Reporting of Perinatal Outcomes in Probiotic Randomized Controlled Trials. A Systematic Review and Meta-Analysis.

The use of probiotic microorganisms in clinical practice has increased in recent years and a significant number of pregnant women are regular consumers of these products. However, probiotics might modulate the immune system, and whether or not this modulation is beneficial for perinatal outcomes is unclear. We performed a systematic review and meta-analysis to evaluate the reporting of perinatal outcomes in randomized controlled trials including women supplemented with probiotic microorganisms during pregnancy. We also analyzed the effects that the administration of probiotic microorganisms exerts on perinatal outcomes. In the review, 46 papers were included and 25 were meta-analyzed. Reporting of perinatal outcomes was highly inconsistent across the studies. Only birth weight, cesarean section, and weeks of gestation were reported in more than 50% of the studies. Random effects meta-analysis results showed that the administration of probiotic microorganisms during pregnancy did not have any a positive or negative impact on the perinatal outcomes evaluated. Subgroup analysis results at the strain level were not significantly different from main analysis results. The administration of probiotic microorganisms does not appear to influence perinatal outcomes. Nonetheless, future probiotic studies conducted in pregnant women should report probiotic strains and perinatal outcomes in order to shed light upon probiotics' effects on pregnancy outcomes.

Associations of Vitamin D Deficiency, Parathyroid hormone, Calcium, and Phosphorus with Perinatal Adverse Outcomes. A Prospective Cohort Study.

Vitamin D deficiency during pregnancy has been linked to perinatal adverse outcomes. Studies conducted to date have recommended assessing interactions with other vitamin D-related metabolites to clarify this subject. We aimed to evaluate the association of vitamin D deficiency during early pregnancy with preterm birth. Secondary outcomes included low birth weight and small for gestational age. Additionally, we explored the role that parathyroid hormone, calcium and phosphorus could play in the associations. We conducted a prospective cohort study comprising 289 pregnant women in a hospital in Granada, Spain. Participants were followed-up from weeks 10-12 of gestation to postpartum. Serum 25-hydroxyvitamin D, parathyroid hormone, calcium, and phosphorus were measured within the first week after recruitment. Pearson's χ2 test, Mann-Whitney U test, binary and multivariable logistic regression models were used to explore associations between variables and outcomes. 36.3% of the participants were vitamin D deficient (<20 ng/mL). 25-hydroxyvitamin D concentration was inversely correlated with parathyroid hormone (ρ = -0.146, p = 0.013). Preterm birth was associated with vitamin D deficiency in the multivariable model, being this association stronger amongst women with parathyroid hormone serum levels above the 80th percentile (adjusted odds ratio (aOR) = 6.587, 95% CI (2.049, 21.176), p = 0.002). Calcium and phosphorus were not associated with any studied outcome. Combined measurement of 25-hydroxyvitamin D and parathyroid hormone could be a better estimator of preterm birth than vitamin D in isolation.

Play as a Method to Reduce Overweight and Obesity in Children: An RCT.

BACKGROUND: Overweight and obesity are the result of a complex interaction between genetic and environmental factors, which begins prenatally. AIM: To analyse an intervention based on play as a means of improving the body composition of children who are overweight or obese. METHODS: The Kids-Play study is a randomized clinical trial (RCT) consisting of 49 children aged 8-12 years on a nine-month intervention programme based on physical activity, play and nutritional advice. Controls had another 49 children, who received only nutritional advice. RESULTS: The play-based intervention achieved a moderate-vigorous level of physical activity in the study group of 81.18 min per day, while the corresponding level for the control group was only 37.34 min. At the start of the intervention, the children in the study group had an average body fat content of 41.66%, a level that decreased to 38.85% by the end of the programme. Among the control group, body fat increased from 38.83% to 41.4% during the same period. CONCLUSIONS: The intervention programme considered, based on both play and nutritional recommendations, produced a decrease in body fat among children aged 8-12 years. However, the control group, which received only nutritional recommendations, experienced an increase in body weight.

A Comparison of Changes in the Fatty Acid Profile of Human Milk of Spanish Lactating Women during the First Month of Lactation Using Gas Chromatography-Mass Spectrometry. A Comparison with Infant Formulas.

Breastfeeding is the ideal way to provide infants with the nutrients they need for healthy growth and development. Milk composition changes throughout lactation, and fat is one of the most variable nutrients in human milk. The aim of this study was to determine the main differences between the fatty acid (FA) profile of human milk samples (colostrum, transitional, and mature milk group) and infant formulas. Human milk samples were provided by lactating women from Granada. Moreover, different commercial infant formulas were analyzed. FAs were determined using gas chromatography coupled with mass spectrometry. According to the results, oleic acid was the predominant monounsaturated fatty acid (41.93% in human milk and 43.53% in infant formulas), while palmitic acid was the most representative saturated fatty acid (20.88% in human milk and 23.09% in infant formulas). Significant differences were found between human milk groups and infant formulas, mainly in long-chain polyunsaturated FAs (LC-PUFAs). The content of araquidonic acid (AA) and docoxahexaenoic acid (DHA) was higher in human milk (0.51% and 0.39%, respectively) than in infant formulas (0.31% and 0.22%, respectively). Linoleic acid (LA) percentage (15.31%) in infant formulas was similar to that found in human milk (14.6%). However, α-linolenic acid (ALA) values were also much higher in infant formulas than in human milk (1.64% and 0.42%, respectively).

Randomized Clinical Trial of an Aquatic Physical Exercise Program During Pregnancy.

OBJECTIVE: To determine the effect of an aquatic physical exercise program performed during pregnancy on rate of intact perineum after childbirth. DESIGN: Randomized clinical trial. SETTING: Health centers in the metropolitan health district of Granada, Spain. PARTICIPANTS: A total of 129 pregnant women (control group [CG] = 64; aquatic exercise group [EG] = 65). METHODS: The intervention was an aquatic physical exercise program specifically designed for pregnant women (Study of Water Exercise During Pregnancy [SWEP] method). Participants were randomly assigned to the CG or EG by simple random sampling. Participants in the EG performed three sessions per week of physical exercises, which were led by the principal investigator. All participants received routine prenatal care. We evaluated status of the perineum after birth, including laceration and episiotomy rates. We also evaluated participants' weight, body mass index (BMI) in the first and third trimesters, parity, the administration of anesthesia, and birth weight of the neonate as potential confounding variables. RESULTS: The women in the EG had a greater rate of intact perineum than those in the CG (odds ratio [OR] = 13.54, 95% confidence interval [CI] [2.75, 66.56]). After adjusting for infant birth weight, the effect of the intervention on intact perineum was an OR of 8.57 (95% CI [1.85, 39.68]. Maternal weight gain did not influence the odds of intact perineum (OR = 1.072, 95% CI [0.896, 1.283]). Women who previously gave birth and followed the SWEP method had an OR of 10.197 (95% CI [2.190, 47.476] for an intact perineum. The administration of anesthesia and previous pregnancy also were associated with intact perineum (OR = 6.68, 95% CI [1.21, 36.84] and OR = 5.42, 95% CI [1.64, 17.89] respectively. CONCLUSION: The women who followed the SWEP method were significantly more likely to have intact perinea after childbirth.

Beneficios inmunológicos de la leche humana para la madre y el niño. Revisión sistemática / Immunological benefits of human milk for the mother and child. Systematic review

Introducción: la leche es un fluido cambiante formado por lípidos, proteínas, minerales y moléculas inmunes. Las tasas de lactancia materna (LM) exclusiva se encuentran por debajo de los objetivos fijados por la Organización Mundial de la Salud (OMS), que establece que las madres deben dar el pecho de forma exclusiva durante 6 meses y suplementarla con otros alimentos durante los dos primeros años. Si se llevan a cabo esas recomendaciones, las madres y sus bebés se verían beneficiados. La leche materna modifica su composición en función de la edad del bebé, el momento del día, la dieta materna o el grado de plenitud de la glándula mamaria. Estudios recientes apuntan que existe una relación dinámica entre el estado de salud del niño y la composición de la leche de la madre, ya que, incluso, aumenta la producción de anticuerpos ante una infección activa del lactante. Objetivo: efectuar una revisión sistemática de la literatura científica a base de reunir los conocimientos actuales relacionados con las propiedades inmunológicas de la lactancia materna y de sus efectos en la salud de la madre y el niño. Métodos: se lleva a cabo una búsqueda sistemática y se seleccionan 21 artículos específicos sobre el tema, siguiendo las directrices PRISMA. Resultados: los estudios analizados muestran que la leche materna tiene gran cantidad de componentes inmunológicos que aumentan ante las necesidades del bebé. También ofrece beneficios físicos y psicológicos para la madre y el niño y supone, igualmente, un ahorro económico al disminuir los ingresos hospitalarios de los bebés, puesto que disminuye su morbilidad. Conclusiones: los bebés alimentados con leche materna tienen menos probabilidades de padecer enfermedades gastrointestinales, respiratorias, alérgicas o asma, y también previene la obesidad infantil. Además, la LM tiene efectos beneficiosos para la madre, pues disminuye el riesgo de padecer cáncer de mama, enfermedades cardiovasculares y el síndrome metabólico. Se deben aumentar las tasas de lactancia materna exclusiva, al menos hasta los 6 meses de vida (AU)

Introduction: Milk is a changing fluid composed of lipids, proteins, minerals and immune molecules. The exclusive breastfeeding (BF) rates are below the targets set by the World Health Organization (WHO) who states that mothers should breastfeed exclusively for 6 months and supplement it with other foods during the first two years. If these recommendations are carried out, they would benefit mothers and their babies. Breast milk changes its composition depending on the baby’s age, the time of day, the mother’s diet or the degree of fullness of the breast. Recent studies suggest that there is a dynamic relationship between the health of children and the composition of breast milk because it increases the production of antibodies against an active infection of the infant. Objective: Perform a systematic review of the scientific literature, grouping current knowledge gathering related to the immunological properties of breast-feeding and its effects on the health of the mother and child. Methods: We conducted a systematic search and 21 specific articles on the subject are selected, following the PRISMA guidelines. Results: The studies analyzed concluded that breast milk has a lot of immune components which increase according to the baby’s needs. It also has physical and psychological benefits for mother and child and it also assumed a cost savings by reducing hospital admissions of infants, because it reduces morbidity. Conclusions: Breast-fed babies have less gastrointestinal, respiratory, allergic diseases or asthma and human milk prevents childhood obesity. In addition, the BF has beneficial effects for the mother; it decreases the risk of breast cancer, cardiovascular disease and metabolic syndrome. Mothers should increase rates of exclusive breastfeeding until at least 6 months (AU)

Efecto rebote de los programas de intervención para reducir el sobrepeso y la obesidad de niños y adolescentes; revisión sistemática / Rebound effect of intervention programs to reduce overweight and obesity in children and adolescents; systematic review

Introducción: los estudios demuestran que el sobrepeso y la obesidad son el resultado de una compleja interacción entre factores genéticos y ambientales que comienza en la etapa prenatal. Dentro de la evidencia de esta relación se analiza el impacto potencial de la experiencia de la nutrición prenatal en el desarrollo de los sistemas endocrino y neuroendocrino que regulan el balance energético, con especial énfasis en el papel de la hormona derivada de los adipocitos, la leptina. Diferentes autores relacionan el riesgo de obesidad con el aumento rápido de peso en los primeros años de vida. Los niños con lactancia natural tienen un menor grado de adiposidad abdominal y, por ello, menor circunferencia de la cintura. Del mismo modo, se ha relacionado la lactancia materna exclusiva con un ritmo más lento de aumento de peso, del orden del 20%. En el estudio de la obesidad se considera efecto rebote cuando el niño recupera su peso de inicio al año de acabar la intervención. Esta problemática es frecuente, por lo que dicha intervención con la familia se hace imprescindible, ya que se trata de lograr la motivación del niño para que lleve una vida saludable. Para esta revisión se han seleccionado estudios que valoren las intervenciones a medio y largo plazo en la obesidad infantil, comprobando la adhesión al tratamiento y el efecto rebote, una vez finalizada la intervención. Objetivo: revisar los estudios que analizan el efecto rebote y la adhesión a los tratamientos de pérdida de peso de los niños y adolescentes con sobrepeso y obesidad. Método: la revisión sistemática fue elaborada siguiendo las directrices PRISMA. Se han seleccionado 19 estudios que analizan la temática planteada. Resultados: varios autores han establecido los efectos beneficiosos a corto y largo plazo de aquellas intervenciones que combinan dieta y actividad física entre niños obesos. Estos resultados muestran la importancia de los programas multidisciplinares para el tratamiento de la obesidad infantil, haciendo hincapié en sus alentadores efectos a largo plazo. Conclusiones: hay estudios en los que se evidencia el efecto rebote, en los programas de corta duración o cuando la intervención se hace al margen de la rutina diaria de los niños. Durante las intervenciones se reduce considerablemente el IMC, pero después aumenta de forma rápida hasta llegar a niveles iniciales o incluso superiores de peso. El tipo de actuaciones más efectivas suelen ser aquellas con una duración superior a un año y que tienen carácter multidisciplinar, con inclusión de la familia y de los centros escolares (AU)

Background: studies show that overweight and obesity are the result of a complex interaction between genetic and environmental factors that begins prenatally. In evidence of this relationship the potential impact of prenatal nutrition experience in the development of the endocrine and neuroendocrine systems that regulate energy balance, with special emphasis on leptin, an adipocytederived hormone. Different authors relate the risk of obesity with rapid weight gain in the first years of life. Breastfeeding children have a lower degree of abdominal adiposity and, therefore, lower waist circumference. Similarly, it has been associated with exclusively breastfeeding with a slower weight gain rate of about 20 %. In the study of obesity, a rebound effect is considered when the child recovers its initial weight a year after finishing the procedure. This problem is common, therefore family intervention is essential in order to achieve the child’s motivation to lead a healthy life. For this review we have selected studies to evaluate interventions of medium and long term in childhood obesity, ensuring adherence to treatment and the rebound effect, once the intervention ended. Aim: to review studies examining the rebound effect and adherence to weight loss treatments for children and adolescents with overweight and obesity. Method: the systematic review was prepared following the PRISMA guidelines. Are selected 19 studies related to the proposed issue. Results: several authors have established the beneficial short and long term effects of interventions that combine diet and physical activity among obese children. These results show the importance of multidisciplinary treatment programs for childhood obesity, emphasizing its encouraging longterm effects. Conclusions: there are studies were the rebound effect in short duration programs is evident. During interventions it is significantly reduced BMI, but then increased quickly to reach even higher levels initial weight. The most effective type of actions tend to be those including the family and schools, they are multidisciplinary and they have a duration longer than 1 year (AU)

Efecto del Phlebodium decumanum y de la coenzima q10 sobre el rendimiento deportivo en jugadores profesionales de voleibol / Effect of Phlebodium decumanun y de la coenzima q10 on sports performance in profesional volleyball players

Introducción: Los programas de entrenamiento físico, se basan en provocar estados de fatiga transitoria para inducir supercompensaciones de los sistemas biológicos implicados en la actividad, con el objeto mejorar el rendimiento del deportista a medio-largo plazo. La administración de suplementos nutricionales con propiedades antioxidantes e inmunomoduladoras, como Phlebodium decumanum y Coenzima Q10, constituyen medidas muy ventajosas para la recuperación de la inflamación y el daño tisular originados por el estrés del ejercicio intenso y mantenido. Metodología: Se llevó a cabo un diseño experimental, longitudinal, a doble ciego, con tres grupos randomizados a partir de una muestra de 30 jugadores varones de voleibol (22-32 años) de la Universidad de Granada, con un nivel de entrenamiento alto (17 horas por semana en los 6 meses previos a la investigación). Se evaluaron los efectos de un programa de entrenamiento físico de un mes de duración, común a todos los grupos de estudio, asociado a la administración simultánea de suplementos nutricionales a base de Phlebodium decumanum (4 cápsulas de 400 mg/ cáp. al día) el Grupo Experimental 1, Phlebodium decumanum(la misma dosis y posología que el grupo 1) más Coenzima Q10 (4 cápsulas de 30 mg/cáp al día) el Grupo Experimental 2, y sustancia placebo, el Grupo Control. Las variables dependientes sanguíneas para valorar los efectos de dicha intervención sobre el perfil endocrinometabólico e inmunológico basales fueron: cortisol e interleuquina 6 relacionados ambos con el eje del estrés inducido por el ejercicio, y ácido láctico y amonio, vinculados esencialmente, al metabolismo energético anaeróbio. Resultados: Todos los grupos del estudio manifestaron cambios adaptativos favorables sobre el perfil endocrihormonano- metabólico e inmunológico, que se objetivaron a través de un descenso significativo basal postest de las concentraciones de cortisol, interleuquina 6, ácido láctico y amoniaco, respecto a los valores previos a la intervención actividad física ± suplemención nutricional protocolizada. Los grupos que mostraron un perfil más favorable, fueron los que recibieron suplementación nutricional frente a placebo, y de entre los primeros, los sujetos que tomaron doble suplementación con Phlebodium decumanum más Coenzima Q10. Conclusiones: La ingesta de Phlebodium decumanum y de Coenzima Q10 durante 4 semanas, mostró efectos protectores sobre el perfil endocrino-metabólico e inmunológico basales, que atribuimos a las propiedades inmunomoduladoras y antioxidantes de ambas sustancias, lo que no sólo resulta altamente beneficioso para retrasar la fatiga y mejorar el rendimiento deportivo, sino también, para disminuir el riesgo de lesiones asociadas al ejercicio físico de alta intensidad (AU)

Introduction: Physical training programmes are based on provoking transitory states of fatigue in order to induce super compensation by the biological systems involved in the activity, in order to improve the athlete’s medium-long term performance. The administration of nutritional supplements with antioxidant and immunomodulatory properties, such as Phlebodium decumanum and coenzyme Q10, can be a very advantageous means of achieving recovery from the inflammation and tissue damage caused by the stress of prolonged, intense exercise. Methodology: An experimental, longitudinal, double- blind experiment was conducted, with three randomized groups obtained from a sample of 30 male volleyball players (aged 22-32 years) at the University of Granada, with a high level of training (17 hours a week during the 6 months preceding the study). The effects were then evaluated of a month-long physical training programme, common to all the study groups, associated with the simultaneous administration of the following nutritional supplements: Phlebodium decumanum (4 capsules of 400 mg/capsule, daily), Experimental Group 1; Phlebodium decumanum (same dose and schedule as Group 1) plus coenzyme Q10 (4 capsules of 30 mg/ capsule, daily), Experimental Group 2; a placebo substance, Control Group. The following dependent blood variables were examined to assess the effects of the intervention on the basal immune and endocrine-metabolic profile: cortisol and interleukin-6, both related to the axis of exercise-induced stress; and lactic acid and ammonium, related essentially to the anaerobic metabolism of energy. Results: All the study groups presented favourable adaptive changes with respect to the endocrine-metabolic and immune profile, as reflected by a significant decrease in the post-test concentrations of cortisol, interleukin 6, lactic acid and ammonium, compared to the values recorded before the physical activity with/without nutritional supplement, per protocol. The groups that achieved the most favourable profile were those which had received nutritional supplementation, rather than the placebo, and among the former, those which had received the double- strength supplement with Phlebodium decumanum plus coenzyme Q10. Conclusions: The intake of Phlebodium decumanum plus coenzyme Q10 for 4 weeks produced protective effects on the endocrine-metabolic and immune profile, which we attribute to the immunomodulatory and antioxidant properties of these substances, which are highly beneficial not only in terms of delaying fatigue and improving athletic performance, but also in reducing the risk of injuries associated with high intensity exercise (AU)

[Effect of phlebodium decumanum and coenzyme Q10 on sports performance in professional volleyball players]. / Efecto del phlebodium decumanum y de la coenzima Q10 sobre el rendimiento deportivo en jugadores profesionales de voleibol.

INTRODUCTION: Physical training programmes are based on provoking transitory states of fatigue in order to induce super compensation by the biological systems involved in the activity, in order to improve the athlete's medium-long term performance. The administration of nutritional supplements with antioxidant and immunomodulatory properties, such as Phlebodium decumanum and coenzyme Q10, can be a very advantageous means of achieving recovery from the inflammation and tissue damage caused by the stress of prolonged, intense exercise. METHODOLOGY: An experimental, longitudinal, double- blind experiment was conducted, with three randomised groups obtained from a sample of 30 male volleyball players (aged 22-32 years) at the University of Granada, with a high level of training (17 hours a week during the 6 months preceding the study). The effects were then evaluated of a month-long physical training programme, common to all the study groups, associated with the simultaneous administration of the following nutritional supplements: Phlebodium decumanum (4 capsules of 400 mg/capsule, daily), Experimental Group 1; Phlebodium decumanum (same dose and schedule as Group 1) plus coenzyme Q10 (4 capsules of 30 mg/ capsule, daily), Experimental Group 2; a placebo substance, Control Group. The following dependent blood variables were examined to assess the effects of the intervention on the basal immune and endocrine-metabolic profile: cortisol and interleukin-6, both related to the axis of exercise-induced stress; and lactic acid and ammonium, related essentially to the anaerobic metabolism of energy. RESULTS: All the study groups presented favourable adaptive changes with respect to the endocrine-metabolic and immune profile, as reflected by a significant decrease in the post-test concentrations of cortisol, interleukin 6, lactic acid and ammonium, compared to the values recorded before the physical activity with/without nutritional supplement, per protocol. The groups that achieved the most favourable profile were those which had received nutritional supplementation, rather than the placebo, and among the former, those which had received the double- strength supplement with Phlebodium decumanum plus coenzyme Q10. CONCLUSIONS: The intake of Phlebodium decumanum plus coenzyme Q10 for 4 weeks produced protective effects on the endocrine-metabolic and immune profile, which we attribute to the immunomodulatory and antioxidant properties of these substances, which are highly beneficial not only in terms of delaying fatigue and improving athletic performance, but also in reducing the risk of injuries associated with high intensity exercise.

Introducción: Los programas de entrenamiento físico, se basan en provocar estados de fatiga transitoria para inducir supercompensaciones de los sistemas biológicos implicados en la actividad, con el objeto mejorar el rendimiento del deportista a medio-largo plazo. La administración de suplementos nutricionales con propiedades antioxidantes e inmunomoduladoras, como Phlebodium decumanum y Coenzima Q10, constituyen medidas muy ventajosas para la recuperación de la inflamación y el daño tisular originados por el estrés del ejercicio intenso y mantenido. Metodología: Se llevó a cabo un diseño experimental, longitudinal, a doble ciego, con tres grupos randomizados a partir de una muestra de 30 jugadores varones de voleibol (22-32 años) de la Universidad de Granada, con un nivel de entrenamiento alto (17 horas por semana en los 6 meses previos a la investigación). Se evaluaron los efectos de un programa de entrenamiento físico de un mes de duración, común a todos los grupos de estudio, asociado a la administración simultánea de suplementos nutricionales a base de Phlebodium decumanum (4 cápsulas de 400 mg/ cáp. al día) el Grupo Experimental 1, Phlebodium decumanum (la misma dosis y posología que el grupo 1) más Coenzima Q10 (4 cápsulas de 30 mg/cáp al día) el Grupo Experimental 2, y sustancia placebo, el Grupo Control. Las variables dependientes sanguíneas para valorar los efectos de dicha intervención sobre el perfil endocrinometabólico e inmunológico basales fueron: cortisol e interleuquina 6 relacionados ambos con el eje del estrés inducido por el ejercicio, y ácido láctico y amonio, vinculados esencialmente, al metabolismo energético anaeróbio. Resultados: Todos los grupos del estudio manifestaron cambios adaptativos favorables sobre el perfil endocri no- metabólico e inmunológico, que se objetivaron a través de un descenso significativo basal postest de las concentraciones de cortisol, interleuquina 6, ácido láctico y amoniaco, respecto a los valores previos a la intervención actividad física ± suplemención nutricional protocolizada. Los grupos que mostraron un perfil más favorable, fueron los que recibieron suplementación nutricional frente a placebo, y de entre los primeros, los sujetos que tomaron doble suplementación con Phlebodium decumanum más Coenzima Q10. Conclusiones: La ingesta de Phlebodium decumanum y de Coenzima Q10 durante 4 semanas, mostró efectos protectores sobre el perfil endocrino-metabólico e inmunológico basales, que atribuimos a las propiedades inmunomoduladoras y antioxidantes de ambas sustancias, lo que no sólo resulta altamente beneficioso para retrasar la fatiga y mejorar el rendimiento deportivo, sino también, para disminuir el riesgo de lesiones asociadas al ejercicio físico de alta intensidad.