CN101360429B - 促进非自然分娩后的肠屏障完整成熟的方法 - Google Patents

促进非自然分娩后的肠屏障完整成熟的方法 Download PDF

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CN101360429B
CN101360429B CN200680047835.6A CN200680047835A CN101360429B CN 101360429 B CN101360429 B CN 101360429B CN 200680047835 A CN200680047835 A CN 200680047835A CN 101360429 B CN101360429 B CN 101360429B
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composition
acid
pufa
nucleotides
described composition
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CN101360429A (zh
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琼希姆·施密特
巩特尔·勃姆
克里斯托弗·比尔曼
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Nutricia NV
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Abstract

本发明涉及喂养及促进剖腹产婴儿健康的方法，包括给予剖腹产婴儿长链多不饱和脂肪酸和/或核苷酸。

Description

促进非自然分娩后的肠屏障完整成熟的方法
技术领域
本发明涉及喂养和治疗剖腹产婴儿的技术。
背景技术
刚出生的婴儿还不具有完整成熟的肠道。在出生后，新生的胃肠道经历了快速的生长和成熟，包括粘液的形成和成熟，以及对过敏原、毒素、和病原微生物的紧密连接的关闭。在人乳中存在一些因子可以促进肠道的成熟。
具渗透性的、不成熟的肠道屏障是导致肠道炎症，感染，痢疾和包括食物过敏在内的特应性疾病的主要原因。完全成熟的肠道，尤其是有了健康肠道菌群的结合，可以减少感染的发生，加强免疫系统，减少食物过敏和/或其他特应性疾病以及减少痢疾，便秘和/或肠炎的发生。
吃母乳的婴儿比吃配方奶粉的婴儿的肠道渗透性的减少更快。然而母乳喂养不一定可以实现。
国际专利WO2004112509描述了一种组合物，这种组合物可以诱导一种肠道屏障的成熟的模式，就像用母乳喂养时观察到的可以促进肠道屏障的成熟，例如：新生儿应激。
国际专利WO2005122790描述了一种方法，这种方法可以通过给予哺乳动物一种组合物，该组合物包含二十碳五烯酸(EPA)，二十二碳六烯酸(DHA)，花生四烯酸(ARA)和至少两种不同的低聚糖，从而促进哺乳动物的肠屏障的完整。
国际专利EP1549158描述了一种婴儿配方奶粉组合物，其中包含3.2mg/L-15.4mg/L的CMP；1.8mg/L-11.0mg/L的UMP；1.8mg/L-8.0mg/L的GMP；0.1mg/L-2.2mg/L的IMP；2.5mg/L-13.2mg/L的AMP.
国际专利WO03043445描述了一些加工的婴儿食品，这种食品的配方是a)油脂，b)核苷酸，c)油脂和核苷酸。
Figure GSB00000666807500021
公司生产了益生菌产品Life
Figure GSB00000666807500022
这种产品是专为婴儿设计的并且适合剖腹产分娩的婴儿。Life
Figure GSB00000666807500023
是用婴儿双歧杆菌制成的。因为这种Life产品仅仅包含唯一的一种双歧杆菌菌种，这样对于婴儿的益处就会非常有限。
发明内容
本发明人发现剖腹产婴儿肠道菌群与阴道分娩的婴儿的肠道菌群不同。特别是剖腹产婴儿肠道双歧杆菌的定殖的比率比较低，而且含有与肠道菌群相关的双歧杆菌种类比阴道分娩的婴儿也要少，尤其是缺少了短双歧杆菌、长双歧杆菌、婴儿双歧杆菌和两歧双歧杆菌。进一步发现剖腹产婴儿的肠道菌群比阴道分娩的婴儿的肠道菌群的双歧杆菌的含量较低。而且进一步发现在出生后6周的剖腹产婴儿的肠道菌群中有高含量的大肠杆菌(不好的)。
健康和完全形成的胃肠道菌群有着重要的生理功效。一个重要的方面就是它能降低(胃肠道)感染的发生。因为剖腹产分娩的婴儿缺乏健康菌群，对于这些婴儿来说，预防感染显得尤为重要。这些婴儿通常在医院的环境生产，由于医源性细菌的存在使剖腹产有病原感染的风险。而且，相对于婴儿的肠道被来源于母亲的阴道和粪便的细菌接种了的情形，健康肠道菌群的弱势发育导致了病原细菌的迅速定殖。为了预防这些(医源性)病原体穿过肠道壁的细菌转移或者细菌(内或外)毒素的转移，改善或者加速剖腹产婴儿的肠道成熟是非常重要的。剖腹产婴儿肠道屏蔽的成熟和/或完整可以进一步减少肠炎，食物过敏和/或其他特应性疾病的发生。
发明者证实剖腹产婴儿肠道屏障的功能是比较弱的，并且发现长链多不饱和脂肪酸(LC-PUFA)和/或核苷酸可以促进肠道屏障的成熟和完整，并且/或对于剖腹产婴儿具有抗炎症的功能。LC-PUFA可以进一步促进产乳酸细菌对粘膜表面的粘附。因此，本发明涉及组合物的应用，所述组合物包含LC-PUFA和/或核苷酸，尤其旨在a)通过促进肠道屏蔽的完善和/或成熟来减少感染的发生，b)通过促进肠道屏蔽的完善和/或成熟来减少(食物)过敏和/或特应性疾病，c)抑制或减弱肠炎进程，否则肠炎会进一步增加肠道屏壁的通透性，和/或d)通过增加产乳酸细菌对剖腹产婴儿粘膜表面的定殖来增加菌群量。
另一个方面，本发明能够通过将上述的活性组分掺入到一种营养组合物中而恰当的进行实践。这种组合物可以给予婴儿并且不会引起剖腹产分娩的婴儿过重的负担。
具体实施方式
本发明提供了一种组合物的应用，这种组合物包含(i)长链多不饱和脂肪酸(LC-PUFA)；和/或(ii)(a)核苷酸和(b)核苷酸前体中的一种，所述核苷酸前体选自核苷、嘌呤碱、嘧啶碱、核糖及脱氧核糖，所述组合物用于制造给予剖腹产婴儿的组合物。进一方面，本发明的方法提供了一种组合物的应用，这种组合物包含(i)长链多不饱和脂肪酸(LC-PUFA)；和/或(ii)(a)核苷酸和(b)核苷酸前体中的一种，所述核苷酸前体选自核苷、嘌呤碱、嘧啶碱、核糖及脱氧核糖，所述组合物用于制造用于i)治疗和/或预防剖腹产婴儿的疾病和/或ii)促进剖腹产婴儿的健康的组合物。
本发明也提供了一种喂养剖腹产婴儿的方法，所述方法包含给予所述婴儿一种组合物，这种组合物包含(i)长链多不饱和脂肪酸(LC-PUFA)，和/或(ii)(a)核苷酸和(b)核苷酸前体中的一种，所述核苷酸前体选自核苷、嘌呤碱、嘧啶碱、核糖及脱氧核糖。
剖腹生产术
剖腹产(c-section)是一种外科生产程序，其中婴儿是通过切开母亲的腹壁和子宫壁而分娩出来的。通常剖腹产是当相对于阴道分娩对母亲或婴儿更安全时被施行。其他时间，产妇可以选定剖腹产而不进行阴道分娩。
长链多不饱和脂肪酸
在整个的描述中，用于本发明的方法中的组合物通常称为“本发明的组合物”。本发明的组合物优选包含长链多不饱和脂肪酸(LC-PUFA)。LC-PUFA是脂肪酸，其中酰基链具有20-24个碳原子长度(优选是20或22个碳原子)，并且其中酰基链在酰基链的所述碳原子中包含至少两个不饱和键。更优选地，本发明的组合物包含至少一种选自二十碳五烯酸(EPA，20:5n3)，二十二碳六烯酸(DHA，22:6n3)，花生四烯酸(ARA，20:4n6)和二十二碳五烯酸(DPA，22:5n3)的LC-PUFA。EPA，DHA和ARA被发现能够高效地减少肠道紧密连接的渗透性(见实施例2)。降低了的紧密连接的渗透性减少了感染的发生和/或减少了过敏原的通过和/或减少了细菌(内或外)毒素的通过。因此在本发明的组合物中LC-PUFA的并入，尤其是EPA，DHA，DPA和/或ARA的并入，能够增强肠屏障的完整性，这对于剖腹产分娩的婴儿来说是非常重要的，因为这些婴儿只有不太完善的肠道菌群，因此他们只有成熟较缓慢的肠道屏障。LC-PUFA具有抗肠炎的功效并且可以促进产乳酸细菌对粘膜表面的粘附，因此促进健康菌群的发育，这进一步有利于剖腹产婴儿中的应用。
由于低浓度的ARA，DHA，DPA和/或EPA已经能够有效地减低紧密连接的渗透性，在本发明的组合物当中，所述组合物优选为营养组合物，LC-PUFA的含量较好不要超过总脂肪含量的15wt.％，更好是不要超过总脂肪含量的10wt.％，甚至更优选不要超过总脂肪含量的5wt.％。本发明组合物优选包含至少占总脂肪含量0.1wt.％，较好是至少0.25wt.％，更好是至少0.5wt.％，甚至更好是至少0.75wt.％的LC-PUFA。由于相同的原因，EPA的含量优选不要超过总脂肪含量的5wt.％，更好的是不要超过1wt.％，但是优选至少要占总脂肪含量的0.025wt.％，更好的是至少0.05wt.％。DHA的含量较好不要超过总脂肪含量的5wt.％，更好不要超过1wt.％，但是至少是总脂肪含量的0.1wt.％。既然ARA被发现对降低紧密连接的渗透性特别有效，本发明组合物包含相对高含量的ARA，较好ARA至少占总脂肪量的0.1wt.％，甚至更好是至少占0.25wt.％，最好是至少占0.35wt.％。ARA的含量较好不要超过5wt.％，更好是不要超过总脂肪量的1wt.％。当上述的肠道组合物成分包含ARA时，加入EPA和DHA有利于平衡ARA的作用，例如：减少ARA代谢产物潜在的促炎症反应的作用。过量的ARA的代谢产物能够引起炎症反应。因此，上述组合物优选包含ARA，EPA和DHA，其中ARA/DHA的重量比优选是0.25以上，较好是0.5以上，甚至更好是1以上。这个ARA/DHA的比率较好是低于25，更好是低于15。ARA/EPA的重量比率较好是在1-100之间，更好是5-20之间。
为了尽可能地模仿人乳并且减少高剂量的LC-PUFA的副作用，所述组合物的LC-PUFA的含量优选不要超过总脂肪含量的3wt.％，n3(Ω3)LC-PUFA的含量优选低于总脂肪含量的1wt.％，n6(Ω6)LC-PUFA的含量优选低于总脂肪含量的2wt.％。ARA的含量优选低于总脂肪含量的1wt.％。EPA/DHA的重量比率优选是1或者低于1。
LC-PUFA可以提供为游离的脂肪酸，甘油三酸酯，甘油二酯，甘油一酸酯，磷脂，或者是以上其中一种或更多的混合物，较好是甘油三酸酯。本发明的组合物较好应包含磷脂形式的ARA和DHA中的至少一种。
核苷酸
在优选的例子中，本发明的组合物包含核苷酸和/或核苷酸前体，所述核苷酸前体选自核苷、嘌呤碱、嘧啶碱、核糖及脱氧核糖。更优的是所述组合物包含核苷酸。所述核苷酸优选是以一磷酸盐，二磷酸盐，或者三磷酸盐的形式，更优选是核苷一磷酸盐。所述核苷酸优选为核糖核苷酸或者脱氧核糖核苷酸，更优选为核糖核苷酸。所述核苷酸可以是单体的，二聚的或多聚的(包括RNA和DNA)。所述核苷酸优选以游离酸或者盐的形式存在，更优选以单钠盐的形式。本发明组合物中的核苷酸的掺入可以促进肠道屏障的完整和/或成熟，这对于剖腹产婴儿是至关重要的，因为这些婴儿不具有发育完善的肠道菌群，因此肠道屏蔽的成熟也很慢。所述组合物优选含有选自胞苷5’-单磷酸(CMP)、尿苷5’-单磷酸(UMP)、腺苷5’-单磷酸(AMP)、鸟苷5’-单磷酸(GMP)及次黄苷5’-单磷酸(IMP)和/或它们的盐，尤其是它们的单体盐中的一种或多种，更优选含有选自CMP、UMP、AMP、GMP及IMP和/或它们的盐，尤其是它们的单体盐中的至少3种。核苷酸种类的增加可以进一步促进肠道屏壁的完善。
本发明的组合物每100g组合物干重较好包含5-100mg，更好是包含5-50mg，最好是包含10-25mg的核苷酸。核苷酸能进一步的促进免疫系统，因此能够增强对肠道内大量的诸如大肠杆菌的病原体的抵抗。
本发明的组合物每100g组合物干重优选包含1-20mg，更优3-12.5mg CMP。本发明的组合物每100g组合物干重优选包含1-20mg，更优2--9mg UMP。本发明的组合物每100g组合物干重优选包含0.5-15mg，更优1.5-8mg AMP。本发明的组合物每100g组合物干重优选包含0.2-10mg，更优0.6-3mg GMP。本发明的组合物每100g组合物干重优选包含0.5-10mg，更优1.3-5mg IMP。
优选的，本发明组合物包含(i)LC-PUFA以及(ii)核苷酸和/或核苷酸前体，所述核苷酸前体选自核苷、嘌呤碱、嘧啶碱、核糖与脱氧核糖，由于这些成分的组合能够出乎意料的增强胃肠道屏壁的功能，免疫系统和/或肠道菌群，例如：设想的协同效应。
非消化性低聚糖
本发明组合物优选包含非消化性低聚糖，所述非消化性低聚糖会被发酵形成有机酸(优选乳酸，丁酸盐，丙酸盐和/或醋酸盐)并且促进肠道产乳酸细菌的生长(下文被称为“非消化糖类”)。优选能够促进双歧杆菌和/或乳酸菌的生长。双歧杆菌和/或乳酸菌含量的增加能够促进健康肠道菌群的形成。而且，形成的有机酸能够促进粘液的产生，因此进一步减少剖腹产婴儿肠道屏蔽的渗透性(见下面的实施例3)。非消化性低聚糖也能够增强在本发明组合物中的LC-PUFA和/或核苷酸的效力，当同时给予非消化性低聚糖与LC-PUFA和/或核苷酸时，就会引起小肠对LC-PUFA和/或核苷酸吸收的延迟，因此延长和/或增加了LC-PUFA和/或核苷酸在结肠中的功效。有利地，本发明组合物中包含了非消化性低聚糖，优选是具有聚合度(DP)为2-250，更优选聚合度为2-100，再优选聚合度为2-10的非消化性低聚糖。
本发明组合物优选含有聚合度低于60，更优低于40，进一步优选低于20，最优低于10的非消化性低聚糖。短链非消化性低聚糖提供改良的乳酸盐和/或醋酸盐产物，促进剖腹产婴儿肠屏壁的完善。所述非消化性低聚糖优选在存在于人上消化道(小肠和胃)的消化酶和酸的作用下不能被消化或者仅部分地被消化，并被人肠道菌群发酵。例如，蔗糖，乳糖，麦芽糖和麦芽糊精被认为是可以消化的。
优选的，本发明组合物包括至少一种选自低聚果糖(包括菊糖)，非消化糊精，低聚半乳糖(包括反式低聚半乳糖)，低聚木糖，低聚阿拉伯糖，阿拉伯半乳糖低聚糖，低聚葡萄糖(包括环式糊精和龙胆低聚糖)，低聚甲壳糖，葡萄甘露低聚糖，半乳甘露低聚糖，低聚甘露糖，低聚岩藻糖，低聚半乳糖醛酸，低聚古罗糖醛酸，低聚甘露糖醛酸，低聚艾杜糖醛酸，低聚riburonic acid，低聚葡萄糖醛酸和它们的混合物的非消化性低聚糖，更优选的是选自低聚果糖，低聚半乳糖(包括反式低聚半乳糖)，低聚岩藻糖，低聚半乳糖醛酸和它们的混合物，进一步优选的是低聚半乳糖和/或菊糖，最优选是反式低聚半乳糖。
本发明的非消化性低聚糖优选自低聚半乳糖和低聚果糖(例如菊糖)。优选至少有50wt.％的本发明的非消化性低聚糖具有2-60的聚合度。在特别优选的例子中，本发明的组合物至少包含低聚半乳糖和低聚果糖。所述低聚半乳糖优选包含具有聚合度为2-10的糖类。所述低聚果糖优选包含具有聚合度为2-60的糖类。优选的，所述低聚半乳糖包含β键，如同人乳低聚糖的情况。
在一个优选的实施例中，本发明的组合物包含低聚半乳糖醛酸。本发明中的低聚半乳糖醛酸有利地减少了病原性微生物在肠上皮细胞的粘附，因此减少了(医源性)致病菌在剖腹产婴儿结肠中的定殖。而且，本发明的低聚半乳糖醛酸促进健康肠道菌群的形成并被发酵，产生肠道有机酸产物和降低肠道pH，从而抑制了(医源性)病原菌的生长。同时给予低聚半乳糖醛酸可以进一步的改善剖腹产婴儿防护由于肠道屏蔽功能不完善和/或肠道菌群不完整而引起的的感染。
本发明中使用的术语低聚半乳糖醛酸优选是指一种低聚糖，其中至少50％的单糖单元是半乳糖醛酸。本发明组合物优选包含具有聚合度为2-250的低聚半乳糖醛酸，较好是2-50，更好是2-20。本发明中使用的低聚半乳糖醛酸优选是来源于果胶，果胶酸盐，和/或多聚半乳糖醛酸。所述低聚半乳糖醛酸优选来源于果胶。优选的，这种果胶的低聚糖由水果果胶和/或蔬菜果胶经水解和/或β-降解而产生的，更优选的是来源于苹果、柑橘和/或糖用甜菜果胶，更优选的，苹果，柑橘和/或糖用甜菜果胶至少被裂解酶处理过。果胶溶解产物和/或低聚半乳糖醛酸优选来源于细菌产物。
在一个优选的实施例中，低聚半乳糖醛酸的至少一个末端己糖醛酸单元有一个双键，其优选位于末端己糖醛酸单元C4和C5之间。双键有效地抵抗了病源菌对肠道上皮细胞的粘附。这对于剖腹产婴儿是非常有利的。优选至少5％，更优选至少10％，进一步优选至少25％的低聚半乳糖醛酸中的末端己糖醛酸单元是不饱和的己糖醛酸单元。因为每个单独的低聚半乳糖醛酸优选包含唯一的一个不饱和的末端己糖醛酸单元，优选少于50％的末端己糖醛酸单元是不饱和的己糖醛酸单元(也就是包含一个双键)。
本发明组合物每100g组合物干重优选包含0.01-10g的具有聚合度为2-250的低聚半乳糖醛酸，更优选是0.05-6g，进一步优选是0.2-2g。本发明组合物每100g营养组合物干重优选包含0.01-10g具有聚合度为2-25的低聚半乳糖醛酸，更优选是0.05-6g，进一步优选是0.2-2g。短链低聚半乳糖醛酸更加有效和/或更适于被包括在本发明的组合物中。
优选的，本发明的组合物包含(i)低聚半乳糖(ii)低聚果糖和(iii)低聚半乳糖醛酸。这种组合尤其适合保护剖腹产婴儿，因为它可以对双歧杆菌和/或乳酸菌提供理想的促进作用，并且减少病源微生物的粘附和减少诸如大肠杆菌的潜在的病源菌的定殖和/或粘附。
产乳酸细菌
本发明组合物优选包含活的或死的产乳酸细菌。例如死的细菌可以经过加热和/或超声波降解法对活的细菌进行灭活处理来制备。活的乳酸菌可以有利的组合在一起促进迅速的定殖于婴儿的肠道。优选以活的微生物的单一或混合的培养物提供产乳酸细菌。每克本发明组合物干重优选包含102-1013个产乳酸细菌的集落形成单元(cfu)，较好是102-1012cfu，更好是105-1010cfu，最好是从104到5x109cfu.。
本发明组合物优选包含乳酸菌属和/或双歧杆菌属的细菌。本发明组合物优选包含选自长双歧杆菌，短双歧杆菌，婴儿双歧杆菌，链状双歧杆菌，假小链双歧杆菌，青春双歧杆菌，动物双歧杆菌，高卢双歧杆菌，乳双歧杆菌和分叉双歧杆菌中的至少一种双歧杆菌，较好是选自短双歧杆菌，婴儿双歧杆菌，分叉双歧杆菌，链状双歧杆菌，长双歧杆菌中的至少一种双歧杆菌，甚至更优选是选自短双歧杆菌和长双歧杆菌中的至少一种双歧杆菌，最优选是短双歧杆菌。优选上述组合物至少包含两种不同的双歧杆菌菌种，亚种或者菌株。优选本发明组合物至少包含一种，更好的是至少包含两种，甚至更好的是包含三种，甚至最好的是包含四种不同的双歧杆菌菌种。优选本发明组合物至少包含一种，更好的是至少包含两种，甚至更好的是包含三种，甚至最好的是包含四种不同的双歧杆菌菌株。通常的上面提到的组合的目的在于增加剖腹产分娩的婴儿肠道中的微生物的种类和/或数量。这有利的影响婴儿并提供大量的健康益处。
本发明的组合物优选包含一种乳酸菌，该乳酸菌选自于干酪乳杆菌，罗伊氏乳酸杆菌，副干酪乳杆菌，鼠李糖乳杆菌，嗜酸乳杆菌，约氏乳杆菌，乳酸乳球菌，唾液乳酸杆菌，卷曲乳杆菌，格氏乳酸杆菌，玉米乳杆菌，发酵乳杆菌和植物乳杆菌；较好的是选自干酪乳杆菌，副干酪乳杆菌，鼠李糖乳杆菌，约氏乳杆菌，嗜酸乳杆菌，发酵乳杆菌；最好是副干酪乳杆菌。甚至更好地，本发明的组合物包含短双歧杆菌和/或副干酪乳杆菌，因为剖腹产婴儿的肠道中这些细菌的生长要受损。进一步增加的生物多样性对剖腹产分娩的婴儿的健康会带来促进的作用。
配方奶粉
本发明的组合物优选肠道给予的，更优选口服。本发明的组合物优选为婴儿配方奶粉。本发明的组合物优选通过混合不同成分制成的人工合成的配方奶粉。本发明的组合物不是天然(不经处理)产生的哺乳动物乳汁，例如，不是人的母乳。本发明的组合物可以方便地作为一种完整的婴儿营养物。本发明组合物优选包含脂质，蛋白质和碳水化合物并且优选以液体食物的形式给予。本发明中涉及的术语“液体食物”包括伴有用法说明的干燥食物(例如：粉末)，在用法说明的指导下将上述干燥的食物混合物和合适的液体(例如：水)混合。
本发明的组合物优选给婴儿提供营养，包含脂质成分，蛋白质成分和碳水化合物成分。其中脂质成分提供总热量的5-50％，蛋白成分提供总热量的5-50％并且碳水化合物成分提供总热量的15-90％。本发明的组合物优选作为婴儿配方奶粉，其中脂质成分提供总热量的35-50％，蛋白质成分提供总热量的7.5-12.5％，碳水化合物成分提供总热量的40-55％。为了计算蛋白质成分所提供热量占总热量的百分比，由蛋白质、肽类和氨基酸提供的总能量需要被考虑在内。
优选的，所述脂质成分包含选自蔬菜油脂和动物油脂中的至少一种脂类与选自鱼类，动物，蔬菜，藻类，真菌和细菌的油脂中的至少一种油的组合。优选的，所述脂质包含至少12mg/100kcal的α-亚麻酸(ALA)。优选的，所述脂质成分中的亚油酸(LA)和亚麻酸(ALA)的重量比是5-15，更优选是5-10。优选的，反式脂肪酸的含量低于总油脂的4wt.％。高浓度的反式脂肪酸会危及肠道屏障的安全。
在上述的营养备料中的蛋白质成分较好是选自非人类的动物蛋白(诸如奶蛋白，肉类蛋白和蛋类蛋白)，蔬菜蛋白(诸如大豆蛋白，小麦蛋白，大米蛋白，马铃薯蛋白和豌豆蛋白)，游离的氨基酸和它们的混合物中的至少一种。牛奶来源的氮源，尤其是诸如酪蛋白和乳清蛋白的牛乳蛋白质是首选的氮源。较好是蛋白质成分含有完整蛋白质，更好是含有完整牛乳清蛋白和/或完整酪蛋白。因为本发明组合物非常适合被用于减少婴儿的过敏反应，婴儿配方奶粉中的蛋白质优选选自水解牛乳蛋白(例如：水解酪蛋白和/或水解乳清蛋白)，蔬菜蛋白和/或氨基酸。这些水解蛋白的使用可以进一步减少婴儿的过敏反应。这些水解蛋白的使用可以有利地促进食物中的蛋白质成分通过剖腹产分娩的婴儿的未成熟的肠道的吸收。
优选的，本发明中的组合物包含可消化的碳水化合物。本发明组成物中使用的可消化的碳水化合物优选选自蔗糖，乳糖，葡萄糖，果糖，淀粉糖浆干粉，淀粉和麦芽，还有他们的混合物，最好是乳糖。
不规则的大便(例如：过硬的大便，不足的大便体积，腹泻)是许多婴儿中主要的问题，尤其是在剖腹产婴儿中。研究发现大便的问题可以通过在液体的食物中给予本发明中的LC-PUFA来减少。本发明的组合物较好是具有50-500mOsm/kg的渗透压，更好是在100-400mOsm/kg之间。根据上面的叙述，虽然仍需给主体提供充足的热量，但是液体的食物不能含有过量的热量密度也是很重要的。因此，液体食物较好应含有在0.1-2.5kcal/ml的热量密度，甚至更好是含有0.5-1.5kcal/ml，最好是含有0.6-0.8kcal/ml。
应用
本发明提供一种喂养剖腹产婴儿的方法，所述方法包含给予所述婴儿以本发明的组合物，所述组合物包括：(i)LC-PUFA；和/或(ii)核苷酸和/或核苷酸前体，所述核苷酸选自核苷、嘌呤碱、嘧啶碱、核糖和脱氧核糖。
本发明也提供一种方法用于i)促进剖腹产婴儿的健康，和/或ii)治疗和/或预防剖腹产婴儿疾病，所述方法包括将本发明组合物给予婴儿。所述疾病优选自由于双歧杆菌菌群含量低而造成的肠道疾病。优选的，所述疾病选自感染和变态反应性疾病(atopic disease)。本发明的组合物较好是给予出生一年内的剖腹产分娩的婴儿，较好是在出生后的三个月，甚至更好是在出生后的两个星期之内，甚至更加好是在出生的后100个小时，更加好是在出生后的72个小时，最好的是在出生后的48小时之内。
本发明组合物可以更为方便地应用于促进肠道屏蔽的成熟；减少肠道屏蔽的渗透性和/或提高免疫系统。本发明的方法优选包括以下步骤：a)将(i)营养学或药学可接受的液体；和(ii)干燥的组合物进行混合，其中这种干燥的组合物(ii)包含LC-PUFA和/或核苷酸，优选包含LC-PUFA和核苷酸；以及步骤b)将步骤a)中得到的组合物给予剖腹产婴儿。
喂养包含LC-PUFA和/或核苷酸的组合物，可以减少(医源性的)病原微生物的迁移，例如大肠杆菌，其他属于革兰氏阴性菌的气单胞菌属，克雷伯菌属，肠杆菌属，假单胞菌属，变形杆菌属和不动杆菌属，和属于革兰氏阳性菌的肠球菌属，葡萄球菌属，链球菌属，芽孢杆菌属和梭状菌属，病毒和/或真菌，尤其是大肠杆菌。因此，本发明的组合物优选用于治疗和/或预防剖腹产婴儿的感染和/或痢疾的方法中的，所述方法包含将本发明的组合物给予剖腹产婴儿。在一个优选的例子中本发明的组合物是应用于治疗和/或预防由大肠杆菌，气单胞菌属，克雷伯菌属，肠杆菌属和/或假单胞菌属，尤其是大肠杆菌引起的感染。
喂养包含LC-PUFA和/或核苷酸和/或核苷酸前体的本发明的组合物，可以减少通过肠道屏蔽的过敏原的迁移。因此本发明的组合物优选用于治疗或预防剖腹产婴儿的过敏，尤其是食物过敏，特应性湿疹(例如特应性皮炎)，哮喘，过敏性鼻炎和/或过敏性结膜炎的方法中，所述方法包含将所述组合物给予剖腹产婴儿。优选地，本发明组合物是应用于治疗和/或预防特应性皮炎。
而且给予本发明的组合物可以增强免疫系统。因此，本发明包含LC-PUFA和/或核苷酸和/或核苷酸前体的组合物可以方便地应用于治疗和/或预防剖腹产婴儿全身感染和/或发炎的方法中。在优选的方法中，本发明的组合物是应用于治疗和/或预防坏死性小肠结肠炎。
在本说明书和其权利要求中，动词“包含”及其类似语是非限制性的，意思是下述项目包括在内，但未提到的并不被排除在外。另外，通过不定冠词″一″或″一个″来提及的元素不排除超过一种元素的可能性，除非上下文清楚地要求有一个且只有一个元素。因此不定冠词″一″或″一个″通常是指“至少有一个”。
实施例
实施例1：剖腹产分娩的婴儿和阴道分娩的婴儿的肠道微生态分子特征的 对比
在本发明的研究中，通过利用特异性引物PCR扩增十种双歧杆菌种，三种瘤胃球菌和一种类杆菌种的方法来研究分娩方式(剖腹产相对于阴道分娩)对于出生后第三天肠道微生物成分的影响。
微生物的DNA提取和分析是根据论文：Favier et al，EnvironMicrobiol2002；68：219-226and Satokari et al，Appl Environ Microbiol2001；67：504-513；Satorkari et al System Appl Microbiol 2003；26：572-584所提供的方法进行的。
表1中列出了在21个剖腹产分娩婴儿的出生后第3天获得的排泄物样品中检测的双歧杆菌和其他菌种。表2给出了在21个阴道分娩婴儿的出生后第3天获得的排泄物样品中检测的双歧杆菌和其他菌种。剖腹产分娩婴儿和阴道分娩婴儿的排泄物中都没有发现齿双歧杆菌，角双歧杆菌，乳酸双歧杆菌，布氏瘤胃球菌，伶俐瘤胃球菌和卵瘤胃球菌菌种的特殊信号。
表1：剖腹产婴儿
Figure GSB00000666807500131
(-)＝无扩增信号；(+/-)＝弱扩增信号；(+)＝阳性扩增信号；(++)＝强烈的扩增信号
可以得出结论认为，剖腹产分娩的婴儿与阴道分娩的婴儿所具有的微生物菌群不同。剖腹产分娩的婴儿体内不仅仅双歧杆菌和其他菌种的数量少很多，而且比剖阴道分娩的婴儿的菌群的菌种种类水平也变化较少。因为双歧杆菌在婴儿的体内菌群中是优势种，这些结果也能被推广为剖腹产婴儿体内数量较少和种类较少的肠道菌群，导致肠道更易被(医源性)病原体侵害。
这些结果显示了本发明的组合物和方法的有益应用，例如：一种能够喂养剖腹产分娩婴儿，起到减少肠道内病原体作用并且能够促进健康肠道菌群并且相应地预防感染，促进健康的免疫系统和尤其促进剖腹产婴儿肠道成熟的方法。
表2：阴道分娩的婴儿
Figure GSB00000666807500141
(-)＝无扩增信号；(+/-)＝弱扩增信号；(+)＝阳性扩增信号；(++)＝强烈的扩增信号
例2：LC-PUFA对于肠道屏壁完整的功效
在鲁米诺间隔室用不同的100μM的多不饱和脂肪酸ARA(花生四烯酸；5，8，11，14-廿碳四烯酸)，DHA(顺式-4，7，10，13，16，19二十二碳六烯酸)，EPA(二十碳五烯酸)或对照的棕榈(C16:0)酸(棕榈)(Sigma，St.Louis公司，美国)对肠道上皮细胞系T84的单细胞层(MC)进行0，24，48和72小时的培养。上皮屏壁的功能通过用上皮伏特欧姆表(EVOM；国际精密仪器，德国)测定跨上皮细胞膜的电阻(TER，Ω.cm2)以及对大小为4kD的FITC标记的右旋糖苷(细胞旁路渗透性标记，Sigma，美国)的渗透性来确定。
在培养72小时后脂肪酸(100μM)对于自发的屏壁完整的影响的结果在表3中列出。表3显示LC-PUFA中的ARA，EPA和DHA减少了分子通量，增加了上皮细胞的电阻。相比之下对照的棕榈酸得到相反的结果，即损害了屏壁完整。这些结果预示了EPA，DHA和ARA有利的应用，特别是本发明组合物中的ARA，以及在本发明方法中的应用，例如，在促进剖腹产婴儿肠道屏壁完整的方法中的应用。同样γ-亚麻酸(GLA)对于基底肠道屏壁的电阻和通量也显示了阳性的结果。
表3
  成分(LC-PUFA)   通量   电阻(TER)
  对照   79   1090
  棕榈酸   161   831
  DHA   72   1574
  ARA   28   1816
  EPA   65   1493
例3：LC-PUFA对IL-4介导的肠道屏壁损坏的作用
在存在IL-4(2ng/ml，浆膜室，Sigma，美国)以及添加或不添加多不饱和脂肪酸ARA，DHA，GLA，EPA，或对照棕榈酸(10μM or100μM，黏膜室，Sigma，St.Louis，USA)的情况下对肠道上皮细胞系T84的单细胞层(MC)进行培养。细胞在用IL-4培养前先用ARA，DHA，EPA，或棕榈酸进行预培养48小时。多不饱和脂肪酸和棕榈酸与IL-4的共培养继续48小时，其间每24小时更换培养基和添加剂。如例2中描述的一样，通过测定跨上皮细胞膜的电阻(TER)和渗透性来确定上皮细胞的屏壁功能。
ARA，DHA，EPA和棕榈酸(100μM)对IL-4介导的屏壁损坏作用的结果在表4中列出。表4中显示LC-PUFA中的ARA，DHA和EPA抑制由IL-4引起的通量的增加。相比之下，相对于对照组，棕榈酸有有害的作用和减少屏壁损伤。结果预示了ARA，DHA和EPA在临床和婴儿营养配方奶粉中能够预防或减少IL-4介导的屏壁损伤(例如，当发生对食物或牛奶的过敏症时)的有利的应用。这些结果预示了本发明组合物中的EPA，DHA和ARA，特别是ARA的有利的应用，，以及在本发明方法中的应用，尤其是用于治疗和/或预防剖腹产婴儿的过敏，特应性湿疹，哮喘，过敏性鼻炎和/或过敏性结膜炎的方法。
表4
  成分(LC-PUFA)   IL-4通量  IL-4电阻
  对照   582  374
  棕榈酸   777  321
  DHA   271   547
  ARA   218   636
  EPA   228   539
例4：剖腹产婴儿体内的菌群
剖腹产婴儿粪便中的双歧杆菌的含量被测定。第一周，在剖腹产婴儿(n＝44)体内的双歧杆菌属菌种占总体细菌的百分比是4.3％，相比之下阴道分娩的婴儿(n＝28)体内的双歧杆菌属菌种占总体细菌的百分比是19.8％。6周后的喂养普通食物的婴儿体内的大肠杆菌的百分比仍然是11.8％(见表5)。
表5
Figure GSB00000666807500171
这些结果显示给予剖腹产婴儿以上述的LC-PUFA和/或核苷酸和/或核苷酸前体是值得期待的。
例6：喂养剖腹产婴儿的方法
在剖腹产婴儿出生两天内，一种营养的组合物被给予婴儿，其中每升的这种营养组合物中包含：
能量672Kcal；蛋白质14g；乳清∶酪蛋白比率是60∶40；脂肪36g；碳水化合物73g；维生素A500μgRE；混合天然类胡萝卜素35μgRE；维生素D312μg；维生素E12mg；维生素K145.0μg；维生素B1(硫胺)400μg；维生素B2(核黄素)1000μg；维生素B6(吡哆醇)400μg；维生素B12(cyanacobalmine)2.0μg；烟酸4.1mg；叶酸120μg；泛酸2800mcg；生物素18μg；维生素C(抗坏血酸)86mg；胆碱100mg；肌醇33mg；牛磺酸67mg；钙510mg；磷290mg；镁50mg；铁7.0mg；锌4.9mg；锰84μg；铜330μg；碘100μg；钠170mg；钾740mg；氯化物460mg和硒14μg；其中脂肪含量包括占总脂肪酸含量的0.65wt.％的LC-PUFA，包括0.35wt.％ARA，0.05wt.％EPA，和0.2wt.％DHA，进一步包含3.6g来源于Elix’orTM(Borculo Domo Ingredients公司，荷兰)的反式半乳糖低聚糖和0.4g来源于RaftilineHPTM(Orafti ActiveFood Ingredients公司，比利时)的低聚果糖和约20mg核苷酸(约6.4mg CMP，约4mg UMP，约6mg AMP，约1.4mg GMP及约2.4mg IMP)。

Claims (12)

1.一种含有以下的组合物在制备给予剖腹产婴儿用于治疗和／或预防剖腹产婴儿感染、腹泻、肠道炎症、过敏、特应性湿疹、哮喘、过敏性鼻炎和／或过敏性结膜炎的组合物中的应用：
(i)长链多不饱和脂肪酸(LC-PUFA)，和
(ii)(a)核苷酸和(b)核苷酸前体中的至少一种，所述核苷酸前体选自核苷、嘌呤碱、嘧啶碱、核糖和脱氧核糖；
所述组合物不是人类母乳，
所述组合物包含占组合物总脂肪重量的0.1-15wt.％的LC-PUFA，以及所述组合物包含5-100mg核苷酸/100g组合物干重。
2.一种含有以下的组合物在制备给予剖腹产婴儿用于促进剖腹产婴儿肠道成熟、减少肠道通透性和／或治疗肠道屏障相关疾病的组合物中的应用：
(i)长链多不饱和脂肪酸(LC-PUFA)，和
(ii)(a)核苷酸和(b)核苷酸前体中的至少一种，所述核苷酸前体选自核苷、嘌呤碱、嘧啶碱、核糖和脱氧核糖；
所述组合物不是人类母乳，
所述组合物包含占组合物总脂肪重量的0.1-15wt.％的LC-PUFA，以及所述组合物包含5-100mg核苷酸／100g组合物干重。
3.根据权利要求1或2所述的应用，其特征在于所述组合物还包含至少一种非消化性低聚糖，所述非消化性低聚糖选自果聚糖，低聚果糖，非消化糊精，低聚半乳糖，低聚木糖，低聚阿拉伯糖，低聚阿拉伯半乳糖，葡萄糖低聚糖，低聚甲壳糖，葡萄甘露低聚糖，半乳甘露低聚糖，低聚甘露糖，岩藻低聚糖，低聚半乳糖醛酸，低聚古罗糖醛酸，低聚甘露糖醛酸，低聚艾杜糖醛酸，低聚riburonic acid，低聚葡萄糖醛酸和以上混合物。
4.根据权利要求3所述的应用，其特征在于所述组合物包含反式-低聚半乳糖和／或低聚果糖。
5.根据权利要求3所述的应用，其特征在于所述组合物包含低聚半乳糖醛酸。
6.根据权利要求3所述的应用，其特征在于所述组合物包含低聚半乳糖、低聚果糖和低聚半乳糖醛酸。
7.根据权利要求1或2所述的应用，其特征在于LC-PUFA选自二十碳五烯酸，二十二碳六烯酸和花生四烯酸。
8.根据权利要求1所述的应用，其特征在于所述组合物包含占组合物总脂肪重量少于3wt.％的LC-PUFA；
a.Ω-3LC-PUFA低于总脂肪含量的1wt.％；
b.Ω-6LC-PUFA低于总脂肪含量的2wt.％；并且
c.花生四烯酸的含量低于总脂肪含量的1wt.％。
9.根据权利要求1或2所述的应用，其特征在于所述组合物包含至少一种核苷酸，所述核苷酸选自胞苷5′-单磷酸、尿苷5′-单磷酸、腺苷5′-单磷酸、鸟苷5′-单磷酸、次黄苷5′-单磷酸及上述核苷酸之一的钠盐。
10.根据权利要求1或2所述的应用，其特征在于所述组合物还包含至少一种属于双歧杆菌属或乳酸菌属的细菌种类。
11.根据权利要求1或2所述的应用，其特征在于其中脂质成分提供了5-50％的总热量，蛋白质成分提供了5-50％的总热量，碳水化合物成分提供了15-90％的总热量。
12.一种如下制备的组合物在制备用于促进剖腹产婴儿健康肠道菌群发育和／或减少肠道病原体的产品中的应用：
将I)营养学或药学可接受的液体和II)干燥的组合物进行混合，其中所述干燥的组合物II包含长链的多不饱和脂肪酸(LC-PUFA)和(a)核苷酸和(b)核苷酸前体中的至少一种，所述核苷酸前体选自核苷、嘌呤碱、嘧啶碱、核糖和脱氧核糖，所述组合物包含占组合物总脂肪重量的0.1-15wt.％的LC-PUFA，以及所述组合物包含5-100mg核苷酸/100g组合物干重。
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