Using mid-upper arm circumference z -score measurement to support youth malnutrition screening as part of a global sports and wellness program and improve access to nutrition care.

Objective: Historically, mid-upper arm circumference (MUAC) has been instrumental to identifying malnutrition in children under 5 years living in resource restricted settings. Less attention is directed to at-risk, school-aged youth. Updated and validated pediatric age- and gender-specific MUAC growth curves expand malnutrition screening opportunities (2 months-18 years) including overweight/obesity. An innovative partnership was created to integrate MUAC z-score measurement trainings and screenings in the Real Madrid Foundation's (RMF) Social Sports Schools (S3) program, which provide sports and wellness programming to under-resourced communities. This work aimed to investigate the feasibility of leveraging non-healthcare professionals (non-HCPs) to identify malnutrition risk as part of RMF S3. Methods: This global, two-part program on malnutrition risk identification included training adult facilitators and screening children attending RMF S3. RMF facilitators were trained with didactic lectures on malnutrition, and practical hands-on learning of proper MUAC z-score tape measurement. Aggregate data on facilitators and the number of times to correctly administer the MUAC z-tape were recorded. Aggregate data on child malnutrition risk screenings were collected. Results: Nine countries participated representing Europe, Pacific Asia, Africa, Latin America, and North America. In total, 143 RMF facilitators were trained, and 318 children were screened across 11 sites. More than half of facilitators were male (56%, n = 80), and majority were coaches (41.3%, n = 59), followed by staff (25.2%, n = 36), and volunteers (16.1%, n = 23). Facilitator attempts ranged from 1 to 4 times for proper MUAC z-score administration with mean 2.12 (± 0.86). There were no significant differences for attempts among RMF facilitator types (p = 0.10). Sixteen percent (n = 51) of children screened were recommended for HCP referral, with concentrations in Pacific Asia (68%, n = 35), Latin America (24%, n = 12), and Africa (8%, n = 4). Conclusions: Findings from our sample demonstrate that integration of MUAC z-score based malnutrition risk screening within community sports and wellness programming among non-HCPs is feasible, and that some regions with less frequent access to routine health care may experience greater benefit from these programs. Equipping non-HCP facilitators in community sports and wellness programs with training on malnutrition screening provides a means to meet under-resourced families where they live to begin conversations around malnutrition risk with the hope of establishing additional pathways to care.

Bacillus clausii for Gastrointestinal Disorders: A Narrative Literature Review.

The gut microbiota is intrinsically linked to human health; disturbances in microbial homeostasis are implicated in both intestinal and extraintestinal disorders. Probiotics are "live microorganisms that, when administered in adequate amounts, confer a health benefit on the host," and many commercial preparations comprising a diverse range of species are available. While probiotics have been much researched, better understanding of the probiotic effects and applications of species such as Bacillus clausii is warranted. In this narrative literature review, we review the characteristics and mechanisms of action supporting B. clausii as a probiotic and discuss the evidence from clinical studies evaluating B. clausii probiotics for the management of a variety of gastrointestinal disorders and symptoms in children and adults. Finally, we highlight the challenges of future research and the need for more robust and diverse clinical evidence to guide physicians in the clinical application of probiotics for gastrointestinal disorders and other conditions.

Recommendations for the adjuvant use of the poly-antibiotic-resistant probiotic Bacillus clausii (O/C, SIN, N/R, T) in acute, chronic, and antibiotic-associated diarrhea in children: consensus from Asian experts.

This paper proposes recommendations for probiotics in pediatric gastrointestinal diseases in the Asia-Pacific region. Evidence-based recommendations and randomized controlled trials in the region are included. Cultural aspects, health management issues and economic factors were also considered. Final recommendations were approved by utilizing a modified Delphi process and applying the Likert scale in an electronic voting process. Bacillus clausii was recommended as an adjunct treatment with oral rehydration solution for acute viral diarrhea. B. clausii may also be considered for prevention of antibiotic-associated diarrhea, Clostridium difficile-induced diarrhea, and as adjunct treatment of Helicobacter pylori. There is insufficient evidence for recommendations in other conditions. Despite a diversity of epidemiological, socioeconomical and health system conditions, similar recommendations currently apply to most Asia-Pacific countries. Ideally, these need to be validated with local randomized-controlled trials.

Bacillus clausii as adjunctive treatment for acute community-acquired diarrhea among Filipino children: a large-scale, multicenter, open-label study (CODDLE).

BACKGROUND: Diarrhea is among the main causes of pediatric mortality in the Philippines. Probiotics have been shown to be beneficial in the management of acute diarrhea. Accordingly, the aim of this population-based study was to assess the safety and effectiveness of Bacillus clausii as an adjunct to standard therapy in Filipino children with acute community-acquired diarrhea of viral origin or associated with antibiotic administration. METHODS: A total of 3178 patients (median age of 2 years) were enrolled in this open-label, multicenter, observational study, and were treated with one to two vials of Bacillus clausii in the following bacterial stains: O/C, SIN, N/R, and T (oral suspension of 2 billion spores per 5-mL vial) for 5 to 7 days. Diarrhea duration, number of stools per day, improvement in gastrointestinal symptoms, children's overall acceptability of Bacillus clausii therapy, and safety and tolerability were assessed. Concomitant treatment with oral rehydration solutions (26.6%), zinc (23.9%), and antibiotics prescribed for conditions other than diarrhea (13.6%) was recorded during the study. All other probiotics and antidiarrheals were prohibited. RESULTS: Therapy with Bacillus clausii was well-tolerated, and the adverse event rate was very low (0.09%). All reported adverse events, which included vomiting, erythematous rashes and stool color change, were mild to moderate. In more than half of the per-protocol population (1535/2916; 52.6%), diarrhea was resolved within the first 3 days of treatment with Bacillus clausii. There was no significant difference (p = 0.297) in mean diarrhea duration between patients with either antibiotic-associated (3.3 ± 1.3 days) or viral diarrhea (3.4 ± 1.3 days). However, children who only received Bacillus clausii supplementation without zinc had a significantly shorter diarrhea duration (3.3 ± 1.3 days) compared to zinc-treated children (3.6 ± 1.6 days; p < 0.001). Bacillus clausii significantly reduced the mean number of stools per day, from 5.2 ± 2.0 stools at baseline to 1.2 ± 0.6 stools at study end (p < 0.001). Similarly, the proportion of patients with loose stools decreased from 81.6% at baseline to 9.2% at end of treatment period. Acceptability of Bacillus clausii therapy was high. CONCLUSION: This study adds knowledge on the good safety profile and on the effectiveness of Bacillus clausii as an adjunct treatment for acute childhood diarrhea.