Colonic metabolism of human milk oligosaccharides and  infant defecation patterns

WU Qingbin

doi:10.11852/zgetbjzz2025-0444

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Chinese Journal of Child Health Care ›› 2026, Vol. 34 ›› Issue (4) : 362-365. DOI: 10.11852/zgetbjzz2025-0444

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Colonic metabolism of human milk oligosaccharides and infant defecation patterns

WU Qingbin

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Abstract

The high-frequency loose stools commonly observed in breastfed infants are not a pathological condition, but rather a specific defecation pattern resulting from the metabolic utilization of human milk oligosaccharides (HMO).As a natural prebiotic, HMO selectively promotes the proliferation of Bifidobacterium, particularly the B.longum subsp.infantis.These bacteria metabolize HMO to produce organic acids such as lactic acid and acetic acid, lowering the intestinal lumen pH and regulating water and electrolyte balance, which may be one of the reasons for the soft consistency and frequent defecation.Secondly, if HMOs are not completely metabolized, they can increase the osmotic load in the intestinal lumen, drawing in water that is then excreted as loose stools.Clinically, assessment should not rely on stool frequency alone.Instead, a stratified evaluation integrating the infant′s general condition, growth trajectory, and stool characteristics is recommended.The diagnosis of physiological diarrhea should be used cautiously to reduce overdiagnosis and unnecessary interventions and to support the continuation and implementation of breastfeeding.

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human milk oligosaccharides / colonic metabolism / bowel movement patterns / infants

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WU Qingbin. Colonic metabolism of human milk oligosaccharides and infant defecation patterns[J]. Chinese Journal of Child Health Care. 2026, 34(4): 362-365 https://doi.org/10.11852/zgetbjzz2025-0444

References

[1] 黄国英, 孙锟, 罗小平.儿科学[M].10版.北京:人民卫生出版社, 2024.
[2] Cheng L, Akkerman R, Kong C, et al.More than sugar in the milk: Human milk oligosaccharides as essential bioactive molecules in breast milk and current insight in beneficial effects[J].Crit Rev Food Sci Nutr, 2021, 61(7):1184-1200.
[3] Masi AC, Stewart CJ.Untangling human milk oligosaccharides and infant gut microbiome[J].iScience, 2021, 25(1):103542.
[4] Zhang B, Li LQ, Liu F, et al.Human milk oligosaccharides and infant gut microbiota: Molecular structures, utilization strategies and immune function[J].Carbohydr Polym, 2022, 276:118738.
[5] Baaleman DF, Wegh CAM, de Leeuw TJM, et al.What are normal defecation patterns in healthy children up to four years of age? A systematic review and meta-analysis[J].J Pediatr, 2023, 261:113559.
[6] Parschat K, Melsaether C, Jäpelt KR, et al.Clinical evaluation of 16-week supplementation with 5HMO-Mix in healthy-term human infants to determine tolerability, safety, and effect on growth[J].Nutrients, 2021,13(8):2871.
[7] Gustin J, Gibb R, Kenneally D, et al.Characterizing exclusively breastfed infant stool via a novel infant stool scale[J].J Parenter Enteral Nutr, 2018,42(Suppl 1):5-11.
[8] Soyyılmaz B, Mikš MH, Röhrig CH, et al.The mean of milk: A review of human milk oligosaccharide concentrations throughout lactation[J].Nutrients, 2021, 13(8):2737.
[9] Ren X, Yan J, Bi Y, et al.Human milk oligosaccharides are associated with lactation stage and lewis phenotype in a Chinese population[J].Nutrients, 2023,15(6):1408.
[10] Walsh C, Lane JA, van Sinderen D, et al.Human milk oligosaccharide-sharing by a consortium of infant derived Bifidobacterium species[J].Sci Rep, 2022, 12(1):4143.
[11] Zhang S, Li T, Xie J, et al.Gold standard for nutrition: A review of human milk oligosaccharide and its effects on infant gut microbiota[J].Microb Cell Fact, 2021, 20(1):108.
[12] Tsukuda N, Yahagi K, Hara T, et al.Key bacterial taxa and metabolic pathways affecting gut short-chain fatty acid profiles in early life[J].ISME J, 2021,15(9):2574-2590.
[13] Laursen MF.Gut microbiota development: Influence of diet from infancy to toddlerhood[J].Ann Nutr Metab, 2021,77 (Suppl 3): 21-34.
[14] Milani C, Duranti S, Bottacini F, et al.The first microbial colonizers of the human gut: Composition, activities, and health implications of the infant gut microbiota[J].Microbiol Mol Biol Rev, 2017, 81(4):e00036-17.
[15] Laue HE, Coker MO, Madan JC.The developing microbiome from birth to 3 years: The gut-brain axis and neurodevelopmental outcomes[J].Front Pediatr, 2022,10:815885.
[16] Duar RM, Henrick BM, Casaburi G,et al.Integrating the ecosystem services framework to define dysbiosis of the breastfed infant gut: The role of B.infantis and human milk oligosaccharides[J].Front Nutr, 2020, 7:33.
[17] Frese SA, Hutton AA, Contreras LN, et al.Persistence of supplemented Bifidobacterium longum subsp.infantis EVC001 in breastfed infants[J].mSphere, 2017, 2(6):e00501-17.
[18] Henrick BM, Hutton AA, Palumbo MC, et al.Elevated fecal pH indicates a profound change in the breastfed infant gut microbiome due to reduction of Bifidobacterium over the past century[J].mSphere, 2018, 3(2):e00041-18.
[19] Olm MR, Dahan D, Carter MM, et al.Robust variation in infant gut microbiome assembly across a spectrum of life-styles[J].Science, 2022, 376(6598):1220-1223.
[20] Derrien M, Alvarez AS, de Vos WM.The gut microbiota in the first decade of life[J].Trends Microbiol, 2019, 27(12):997-1010.
[21] Casaburi G, Duar RM, Brown H, et al.Metagenomic insights of the infant microbiome community structure and function across multiple sites in the United States[J].Sci Rep, 2021, 11(1):1472.
[22] Benninga MA, Faure C, Hyman PE,et al.Childhood functional gastrointestinal disorders: Neonate/toddler[J].Gastroenterology, 2016, 150(6):1443-1455.
[23] Akkerman R, Faas MM, de Vos P.Non-digestible carbohydrates in infant formula as substitution for human milk oligosaccharide functions: Effects on microbiota and gut maturation[J].Crit Rev Food Sci Nutr, 2019, 59(9):1486-1497.
[24] Solasaari T, Korpela K, Lommi S,et al.Bowel function in a prospective cohort of 1052 healthy term infants up to 4 months of age[J].Eur J Pediatr, 2024, 183(8):3557-3565.
[25] Zeevenhooven J, Koppen IJ, Benninga MA.The New Rome Ⅳ criteria for functional gastrointestinal disorders in infants and toddlers[J].Pediatr Gastroenterol Hepatol Nutr, 2017, 20(1):1-13.
[26] Malone JC, Thavamani A.StatPearls[M].Treasure Island (FL): StatPearls Publishing, 2025.