medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-11-57-65medsovet-6289Research ArticleГАСТРОЭНТЕРОЛОГИЯGASTROENTEROLOGYЧто нужно знать об углеводном компоненте детских смесей для искусственного вскармливанияWhat we should know about the carbohydrate component of infant formulahttps://orcid.org/0000-0003-4200-4598ЗахароваИ. Н.ZakharovaI. N.

Захарова Ирина Николаевна - доктор медицинских наук, профессор, заведующая кафедрой педиатрии имени академика Г.Н. Сперанского.

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Irina N. Zakharova, Dr. Sci. (Med.), Professor, Head of the Department of Pediatrics named after Academician G.N. Speransky.

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

zakharova-rmapo@yandex.ruhttps://orcid.org/0000-0002-5169-9187ДавыдовскаяА. А.DavydovskayaA. A.

Давыдовская Анна Алексеевна - кандидат медицинских наук, научный советник.

123112, Москва, Пресненская наб., д. 10Б

Anna A. Davydovskaya, Cand. Sci. (Med.), Scientific Advisor.

10B, Presnenskaya Emb., Moscow, 123112

anna.davydovskaya@gmail.comРоссийская медицинская академия непрерывного профессионального образованияРоссияRussian Medical Academy of Continuous Professional EducationRussian FederationКампина, ОООРоссияCampina, LLCRussian Federation2021080820210115765Copyright © Захарова И.Н., Давыдовская А.А., 20212021Захарова И.Н., Давыдовская А.А.Zakharova I.N., Davydovskaya A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6289

Статья посвящена обсуждению углеводного компонента детских искусственных смесей для вскармливания здоровых и больных детей. Показана роль гликемических и негликемических углеводов. Помимо лактозы, при создании детских смесей могут использоваться следующие гликемические углеводы: мальтоза, сахароза, глюкоза, сироп глюкозы, мальтодекстрины, предварительно обработанный крахмал и желатинизированный крахмал. В детском питании применяются также резистентные олигосахариды, некрахмальные полисахариды, резистентные модифицированные крахмалы. Обсуждаются состав и количество лактозы – основного углевода женского молока. В статье приведены данные о роли галактозы, являющейся условно эссенциальной для детей первых месяцев жизни ввиду быстрых темпов роста младенца. Представлены сведения о расщеплении лактозы, значимости ферментов для процессов переваривания и усвоения, пребиотических эффектах лактозы, ее влиянии на абсорбцию кальция и других минеральных веществ. К преимуществам лактозы относятся ее низкий гликемический индекс, а также пониженная сладость, что влияет на правильное развитие вкуса и низкий риск кариеса по сравнению с другими ферментируемыми сахарами. Обсуждаются особые требования к составу углеводного компонента низколактозных и безлактозных смесей в связи с часто неоправданным ростом частоты их использования. Приведены доказательства с использованием Кокрейновского систематического обзора (2018) того, что снижение или исключение содержания лактозы из питания грудного ребенка с младенческими коликами не всегда целесообразно. В специальных низколактозных и безлактозных смесях лактозу заменяют на полимеры глюкозы – мальтодекстрин, сироп глюкозы, твердый сироп глюкозы, которые производят путем гидролиза крахмалов (кукурузного, рисового или картофельного). В статье обсуждаются данные о влиянии мальтодекстрина на состояние слизистой кишки, микробиоту толстой кишки и о возможной роли этого ингредиента в патогенезе хронических воспалительных заболеваний кишечника. Результаты различных работ в отношении влияния мальтодекстрина на кишечную микробиоту противоречивы. Однако при наличии симптомов лактазной недостаточности у ребенка на искусственном вскармливании назначаются специальные низколактозные или безлактозные продукты. Грубой ошибкой является назначение безлактозных смесей на основе интактного белка или частичного гидролиза при вторичной лактазной недостаточности, обусловленной аллергией к белкам коровьего молока. В составе углеводного компонента лечебных гидролизатов Friso отсутствует мальтодекстин, а лактоза частично или полностью заменена сиропом глюкозы.

The article is devoted to the discussion of the carbohydrate component of infant formula for feeding healthy and sick children. The role of glycemic and non-glycemic carbohydrates is shown. In addition to lactose, the following glycemic carbohydrates can be used in infant formulas: maltose, sucrose, glucose, glucose syrup, maltodextrins, pretreated starch and gelatinized starch. Resistant oligosaccharides, nonstarch polysaccharides, and resistant modified starches are also used in child nutrition. The composition and amount of lactose, the main carbohydrate of women’s milk, is discussed. The article presents data on the role of galactose, which is conditionally essential for children in the first months of life due to the rapid growth rate of the infant. Information is presented on the lactose breakdown, the importance of enzymes in the digestion and assimilation processes, the prebiotic effects of lactose, and its effect on the absorption of calcium and other minerals. Advantages of lactose include its low glycemic index, as well as its reduced sweetness, which affects the proper development of taste and low risk of dental caries compared to other fermentable sugars. Specific requirements for the carbohydrate composition of low-lactose and lactose-free formulas are discussed because of the often unwarranted increase in the frequency of their use. Evidence is presented using the Cochrane Systematic Review (2018) that reducing or eliminating lactose from infant formulas in infants with infantile colic is not always appropriate. Special low-lactose and lactose-free formulas replace lactose with glucose polymers such as maltodextrin, glucose syrup, and solid glucose syrup, which are produced by hydrolyzing starches (corn, rice, or potato). The article discusses the data on the effect of maltodextrin on the state of the intestinal mucosa, the microbiota of the large intestine and the possible role of this ingredient in the pathogenesis of chronic inflammatory bowel diseases. The results of various studies regarding the effect of maltodextrin on the intestinal microbiota are contradictory. However, special low-lactose or lactose-free products are prescribed in the presence of symptoms of lactase deficiency in an artificially fed baby. It is a major mistake to prescribe lactose-free mixtures on the basis of intact protein or partially hydrolysed ones for secondary lactase deficiency caused by an allergy to cow’s milk proteins. The carbohydrate component of Friso therapeutic hydrolysates contains no maltodextrin, and lactose is partially or completely replaced with glucose syrup.

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The authors declare that there are no conflicts of interest present.