 2014; 87:41-51
  5. Kapiki A, Costalos C, Oikonomidou C, Triantafyllidou A, Loukatou E, Pertrohilou V. The effect of a fructo-oligosaccharide supplemented formula on gut flora of preterm infants. Early Hum Dev 2007; 83:335-9
  6. Ben XM, Li J, Feng ZT, Shi SY, Lu YD, Chen R, Zhou XY. Low level of galacto-oligosaccharide in infant formula stimulates growth of intestinal Bifidobacteria and Lactobacilli. World J Gastroenterol 2008; 14:6564-8
  7. Ben XM, Zhou XY, Zhao WH, Yu WL, PanW, Zhang WL, Wu SM, Van Beusekom CM, Schaafsma A. Supplementation of milk formula with galacto-oligosaccharides improves intestinal micro-flora and fermentation in term infants. Chin Med J (Engl) 2004; 117:927-31
  8. Ortuño I, Espín B, Vasallo MI, Gil D, Vidal ML, Infante D, Leis R, Maldonado J, Moreno JM, Roman E. Prebiotic effect during the first year of life in healthy infants fed formula containing GOS as the only prebiotic: a multicentre, randomised, double-blind and placebo-controlled trial. Eur J Nutr 2014;
  9. Topping DL, Clifton PM. Short-chain fatty acids and human colonic function: roles of resistant starch and nonstarch polysaccharides. Physiol Rev 2001; 81:1031-64
  10. Holscher HD, Faust KL, Czerkies LA, Litov R, Ziegler EE, Lessin H, Hatch T, Sun S, Tappenden KA. Effects of prebiotic-containing infant formula on gastrointestinal tolerance and fecal microbiota in a randomized controlled rial. JPEN J Parenter Enteral Nutr 2012; 36(1 Suppl):95S-105S
  11. Bakker-Zierikzee AM, Alles MS, Knol J, Kok FJ, Tolboom JJ, Bindels JG. Effects of infant formula containing a mixture of galacto- and fructo-oligosaccharides or viable Bifidobacterium animalis on the intestinal microflora during the first 4 months of life. Br J Nutr 2005; 94:783-90
  12. Knol J, Scholtens P, Kafka C, Steenbakkers J, Gro S, Helm K, Klarczyk M, Sch€opfer H, B€ockler HM, Wells J. Colon microflora in infants fed formula with galacto- and fructo-oligosaccharides: more like breast-fed infants. J Pediatr Gastroenterol Nutr 2005; 40:36-42
  13. Seifert S, Watzl B. Inulin and oligofructose: review of experimental data on immune modulation. J Nutr 2007; 137(11 Suppl):2563S-7S
  14. Gopalakrishnan A, Clinthorne JF, Rondini EA, McCaskey SJ, Gurzell EA, Langohr IM, Gardner EM, Fenton JI. Supplementation with galacto-oligosaccharides increases the percentage of NK cells and reduces colitis severity in Smad3-deficient mice. J Nutr 2012; 142:1336-42
  15. Arslanoglu S, Moro GE, Schmitt J, Tandoi L, Rizzardi S, Boehm G. Early dietary intervention with a mixture of prebiotic oligosaccharides reduces the incidence of allergic manifestations and infections during the first two years of life. J Nutr 2008; 138:1091-5
  16. Rao S, Srinivasjois R, Patole S. Prebiotic supplementation in full-term neonates: a systematic review of randomized controlled trials. Arch Pediatr Adolesc Med 2009; 163:755-64
  17. Fanaro S, Marten B, Bagna R, Vigi V, Fabris C, Peña-Quintana L, Argüelles F, Scholz-Ahrens KE, Sawatzki G, Zelenka R, et al. Galacto-oligosaccharides are bifidogenic and safe at weaning: a double-blind randomized multicenter study. J Pediatr Gastroenterol Nutr 2009; 48:82-8
  18. Scalabrin DM, Mitmesser SH, Welling GW, Harris CL, Marunycz JD, Walker DC, Bos NA, Tölkkö S, Salminen S, Vanderhoof JA. New prebiotic blend of polydextrose and galacto-oligosaccharides has a bifidogenic effect in young infants. J Pediatr Gastroenterol Nutr 2012; 54:343-52
  19. Piemontese P, Giannì ML, Braegger CP, Chirico G, Grüber C, Riedler J, Arslanoglu S, van Stuijvenberg M, Boehm G, Jelinek J, et al. Tolerance and safety evaluation in a large cohort of healthy infants fed an innovative prebiotic formula: a randomized controlled trial. PLoS One 2011; 6:e28010
  20. Srinivasjois R, Rao S, Patole S. Prebiotic supplementation in preterm neonates: updated systematic review and meta-analysis of randomised controlled trials. Clin Nutr 2013; 32:958-65
  21. Vos AP, Haarman M, Buco A, Govers M, Knol J, Garssen J, Stahl B, Boehm G, M’Rabet L. A specific prebiotic oligosaccharide mixture stimulates delayed-type hypersensitivity in a murine influenza vaccination model. Int Immunopharmaco 2006; 6:1277-86
  22. Muraro A, Halken S, Arshad SH, Beyer K, Dubois AE, Du Toit G, Eigenmann PA, Grimshaw KE, Hoest A, Lack G, et al. EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy. Allergy 2014; 69:590-601
  23. Foolad N, Armstrong AW. Prebiotics and probiotics: the prevention and reduction in severity of atopic dermatitis in children. Benef Microbes 2014; 5:151-60


Prebiotics in infant formula

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