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Agenda: 1. Definition 2. Mechanisms of Action 3. Probiotic effects, what does the evidences say

P robiotics & Prebiotics in P aediatrics Dr.Hamid Rahimi Subspecialist in Pediatric Infectious Diseases, Isfahan University of Medical Sciences. Agenda: 1. Definition 2. Mechanisms of Action 3. Probiotic effects, what does the evidences say. What are probiotics?. Definition. Examples.

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Agenda: 1. Definition 2. Mechanisms of Action 3. Probiotic effects, what does the evidences say

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  1. Probiotics & Prebiotics in PaediatricsDr.Hamid RahimiSubspecialist in Pediatric Infectious Diseases, Isfahan University of Medical Sciences

  2. Agenda:1. Definition2. Mechanisms of Action3. Probiotic effects, what does the evidences say

  3. What are probiotics? Definition Examples • Live microorganisms which when administered in adequate amounts confer a health benefit on the host • Lactobacilli • Bifidobacteria • Streptococcus • S boulardii Joint FAO/WHO Expert Consultation 2001

  4. Prebiotic: A nondigestible food ingredient that benefits the host by selectively stimulating the favorable growth and/or activity of 1 or more indigenous probiotic bacteria. • OS supplementation (GOS and/or FOS) • Inulin, Soybean • Synbiotic: A product that contains both probiotics and prebiotics. • Evidence for synergy of a specific prebiotic for a probiotic in the product is not essential. Synbiotics may be separate supplements or may exist in functional foods as food additives.

  5. Functional food: Any modified food or food ingredient that provides a health benefit beyond that ascribed to any specific nutrient/nutrients it contains. • It must remain a food, and it must demonstrate its effect in amounts normally expected to be consumed in the diet. • Benefits may include functions relevant to improving health and well-being and/or reduction of risk of disease.

  6. How do probiotics work? • Level 1 • Luminal effects • Level 2 • Epithelial effects • Level 3 • Immune effects Rijkers et al. J Nutr 2010;140:671S-676S Ewaschul & Madsen Function Food Rev 2009;2:29-41

  7. Facts.. • Higher rate of Infection in C/S babies • Higher Allergy prevalence in recent years

  8. Hygiene Hypothesis Improved hygienic conditions ↓ Less microbial exposure during early childhood ↓ Slower post-natal maturation of the immune system ↓ Delayed development of the optimal balance between TH-1 and TH-2-like immune response Stachan BMJ, 1989

  9. Normal Immune Function

  10. Probiotics; What does evidences say?

  11. Published RCTs & systematic reviews/meta-analyses on probiotics RCTs Meta-analysis CochraneCollaboration (searchdate : January 2011) 644 73

  12. ESPGHAN & AAP Positioning in Safety

  13. Effective • Modestly effective in • Treating acute viral gastroenteritis in healthy children • Preventing antibiotic-associated diarrhea in healthy children. • There is some evidence that probiotics prevent NEC in very low birth weight infants (birth weight between 1000 and 1500 g), but more studies are needed.

  14. Encouraging but require further confirmation • For treatment of childhood H pylori gastritis, irritable bowel syndrome, chronic ulcerative colitis, and infantile colic, as well as in preventing childhood atopy, although encouraging, RCTs are preliminary and require further confirmation.

  15. Probiotics have not been proven to be beneficial in treating or preventing human cancers or in treating children with Crohn disease.

  16. Safety concerns • There are also safety concerns with the use of probiotics in infants and children who are immunocompromised, chronically debilitated, or seriously ill with indwelling medical devices.

  17. Addition of probiotics to powdered infant formulas has not been demonstrated to be harmful to healthy term infants. • On the other hand, evidence of clinical efficacy for their addition is insufficient to recommend the routine use of these formulas. • No RCTs have directly compared the health benefits of feeding human milk versus infant formula supplemented with probiotics.

  18. Addition of oligosaccharides as prebiotics to infant formula is not unreasonable but lacks evidence demonstrating clinical efficacy at this time. Cost/benefit studies are also necessary to support their addition to infant formulas.

  19. Important questions remain… • Important questions remain in establishing the clinical applications for pro/prebiotics, including … • The optimal duration of probiotic administration • Preferred microbial dose and species • The long-term impact on the gut microflora • Whether there is significant biological benefit in the administration of probiotics during pregnancy and lactation • biological benefit derived from probiotic-containing infant formulas.

  20. Dosage • Duration • How to Store • How to use

  21. Quality is also a major issue in using probiotics in clinical practice. Many probiotic preparations do not contain the number of viable CFUs stated on the label. • www.ConsumerLab.com, an independent laboratory that performs quality control assessments of dietary supplements, recently found in an analysis of probiotic products that 5 of 19 brands analyzed did not contain the number of live organisms claimed on the label.

  22. Continue breast feeding • Limit antibiotic therapy

  23. Thank You

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