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Oligosaccharides And Infant Immunity

Key takeaways

  • GOS/FOS mixture can mimic the immunomodulatory function of human milk oligosaccharides (HMOs)1.
  • GOS/FOS mixture has shown efficacy in reducing infections and allergic incidences2.
  • Dietary GOS/FOS supplements hold potential for establishing infant immunity2.

HMOs are essential components of human milk that have both direct communication with the immune cell, and probiotic capability3. A dietary intervention supplemented with Galactooligosaccharides (GOS) and fructooligosaccharides (FOS) (9:1 [weight/weight]) can function as prebiotic and has an immunomodulatory effect similar to HMOs1,3,4. This article reviews the impact of feed supplemented with prebiotic GOS/FOS mixture on the immunity of infants.

Dietary intervention with GOS and FOS: Impact on an infant’s immune system

Evidence suggests that interaction between the intestinal immune and epithelial cells, and the intestinal microbiota plays an essential role in the post-natal immune system development. Balanced gut flora is mainly colonized with lactobacilli, and bifidobacteria is vital to educate and expand the immune system in early life2,3. Clinical studies in preterm and term infants have found that feed supplemented with a prebiotic mixture of GOS/FOS produces an intestinal microbiota similar to that reported in breast-fed infants3. It was also found that the prebiotic GOS/FOS mixture enhanced the count of bifidobacteria2.

Owing to the ability of prebiotic GOS/FOS mixture to establish a balanced microbiota, it can play a significant role in the development of the immune system2,5. Clinical studies have indicated that dietary intervention with GOS/FOS increased the concentration of fecal secretory immunoglobulin A (sIgA) in infants after 26 weeks. This finding suggests the beneficial effect of the GOS/FOS mixture on mucosal immunity5.

The dietary intervention supplemented with GOS/FOS mixture has several immunological benefits (Figure 1)2,3.

oligosaccharides and infant immunity Figure 1

Figure 1 Immunological benefits of prebiotic GOS/FOS mixture (Source: Boehm et al., 2008; Arslanoglu et al., 2008)2,3.

Effect of GOS and FOS on immunity: Clinical evidence


Numerous clinical studies have shown the preventive effect of GOS/FOS mixture on the occurrence of infection. Some studies have been summarized below (Table 1).

Table 1: Clinical studies with prebiotic oligosaccharide in healthy term infants. (Adapted from Arslanoglu et al., 2007, Bruzzese et al.,2006, and Arslanoglu et al., 2008)1,3,6

Prebiotic compound Target group, age Study group Main outcome
GOS/FOS (8 g/l) Healthy term infants with a history of atopy.
Age:0-6 months
Prebiotic (n=102)
Control (n=104)
Reduced incidence of infection (p<0.05).
GOS/FOS (8g/l) Healthy term infants.
Age: 0-12 months
Prebiotic (n=136)
Control (n=145)
Reduced rate of infection (diarrhea (p<0.01)and recurrent upper respiratory infections(p<0.05).
GOS/FOS (8 g/l) Healthy term infants with a history of atopy.
Age: 0-6 months
Prebiotic (n=66)
Control (n=68)
Reduced incidence of overall and upper respiratory tract infections (p<0.01).

Allergy symptoms

Early nutritional intervention with prebiotic GOS/FOS mixture is effective in reducing the incidence of atopic dermatitis and other allergic manifestations as indicated through a randomized trial (Figure 2)3.

Study design Randomized, prospective, double-blind, placebo-controlled oligosaccharides-and-infant-immunity-figure-2
N 134
Population Healthy term infants with a parental history of atopy.
Cohorts Prebiotic-GOS/FOS (8g/l);
n=66 Placebo- Maltodextrin-supplemented dietary intervention (8 g/l);
Duration First six months of life
Follow-up Two years
Results A Significant reduction (p<0.5) in the incidence of atopic dermatitis, allergic urticaria, and recurrent wheezing in the probiotic group as compared to the placebo group.

Table 2: Schematic representation of the randomized, double-blind clinical study. The graph includes cumulative incidence (%) of atopic dermatitis and other allergic manifestations in placebo and GOS/FOS groups. (Adapted from Arslanoglu et al., 2008)3

Immune response

GOS/FOS has been reported to enhance beneficial antibody profiles. A double-blind, randomized study was conducted on 84 healthy term infants at risk for allergy, to evaluate the effect of GOS/FOS on the immune response. Infants were divided into placebo (n=43) and GOS/FOS (n=41) groups. The result indicated that GOS/FOS supplementation led to a significant decrease in the plasma level of IgG1, IgG2, IgG3, and total IgE. Reduction in cow’s milk specific IgG1 was also observed. Overall, the GOS/FOS mixture modulates the immune response toward cow’s milk protein (CMP)without affecting response to vaccination6.


Prebiotic oligosaccharides like GOS/FOS mixture can mimic the immunomodulatory function of HMOs and support establishing an infant’s immune function1,2.


  1. Arslanoglu S, Moro GE, Boehm G. Early supplementation of prebiotic oligosaccharides protects formula-fed infants against infections during the first 6 months of life. The Journal of nutrition. 2007 Nov;137(11):2420-4.
  2. Boehm G, Moro G. Structural and functional aspects of prebiotics used in infant nutrition. The Journal of nutrition. 2008 Sep;138(9):1818S-28S.
  3. Arslanoglu S, Moro GE, Schmitt J, Tandoi L, Rizzardi S, Boehm G. Early dietary intervention with a mixture of prebiotic oligosaccharides reduces the incidence of allergic manifestations and infections during the first two years of life. The Journal of nutrition. 2008 Jun ;138(6):1091-5.
  4. Van Hoffen E, Ruiter B, Faber J, M'Rabet L, Knol EF, Stahl B, Arslanoglu S, Moro G, Boehm G, Garssen J. A specific mixture of short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides induces a beneficial immunoglobulin profile in infants at high risk for allergy. Allergy. 2009 Mar;64(3):484-7.
  5. 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. Critical reviews in food science and nutrition. 2019 May;59(9):1486-97.
  6. Bruzzese E, Volpicelli M, Salvini F, Bisceglia M, Lionetti P, Chinquetti M, Iacono G, Guarino A. Early administration of GOS/FOS preventsintestinal and respiratory infections in infants. Journal of pediatric gastroenterology and nutrition. 2006 May;42:E95