Probiotic L reuteri may protect children from diarrhea

The probiotic Lactobacillus reuteri may reduce the incidence of diarrhea in children in developing countries, according to a study published online April 9 in Pediatrics.

Rina Augustina, MD, from the Division of Pediatric Gastroenterology, Department of Child Health, University of Indonesia, Jakarta, and colleagues conducted a 6-month randomized controlled trial involving 494 children aged 1 to 6 years who resided in a low-socioeconomic community of Indonesia during 2007 to 2008. The researchers randomly assigned the children into 4 groups, with 124 children receiving low-lactose milk with low calcium (about 50 mg/day) content and others receiving regular-calcium (about 440 mg/day) milk with placebo (126 children), Lactobacillus casei CRL431 (120 children), or L reuteri DSM17938 (124 children). Their objectives were to determine whether supplemented calcium and probiotics alleviated the incidence and duration of diarrhea and acute respiratory tract infections (ARTIs) in the community studied.

The researchers found that for all of the reported diarrheal episodes, on a broadly defined basis (2 or more loose/liquid stools in 24 hours), the children receiving the regular-calcium milk and L reuteri had a 32% lower incidence of diarrhea (relative risk, 0.68; 95% confidence interval, 0.46 - 0.99) compared with children receiving regular-calcium milk and placebo. None of the other interventions affected the incidence of diarrhea or the incidence or duration of ARTIs.

When the researchers applied a narrower World Health Organization (WHO) definition of diarrhea (3 or more loose/liquid stools in 24 hours), they found no significant difference among the groups. "Although the WHO definition is the best validated, it may not be generalizable to different settings such as our intervention, which included children of older age and in an urban community setting," the researchers write.

However, when they restricted their analysis to children with lower nutritional status, defined as those children who were below median height and weight for their ages, the researchers saw a significant protective effect of L reuteri under both definitions of diarrhea.

"Our results indicate that the effect of a probiotic, such as L reuteri DSM17938, on diarrhea is modified by nutritional status and is confined to children with lower nutritional status," the researchers conclude.

The authors report that their study is the first large randomized controlled trial involving calcium with or without 1 of 2 probiotic strains to reduce diarrhea and ARTIs. Previous studies, they write, provided mixed results and differed in strains.

In this study, mothers were instructed to provide 180 mL of sweetened chocolate milk twice a day for the children to drink through straws coated inside with oil drops as placebo, with L casei, or with L reuteri. The milk, packed in tetra packs, was kept cold throughout, and the probiotic dosage (5 × 108 colony-forming units/day) fell within guidelines of the Food and Agriculture Organization of the United Nations/WHO. The children maintained their regular diet but were requested to exclude any other "probiotic, prebiotic, or high-calcium foods/drinks other than the supplied ones."

"Our results underline that probiotic effects are strain specific, as we found protective effects of L reuteri DSM17938 against acute diarrhea in children, whereas supplementation of L casei CRL431 (without other strains) was without effect," the researchers write.

Although the results need to be confirmed by at least 1 more independent study, the authors conclude that L reuteri supplementation with regular calcium milk may reduce the burden of infectious diarrhea in children.

The researchers write that diarrhea and ARTIs contribute to 25% and 16%, respectively, of the mortality rate for young children in Indonesia, according to the republic's Ministry of Health.

Source: http://www.medscape.com/viewarticle/761711?sssdmh=dm1.774171&src=nldne