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1.
Nutrients ; 11(9)2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31480222

RESUMO

This study aims to determine the prevalence of risk of malnutrition on admission and discharge in African hospitals, and to identify the association with selected indicators. In this multi-center prospective cohort study, adult patients from hospitals in South Africa, Kenya, and Ghana were screened on admission and discharge and contacted 3 months post-discharge. Relevant morbidity and mortality outcomes were assessed. At risk of malnutrition was indicated if NRS-2002 score ≥3. Adult patients (n = 2126; 43.11 years, IQR: 31.95-55.60; 52.2% female) were screened on admission and 61% were identified as at risk of malnutrition. The proportion of at-risk patients for the three hospitals in Kenya and Ghana (66.2%) were significantly higher than that of the three South African hospitals (53.7%) (Chi2 = 31.0; p < 0.001). Discharge risk of malnutrition was 71.2% (n = 394). Mean length of stay (LOS) was 6.46 ± 5.63 days. During hospitalization, 20.6% lost ≥5% body weight, 18.8% were referred for nutrition support, and discharge BMI (23.87 ± 7.38 kg/m2) was significantly lower than admission BMI (24.3 ± 7.3 kg/m2) (p < 0.001). Admission nutrition risk was associated with lower admission and discharge BMI (p < 0.001), longer LOS (p < 0.001), increased 3-month re-admission rates (Chi2 = 1.35; p = 0.245) and increased mortality (Chi2 = 21.68; p < 0.001). Nearly two-thirds of patients were at risk of malnutrition on admission. This was associated with longer LOS and greater hospital mortality. The nutritional status of patients deteriorated during hospitalization. Routine screening practices with appropriate nutrition support action should be implemented as a matter of urgency.

2.
JPEN J Parenter Enteral Nutr ; 43 Suppl 1: S5-S23, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30812055

RESUMO

BACKGROUND: Micronutrients, an umbrella term used to collectively describe vitamins and trace elements, are essential components of nutrition. Those requiring alternative forms of nutrition support are dependent on the prescribed nutrition regimen for their micronutrient provision. The purpose of this paper is to assist clinicians to bridge the gap between the available guidelines' recommendations and their practical application in the provision of micronutrients via the parenteral route to adult patients. METHODS: Based on the available evidenced-based literature and existing guidelines, a panel of multidisciplinary healthcare professionals with significant experience in the provision of parenteral nutrition (PN) and intravenous micronutrients developed this international consensus paper. RESULTS: The paper addresses 14 clinically relevant questions regarding the importance and use of micronutrients in various clinical conditions. Practical orientation on how micronutrients should be prescribed, administered, and monitored is provided. CONCLUSION: Micronutrients are a critical component to nutrition provision and PN provided without them pose a considerable risk to nutrition status. Obstacles to their daily provision-including voluntary omission, partial provision, and supply issues-must be overcome to allow safe and responsible nutrition practice.

4.
JPEN J Parenter Enteral Nutr ; 43(1): 32-40, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30175461

RESUMO

BACKGROUND: This initiative aims to build a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. METHODS: The Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications. RESULTS: A 2-step approach for the malnutrition diagnosis was selected, that is, first screening to identify at risk status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among GLIM participants that selected 3 phenotypic criteria (non-volitional weight loss, low body mass index, and reduced muscle mass) and 2 etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least 1 phenotypic criterion and 1 etiologic criterion should be present. Phenotypic metrics for grading severity are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology-related diagnosis categories. CONCLUSIONS: A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The construct should be re-considered every 3-5 years.

5.
Public Health Nutr ; 21(8): 1444-1454, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29455703

RESUMO

OBJECTIVE: To develop health-endorsement logos (HEL) for food products indicating healthy choices based on the South African nutrient profile model and to pilot test these logos with consumers. DESIGN: Multistage mixed-methods design. SETTING: Cape Town, South Africa. SUBJECTS: Nine focus group discussions (FGD) were conducted with adult consumers to explore what types of HEL are preferred and why. Based on the findings, ten HEL were designed by a graphic design team. A modified Delphi technique, conducted with experts in the fields of nutrition and food science, was employed to eliminate lowest-scoring HEL and to improve the design of the remaining logos. Participants from the initial FGD participated in pilot testing the improved logos. RESULTS: Participants from FGD (n 67) were positive about a single HEL, stating it would make food labelling less confusing as they did not understand the various HEL used. Participants indicated the logo should include wording related to 'healthy choice' or 'better choice' and pictures/symbols related to health and/or food. During two rounds of scoring and comments by experts (n 19), five logos were eliminated and the design of the remaining five improved. Three of five remaining logos received overall rankings of 3·08/5, 3·28/5 and 3·39/5, respectively, during FGD (n 36) in the pilot-testing phase. CONCLUSION: HEL were designed and consumer tested. Three designs were submitted to the national Department of Health to consider for implementation, after further testing, as a tool to assist in addressing the high incidence of non-communicable diseases in South Africa.


Assuntos
Rotulagem de Alimentos/métodos , Comportamentos Relacionados com a Saúde , Promoção da Saúde/métodos , Política Nutricional , Adulto , Idoso , Recursos Audiovisuais , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , África do Sul
6.
BMC Infect Dis ; 17(1): 570, 2017 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-28810840

RESUMO

BACKGROUND: The existence of a bi-directional relationship between tuberculosis (TB) and insulin resistance (IR)/diabetes has been alluded to in literature. Although diabetes has been linked to increased tuberculosis risk, the relationship between tuberculosis as a causative factor for IR remains unclear. The study aimed to determine if an association existed between tuberculosis and IR development in adults with newly diagnosed pulmonary tuberculosis at baseline. It was additionally aimed to document changes in IR status during TB follow-up periods. METHODS: This cross-sectional study evaluated ambulatory participants at baseline for IR prevalence via anthropometry, biochemistry and diagnostic IR tests [homeostasis model assessment-IR (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI)]. A prospective cohort sub-section study was additionally performed on approximately half of the baseline study population, who were followed-up at two and five months whilst on tuberculosis treatment. Summary statistics, correlation co-efficients and appropriate analysis of variance were used to describe and analyse data. Participants were excluded if they presented with other forms of tuberculosis, were HIV-positive, obese or had any pre-disposing IR conditions such as diabetes or metabolic syndrome. RESULTS: Fifty-nine participants were included from August 2013 until December 2014 (33.95 ± 12.02 years old; 81.4% male). IR prevalence was 25.4% at baseline, determined by a calculated HOMA-IR cut-off point of 2.477. Patients with IR were younger (p = 0.04). Although the difference between IR levels in participants between baseline and follow-up was not significant, a decrease was observed over time. The majority of participants (61.0%) presented with a normal BMI at baseline. Mean baseline values of fasting glucose were within normal ranges (4.82 ± 0.80 mmol/L), whereas increased mean CRP levels (60.18 ± 50.92 mg/L) and decreased mean HDL-cholesterol levels (males: 0.94 ± 0.88 mmol/L; females: 1.14 ± 0.88 mmol/L) were found. CONCLUSIONS: The study found an association between tuberculosis and IR development in newly diagnosed pulmonary tuberculosis patients. Although not significant, IR levels decreased over time, which could be indicative of a clinical improvement. A high prevalence of IR amongst young tuberculosis patients therefore highlights the need for early identification in order to facilitate a reversal of IR and prevent possible IR-related complications.


Assuntos
Resistência à Insulina , Tuberculose Pulmonar/fisiopatologia , Adulto , Glicemia/metabolismo , HDL-Colesterol/sangue , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , África do Sul/epidemiologia , Tuberculose Pulmonar/epidemiologia
7.
Nutr J ; 15(1): 73, 2016 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-27485319

RESUMO

BACKGROUND: Not only is glutamine deficiency an independent predictor of mortality in intensive care unit (ICU) patients, but glutamine supplementation is also recommended for its proven outcome benefits. However, recent data suggest that early glutamine supplementation in certain patient groups increase mortality. The aim of this study was to investigate plasma glutamine levels of adult ICU patients in the South African setting and to determine relationships between glutamine levels, gender, diagnostic categories and selected inflammatory markers. The data from this study will be used as baseline measurement to support a large scale study that will be undertaken in the South African ICU population. METHODS: This cross-sectional, analytical study included 60 mixed adult ICU patients within 24 h post ICU admission. Plasma glutamine levels were determined on admission. The relationship between glutamine levels, Interleukin-6 (IL-6) and C-reactive protein (CRP); as well as gender- and diagnosis-related differences in glutamine levels were also investigated. A non-parametric ROC curve was computed to determine the CRP concentration cut-off point above which glutamine becomes deficient. RESULTS: The median plasma glutamine level (497 µmol/L) was in the normal range; however, 38.3 % (n = 23) of patients had deficient (<420 µmol/L) and 6.7 % (n = 4) had supra-normal glutamine levels (>930 µmol/L). No significant difference could be detected between glutamine levels and gender or diagnosis categories as a group. When only the medical and surgical categories were compared, the median plasma glutamine level of the medical patients were significantly lower than that of the surgical patients (p = 0.042). Glutamine showed inverse associations with CRP levels (r = -0.44, p < 0.05) and IL-6 concentrations (r = -0.23, p = 0.08). A CRP cut-off value of 95.5 mg/L was determined above which glutamine levels became deficient. CONCLUSIONS: About a third of patients (38 %) were glutamine deficient on admission to ICU, whereas some presented with supra-normal levels. While glutamine levels correlated inversely with inflammatory markers, and a CRP value of above 95.5 mg/L indicated potential glutamine deficiency, the clinical application of this finding needs further investigation.


Assuntos
Glutamina/deficiência , Unidades de Terapia Intensiva , Adulto , Biomarcadores/sangue , Proteína C-Reativa/análise , Cuidados Críticos , Estudos Transversais , Feminino , Glutamina/sangue , Humanos , Inflamação/sangue , Interleucina-6/sangue , Masculino , África do Sul
8.
Nutrition ; 32(9): 985-8, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27155953

RESUMO

OBJECTIVE: Optimal protein delivery in the intensive care unit (ICU) may offer a significant mortality benefit, whereas energy overfeeding leads to worse outcomes. The aim of the present study was to assess actual protein versus energy delivery in a multidisciplinary adult ICU. METHODS: We conducted a retrospective review of ICU charts to determine total protein delivery and energy delivery, inclusive of non-nutritional energy sources (NNES), from admission until a maximum of 7 d. The outcome variables were protein and energy delivery relative to targets and cumulative protein and energy balance. RESULTS: We included 71 patients (49% male), with a mean age of 49.2 ± 17.1 y. Of the patients, 68% were medical and 32% surgical. Nutrition therapy was initiated within 14.5 ± 14.1 h. The majority (80%) received enteral nutrition (EN). Median protein delivery and energy delivery were 75 g/d (1.1 g·kg·d(-1), range 21-135 g/d) and 1642 kcal/d (26 kcal·kg·d(-1), range 740-2619 kcal/d), meeting 89% (range 24-103%) and 100% (range 39-133%) of target, respectively. NNES, mostly from carbohydrate-containing intravenous fluids, contributed 8% (range 0-29%) to total energy delivery (133 kcal/d, range 0-561). Protein and energy underfeeding occurred in 51% and 27% of cases, respectively. Only 59% of those with an adequate energy delivery (90-110% of target) achieved an adequate protein delivery. A significant negative correlation was found between cumulative protein and energy balance and time to initiation of NT (protein: R = -0.33, P = 0.006; energy: R = -0.28, P = 0.017). CONCLUSIONS: Early initiation of EN with currently available energy-rich formulas is insufficient to achieve adequate protein delivery. NNES add to total energy delivery. Novel EN formulas with a lower nonprotein energy-to-nitrogen ratio may help to optimize protein delivery without the harmful effects of energy overfeeding.


Assuntos
Cuidados Críticos/métodos , Proteínas na Dieta/administração & dosagem , Nutrição Enteral/métodos , Nutrição Enteral/estatística & dados numéricos , Estado Nutricional , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estado Terminal , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
9.
J Trop Pediatr ; 61(3): 155-64, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25724213

RESUMO

OBJECTIVE: To assess the effect of probiotics on the incidence of necrotizing enterocolitis (NEC) in premature infants born to human immunodeficiency virus (HIV)-positive and HIV-negative women. PATIENTS AND METHODS: HIV-exposed and HIV-unexposed premature infants were randomized to either the probiotic or the placebo group. The probiotic consisted of 1 × 10(9) colony-forming units, Lactobacillus rhamnosus GG and Bifidobacterium infantis per day. RESULTS: In total, 74 HIV-exposed and 110 HIV-unexposed infants were enrolled and randomized. The incidence of death [4 (5.4%) vs. 7 (6%); p = 0.79] and NEC [4 (5%) vs. 5 (5%); p = 0.76] did not differ significantly between the HIV-exposed and HIV-unexposed groups. A significant difference was found for total NEC incidence between the study and control groups [3 (3%) vs. 6 (6%); p = 0.029]. The incidence of NEC in the HIV-exposed group differed significantly [Bells I 2 (5%) vs. Bells III 2 (5%); p = 0.045). CONCLUSION: Probiotic supplementation reduced the incidence of NEC in the premature very low birth weight infants; however, results failed to show a lower incidence of NEC in HIV-exposed premature infants. A reduction in the severity of disease was found in the HIV-exposed study group.


Assuntos
Bifidobacterium , Suplementos Nutricionais , Infecções por HIV , Lactobacillus rhamnosus , Probióticos/uso terapêutico , Método Duplo-Cego , Enterocolite Necrosante/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Índice de Gravidade de Doença
10.
BMC Res Notes ; 7: 754, 2014 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-25342591

RESUMO

BACKGROUND: This study assessed how the food industry applies the knowledge and evidence gained from synbiotics, probiotics or prebiotics research in infants, on the general paediatric population. This study also explored: what happens after the clinical trials using infant formula are completed, data is published or remains unpublished; the effectiveness and type of medium the formula manufacturers use to educate consumers on probiotic, prebiotic or synbiotic infant formula. FINDINGS: This was a descriptive study (a survey) that used a structured questionnaire. All listed companies that manufacture and / or market food products with added probiotics, prebiotics or synbiotics for infants were identified and invited to participate. People responsible for research and development were invited to participate in the survey. A letter of invitation was sent to selected participants and if they expressed willingness to take part in the study, a questionnaire with a written consent form was sent. Descriptive statistics and associations between categorical variables were to be tested using a Chi-square test, a p < 0.05 was statistically significant.A total of 25 major infant formulas, baby food manufacturers were identified, invited to participate in the survey. No company was willing to participate in the survey for different reasons: failure to take any action 5 (20%), decision to participate indefinitely delayed 2 (8%), sensitivity of requested information 3 (12%), company does not conduct clinical trials 1 (4%), company declined without further information 4 (16%), erroneous contact information 6 (24%), refusal by receptionists to forward telephone calls to appropriate staff 3 (12%), language barrier 3 (12%), company no longer agrees to market research 1 (4%). CONCLUSION: Due to a poor response rate in this study, no conclusion could be drawn on how the food industry applies evidence gained through probiotics, prebiotics or synbiotics research on infants for the benefit of the general paediatric population. More information and greater transparency is needed from the infant formula manufacturers on how they apply the evidence gained from the research on probiotics, prebiotics and synbiotics on infants.


Assuntos
Medicina Baseada em Evidências , Indústria Alimentícia , Fórmulas Infantis , Prebióticos , Probióticos , Simbióticos , Distribuição de Qui-Quadrado , Informação de Saúde ao Consumidor , Qualidade de Produtos para o Consumidor , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Indústria Alimentícia/normas , Fidelidade a Diretrizes , Guias como Assunto , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Fórmulas Infantis/normas , Marketing de Serviços de Saúde , Prebióticos/efeitos adversos , Prebióticos/normas , Probióticos/efeitos adversos , Probióticos/normas , Controle de Qualidade , Projetos de Pesquisa , Inquéritos e Questionários , Simbióticos/efeitos adversos , Simbióticos/normas
11.
Nutrition ; 30(10): 1151-7, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25194614

RESUMO

OBJECTIVES: Irritable bowel syndrome (IBS) is a common diagnosis in gastroenterology. Its etiology is unknown and therapeutic options limited. Trials suggest probiotics may be beneficial. The aim of this study was to assess the symptomatic efficacy of Lactobacillus plantarum 299 v (L. plantarum 299 v) for the relief of abdominal pain in patients with IBS fulfilling Rome II criteria. METHODS: This study was conducted in a referral hospital. Trial participants were randomized to receive either two capsules of L. plantarum 299 v at a dosage of 5 × 10(9) cfu per capsule or placebo daily for 8 wk. Severity of abdominal pain was assessed using a visual analog scale at each visit and a quality-of-life IBS (QoL-IBS) questionnaire was also completed. RESULTS: There was no significant difference in abdominal pain relief between the study and placebo groups (P = 0.800). There was also no difference in QoL- IBS scores between the groups (P = 0.687). Both groups had a significant improvement in abdominal pain scores over the study period, from an average of 251.55 to 197.90 (P < 0.0001) indicating a large placebo effect. CONCLUSION: An 8-wk treatment with L. plantarum 299 v did not provide symptomatic relief, particularly of abdominal pain and bloating, in patients fulfilling the Rome II criteria.


Assuntos
Dor Abdominal , Síndrome do Intestino Irritável , Lactobacillus plantarum , Probióticos , Dor Abdominal/tratamento farmacológico , Adulto , Método Duplo-Cego , Feminino , Humanos , Síndrome do Intestino Irritável/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Probióticos/uso terapêutico , Qualidade de Vida , Resultado do Tratamento
12.
J Nutr ; 144(8): 1227-33, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24919691

RESUMO

The heavy burden of maternal HIV infection has resulted in a high prevalence of premature birth and associated necrotizing enterocolitis (NEC). Human milk oligosaccharides (HMOs) were recently associated with HIV infection and transmission through breastfeeding and were also shown to reduce NEC in an animal model, particularly the HMO disialyllacto-N-tetraose (DSLNT). The primary aim of this study was to verify differences in HMO composition between HIV-infected and HIV-uninfected women. The secondary aim was to assess whether the HMO composition in the milk of mothers whose infants were diagnosed with NEC differs from that of mothers whose infants did not develop NEC. This study forms part of a larger clinical trial conducted at the Tygerberg Children's Hospital, Cape Town, South Africa, which recruited HIV-infected and HIV-uninfected mothers and their preterm infants (<34 wk gestation; ≥500 and ≤1250 g). Eighty-two mother-infant pairs were selected for the substudy. Mother-infant pairs were stratified according to the mother's HIV (infected/uninfected) and secretor status (secretor/nonsecretor). HMOs in 4- and 28-d postpartum milk samples were analyzed by HPLC and compared between groups. Our results confirm previous reports that HIV-infected mothers have higher relative abundances of 3'-sialyllactose in their milk compared with HIV-uninfected mothers (10.7% vs. 6.8%; P < 0.01). Most intriguingly, the data also indicated that low concentrations of DSLNT in the 4-d milk samples in the mother's milk increased the infant's risk of NEC (200 ± 126 vs. 345 ± 186 µg/mL; P < 0.05), which is in accordance with results from previously published animal studies and warrants further investigation. This trial was registered at clinicaltrials.gov as NCT01868737.


Assuntos
Enterocolite Necrosante/epidemiologia , Infecções por HIV/metabolismo , Leite Humano/química , Oligossacarídeos/análise , Nascimento Prematuro/epidemiologia , Adulto , Aleitamento Materno , Enterocolite Necrosante/etiologia , Feminino , Infecções por HIV/complicações , Humanos , Incidência , Recém-Nascido Prematuro/metabolismo , Recém-Nascido de muito Baixo Peso/metabolismo , Masculino , Mães , Gravidez , Nascimento Prematuro/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , África do Sul , Adulto Jovem
13.
Nutrition ; 30(6): 645-53, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24613436

RESUMO

OBJECTIVE: The aim of this study was to compare the effect of administration of probiotics on feeding tolerance and growth outcomes of HIV-exposed (but uninfected) versus HIV non-exposed preterm infants. The null hypothesis of this study states that there will be no difference in the feeding tolerance and growth outcomes for both probiotic-exposed and unexposed premature very low birth weight infants. METHODS: A randomized, double-blind, placebo-controlled trial was conducted during the period from July 2011 to August 2012. HIV-exposed and non-exposed premature (<34 wk gestation) infants with a birth weight of ≥500 g and ≤1250 g were randomized to receive either a probiotic mixture or placebo. The multispecies probiotic mixture consisted of 1 × 10(9) CFU, Lactobacillus rhamnosus GG and Bifidobacterium infantis per day and was administered for 28 d. Anthropometrical parameters, daily intakes, and feeding tolerance were monitored. RESULTS: Seventy-four HIV-exposed and 110 unexposed infants were enrolled and randomized (mean birth weight 987 g ± 160 g, range, 560-1244 g; mean gestational age 28.7 wk). In all 4227 probiotic doses were administered (mean 22.9/infant). There was no difference in the average daily weight gain for treatment groups or HIV exposure. The HIV-exposed group achieved significantly higher z scores for length and head circumference at day 28 than the unexposed group (P < 0.01 and P = 0.03, respectively). There were no differences in the incidence of any signs of feeding intolerance and abdominal distension between the groups. CONCLUSION: Probiotic supplementation did not affect growth outcomes or the incidence of any signs of feeding intolerance in HIV exposure.


Assuntos
Desenvolvimento Infantil , Suplementos Nutricionais , Infecções por HIV , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Probióticos/administração & dosagem , Bifidobacterium , Peso ao Nascer , Método Duplo-Cego , Feminino , Humanos , Lactente , Recém-Nascido Prematuro/crescimento & desenvolvimento , Lactobacillus rhamnosus , Masculino , Resultado do Tratamento , Ganho de Peso
14.
BMC Med Res Methodol ; 13: 137, 2013 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-24219082

RESUMO

BACKGROUND: There is little or no information available on the impact of funding by the food industry on trial outcomes and methodological quality of synbiotics, probiotics and prebiotics research in infants. The objective of this study was to compare the methodological quality, outcomes of food industry sponsored trials versus non industry sponsored trials, with regards to supplementation of synbiotics, probiotics and prebiotics in infant formula. METHODS: A comprehensive search was conducted to identify published and unpublished randomized clinical trials (RCTs). Cochrane methodology was used to assess the risk of bias of included RCTs in the following domains: 1) sequence generation; 2) allocation concealment; 3) blinding; 4) incomplete outcome data; 5) selective outcome reporting; and 6) other bias. Clinical outcomes and authors' conclusions were reported in frequencies and percentages. The association between source of funding, risk of bias, clinical outcomes and conclusions were assessed using Pearson's Chi-square test and the Fisher's exact test. A p-value < 0.05 was statistically significant. RESULTS: Sixty seven completed and 3 on-going RCTs were included. Forty (59.7%) were funded by food industry, 11 (16.4%) by non-industry entities and 16 (23.9%) did not specify source of funding. Several risk of bias domains, especially sequence generation, allocation concealment and blinding, were not adequately reported. There was no significant association between the source of funding and sequence generation, allocation concealment, blinding and selective reporting, majority of reported clinical outcomes or authors' conclusions. On the other hand, source of funding was significantly associated with the domains of incomplete outcome data, free of other bias domains as well as reported antibiotic use and conclusions on weight gain. CONCLUSION: In RCTs on infants fed infant formula containing probiotics, prebiotics or synbiotics, the source of funding did not influence the majority of outcomes in favour of the sponsors' products. More non-industry funded research is needed to further assess the impact of funding on methodological quality, reported clinical outcomes and authors' conclusions.


Assuntos
Indústria Alimentícia/economia , Fórmulas Infantis/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto/economia , Organização do Financiamento , Humanos , Lactente , Prebióticos/efeitos adversos , Probióticos/efeitos adversos , Viés de Publicação , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Projetos de Pesquisa , Simbióticos/efeitos adversos
15.
Nutr J ; 11: 81, 2012 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-23035863

RESUMO

BACKGROUND: Synbiotics, probiotics or prebiotics are being added to infant formula to promote growth and development in infants. Previous reviews (2007 to 2011) on term infants given probiotics or prebiotics focused on prevention of allergic disease and food hypersensitivity. This review focused on growth and clinical outcomes in term infants fed only infant formula containing synbiotics, probiotics or prebiotics. METHODS: Cochrane methodology was followed using randomized controlled trials (RCTs) which compared term infant formula containing probiotics, prebiotics or synbiotics to conventional infant formula with / without placebo among healthy full term infants. The mean difference (MD) and corresponding 95% confidence intervals (CI) were reported for continuous outcomes, risk ratio (RR) and corresponding 95% CI for dichotomous outcomes. Where appropriate, meta-analysis was performed; heterogeneity was explored using subgroup and sensitivity analyses. If studies were too diverse a narrative synthesis was provided. RESULTS: Three synbiotic studies (N = 475), 10 probiotics studies (N = 933) and 12 prebiotics studies (N = 1563) were included. Synbiotics failed to significantly increase growth in boys and girls. Use of synbiotics increased stool frequency, had no impact on stool consistency, colic, spitting up / regurgitation, crying, restlessness or vomiting. Probiotics in formula also failed to have any significant effect on growth, stool frequency or consistency. Probiotics did not lower the incidence of diarrhoea, colic, spitting up / regurgitation, crying, restlessness or vomiting. Prebiotics in formula did increase weight gain but had no impact on length or head circumference gain. Prebiotics increased stool frequency but had no impact on stool consistency, the incidence of colic, spitting up / regurgitation, crying, restlessness or vomiting. There was no impact of prebiotics on the volume of formula tolerated, infections and gastrointestinal microflora. The quality of evidence was compromised by imprecision, inconsistency of results, use of different study preparations and publication bias. AUTHORS' CONCLUSIONS: There is not enough evidence to state that supplementation of term infant formula with synbiotics, probiotics or prebiotics does result in improved growth or clinical outcomes in term infants. There is no data available to establish if synbiotics are superior to probiotics or prebiotics.


Assuntos
Desenvolvimento Infantil , Fórmulas Infantis , Prebióticos , Probióticos , Humanos , Lactente , Fórmulas Infantis/química , Recém-Nascido , Probióticos/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Nascimento a Termo
16.
Nutr J ; 11: 58, 2012 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-22928998

RESUMO

BACKGROUND: Previous reviews (2005 to 2009) on preterm infants given probiotics or prebiotics with breast milk or mixed feeds focused on prevention of Necrotizing Enterocolitis, sepsis and diarrhea. This review assessed if probiotics, prebiotics led to improved growth and clinical outcomes in formula fed preterm infants. METHODS: Cochrane methodology was followed using randomized controlled trials (RCTs) which compared preterm formula containing probiotic(s) or prebiotic(s) to conventional preterm formula in preterm infants. The mean difference (MD) and corresponding 95% confidence intervals (CI) were reported for continuous outcomes, risk ratio (RR) and corresponding 95% CI for dichotomous outcomes. Heterogeneity was assessed by visual inspection of forest plots and a chi² test. An I² test assessed inconsistencies across studies. I²> 50% represented substantial heterogeneity. RESULTS: Four probiotics studies (N=212), 4 prebiotics studies (N=126) were included. Probiotics: There were no significant differences in weight gain (MD 1.96, 95% CI: -2.64 to 6.56, 2 studies, n=34) or in maximal enteral feed (MD 35.20, 95% CI: -7.61 to 78.02, 2 studies, n=34), number of stools per day increased significantly in probiotic group (MD 1.60, 95% CI: 1.20 to 2.00, 1 study, n=20). Prebiotics: Galacto-oligosaccharide/Fructo-oligosaccharide (GOS/FOS) yielded no significant difference in weight gain (MD 0.04, 95% CI: -2.65 to 2.73, 2 studies, n=50), GOS/FOS yielded no significant differences in length gain (MD 0.01, 95% CI: -0.03 to 0.04, 2 studies, n=50). There were no significant differences in head growth (MD -0.01, 95% CI: -0.02 to 0.00, 2 studies, n=76) or age at full enteral feed (MD -0.79, 95% CI: -2.20 to 0.61, 2 studies, n=86). Stool frequency increased significantly in prebiotic group (MD 0.80, 95% CI: 0.48 to 1.1, 2 studies, n=86). GOS/FOS and FOS yielded higher bifidobacteria counts in prebiotics group (MD 2.10, 95% CI: 0.96 to 3.24, n=27) and (MD 0.48, 95% CI: 0.28 to 0.68, n=56). CONCLUSIONS: There is not enough evidence to state that supplementation with probiotics or prebiotics results in improved growth and clinical outcomes in exclusively formula fed preterm infants.


Assuntos
Desenvolvimento Infantil , Medicina Baseada em Evidências , Fórmulas Infantis , Prebióticos , Probióticos , Defecação , Ingestão de Energia , Humanos , Lactente , Fórmulas Infantis/química , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Probióticos/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Ganho de Peso
17.
Nutrition ; 27(7-8): 745-58, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21679878

RESUMO

OBJECTIVE: This systematic review assessed the effects of micronutrient supplementation on adults recovering from critical illness. Primary outcomes included clinical endpoints (mortality, infectious complications, length of intensive care unit and of hospital stay). Secondary outcomes included descriptions of practice issues, micronutrient status, morbidity, course of the acute-phase response, and oxidative stress. METHODS: Electronic bibliographic databases, bibliographies of retrieved articles, and personal files were searched and reviewed. Randomized controlled trials (RCTs) of micronutrient supplementation in adult critically ill patients administered enterally and/or parenterally in addition to their routine care were included. Two authors independently extracted data and assessed trial quality. The random-effects model was used to estimate overall relative risk (RR)/mean difference and effect size. P<0.05 was considered statistically significant. RESULTS: Fifteen (n=1714) and 18 (n=1849) RCTs were included for the primary and secondary objectives, respectively. Fourteen trials (n=1468) showed a statistically significant decrease in overall mortality (RR 0.78, 95% confidence interval 0.67-0.90, I2=0%, P=0.0009). Six RCTs (n=1194) indicated a statistically significant decrease in 28-d mortality (RR 0.75, 95% confidence interval 0.63-0.88, I2=0%, P=0.0006). Micronutrient supplementation was not associated with a decrease in infectious complications, length of intensive care unit, or length of hospital stay. In subgroup analyses, a sensitivity analysis of combined micronutrients indicated a significant decrease in mortality (RR 0.69, 95% confidence interval 0.54-0.90, I2=2%, P=0.006). The secondary outcomes confirmed that timing, duration, and dosing appear to be key factors to ensure optimal clinical benefit. CONCLUSION: This review does suggest a potential benefit of micronutrient supplementation in critically ill adults by possibly being associated with a decrease in mortality.


Assuntos
Estado Terminal/terapia , Suplementos Nutricionais , Mortalidade Hospitalar , Micronutrientes/uso terapêutico , Humanos , Resultado do Tratamento
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