出生时的肠道菌群如何影响终身健康

Now, I know it might be easy to think that microbes are bad, especially for infants,

我知道很容易去这么想，微生物不好，尤其是对婴儿来说，

but research has in fact proven the opposite.

但是事实上，研究证明了相反的结果。

And the truth might be a little bit more complex, but it's actually way more interesting.

事实可能更加复杂一些，但是也更加有趣。

It seems that we need microbes to be programmed for good health,

看上去我们需要微生物来为健康助力，

but not just any microbes, we need the right combination.

但并不是任何微生物都可以，我们需要正确的组合。

We succeed best with the little microbial bodies we have adapted to coexist with during evolution.

在进化过程中，我们适应的与之共存的微生物（组合）是最佳的。

And I guess it won't surprise you to learn that we start acquiring that right combination right at birth.

我猜你们也不会惊讶于我们从一出生之时就开始获寻那种正确的组合。

Well, at least some of us do.

至少我们中的一些人是这样的。

Babies born by C-section and babies born vaginally aren't the same when it comes to microbial start to life,

剖腹产出生的婴儿和顺产出生的婴儿在出生时拥有的微生物群是不一样的，

and after birth there are countless different early life events and circumstances

出生后有数不清的早期事件和环境因素

that further modulate the way the gut microbiota is developing,

会进一步调整肠道菌群的发育，

such as the medications that might be prescribed for the infant or the mother,

像是开给婴儿或是母亲的药物，

number of pets and siblings in the family, as well as level of hygiene at home,

家庭中宠物和兄弟姐妹的数量，以及居家的卫生水平，

and, in this case, it's actually better if it's not that perfectly clean all the time.

这种情况下，事实上不总保持过分清洁反而是好事。

And also nutrition, both mothers and infants.

还有母亲和婴儿的营养状况。

All of these events and circumstances play a huge role in the gut microbial development

所有这些事件和环境都在肠道菌群发育的过程中扮演着重要的角色，

and that has a huge impact on the lifelong health of that baby.

也对婴儿的长远健康产生着巨大的影响。

And I'm not talking about small health implications here. I'm talking about the big stuff.

我讲的不是细微的健康影响。我讲的是很大的影响。

Microbes we acquire or do not acquire affect our likelihood of developing diseases like obesity, diabetes and even some cancers.

我们获取或未获取的微生物影响着我们得像是肥胖症、糖尿病、甚至是一些癌症的概率。

Since many of these early life events I just listed are such that we cannot affect them,

因为许多我刚刚列出的早期事件是我们无法掌控的，

they are inevitable, for example C-sections have been invented to save lives, and they do that daily,

因此这些事件不可避免，比如为了拯救生命发明出的剖腹产，每天都在发生，

and most medications are prescribed for a valid reason, especially for infants, and so on.

开大多数药物都有合理的理由，尤其对婴儿来说，等等。

That is why we have to learn how to protect the health of these babies

这就是为什么我们需要学习如何保护这些婴儿的健康，

after the occurrence of such early life events that might disrupt their gut microbiota development.

在这些可能会扰乱婴儿肠道菌群发育的早期人生事件发生之后。

I work as a researcher and as a technical lead of an infant health platform,

我是一名研究人员，同时还是一个婴儿健康平台的技术带头人，

and the question I'm trying to find a solution to every day at work,

有一个我每天在工作中试图解答的问题，

and the same question I'm aiming to answer in this talk,

同时也是我在这个演讲中试图回答的问题，

is how can we make sure that all babies get the same shot at lifelong health,

那就是，从长远来看，我们如何确保这些婴儿在健康方面处于同一起跑线，

no matter how they're born or what early life events they encounter.

无论他们是以什么样的出生方式或是在生命早期有什么样的经历。

Seems like a noble cause, right? Great. So let's figure this out.

听上去是很崇高的事业，对吧？很好。那么让我们来一起分析一下。

To begin, remember how I said that we need the right combination of microbes?

首先，还记得我说过我们需要正确的微生物组合吗？

Well, to get that combination right, we need to receive those microbes that inhabit our bodies in a certain order.

要获得正确的组合，我们就需要以特定的顺序来接收生活在我们体内的微生物。

You can think of it like a colonization march.

我们可以将其看成一种殖民活动。

The very early microbes that inhabit our bodies first change the environment in the infant's gut

最早进入我们身体的微生物改变了婴儿的肠道环境，

so that the next microbes are able to move in, kind of like the first invaders come in first

这样下一批微生物才能进来，就有点像最早的殖民者第一个到来，

and set up the infrastructure for the other settlers to build upon.

并为后来的人搭建起一定的基础设施。

Now, if babies are born via C-section, that early phase of colonization is greatly altered,

如果婴儿是剖腹产出生的，那么他们体内早期的“殖民”阶段就会被大大的改写，

because instead of vaginal, fecal and skin bacteria of the mother, mainly only skin bacteria enter the infant gut.

因为母亲的阴道、粪便和皮肤上的细菌三者中，只有皮肤上的细菌才会进入婴儿的肠道。

And that sets that colonization march to a totally different tone,

这就给“殖民行军”设定了完全不同的基调，

and simply because that's different to what we've adapted to during evolution,

仅仅是因为剖腹产和我们通过进化所适应的方式（顺产）不同，

that might cause some health disadvantages for C-section-born babies later on.

这就可能会在将来为剖腹产出生的婴儿带来一些健康劣势。

We can take weight development as an example here.

我们以体重的发展举例。

It has been already shown in several studies that gut microbiota composition

数个研究已经显示，肠道菌群成分

is associated to weight as well as the likelihood of developing diseases like diabetes or cardiovascular diseases.

和体重以及患上像是糖尿病、心血管疾病的概率有着相关性。

But now there are some indications that you could already at infancy see from a fecal sample of a baby

然而现在有些证据表明，你已经可以在婴儿时期，从婴儿的粪便样本中看出，

some microbes missing from those individuals who will later on develop to be obese or overweight.

将来会肥胖或超重的个体，他们的肠道内缺少一些微生物。

It has also been shown that those same microbes might be missing from babies

还有证据表明，这些微生物同样缺少在

who are born by C-section or who are predisposed to heavy loads of antibiotics in early life.

通过剖腹产出生的婴儿和在生命早期接触大量抗生素的婴儿体内。

And to kind of close this loop, it has also been shown in some research

除此之外，还有研究显示，

that babies born by C-section or are prescribed with many, many antibiotics early in life

通过剖腹产出生的婴儿或是在生命早期摄入大量抗生素的婴儿

are more likely to be obese or overweight, even by 50 percent, which is a lot.

变得肥胖或超重的概率要高出50%，这是个很大的数字。

Now, I know you might be thinking at this point that,

我知道你们可能现在在想，

oh no, I just had a C-section or I was born via C-section or my child had the antibiotics.

哦不好，我刚刚接受了剖腹产，或是我是剖腹产出生的，或是我的孩子摄入了抗生素。

But I want you to not worry.

但是我希望你们不要担心。

If these microbes are missing or are lost for any reason,

如果这些微生物因为某些原因而缺失或是不见了，

they can be acquired later, but the baby just needs a little help with that.

它们仍可以在将来被获取，只是这时婴儿需要一些帮助。

One thing that has already for some time been known to help is breastfeeding.

一段时间以来已经为人所知的一种方法就是母乳喂养。

Breast milk is kind of miraculous: in addition to containing nutrients for the baby,

母乳真是神奇的东西：除了帮婴儿维持营养供应，

it seems to contain food for the good microbes as well.

母乳还包含了给有益微生物的养分。

That's great for a breastfed baby, but we all know that all babies are not breastfed.

这对母乳喂养的婴儿来说太好了，但我们都知道不是所有的婴儿都是母乳喂养的。

So what could we do to ensure that also those babies who are not breastfed could restore their microbiota development

那么我们可以做些什么，来确保没有母乳喂养的婴儿可以恢复他们的菌群发育

after encountering those disruptive early life events that might disrupt their gut microbiota development?

在遭受到可能会导致肠道菌群发育紊乱的干扰性生命早期事件之后？

And now we get to the actual solution part of this talk.

现在我们到了这个演讲的实际解决方案部分。

The research in this field has been taking giant steps lately.

最近，这个领域的研究取得了巨大的进展。

First, it was understood that if there are some microbes missing, they can be ingested.

首先，人们发现如果有些微生物缺失了，它们可以被摄入。

We call the good microbes, when they are ingested, probiotics,

我们称这些被摄入的有益微生物为益生菌，

and probiotics have been tested in several clinical trials during the years, also in infants,

益生菌已经在多年的临床试验中，包括婴儿身上，

with great effects, such as reducing their risk of eczema later in life.

显示了不错的效果，比如降低将来患湿疹的风险。

Now, a second revolution was realized when the eyes of researchers were turned to breast milk.

当研究人员将目光转向母乳，第二项革命就发生了。

That was logical, as, like I mentioned,

这很符合逻辑，正如我提到的，

it was already known that breastfeeding is able to support the healthy development of gut microbiota.

母乳喂养对健康菌群发展的支持作用已为人熟知。

There were these particles in breast milk that were found already in the 1930s called human milk oligosaccharides,

上世纪30年代，人们就已经在母乳中发现了叫做人乳寡糖（HMO）的颗粒，

but their function remained a mystery for decades and decades after their initial discovery.

但是在被发现的几十年后，它们的作用仍是一个谜。

They were really puzzling for researchers, as they are really abundant in human milk.

研究人员对此感到十分困惑，因为它们在母乳中含量丰富。

They are actually the third-largest group of solids, but they are not digestible by humans, not even infants.

人乳寡糖实际上是（母乳中）第三大固态物质，但它们无法被人，甚至婴儿消化。

So why would mothers synthesize something to breast milk, use their resources

那么为什么母亲们会消耗资源，在母乳中合成

to put something there that is not utilizable by the infant?

婴儿无法使用的东西？

Usually nature does not work that way. Right?

通常情况下，大自然是不会这么做的。是吧？

So it was quite a revelation when it was finally understood what's the role of these particles,

所以在人们最终知晓这些颗粒的作用之后惊讶的发现，

and that it is to selectively feed the microbes that are best for infants, and that way to affect the infant health.

人乳寡糖能够选择性的培育对婴儿来说最好的微生物，从而影响婴儿的健康。

There are over a hundred of different HMO structures,

HMO有上百种不同的结构，

and nowadays we are able to synthesize some of them also in the lab,

现今，我们可以在实验室中合成其中的一些，

and that enables us to package them up with probiotics for children and infants

这让我们可以将其和益生菌组合起来，

who are not able to receive them from breast milk to restore their microbiota after encountering disruptive early life events.

帮助那些在经历了干扰性生命早期事件后，无法从母乳中获取益生菌来恢复肠道菌群的孩童和婴儿。

And that is the solution. As a researcher,

这就是解决方案。作为研究人员，

I must say at this point that research in this field is still ongoing and a lot of work remains to be done.

我必须在此说明，这个领域的研究仍在进展之中，许多的研究仍需要完成。

That's a favorite sentence of us scientists.

这是科学工作者最喜欢说的一句话。

But we are taking steps towards understanding better and better which are the key missing microbes in various situations

但我们正采取措施，一步步更好的理解在不同情况下缺失的关键微生物是什么，

and what HMOs we should package with which probiotics to help restore the microbiota of that particular baby in that particular case.

什么样的HMO应该与什么微生物组合起来，以恢复在特定病例下特定婴儿的肠道菌群。

What I wish you to remember from this talk is that, yes,

我希望你们通过这个演讲记住的是，

vaginally born breastfed baby has the microbiota we have evolved to adapt to,

顺产出生、母乳喂养的婴儿的确拥有我们通过进化得以适应的菌群，

but in cases where that is not possible, there are means to reduce the negative health consequences.

但如果无法实现顺产或母乳喂养，仍有方法可以减少对健康的负面影响。

Lastly, I wish you to imagine a world for a while,

最后，我希望你们花些时间想象一下这样的世界，

a world where there would be such a health care system that when you take your baby to a health care check,

这个世界中有这样的医疗保健体系，当你带你的婴儿去体检时，

they would routinely monitor the gut microbiota development of that baby,

该系统会程序性的检查婴儿的肠道菌群发展状况，

and if any disruptions would be noted, a tailor-made product to restore the microbiota would be prescribed.

如果有任何的紊乱被检测到了，你就会得到用来恢复菌群的个性化处方。

I mean, how wonderful would that be,

我的意思是，那会多么美好啊，

if the onset of any chronic diseases would be extremely rare because of this preemptive health care system?

如果有了这样的前瞻性医疗保健系统，任何慢性疾病的发病率都会显著减少。

Can you imagine such a world? Do you believe that that kind of future would be possible?

你们能想象这样的世界吗？你们相信这样的未来会实现吗？

I do. I believe in that future and I want to contribute in the unfolding of that future,

我相信。我相信这样的未来，我也想为实现这样的未来出一份力，

a future in which each baby has an equal starting point for life to be programmed for lifelong health. Thank you.

一个每个婴儿都有平等起点、能够规划终身健康的未来。谢谢。

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