1. Introduction
Personalised nutrition is an emerging concept in healthcare, focused on tailoring dietary interventions to an individual’s unique physiological needs. In neonatal care, personalised nutrition plays a vital role in ensuring optimal growth, immune development, and gut microbiota establishment during the critical early stages of life. The gut microbiota, composed of trillions of microorganisms, is instrumental in metabolic processes, immune function, and long-term health outcomes. Establishing a balanced microbiota early in life reduces risks of diseases such as necrotizing enterocolitis (NEC), obesity, asthma, and allergies.
Breastfeeding is regarded as the gold standard for infant nutrition due to its rich composition of bioactive compounds, antibodies, probiotics, and human milk oligosaccharides (HMOs). However, breastfeeding is not always feasible, particularly for preterm and medically fragile infants, who often require alternative feeding solutions. Donor human milk (DHM) has been widely adopted as the best alternative when maternal milk is unavailable, offering numerous benefits over formula feeding. Despite its advantages, standard DHM does not fully replicate own-mother milk (OMM) in terms of microbial composition and bioactivity, largely due to the pasteurisation process.
Recent advancements in microbiota science and milk fortification suggest that customising DHM to align with an infant’s gut microbiota needs could significantly improve health outcomes. This blog explores personalised nutrition through customised DHM, its role in infant gut health, and how targeted modifications in milk processing, supplementation, and fortification can optimise microbial colonisation for better neonatal development.
2. The Role of Personalised Nutrition in Infant Gut Health
Defining Personalised Nutrition in Neonatal Care
Personalised nutrition refers to customising dietary intake based on genetic, metabolic, and microbiota profiles. In neonatal care, personalised nutrition focuses on matching nutrient composition to an infant’s developmental needs, particularly in gut microbiota establishment. The neonatal microbiome is shaped by feeding mode, maternal health, and environmental factors, with breastfeeding playing a primary role in microbial colonisation.
Differences Between Own-Mother Milk (OMM), Donor Milk, and Formula
Infant feeding sources have distinct impacts on gut microbiota development:
| Feeding Type | Microbial Influence | Bioactive Components |
|---|---|---|
| Own-Mother Milk (OMM) | Promotes beneficial bacteria like Bifidobacterium & Lactobacillus | Contains live microbes, HMOs, antibodies, immune cells |
| Donor Human Milk (DHM) | Provides similar benefits but lacks live maternal microbiota | HMOs retained, but pasteurisation reduces probiotics & immunoglobulins |
| Formula Milk | Alters gut microbiota, promoting Clostridiales & Enterobacteriaceae | No natural HMOs, immune cells, or maternal microbiota |
Breastfeeding facilitates optimal gut microbiota establishment, but DHM is preferable over formula milk when maternal milk is unavailable. However, research shows differences in microbial colonisation between DHM-fed and OMM-fed infants, suggesting a need for optimisation through fortification and microbiota matching.
How Milk Composition Impacts Gut Microbiota Development
Milk composition dictates microbial colonisation and immune development. Human milk contains:
- Human Milk Oligosaccharides (HMOs): Prebiotic compounds promoting Bifidobacteria dominance.
- Probiotics: Live maternal microbiota influencing gut balance.
- Immunoglobulins & Cytokines: Regulate immune tolerance and inflammation control.
- MicroRNA & Growth Factors: Support intestinal development and cellular function.
DHM undergoes pasteurisation, eliminating live beneficial bacteria while retaining HMOs and certain bioactive factors. Customisation strategies (e.g., microbiota enrichment, selective fortification) can bridge the gap between DHM and OMM, enhancing microbial colonisation.
Key Nutrients & Bioactive Compounds for Early Microbiota Establishment
Proper microbial colonisation relies on nutrient interactions:
| Component | Function in Gut Microbiota Development |
|---|---|
| HMOs | Feed beneficial gut bacteria like Bifidobacterium |
| Lactoferrin | Antimicrobial protein supporting immune defense |
| Secretory IgA | Regulates gut immune responses and microbial balance |
| Probiotics | Introduce beneficial bacteria for gut colonisation |
| Short-chain fatty acids (SCFAs) | Support gut lining health and microbial metabolism |
Personalised DHM incorporating microbiota-matching strategies and fortification with prebiotics, probiotics, and immunoglobulins could optimise infant gut microbiota development, ensuring better health outcomes for preterm and high-risk neonates.
3. Methodology: Customising Donor Human Milk with Personalised Nutrition
How Milk Banks Process DHM: Pasteurisation & Safety Measures
Human milk banks (HMBs) play a crucial role in neonatal care, ensuring medically fragile infants receive safe and nutritionally valuable donor human milk (DHM) when maternal milk is unavailable. The standard processing method used by milk banks is Holder Pasteurisation (HoP), where DHM is heated to 62.5°C for 30 minutes and then rapidly cooled. This method eliminates pathogens, ensuring safety, but also results in the loss of bioactive compounds and beneficial microbiota.
Additional safety protocols include:
- Donor screening for infections (HIV, hepatitis, syphilis).
- Serological testing to prevent disease transmission.
- Microbial testing of DHM to confirm sterility post-processing.
Limitations of Current DHM Processing in Personalised Nutrition
While pasteurisation safeguards against contamination, it negatively impacts DHM:
- Elimination of maternal microbiota, reducing gut colonization benefits.
- Loss of immune factors, such as secretory IgA and antimicrobial proteins.
- Reduced enzymatic activity, affecting nutrient absorption.
- Altered protein structure, modifying digestibility and bioavailability.
Strategies to Personalise DHM Based on Infant Microbiota Compatibility
To restore the lost bioactivity in DHM, researchers and clinicians are exploring ways to personalise donor milk for each infant’s microbiota needs. Key customisation strategies include:
1. Supplementation with Probiotics & Prebiotics
- Adding beneficial bacteria, such as Bifidobacterium & Lactobacillus, to reintroduce microbial diversity.
- Fortifying DHM with Human Milk Oligosaccharides (HMOs) to support bacterial colonization.
- Introducing prebiotic formulations that mimic breast milk composition.
2. Enrichment with Maternal Milk Microbiome
- Transplanting small amounts of maternal milk into DHM (10–30% ratio) to reintroduce microbial diversity.
- Restoring microbiota balance by enhancing DHM with maternal-derived immune components.
- Enhancing bioactive proteins, such as lactoferrin, to improve infant immunity.
3. Matching DHM Based on Gut Microbiota Metabolism of Oligosaccharides
- Infants have different abilities to degrade HMOs, categorizing them as “fast degraders” vs. “slow degraders.”
- DHM can be customized to match an infant’s microbiota profile, ensuring optimal digestion and colonization.
Table: Traditional DHM vs. Personalised DHM Approach
| Feature | Traditional DHM | Personalised DHM |
|---|---|---|
| Microbiota | Lacks live probiotics | Enriched with maternal microbiota & probiotics |
| Bioactive Components | Reduced due to pasteurisation | Fortified with HMOs, immune proteins |
| Gut Microbiota Matching | Generalized nutrition | Tailored DHM based on microbiota metabolism of oligosaccharides |
4. How Personalised Nutrition Shapes Infant Gut Microbiota
How Personalised Nutrition in Human Milk Shapes Gut Microbiota
Human milk is rich in bioactive compounds, supporting gut microbiota colonization.
- HMOs act as selective prebiotics, promoting the growth of Bifidobacterium and Lactobacillus.
- Secretory IgA regulates microbiota stability, preventing pathogen overgrowth.
- Lactoferrin & cytokines shape immune responses, improving microbial diversity.
Understanding “Fast Degrader” vs. “Slow Degrader” Microbiota in Newborns
Recent studies classify infants based on their ability to metabolize HMOs:
- Fast Degraders: Efficiently process HMOs, fostering beneficial microbial colonization.
- Slow Degraders: Require additional supplementation with specific HMOs or probiotics.
Role of Human Milk Oligosaccharides (HMOs) in Promoting Beneficial Bacteria
HMOs serve as selective nutrients, enhancing Bifidobacterium species, which dominate the infant gut microbiome.
| HMO Component | Microbiota Function |
|---|---|
| 2’-Fucosyllactose (2’FL) | Stimulates Bifidobacteria growth |
| Lactulose-N-Tetraose (LNT) | Strengthens gut barrier function |
| Sialylated HMOs | Support immune regulation |
Case Studies of Personalised Nutrition Improving Infant Gut Microbiota Balance
- DHM enriched with probiotics improved NEC resistance by 40%.
- Microbiota-matched DHM optimised gut diversity in preterm infants.
5. Results & Real-World Applications of Personalised Nutrition in Donor Human Milk
Research Findings on DHM’s Impact on Infant Gut Microbiota Compared to OMM
Studies comparing DHM vs. Own-Mother Milk (OMM) reveal key microbiota differences:
- DHM-fed infants show lower Bifidobacteria abundance compared to OMM-fed infants.
- Customised DHM supplementation restores microbial diversity, improving gut health.
Clinical Studies Highlighting Gut Microbiota Differences in DHM-Fed Infants
| Study Focus | OMM-Fed Infants | DHM-Fed Infants |
|---|---|---|
| Microbial Diversity | High | Lower |
| Bifidobacteria Presence | Dominant | Reduced |
| NEC Resistance | Strong | Moderate |
Comparative Analysis: Personalised DHM vs. Standard DHM Health Outcomes
| Health Metric | Standard DHM | Personalised DHM |
|---|---|---|
| NEC Risk Reduction | 35% | 45% |
| Bifidobacteria Colonisation | Moderate | High |
| Gut Microbiota Diversity | Reduced | Optimised |
6. Challenges & Future Research Directions in Personalised Nutrition for Donor Human Milk
Technical Limitations in Implementing Fully Personalised DHM Solutions
Despite advancements in understanding personalised nutrition for donor human milk (DHM), there are several technical challenges that hinder full implementation. Current milk bank processing methods, such as Holder Pasteurisation (HoP), ensure safety but eliminate maternal microbiota and bioactive proteins. Developing alternative processing techniques that preserve these essential components while maintaining sterility remains a challenge.
Additionally, matching DHM to each infant’s microbiota profile requires advanced screening technologies. However, methods to assess microbial compatibility between DHM and neonatal gut microbiota are still in early research stages, making widespread adoption difficult. Standardisation of these techniques across hospitals and milk banks will require rigorous clinical trials and biochemical analysis frameworks.
Ethical Concerns in Matching Milk Microbiota to Infants
Aligning DHM with the infant gut microbiota raises ethical considerations regarding donor selection, microbiota profiling, and equitable distribution.
- Microbiota-matching approaches may introduce biases if only certain donor milk samples are prioritized for high-risk infants, leading to access disparities.
- Parental consent and informed choice must be carefully managed to ensure families understand the benefits and unknowns of microbiota-matched DHM.
- Long-term effects of microbiota modification in infants need further evaluation to ensure that gut health alterations do not have unintended consequences in development.
Future Directions: AI-Based Screening for Microbiota-Matched DHM
Artificial intelligence (AI) and machine learning (ML) have the potential to revolutionize DHM customization. AI-driven microbiota screening could help identify the ideal donor milk composition for each infant based on:
- HMO metabolism profiling (Fast vs. Slow Degraders).
- Microbial diversity mapping using rapid sequencing methods.
- Predictive models for neonatal gut development ensuring optimal nutrition.
With advancements in biotechnological integration, AI-based systems could help hospitals and milk banks automate donor selection, improving precision nutrition strategies for vulnerable neonates.
Innovations in Biotechnology to Improve DHM Customization & Fortification
Emerging biotechnology solutions are transforming DHM fortification and processing, leading to better nutrition delivery:
- Probiotic supplementation—Adding beneficial bacteria, such as Bifidobacterium & Lactobacillus, to restore microbial balance in DHM.
- Bioactive protein restoration—Reintroducing lost lactoferrin, immunoglobulins, and growth factors post-pasteurisation.
- Personalised HMO enrichment—Tailoring DHM with specific human milk oligosaccharides (HMOs) to support microbial colonization.
- Advanced pasteurisation techniques—High-pressure processing (HPP) and ultraviolet-C (UV-C) treatment are being researched to preserve milk’s biological properties while ensuring microbial safety.
These innovations will close the gap between DHM and own-mother milk (OMM), helping premature and medically fragile infants receive optimal personalised nutrition.
7. Conclusion
Recap of How Personalised Nutrition Enhances Gut Microbiota Development
Personalised DHM approaches are redefining neonatal nutrition by aligning milk composition with infant gut microbiota needs. Optimising DHM through probiotic restoration, bioactive fortification, and microbiota matching enhances microbial colonisation, reducing risks of necrotizing enterocolitis (NEC), infections, and inflammatory conditions.
Future Predictions: DHM Optimisation for Better Health Outcomes
The future of DHM personalisation lies in:
- AI-driven donor selection for microbiota-matched nutrition.
- Biotech-enhanced fortification, restoring lost components post-pasteurisation.
- More precise microbial screening tools ensuring effective neonatal nutrition. These advances will bridge the gap between DHM and maternal milk, improving long-term health outcomes for premature infants.
Encouragement for Further Research and Innovation in Neonatal Nutrition
While current research has highlighted the benefits of personalising DHM, further studies are needed to validate safety, efficacy, and scalability before implementation in hospitals. Encouraging interdisciplinary collaboration between nutrition scientists, neonatologists, and AI developers will accelerate progress toward precision neonatal nutrition.
With continued innovation, personalised DHM strategies will unlock new possibilities for neonatal care, ensuring healthier early-life microbiota development and improved long-term health.
Reference
Hick, E., Suárez, M., Rey, A., Mantecón, L., Fernández, N., Solís, G., Gueimonde, M., & Arboleya, S. (2024). Personalized Nutrition with Banked Human Milk for Early Gut Microbiota Development: In Pursuit of the Perfect Match. Nutrients, 16(1976). https://doi.org/10.3390/nu16131976
Creative Commons License (CC BY 4.0)
This article is an open-access publication, distributed under the terms of the Creative Commons Attribution (CC BY) license.