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Benefits of probiotics for kids

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Discover the benefits of probiotics for kids.

Under normal conditions, the different surfaces of the organism are colonized by a large number of microbial cells. Within these surfaces, the intestine is the most intensely colonized area and constitutes a highly dynamic ecosystem.

The intestinal microbiota plays a key role in the health of individuals, with functions such as protecting against the colonization of pathogenic germs, regulating intestinal transit, conjugating bile acids and promoting enterohepatic circulation, fermenting undigested carbohydrates, producing vitamins and growth factors, and, finally, the maturation of the immune system.

Benefits of probiotics for kids

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At present, great importance is given to the modulation of this intestinal microbiota through functional foods, which are those that add a beneficial effect on health to the nutritional function.

Some of these foods have as constituents probiotics (live microorganisms that, when administered in adequate amounts, produce a beneficial effect on the health and well-being of the host), prebiotics (non-digestible carbohydrates whose ingestion induces the growth of beneficial microorganisms), and synbiotics, association of the two above.

The main species of probiotics that are integrated into food are bacteria capable of producing lactic acid and that belong to two main genera: Lactobacillus, used in the fermentation of food, and Bifidobacterium, strictly anaerobic germs.

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Non-bacterial microorganisms are also used, such as Saccharomyces boulardii (non-pathogenic yeast), and non-pathogenic bacteria such as Streptococcus thermophilus and Escherichia coli Nissle 1917. The nomenclature considers the genus, species, and strain (alphanumeric code).

They are mainly carbohydrates that cannot be digested by the small intestine and are fermented by the colonic microbiota. In this way, they favor the proliferation of intestinal bacteria such as bifidobacteria and lactobacilli.

In Europe, the main prebiotics used in food is fructooligosaccharides (FOS) and inulin. FOS are included naturally in plant species such as asparagus, leek, garlic, artichoke, radicchio, and onion. Inulin is found in foods such as wheat, onions, garlic, leeks, and bananas.

These preparations: 1) would provide a barrier against pathogenic microorganisms, thus protecting against infectious and antibiotic-associated diarrhea; 2) they would improve the absorption of nutrients such as calcium, enhancing bone mineralization;

Clinical applications of probiotics and prebiotics

Probiotics have been used in a large number of pediatric pathologies, mainly in gastrointestinal problems with alterations in the intestinal microbiota such as infectious diarrhea, bacterial overgrowth, necrotizing enterocolitis, and, more recently, in chronic inflammatory processes such as inflammatory bowel disease or functional disorders such as infant colic or constipation.

Its beneficial effect has also been assessed in immunological alterations such as atopic dermatitis, in the prevention and treatment of food allergy, and, in recent years, in the prevention of pathology in the preterm newborn and H. pylori infection. In addition, there are several open lines of research in probiotic and prebiotic supplementation in childhood.

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The great diversity in the design of the studies carried out justifies the great variability in the efficacy results. Most meta-analyses of these studies conclude that there are insufficient treatment studies with specific probiotics in defined groups of patients to be able to establish definitive treatment guidelines.

It must be considered that the different probiotics employ different action strategies and that not all probiotic strains have the same resistance or colonization capacity and, therefore, do not have the same clinical efficacy.

Therefore, it must be considered that the effects in clinical practice are strain-specific and are not indicated for the same situations. Pooled data from different strains could lead to false conclusions.

The use of probiotics should focus on matching the strains and doses of the product used to the situation for which it has shown benefit in clinical trials. The main applications of the use of probiotics and prebiotics in childhood are described below:

Acute infectious diarrhea

The greatest evidence on the efficacy of probiotics has been described in the treatment of acute infectious diarrhea. The mechanisms involved are stimulation of the immune system, competition for adhesion sites on intestinal cells, and the production of substances that neutralize pathogenic microorganisms.

The different systematic reviews carried out on the studies published with different strains conclude, despite their great variability, that probiotics produce a beneficial effect on the evolution of acute infectious diarrhea.

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Specifically, a decrease in the risk of diarrhea on the third day and the average duration has been observed, effects evidenced mainly with Lactobacillus rhamnosus GG, L. reuteri, and S. boulardii.

The beneficial effect of probiotics is more significant in diarrhea caused by rotavirus, although there are also benefits in diarrhea caused by other viruses.

It has not been possible to demonstrate its efficacy in those produced by invasive germs, although recent work with S. boulardiihas shown greater effectiveness compared to metronidazole in the treatment of diarrhea due to amoeba.

There is very limited evidence of its efficacy in the treatment of persistent diarrhea in children. The beneficial effects were more notable the earlier the probiotics were administered in the course of the disease, with no evidence of adverse effects with their administration.

Based on the above data, several of the current guidelines or recommendations for the treatment of acute gastroenteritis contemplate the use of probiotics of proven efficacy and at adequate doses.

To date, very few studies have concluded that the use of probiotics significantly reduces the incidence of community-acquired diarrhea. Lactobacillus (rhamnosus, GG, reuteri, and casei) have shown benefit in preventing rotavirus diarrhea in daycare centers, needing to treat 7 children to prevent 1 case.

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In hospitalized children, comparing administration of Lactobacillus rhamnosus G G with placebo, the probiotic may decrease the overall incidence of healthcare-associated diarrhea, including rotavirus diarrhea.

Antibiotic-associated diarrhea

The studies carried out, mainly in adults, have been able to show that the intake of probiotics in combination with antibiotics reduces the risk of diarrhea associated with them.

However, there are currently no conclusive studies to routinely recommend the joint use of probiotics and antibiotics, although some strains, mainly Saccharomyces boulardii and Lactobacillus GG , have shown their efficacy in reducing the incidence of diarrhea in patients receiving antibiotic therapy.

Its administration must be carried out at the beginning of the treatment and not when the condition has been triggered where they are no longer useful.

Inflammatory bowel disease

The use of probiotics in inflammatory bowel disease is, from the pathophysiological point of view, a good therapeutic alternative.

However, although the data from the studies carried out suggest that they would have a favorable impact, it would be desirable to be able to carry out more controlled trials and with a greater number of patients to be able to apply in practice the beneficial effects that they have on the intestinal flora and that they would have a positive impact on the illness.

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Some probiotic preparations are effective in ulcerative colitis and pouchitis (particularly the VSL3 mixture).

Irritable bowel syndrome

Although the pathophysiology of this type of functional abdominal pain is unknown, some data support its relationship with the intestinal microbiota, which is different from that of healthy individuals.

In addition, its establishment is related in a third of the cases with gastrointestinal infectious processes and it has also been observed in a high proportion of these patients with pictures compatible with bacterial overgrowth. A meta-analysis of 3 clinical trials in children suggests a modest improvement with Lactobacillus GG.

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Bacterial overgrowth

Probiotics are effective in children with intestinal bacterial overgrowth as a complication of pathologies such as short bowel and post-enteritis syndrome, since they suppress pathogenic bacteria, induce an anaerobic microbiota, increase short-chain fatty acids in feces, decrease inflammation and improve nutritional status.

Lactobacillus GG and Lactobacillus Plantarum 299V have been successfully used in children affected by the short intestine and bacterial overgrowth who did not respond to antibiotic treatment, to avoid serious complications such as intestinal atrophy and inflammation.

Abdominal pain

The principles of treatment with probiotics are based on the improvement of intestinal permeability, the regulation of the immune and inflammatory response, and the regulation of intestinal motility.

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There is a limitation in the studies carried out to date, both from the methodological point of view and in the strains used or their doses.

The effect of Lactobacillus GG has been analyzed in several trials and, although encouraging results have been found, it seems that more studies are necessary to see the efficacy of probiotics in abdominal pain in childhood.

Constipation

The use of probiotics as therapy for constipation is based on the imbalance of the intestinal microbiota that has been observed in children who suffer from it, but its efficacy in the pediatric age has not been established.

They appear to have a positive but minor effect on the number of bowel movements per week, but most studies have been in adults.

The use of prebiotics (soluble dietary fiber) increases the water retention capacity of feces and stimulates the growth of probiotic bifidobacteria, increasing the average number of stools and reducing their consistency.

Inulin and FOG have dose-dependent laxative effects that are attributed to the increase in microbial biomass as a result of its fermentation in the colon, unlike insoluble dietary fiber that increases fecal mass by favoring water retention.

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Infant colic

Its use is based on the existence of abnormal colonic microbiota in infants with colic. Its mechanism of action is based on improving intestinal motility and exerting direct effects on the nerve pathway of visceral pain.

The strain of Lactobacillus reuteri DSM 17938, administered in lyophilized form at a dose of 10 8 CFU/day in suspension, 30 minutes before the first intake of the day, has been studied.

The response rate (decreased crying time) was significantly higher in infants treated with L. reuteri versus placebo. Its use, in combination with other therapeutic measures, is intended to achieve an effective and safe individualized treatment plan.

Helicobacter pylori infection

Fewer side effects and better tolerance to triple therapy have been observed in pediatric patients with the addition of prebiotics to antibiotic treatment.

It would act by immunological and non-immunological mechanisms, producing antimicrobial substances, competing for adhesion to the intestinal cell, and providing a mucosal barrier.

The few studies carried out in children show a decrease in the side effects of antibiotic treatment with probiotics, although without clear evidence of a higher rate of eradication, having used Lactobacillus GG, Lactobacillus reuteri, and a mixture of various strains.

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Necrotizing enterocolitis

The use of enteral probiotic supplements can reduce the incidence of NEC, the risk of severe NEC (stage 2 or more), and mortality in premature infants.

The safety and efficacy of these supplements need further evaluation for neonates < 1,000 g PRN. Given the potential risk of the administration of live bacteria in large doses in immunologically immature neonates, generally affected by other diseases, it is necessary to carry out more controlled and multicenter studies to evaluate their efficacy and safety, especially if they are going to be used other strains of probiotics that have been beneficial in other gastrointestinal pathologies.

For this reason, some authors warn to be more cautious in the introduction of probiotics in premature infants on a routine basis until better determining the safety, quality,

Lactose intolerance

Although there are studies that show better digestion of lactose and less excretion of hydrogen in the expired air in these patients who consume fermented dairy products, at present, there is insufficient evidence to recommend the use of probiotics in the systematic management of intolerance to lactose.

Celiac Disease

Although at present the only treatment for celiac disease is a gluten-free diet, it is possible that, based on the alteration of the existing intestinal microbiota in these patients, in the future, the administration of bifidobacteria may produce beneficial effects, although for this more studies are necessary.

Obesity

The modulation of the intestinal microbiota is a fundamental objective in the search for new preventive treatments for obesity and research in this area continues today.

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Although this line of research is just beginning and involves bacteria not classically considered as probiotics, the studies carried out are providing key information to discover new factors involved in the development of obesity and metabolic diseases, as well as to improve nutritional intervention strategies to prevent them.

Malnutrition

Currently, there are no multicenter studies that clarify the benefits and recommend the use of probiotics in severe malnutrition; but it is clear that these therapeutic agents play an important role in immunity and the balance of the intestinal bacterial flora, having an important impact on malnutrition. More studies are expected to emerge in the future to define the role of probiotics in deficient nutritional situations.

Cystic fibrosis

Probiotic treatment, in addition to being an alternative to decontaminating antibiotic treatment, can also improve bowel function in cystic fibrosis, both clinically and biochemically.

Therefore, its administration could be scheduled regularly. The studies carried out offer a promising outlook, but so far they are pilot studies, which include few patients and do not take into account the multitude of factors that influence the pathogenesis of this disease, so further research is necessary and taking these preliminary data.

Atopic diseases

The theoretical relationship between the composition of the intestinal microbiota and eczema, with a possible alteration in intestinal permeability and the presence of markers of inflammation, has been the basis for the use of probiotics in this pathology.

The studies available with probiotic supplementation in children at atopic risk versus placebo to modify the early development of their intestinal microbiota have not observed a clear improvement in eczema, so it is necessary to confirm this benefit in children at atopic risk in the first 6 months of life.

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Food Allergy

A recent study raises the possibility of an earlier acquisition of tolerance in cow’s milk protein allergy, both IgE-mediated and non-IgE-mediated, with the use of a cow’s milk protein hydrolyzate supplemented with Lactobacillus GG.

Supplementation of infant milk formulas

A recent review by the Expert Committee of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) establishes the possible benefits of administering formulas supplemented with probiotics to infants under 4-6 months of age and according to the available evidence, In both stool frequency and consistency there may have been a modest benefit from LGG supplementation.

In older infants, the possible benefits would be gastrointestinal infections ( B. lactis ), decreased use of antibiotics ( B. lactis and S thermophilus or L reuteri ), and colic irritability ( B. lactis or S thermophilus ).

About prebiotics, a general recommendation cannot be made and it is considered that their supplementation in the diet can increase the number of beneficial bifidobacteria in the stool and decrease their consistency with a beneficial effect on constipation.

No adverse effects have been found regarding the use of prebiotics in infant feeding and more information is needed before widespread use in premature infants and children with special problems such as immunodeficiencies.

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