Foreword

In the past few years, fundamental biochemical and clinical findings on the properties of human milk have confirmed breastfeeding as a key point in the development of several critical functions in the infant. We are now constantly looking beyond the purely nutritional value of human milk and we are aware that nutrition, especially in the first year of life, means much more than providing the infant with an adequate supply of nutrients in order to fully meet the requirements of the growing organism. A host of physiologically active components contribute to improved performance and to other relevant health benefits associated with feeding human milk. There is considerable scientific evidence to show that resistance to infectious disease is one of the main advantages of breastfeeding. The protection against infection afforded by human milk is partly connected to the modulation of the indigenous microflora. Many milk components may influence the development of the specific microbial ecosystem of breastfed infants, which is usually dominated by bifidobacteria. Although, so far, the factors involved in non-specific defence have not been clearly identified, substances of suggested importance include lactoferrin and complex oligosaccharides. Recent results confirm that some oligosaccharides survive the gastrointestinal passage and the absorptive processes in the gut and may thus stimulate the growth of bifidobacteria and other carbohydrate fermenting biota, which find optimal conditions for growth when the chyme is rich in carbohydrates and poor in protein. Such conditions, typical of exclusive breastfeeding, may now be partly reproduced using milk formulae with reduced protein content and supplemented with a blend of natural food ingredients such as galacto-oligosaccharides (GOS) and fructo-oligosaccharides (FOS) that are similar, but not identical, to some of the oligosaccharides present in human milk. This approach is consistent with the concept that the metabolic outcome and the performance of breastfed babies are the only correct reference standards currently available. In accordance with this view, safety and efficacy tests for milk formulae are presently based not so much on a strict biochemical similarity and adherence to the human milk model as on the global results obtained by feeding a baby at the breast. To cover this emerging relevant field in infant nutrition, this workshop has dealt mainly with research findings and reviews on the intestinal ecosystem of the infant, the protective properties of GOS and FOS as prebiotics and their effect on stool characteristics, calcium absorption and also on some “minor” clinical problems of the formula-fed infant. Appropriate post-discharge nutrition of very low birthweight infants is another major theme of this publication. Practices vary considerably among intensive care centres for the newborn and there is a paucity of well-defined information on this matter. This emerging, relevant topic in infant nutrition has been widely discussed in two papers, indicating that an increasing intake of proteins and LC-PUFAs in the diet 4–8 mo post-hospital discharge can have a positive influence on cognitive performance, although without any remarkable effects on somatic growth. We hope this publication offers the reader some interesting information and contributes favourably to a better understanding of these exciting developing fields of research. In addition to the main topics of the meeting, other relevant issues specific to infant nutrition were presented to an interested audience by qualified speakers, which led to animated discussion. The intelligent support and competent and qualified efforts of Numico, which has a long-standing and welldeserved reputation in infant nutrition, are gratefully acknowledged.