Effects of a synbiotic on symptoms,and daily functioning in attention deficit hyperactivity disorder – A double-blind randomized controlled trial

Some prebiotics and probiotics have been proposed to improve psychiatric symptoms in children with autism. However, few studies were placebo-controlled, and there is no study on persons with an attention deficit hyperactivity disorder (ADHD) diagnosis. Our aim was to study effects of Synbiotic 2000 on psychiatric symptoms and functioning in children and adults with ADHD without an autism diagnosis. Children and adults (n = 182) with an ADHD diagnosis completed the nine weeks randomized double-blind parallel placebo-controlled trial examining effects of Synbiotic 2000 on the primary endpoints ADHD symptoms, autism symptoms and daily functioning, and the secondary endpoint emotion regulation, measured using the questionnaires SNAP-IV, ASRS, WFIRS, SCQ, AQ and DERS-16. Levels at baseline of plasma C-reactive protein and soluble vascular cell adhesion molecule-1 (sVCAM-1), central to leukocyte-endothelial cell adhesion facilitating inflammatory responses in tissues, were measured using Meso Scale Discovery. Synbiotic 2000 and placebo improved ADHD symptoms equally well, and neither active treatment nor placebo had any statistically significant effect on functioning or sub-diagnostic autism symptoms. However, Synbiotic 2000, specifically, reduced sub-diagnostic autism symptoms in the domain restricted, repetitive and stereotyped behaviors in children, and improved emotion regulation in the domain of goal-directed behavior in adults. In children with elevated sVCAM-1 levels at baseline as well as in children without ADHD medication, Synbiotic 2000 reduced both the total score of autism symptoms, and the restricted, repetitive and stereotyped behaviors. In adults with elevated sVCAM-1 at baseline, Synbiotic 2000 significantly improved emotion regulation, both the total score and four of the five subdomains. To conclude, while no definite Synbiotic 2000-specific effect was detected, the analysis of those with elevated plasma sVCAM-1 levels proposed a reduction of autism symptoms in children and an improvement of emotion regulation in adults with ADHD.Trial registration number: ISRCTN57795429.     

Probiotics and prebiotics in neonatal necrotizing enterocolitis: New opportunities for translational research

Neonatal necrotizing enterocolitis (NEC) in premature infants has been recognized as a defined disease entity for at least four decades. Although survival has increased due to the advent of more sophisticated intensive care, incidence and long term health impacts due to NEC remain unchanged and no preventive therapy is currently available. Different probiotic strains of bacteria have been examined in their ability to prevent NEC with varied but encouraging results. Undigestable prebiotic sugars known to promote the growth of probiotic bacteria in the colon have been used in neonates with no clear benefit. The literature on NEC and probiotics is now cluttered with more reviews and meta-analyses than number of clinical trials. On the other hand, significant new information is available on microbiota and their impact on gut immunity. This review attempts to reiterate the risk factors of NEC and the pathogenesis of NEC with special reference to gut permeability. The reader is then introduced to gut microbiota, uniqueness and differences among probiotic strains, and how multiple resident flora talk to each other in the community setting in the human gut. After presenting a concise review of available clinical research results, the reader is challenged to question as to why no precise answer is available at present. Some modalities to examine the complex microflora and changes in the neonatal gut are then proposed including non-invasive methods and mathematical modeling. The review concludes by attracting the reader's attention to known immunomodulators of inflammation and injury. Justice to this review will be done only if the readers, clinical, and basic science investigators from multiple fields gather courage for a paradigm shift and embark on understanding the pathophysiology of the disease and attempt to discern the difference from equally preterm, equally vulnerable neonates that do not develop NEC. Learning about the developing microbiota in neonatal gut and its immunological impacts on the host in the face of many variables will provide a leap in our pursuit to select better, if not the best candidate probiotics, and put them to work against this stubborn disease that continues to take a toll on our precious neonates and the society.     

Changes in nutrient absorption in children and adolescents caused by fructans,especially fructooligosaccharides and inulin

IntroductionFructans, such as inulin and fructooligosaccharides (FOS), have several effects on human health owing to their prebiotic character, including anti-microbial and anti-cancer effects, and to their influence on the absorption of minerals, which is very important in childhood and adolescence.ObjectiveOur aim was to review the role of some fructans in the absorption of vitamins and minerals in children and adolescents.MethodsWe conducted a narrative review of the absorption of nutrients with fructans. We collected quantitative data for our thematic analysis, which was performed using the electronic databases Medline, Lilacs, Web of Science, and Scopus from January 2000 and January 2019. This review comprises a total of 10 articles.ResultsFew studies were found regarding the use of prebiotics and nutrient absorption in children. Studies on calcium, iron, magnesium, and vitamin D were the most prevalent. Some studies reported that FOS appears to increase calcium uptake in the gut and stimulates the growth of bifidobacterium in the colon, reducing iron intake by enteric pathogens, and increasing the absorption of these minerals. Others reported an improvement in the absorption of vitamin D and E with inulin.ConclusionConsumption of fructans improves the health of the microbiota, altering the absorption of some nutrients.     

益生菌在特应性皮炎中的应用进展

特应性皮炎是一种慢性复发性皮肤病,大部分发生在婴儿和童年期.流行病学研究发现,在过去的30年中,许多国家特应性皮炎的患病率大幅度增加,皮肤屏障破坏、免疫功能异常、菌群改变是其发病的主要原因.益生菌是活的微生物,补充适当的数量对宿主产生益处,作为一个免疫调节剂,已证明其安全性,临床上可以治疗炎症性皮肤病,如特应性皮炎.     

膳食纤维与结直肠肿瘤的研究进展

长久以来,膳食纤维被认为可以降低结直肠肿瘤发生风险.膳食纤维做为益生元,被肠内益生菌酵解,可产生多种短链脂肪酸,降低肠内致癌物浓度,加速致癌物的排出,影响胆汁酸代谢.但有少数前瞻性研究结果并不支持该假说,其抗结直肠肿瘤作用的机制尚需要进一步研究.     

The effect of prebiotics in the management of neonatal hyperbilirubinaemia

Background:  Breast milk oligosaccharides such as galacto-oligosaccharides (scGOS) and fructo-oligosaccharides (lcFOS) can influence the intestinal microbial flora. The latter, in turn, can modulate several intestinal and extraintestinal functions, including bilirubin metabolism. Supplementing infant formula with a prebiotic mixture might then be a novel and safe intervention to manage mild neonatal hyperbilirubinaemia.
Aim:  To investigate the effect of dietary supplementation with prebiotics on moderate hyperbilirubinaemia in healthy, term infants.
Methods:  A prospective, double-blind, clinical trial was performed on seventy-six consecutive newborns who were randomly assigned to receive a formula containing 0.8 g/dL of a mixture from scGOS and lcFOS (ratio 9:1), or maltodextrines as placebo for 28 days. Bilirubin levels were determined by the transcutaneous bilirubin measurement within 2 h after birth (T1), at 24, 48 and 72 h and at 5, 7, 10 and 28 days of life. The number of stool per day was also recorded.
Results:  Neonates receiving prebiotics showed a larger number of stools over all the duration of dietary intervention compared to that of those on placebo (Repeated Measures ANOVA p < 0.001; day 28 3.4 ± 0.0.9 vs 1.7 ± 0.9, respectively; Dunn test p < 0.05). Neonates whose formula was supplemented with prebiotics showed a lower transcutaneous bilirubin that was statistically significant from 72 h of life (5.46 ± 1.6 vs 7.07 ± 2.49, post hoc Dunn test, p < 0.05) throughout the duration of the dietary intervention (day 28 2.41 ± 0.4 vs 2.85 ± 0.5, post hoc Dunn test, p < 0.05).
Conclusion:  The addition of prebiotics to standard infant diet might represent a novel strategy to help control neonatal hyperbilirubinaemia.