Beyond Breastfeeding: A One Health Decalogue for Nurturing the Infant Microbiota

Valentina Biagioli^1,2*Mariarosaria Matera^2,3Ilaria Cavecchia^2,4Mariateresa Illiceto⁵Laura Pennazzi²Gaia Luongo⁶Sebastian Lugli²Pasquale Striano^7,8

• ¹Universita degli Studi di Genova Dipartimento di Neuroscienze Riabilitazione Oftalmologia Genetica e Scienze Materno-Infantili, Genoa, Italy
• ²Microbiota International Clinical Society, 10123 Turin, Italy, Turin, Italy
• ³Department of Pediatric Emergencies, Misericordia Hospital, Grosseto, Italy, Grosseto, Italy
• ⁴Microbiomic Department, Koelliker Hospital, 10134 Turin, Italy, Turin, Italy
• ⁵Department of Pediatrics- Unit of Pediatric Gastroenterology and Endoscopy, Santo Spirito Hospital, Pescara, Italy, Pescara, Italy
• ⁶Genoa Italy, Genoa, Italy
• ⁷Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy, Genova, Italy
• ⁸Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto “Giannina Gaslini”, Genoa, Italy, Genoa, Italy

Background: Early-life nutrition is a key determinant of infant gut microbiota development, immune maturation, and long-term health outcomes. Although breastfeeding is widely recognized as the optimal feeding strategy, many mothers are unable to breastfeed, underscoring the need for practical, evidence-based guidance to support infant health beyond breastfeeding. A One Health approach enables the integration of nutritional, microbial, clinical, environmental, and socio-cultural factors that influence maternal-infant dyads. Methods: A narrative review of the literature was conducted using PubMed, Scopus, and Google Scholar, focusing more on works published from 2020 to 2026. Evidence was synthesized on maternal and infant nutrition, breast milk bioactive components, infant formula feeding, gut microbiota development, and short-and long-term health outcomes in non-breastfed infants. Based on this interdisciplinary evidence, a translational "One Health Decalogue" was developed for mothers who are unable to breastfeed. Findings: The reviewed literature highlights that infant nutrition, particularly in the absence of breastfeeding, significantly influences gut microbiota composition, immune programming, metabolic regulation, and neurodevelopment. Key modifiable factors include formula composition, feeding practices, maternal health status, environmental exposures, caregiver education, and psychosocial support. The proposed One Health Decalogue synthesizes these elements into ten actionable principles aimed at supporting microbial resilience, promoting healthy development, and reducing health inequalities when breastfeeding is not possible. Conclusions: Translating scientific evidence into practical tools is essential to support infants who cannot be breastfed. The One Health Decalogue presented in this review provides a comprehensive, interdisciplinary, and translational framework for healthcare professionals, families, and public health policies, fostering informed nutritional choices and holistic strategies to optimize infant health beyond breastfeeding.