Human Milk Oligosaccharides (HMOs): What Are They and Why Are They Important for Babies?

When we think about breast milk, nutrients such as proteins, fats and vitamins may come to mind first. But breast milk also contains many other components that interact with a baby’s developing body in interesting ways. Human milk oligosaccharides (HMOs) are one of them.

Unlike many nutrients commonly associated with breast milk, HMOs play unique roles in a baby's developing body. Their relationship with gut bacteria and the immune system has made them an important area of research.

What Exactly are Human Milk Oligosaccharides?

Human milk oligosaccharides are complex carbohydrates naturally found in breast milk. They are different from lactose, the main carbohydrate in human milk that provides energy.

Rather than being broken down and absorbed in the same way as many nutrients, most HMOs pass through the upper digestive tract largely undigested. This means they have roles further along the digestive system.

Scientists have identified many structurally different HMOs in human milk. They form a diverse group of naturally occurring components, with different HMOs potentially having different biological roles.

If Babies Don’t Digest Most HMOs, Why are They There?

It may sound unusual for breast milk to contain carbohydrates that a baby does not fully digest. But HMOs do not need to be absorbed like conventional nutrients to have a role.

Many reach the lower gut largely intact rather than being absorbed earlier in digestion. Reaching this part of the digestive system gives HMOs opportunities to interact with the microorganisms living there.

That is where one of their most interesting roles begins: their relationship with the baby's developing gut microbiome.

HMOs and Your Baby’s Developing Gut

A baby’s gut microbiome, the community of microorganisms living in the digestive tract, develops rapidly during early life. Feeding is one of several factors that can influence how this community takes shape.

Certain HMOs can selectively support the growth and activity of beneficial bacteria, including particular Bifidobacterium species. By providing nutrients that these bacteria can use, HMOs in breast milk may help shape the gut environment during this important period of development.

How Do HMOs Help With the Baby’s Natural Defences?

Some HMOs can act as “decoys” for certain microbes, interacting with them in ways that may make it harder for the microbes to attach to cells lining the gut. HMOs are also being studied for the ways they may interact with the developing immune system. Research suggests that some may influence how the immune system responds during early development.

These functions do not mean that HMOs prevent babies from becoming ill. Rather, they are part of the many biological components in human milk that may contribute to a baby's developing natural defences.

HMO Benefits for Babies: What Does the Research Say?

Human milk oligosaccharide benefits are being studied individually and in combination, and research shows their effects can vary depending on the specific HMO studied.

This means HMO benefits for babies should not be attributed to a single HMO or viewed as guaranteed health outcomes. Human milk contains many biologically active components, while genetics, environment and other factors also contribute to a baby's development.

As research continues, we are learning more about where individual HMOs may have a role and how their effects can differ.

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Are HMOs the Same in Every Mother’s Breast Milk?

The types and amounts of HMOs in breast milk can differ from one mother to another. Genetics is one factor behind these differences, and HMO composition can also change across stages of lactation.

This natural variation does not mean that one mother’s milk is “better” than another’s. It simply reflects the biological differences in human milk composition. Researchers continue to study how these variations may influence the way individual HMOs function and interact with a baby’s gut microbiome.

What About HMOs Added to Infant Formula?

Parents may also come across HMOs when reading infant formula labels. Some formulas now contain specific HMOs produced through specialised manufacturing processes.

These added HMOs may be structurally similar or identical to particular HMOs naturally present in human milk and are being studied for their effects in formula-fed infants. However, human milk naturally contains a much broader and individually varying mixture of HMOs.

The presence of selected HMOs in a formula, therefore, does not make its overall composition identical to breast milk. Parents using formula can discuss their baby’s feeding needs with their paediatrician rather than choosing a product based on a single ingredient.

A Small Component With an Interesting Role

HMOs show that not everything in human milk has to work like a conventional nutrient to have a biological role. Although much has already been discovered about them, research continues to explore the functions of individual HMOs and their interactions with other components of human milk.

For parents, there is no need to understand the science behind every HMO. What matters is recognising that they are part of the naturally complex composition of human milk and are an evolving area of infant health research.

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