Influence of biotic interventions on the immune response to vaccines in young and older adults.

Vaccination is the most effective way to confer potent and long-term protection from infectious diseases. However, poorer responses to immunization are common in young adults with sub-optimal immune health and the elderly because of immunosenescence and increased comorbidities. Recent mechanistic studies have highlighted that the microbiota and its compounds modulate many molecular pathways that can influence the host immune system. Consequently, altering the microbiota composition or activity with immunonutrition, specifically with biotic interventions (probiotics, prebiotics, synbiotics, or postbiotics), may enhance the immune response and vaccine efficacy. This review aims to examine the available data for these biotic strategies to provide clinicians, researchers, and vaccine developers with a mechanistically driven synthesis of how biotic interventions could modulate the immune responses to vaccination. The article describes some postulated mechanistic pathways involved in immunological responses to vaccines and immunomodulation with biotic interventions. Randomized clinical trials were also reviewed to evaluate the impact of specific biotic interventions on vaccination outcomes in different age groups. Few strains and formulations significantly increased antigen-specific antibody titers in individual of all ages. However, studies have also pointed to a substantial heterogeneity that can be attributed to the difference in biotic intervention, strain, dose, viability, type of vaccine antigen, study location, as well as duration, and timing of administration. Future investigations should focus on establishing optimal strains, doses, and timing of administration with respect to vaccination, especially in the elderly and children, where vaccine effectiveness and duration of immunization matter.

The associations between pediatric weight status and cystic fibrosis-related diabetes status and health-related quality of life among children and young adults with cystic fibrosis: A systematic review.

BACKGROUND: Cystic fibrosis (CF) is a life-shortening genetic disease, yet life expectancy has recently increased, shifting the focus to disease management and health-related quality of life (HRQoL). Identification of clinical factors, such as weight status and CF-related diabetes (CFRD), that are associated with HRQoL can inform clinicians about the patient's health perception. The goal of this systematic review was two prong: identify the association of pediatric weight status and HRQoL and determine how CFRD status impacts HRQoL. METHODS: A systematic review of published research was conducted following the methodology in the Cochrane Handbook on Systematic Reviews for Interventional Studies. Results were reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses. Risk of bias was assessed using the National Heart Lung & Blood Institute tool. A meta-analysis was not performed due to variability of the inclusion/exclusion criteria, differences in outcome reporting, and insufficient primary outcome data to pool. RESULTS: Nine studies met inclusion criteria (n = 6 explored weight status and n = 3 studied CFRD), for a total of 1585 subjects (CFRD cases = 87). Pediatric weight status was positively associated with HRQoL, most commonly the Body Image and Eating Disturbance domains. CFRD was negatively associated with HRQoL, specifically the Treatment Burden and Weight domains. CONCLUSIONS: Based on the limited data available, improved pediatric weight status appears to increase HRQoL while a CFRD diagnosis appears to decrease HRQoL. More research is needed to fully understand the role of these clinical factors on HRQoL, especially with life expectancy increasing among those with CF.

Role of Probiotics in Managing Gastrointestinal Dysfunction in Children with Autism Spectrum Disorder: An Update for Practitioners.

Children with autism spectrum disorder (ASD) are 4 times as likely to experience gastrointestinal symptoms as children without ASD. The gut microbiota has increasingly been the subject of investigation as a contributing factor to these symptoms in this population because there is evidence to suggest that alterations in the intestinal microflora are correlated with gastrointestinal and ASD symptom severity. Probiotic therapy has been proposed as a treatment for augmented gastrointestinal symptom severity in children with ASD. This narrative review systematically searched the literature to provide an update for practitioners on the state of the evidence surrounding probiotic therapy in children with ASD as a treatment option for reducing gastrointestinal symptoms. A total of 186 articles were screened and 5 articles met the inclusion criteria. A collective sample of 117 children with ASD is represented and outcomes addressed include improvement in gastrointestinal symptoms as well as influence of probiotic supplementation on the gut microbiota and ASD symptoms and behavior. There is promising evidence to suggest that probiotic therapy may improve gastrointestinal dysfunction, beneficially alter fecal microbiota, and reduce the severity of ASD symptoms in children with ASD. Future research is still warranted in this area because there are methodologic flaws in the available literature and optimal species, strains, dosages, and duration of treatment have not been identified.

Comparison of Calorie and Protein Intake of Very Low Birth Weight Infants Receiving Mother's Own Milk or Donor Milk When the Nutrient Composition of Human Milk Is Measured With a Breast Milk Analyzer.

BACKGROUND: In premature infants, donor breast milk (DBM) is assumed to provide reduced nutrients vs. mother's own milk (MOM). This study examined calorie and protein delivery when very low birth weight infants were fed fortified MOM or DBM, with a known nutrient composition, relative to established nutrition recommendations and to determine if there were differences between the groups. METHODS: A retrospective medical record review was conducted in 29 very low birth weight infants receiving MOM or DBM. Nutrient content of human milk was measured using the Calais Analyzer. Added fortifiers feeding volume, and weight were collected to determine total daily calorie and protein intake. RESULTS: 145 days of enteral feedings among 29 infants were included, 78 (53.8%) from DBM and 67 (46.2%) from MOM. Mean daily fluid intake among infants receiving DBM was significantly higher when compared with MOM, 150.6 ± 7.6 mL/kg vs 146.8 ± 11.3 mL/kg (P = .016). DBM feedings provided 110.1 ± 9.0 kcals/kg/d vs 113.0 ± 21.0 kcals/kg/d from MOM feedings (P = .275). Mean protein intake was similar, 4.1 ± 0.5 g /kg/d on DBM days vs 4.0 ± 0.5 g kg/d on MOM days (P = .162). A total of 46 of 78 DBM days (59.0%) and 30 of 67 MOM days (44.8%) were below the minimum established calorie needs of 110 kcals/kg/day. CONCLUSIONS: DBM provides comparable nutrient intake to MOM at a higher enteral feeding volume. However, both types of human milk failed to meet energy needs with standard fortification regimens.

Body Composition in Adults With Intellectual Disabilities: Implications for Practice.

Health care professionals require increased knowledge of health and disabilities to effectively implement health promotion initiatives at both the individual and group level for adults with intellectual disabilities (ID). The aim of this review is to examine the feasibility, reliability, and validity of various field-based measurements to assess body composition among adults with ID as compared to nondisabled controls. The literature was systematically searched from 1990 to 2017 for primary articles pertaining to the subject matter that were published in the English language and included only individuals ≥18 years of age. 1,989 studies were screened and 8 studies were included for review. Several field-based measurements for body composition are feasible and reliable yet none have been validated for use in adults with ID. Awareness of the various methods for assessing body composition in adults with ID in clinical practice, while simultaneously understanding their limitations, is necessary.