Skip to main content
    • Aa
    • Aa

Breast- v. formula-feeding: impacts on the digestive tract and immediate and long-term health effects

  • Isabelle Le Huërou-Luron (a1) (a2), Sophie Blat (a1) (a2) and Gaëlle Boudry (a1) (a2)

The health benefits of breast-feeding have been recognised for a long time. In particular, breast-feeding is associated with lower incidence of necrotising enterocolitis and diarrhoea during the early period of life and with lower incidence of inflammatory bowel diseases, type 2 diabetes and obesity later in life. The higher nutritional and protective degree of human milk is related to its nutritional composition that changes over the lactation period and to the biological activities of specific components while lower growth rate of breast-fed infants may be attributed to their self-regulation of milk intake at a lower level than formula-fed infants. Many results now suggest that the developmental changes in intestinal and pancreatic function that occur postnatally are modulated by the diet. Indeed, formula-feeding induces intestinal hypertrophy and accelerates maturation of hydrolysis capacities; it increases intestinal permeability and bacterial translocation, but does not induce evident differences in microbiota composition. Whether these changes would be beneficial for enhancing absorptive capacities and for educating the gut-associated immune system remains to be further studied. Moreover, it is evident that formula-feeding increases basal blood glucose and decreases plasma ketone body concentrations, while discrepancies on postprandial glycaemia, insulin and incretin responses in both human studies and experimental studies are inconclusive. Manipulating the composition of formula, by reducing protein content, adding prebiotics, growth factors or secretory IgA can modulate intestinal and pancreatic function development, and thereby may reduce the differential responses between breast-fed and formula-fed neonates. However, the developmental responses of the digestive tract to different feeding strategies must be elucidated in terms of sensitivity to developing diseases, taking into account the major role of the intestinal microbiota.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Breast- v. formula-feeding: impacts on the digestive tract and immediate and long-term health effects
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Breast- v. formula-feeding: impacts on the digestive tract and immediate and long-term health effects
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Breast- v. formula-feeding: impacts on the digestive tract and immediate and long-term health effects
      Available formats
Corresponding author
*Corresponding author: Dr Isabelle Le Huërou-Luron, fax +33 223485080, email
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

2 P Hoddinott , D Tappin & C Wright (2008) Breast feeding. BMJ 336, 881887.

4 C Agostoni , C Braegger , T Decsi , . (2009) Breast-feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 49, 112125.

5 KG Dewey , J Heinig & LA Nommsenrivers (1995) Differences in morbidity between breast-fed and formula-fed infants. J Pediatr 126, 696702.

6 PW Howie , JS Forsyth , SA Ogston , . (1990) Protective effect of breast feeding against infection. BMJ 300, 1116.

7 UM Saarinen & M Kajosaari (1995) Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old. Lancet 346, 10651069.

8 E Savilahti & KM Saarinen (2009) Early infant feeding and type 1 diabetes. Eur J Nutr 48, 243249.

9 EJ Mayer , RF Hamman , EC Gay , . (1988) Reduced risk of IDDM among breast-fed children. The Colorado IDDM Registry. Diabetes 37, 16251632.

11 AR Barclay , RK Russell , ML Wilson , . (2009) Systematic review: the role of breastfeeding in the development of pediatric inflammatory bowel disease. J Pediatr 155, 421426.

12 DJ Pettitt , MR Forman , RL Hanson , . (1997) Breastfeeding and incidence of non-insulin-dependent diabetes mellitus in Pima Indians. Lancet 350, 166168.

14 C Doak , BL Heitmann , C Summerbell , . (2009) Prevention of childhood obesity – what type of evidence should we consider relevant? Obes Rev 10, 350356.

15 WA Walker (2004) The dynamic effects of breastfeeding on intestinal development and host defense. Adv Exp Med Biol 554, 155170.

16 C Kunz & B Lönnerdal (1992) Re-evaluation of the whey protein/casein ratio of human milk. Acta Paediatr 81, 107112.

17 SM Innis (1992) Human milk and formula fatty acids. J Pediatr 120, S56S61.

18 B Lönnerdal (2008) Personalizing nutrient intakes of formula-fed infants: breast milk as a model. Nestle Nutr Workshop Ser Pediatr Program 62, 189198.

21 KG Dewey & B Lönnerdal (1986) Infant self-regulation of breast milk intake. Acta Paediatr Scand 75, 893898.

23 B Rebhan , M Kohlhuber , U Schwegler , . (2009) Breastfeeding duration and exclusivity associated with infants' health and growth: data from a prospective cohort study in Bavaria, Germany. Acta Paediatr 98, 974980.

25 FM Thompson , AG Catto-Smith , D Moore , . (1998) Epithelial growth of the small intestine in human infants. J Pediatr Gastroenterol Nutr 26, 506512.

29 T Kanno , N Koyanagi , Y Katoku , . (1997) Simplified preparation of a refined milk formula comparable to rat's milk: influence of the formula on development of the gut and brain in artificially reared rat pups. J Pediatr Gastroenterol Nutr 24, 242252.

30 B Dvorak , DL McWilliam , CS Williams , . (2000) Artificial formula induces precocious maturation of the small intestine of artificially reared suckling rats. J Pediatr Gastroenterol Nutr 31, 162169.

31 LT Weaver , L Landymore-Lim & A Lucas (1991) Neonatal gastrointestinal growth and function: are they regulated by composition of feeds? Biol Neonate 59, 336345.

34 LA Heitlinger , TM Rossi , PC Lee , . (1991) Human intestinal disaccharidase activities: correlation with age, biopsies technique, and degree of villus atrophy. J Pediatr Gastroenterol Nutr 12, 204208.

35 SK Gupta , SK Chong & JF Fitzgeral (1999) Disaccharidase activities in children: normal values and comparison based on symptoms and histologic changes. J Pediatr Gastroenterol Nutr 28, 246251.

36 SR Chowdhury , DE King , BP Willing , . (2007) Transcriptome profiling of the small intestinal epithelium in germfree versus conventional piglets. BMC Genomics 8, 215231.

37 F Backhed , H Ding , T Wang , . (2004) The gut microbiota as an environmental factor that regulates fat storage. Proc Natl Acad Sci U S A 101, 1571815723.

38 KC Mountzouris , AL McCartney & GR Gibson (2002) Intestinal microflora of human infants and current trends for its nutritional modulation. Br J Nutr 87, 405420.

39 I Adlerberth & AE Wold (2009) Establishment of the gut microbiota in Western infants. Acta Paediatr 98, 229238.

40 B Kleessen , H Bunke , K Tovar , . (1995) Influence of two infant formulas and human milk on the development of the faecal flora in newborn infants. Acta Paediatr 84, 13471356.

41 U Siigur , A Ormisson & A Tamm (1993) Faecal short-chain fatty acids in breast-fed and bottle-fed infants. Acta Paediatr 82, 536538.

42 AM Parrett & CA Edwards (1997) In vitro fermentation of carbohydrate by breast fed and formula fed infants. Arch Dis Child 76, 249253.

43 M Nakayama , M Yajima , S Hatano , . (2003) Intestinal adherent bacteria and bacterial translocation in breast-fed and formula-fed rats in relation to susceptibility to infection. Pediatr Res 54, 364371.

44 J Penders , EE Stobberingh , PA van den Brandt , . (2007) The role of the intestinal microbiota in the development of atopic disorders. Allergy 62, 12231236.

47 F Backhed (2009) Changes in intestinal microflora in obesity: cause or consequence? J Pediatr Gastroenterol Nutr 48, S56S57.

49 MG Gareau , J Jury , PC Yang , . (2006) Neonatal maternal separation causes colonic dysfunction in rat pups including impaired host defense. Pediatr Res 59, 8388.

50 F Barreau , L Ferrier , J Fioramonti , . (2004) Neonatal maternal deprivation triggers long-term alterations in colonic epithelial barrier and mucosal immunity in rats. Gut 53, 501506.

51 JO Gebbers & JA Laissue (2004) Bacterial translocation in the normal human appendix parallels the development of the local immune system. Ann N Y Acad Sci 1029, 337343.

52 M Urao , DH Teitelbaum , RA Drongowski , . (1996) The association of gut-associtaed lymphoid tissue and bacterial translocation in the newborn rabbit. J Pediatr Surg 31, 14821487.

53 C Catassi , A Bonucci , GV Coppa , . (1995) Intestinal permeability changes during the first month: effect of natural versus artificial feeding. J Pediatr Gastroenterol Nutr 21, 383386.

54 LT Weaver , MF Laker , R Nelson , . (1987) Milk feeding and changes in intestinal permeability and morphology in the new born. J Pediatr Gastroenterol Nutr 6, 351358.

55 JN Udall , P Colony , L Fritze , . (1981) Development of gastrointestinal mucosal barrier. II. The effect of natural versus artificial feeding on intestinal permeability to macromolecules. Pediatr Res 15, 245249.

56 S Teichberg , E Isolauri , RA Wapnir , . (1990) Development of the neonatal rat small intestinal barrier to nonspecific macromolecular absorption: effect of early weaing to artificial diets. Pediatr Res 28, 3137.

57 M Yajima , M Nakayama , S Hatano , . (2001) Bacterial translocation in neonatal rats: the relation between intestinal flora, translocated bacteria and influence of milk. J Pediatr Gastroenterol Nutr 33, 592601.

58 M Urao , J Moy , J Van Camp , . (1995) Determinant of bacterial translocation in the newborn: small bowel versus large bowel colonization. J Pediatr Surg 30, 831836.

59 LG Go , CT Albanese , SC Watkins , . (1994) Breast milk protects the neonate from bacterial translocation. J Pediatr Surg 29, 10591064.

60 G Steinwender , G Schimpl , B Sixl , . (1996) Effect of early nutritional derivation and diet on translocation of bacteria from the gastrointestinal tract in the newborn rat. Pediatr Res 39, 415420.

61 TE Adrian , G Soltesz , IZ MacKenzie , . (1995) Gastrointestinal and pancreatic hormones in the human fetus and mother at 18–21 weeks of gestation. Biol Neonate 67, 4753.

62 A Aynsley-Green , A Lucas & SR Bloom (1979) The effect of feeds of differing composition on entero-insular hormone secretion in the first hours of life in human neonates. Acta Paediatr Scand 68, 265270.

63 A Lucas , S Boyes , SR Bloom , . (1981) Metabolic and endocrine responses to a milk feed in six-day-old term infants: differences between breast and cow's milk formula feeding. Acta Paediatr Scand 70, 195200.

64 L Salmenpera , J Perheentupa , MA Siimes , . (1988) Effects of feeding regimen on blood glucose levels and plasma concentrations of pancreatic hormones and gut regulatory peptides at 9 months of age: comparison between infants fed with milk formula and infants exclusively breast-fed from birth. J Pediatr Gastroenterol Nutr 7, 651656.

65 P Mcclean & LT Weaver (1993) Ontogeny of human pancreatic exocrine function. Arch Dis Child 68, 6265.

66 M Cosgrove , H Losty , HR Jenkins , . (1997) Faecal chymotrypsin in small for gestational age infants: effects of nucleotides and breast feeding. Arch Dis Child Fetal Neonatal Ed 76, F201F202.

68 SC Kalhan , LJ D'Angelo , SM Savin , . (1979) Glucose production in pregnant women at term gestation. Sources of glucose for human fetus. J Clin Invest 63, 388394.

69 PW Aldoretta , TD Carver & WW Hay Jr (1998) Maturation of glucose-stimulated insulin secretion in fetal sheep. Biol Neonate 73, 375386.

70 T Otonkoski , S Andersson , M Knip , . (1988) Maturation of insulin response to glucose during human fetal and neonatal development. Studies with perfusion of pancreatic isletlike cell clusters. Diabetes 37, 286291.

71 AJ Weinhaus , MT Tabiin , P Poronnik , . (2003) Insulin secretagogues, but not glucose, stimulate an increase in [Ca2+]i in the fetal human and porcine β-cell. J Clin Endocrinol Metab 88, 27532759.

72 G Srinivasan , RS Pildes , G Cattamanchi , . (1986) Plasma glucose values in normal neonates: a new look. J Pediatr 109, 114117.

73 MA Sperling , PV DeLamater , D Phelps , . (1974) Spontaneous and amino acid-stimulated glucagon secretion in the immediate postnatal period. Relation to glucose and insulin. J Clin Invest 53, 11591166.

75 SC Kalhan , DM Bier , SM Savin , . (1980) Estimation of glucose turnover and 13C recycling in the human newborn by simultaneous [1-13C]glucose and [6,6-2H2]glucose tracers. J Clin Endocrinol Metab 50, 456460.

76 JM Hawdon , MP Ward Platt & A Aynsley-Green (1992) Patterns of metabolic adaptation for preterm and term infants in the first neonatal week. Arch Dis Child 67, 357365.

77 M Cornblath , JM Hawdon , AF Williams , . (2000) Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics 105, 11411145.

79 J Gentz , B Persson , M Kellum , . (1971) Effect of feeding on intravenous glucose tolerance and insulin response in piglets during the first day of life. Life Sci II 10, 137144.

80 AC Mendonca , EM Carneiro , JR Bosqueiro , . (1998) Development of the insulin secretion mechanism in fetal and neonatal rat pancreatic B-cells: response to glucose, K+, theophylline, and carbamylcholine. Braz J Med Biol Res 31, 841846.

81 BM Shields , B Knight , L Shakespeare , . (2006) Determinants of insulin concentrations in healthy 1-week-old babies in the community: applications of a bloodspot assay. Early Hum Dev 82, 143148.

82 BE Ginsburg , BS Lindblad , A Lundsjo , . (1984) Plasma valine and urinary C-peptide in breast-fed and artificially fed infants up to 6 months of age. Acta Paediatr Scand 73, 213217.

83 R Jost , JC Maire , F Maynard , . (1999) Aspects of whey protein usage in infant nutrition, a brief review. Int J Food Sci Technol 34, 533542.

84 K Macé , P Steenhout , P Klassen , . (2006) Protein quality and quantity in cow's milk-based formula for healthy term infants: past, present and future. In Protein and Energy Requirements in Infancy and Childhood, pp. 189205 [ J Rigo and EE Ziegler , editors]. Vevey: Nestlé Ltd.

85 G Colome , C Sierra , J Blasco , . (2007) Intestinal permeability in different feedings in infancy. Acta Paediatr 96, 6972.

87 E Barrat , C Michel , G Poupeau , . (2008) Supplementation with galacto-oligosaccharides and inulin increases bacterial translocation in artificially-reared newborn rats. Pediatr Res 64, 3439.

88 IM Bovee-Oudenhoven , SJ Ten Bruggencate , ML Lettink-Wissink , . (2003) Dietary fructo-oligosaccharides and lactulose inhibit intestinal colonisation but stimulate translocation of salmonella in rats. Gut 52, 15721578.

90 RT Maxson , DD Johnson , RJ Jackson , . (1996) The protective role of enteral IgA supplementation in neonatal gut-origin sepsis. Ann N Y Acad Sci 778, 405407.

91 EC Dickinson , JC Gorga , M Garrett , . (1998) Immunoglobulin A supplementation abrogates bacterial translocation and preserves the architecture of the intestinal epithelium. Surgery 124, 284290.

92 SE Balmer , PH Scott & BA Wharton (1989) Diet and faecal flora in the newborn: lactoferrin. Arch Dis Child 64, 16851690.

93 AK Roberts , R Chierici , G Sawatzki , . (1992) Supplementation of an adapted formula with bovine lactoferrin: 1. Effect on the infant faecal flora. Acta Paediatr 81, 119124.

94 BL Nichols , K McKee , M Putman , . (1989) Human lactoferrin supplementation of infant formulas increases thymidine incorporation into the DNA of rat crypt cells. J Pediatr Gastroenterol Nutr 8, 102109.

95 T Hagiwara , I Shinoda , Y Fukuwatari , . (1995) Effects of lactoferrin and its peptides on proliferation of rat intestinal epithelial cell line, IEC-18, in the presence of epidermal growth factor. Biosci Biotechnol Biochem 59, 18751881.

96 V Buccigrossi , G de Marco , E Bruzzese , . (2007) Lactoferrin induces concentration-dependent functional modulation of intestinal proliferation and differentiation. Pediatr Res 61, 410414.

99 H Okuyama , M Urao , D Lee , . (1998) The effect of epidermal growth factor on bacterial translocation in newborn rabbits. J Pediatr Surg 33, 225228.

100 VM Houle , EA Schroeder , J Odle , . (1997) Small intestinal disaccharidase activity and ileal villus height are increased in piglets consuming formula containing recombinant human insulin-like growth factor-I. Pediatr Res 42, 7886.

102 VY Yu (2002) Scientific rationale and benefits of nucleotide supplementation of infant formula. J Pediatr Child Health 38, 543549.

104 SE Balmer , LS Hanvey & BA Wharton (1994) Diet and faecal flora in the newborn: nucleotides. Arch Dis Child Fetal Neonatal Ed 70, 137140.

106 R Forste & JP Hoffmann (2008) Are US mothers meeting the Healthy People 2010 breastfeeding targets for initiation, duration, and exclusivity? The 2003 and 2004 National Immunization Surveys. J Hum Lact 24, 278288.

107 D Turck (2005) Breast feeding: health benefits for child and mother. Arch Pediatr 12, Suppl. 3, S145S165.

110 A Palou & C Pico (2009) Leptin intake during lactation prevents obesity and affects food intake and food preferences in later life. Appetite 52, 249252.

113 G Bobe , GL Lindberg , AE Freeman , . (2007) Short communication: composition of milk protein and milk fatty acids is stable for cows differing in genetic merit for milk production. J Dairy Sci 90, 39553960.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Nutrition Research Reviews
  • ISSN: 0954-4224
  • EISSN: 1475-2700
  • URL: /core/journals/nutrition-research-reviews
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 186
Total number of PDF views: 1240 *
Loading metrics...

Abstract views

Total abstract views: 2084 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 27th June 2017. This data will be updated every 24 hours.