Yogurt for treating antibiotic-associated diarrhea: Systematic review and meta-analysis

Milk-derived Lactobacillus with high production of short-chain fatty acids relieves antibiotic-induced diarrhea in mice

Antibiotic-associated diarrhea (AAD) is a common side effect during antibiotic treatment, and this has warranted research into alternative protocols. In this study, we investigated the potential therapeutic effects of three cohorts, Lactobacillus plantarum KLDS 1.0386, Lactobacillus acidophilus KLDS 1.0901 and a mixed strain of both, on intestinal inflammation, the intestinal mucosal barrier, and microbial community in mice with ampicillin-induced diarrhea. The results showed that Lactobacillus inhibited the activation of the TLR4/NF-κB signaling pathway, decreased the expression of pro-inflammatory cytokines, increased the expression of anti-inflammatory cytokines in the murine intestine, and alleviated the intestinal barrier damage and inflammation induced by ampicillin. In addition, Lactobacillus ameliorates intestinal epithelial barrier damage by increasing the expression of tight junction proteins and aquaporins. After Lactobacillus treatment, the diversity of gut microbiota increased significantly, and the composition and function of gut microbiota gradually recovered. In the gut microbiota, Bacteroidetes and Escherichia Shigella related to the synthesis of short-chain fatty acids (SCFAs) were significantly affected by ampicillin, while Lactobacillus regulates the cascade of the microbial-SCFA signaling pathway, which greatly promoted the generation of SCFAs. Collectively, Lactobacillus showed better results in treating AAD, especially in mixed strains.

Attributes of Culture Bacteria as Influenced by Ingredients That Help Treat Leaky Gut

Consumers are becoming aware of functional ingredients such as medicinal herbs, polyphenols, mushrooms, amino acids, proteins, and probiotics more than ever before. Like yogurt and its probiotics, L-glutamine, quercetin, slippery elm bark, marshmallow root, N-acetyl-D-glucosamine, licorice root, maitake mushrooms, and zinc orotate have demonstrated health benefits through gut microbiota. The impact of these ingredients on yogurt starter culture bacteria characteristics is not well known. The objective of this study was to determine the influence of these ingredients on the probiotic characteristics, tolerance to gastric juices and lysozyme, protease activity, and viability of Streptococcus thermophilus STI-06 and Lactobacillus bulgaricus LB-12. Acid tolerance was determined at 0, 30, 60, 90, and 120 min of incubation, whereas bile tolerance was analyzed at 0, 4, and 8 h. The microbial growth was determined at 0, 2, 4, 6, 8, 10, 12, 14, and 16 h of incubation, while protease activity was evaluated at 0, 12, and 24 h. The application of marshmallow root, licorice root, and slippery elm bark improved bile tolerance and acid tolerance of S. thermophilus. These ingredients did not impact the bile tolerance, acid tolerance, and simulated gastric juice tolerance characteristics of L. bulgaricus over 8 h and 120 min (respectively) of incubation. Similarly, the growth of S. thermophilus and L. bulgaricus was not affected by any of these functional ingredients. The application of marshmallow root, N-acetyl-D-glucosamine, and maitake mushroom significantly increased the protease activity of S. thermophilus, whereas the protease activity of L. bulgaricus was not affected by any ingredient. Compared to the control, marshmallow root and quercetin samples had higher mean log counts and log counts for S. thermophilus on the simulated gastric juice and lysozyme resistance in vitro test, respectively. For L. bulgaricus, licorice root, quercetin, marshmallow root, and slippery elm bark samples had higher log counts than the control samples.

The efficacy of fermented foods in the treatment and management of diarrhoeal diseases: A systematic review and meta-analysis

Background: Diarrhoeal disease is a major cause of global infant mortality, and compromises the ability of many countries with respect to achieving sustainable development goals. The WHO's recommendation of Oral Rehydration Solution (ORS) and zinc in the management of this disease, may not be readily available. Consideration and assessment of cultural practices in its management has been an area of increased interest over the last decade. Aim: This study aims to systematically evaluate efficacy of the consumption of traditional fermented foods as functional products for the treatment and management of diarrhoea. Methods: Following PRISMA guidelines, a systematic review was conducted of electronic databases (Cochrane Library, Ovid Medline and Pubmed) databases with no restrictions on language and publication date for RCTs that investigated the effect of consumption of fermented foods on the treatment of diarrhoea in children under five years of age. Results: Seven RCTs were included. Meta-analysis showed that compared to control, consumption of fermented foods significantly reduced mean duration of diarrhoea, -0.61 days; (95% CI, -1.04, -0.18); length of hospitalization, -0.35 days (95% CI, -0.69, -0.02); but not mean daily frequency of stool -2.00 (95% CI,-7.03, 3.04). Conclusion: Limited available evidence suggests that consumption of fermented foods may help reduce duration and severity of symptoms as a treatment of diarrhoea. More high quality research needs to be undertaken to investigate the efficacy of fermented food as an effective alternative to ORS as a potential WHO recommendation for management of diarrhoeal disease.

Effect of Lactobacillus plantarum P9 on defecation, quality of life and gut microbiome in individuals with chronic diarrhoea: Protocol for a randomized, double-blind, placebo-controlled clinical trial

Background

Probiotics may be an ideal choice for these patients, given it can improve the defecation and quality of life of individuals with chronic diarrhoea. However, evidence-based medical research is still limited to support its use as a diarrhoea agent.

Method

A randomized, double-blind, placebo-controlled clinical trial is designed to pinpoint the efficiency and possible action modes of probiotics for chronic diarrhoea. 200 eligible volunteers with chronic diarrhoea are randomly assigned to a probiotic group (orally taking Lactobacillus plantarum p9 probiotics powder) or a placebo group. Except an independent project administrator who will be responsible for unblinding, the other researchers are blinded. Primary outcome is diarrhoea severity score, and secondary outcomes include weekly mean frequency of defecation, weekly mean stool appearance score, weekly mean stool urgency score, emotional state score, gut microbiome, and faecal metabolome. Each outcome measure will be assessed at the timepoints of pre-administration (day 0), administration (day 14 and/or 28), and post-administration (day 42) to identity inter- and intra-groups differences. Adverse events will be recorded to evaluate the safety of L. plantarum p9.

Discussion

The study protocol will provide high-quality evidence for the use of probiotics as a diarrhoea agent when it is strictly conducted out, providing evidence regarding whether and to what extent L. plantarum p9 can improve the defecation and well-being of individuals with chronic diarrhoea.

Trial registration

Chinese Clinical Trial Registry (ChiCTR) (NO. ChiCTR2000038410). Registered on November 22, 2020, https://www.chictr.org.cn/showproj.aspx?proj=56542.

Beneficial Effects of Yoghurts and Probiotic Fermented Milks and Their Functional Food Potential

Probiotic fermented milks and yoghurts are acidified and fermented by viable bacteria, usually L. bulgaricus and S. thermophilus, resulting in a thicker product with a longer shelf life. They are a nutrition-dense food, providing a good source of calcium, phosphorus, potassium, vitamin A, vitamin B2, and vitamin B12. Additionally, they deliver high biological value proteins and essential fatty acids. There is accumulating evidence suggesting that yoghurt and fermented milk consumption is related to a number of health advantages, including the prevention of osteoporosis, diabetes, and cardiovascular diseases, as well as the promotion of gut health and immune system modulation. This review aims at presenting and critically reviewing the beneficial effects from the consumption of probiotic fermented milks in human health, whilst revealing potential applications in the food industry.

Health effects of yogurt consumption during paediatric age: a narrative review

Yogurt is a fermented milk product characterised by a peculiar nutritional composition with live and viable cultures of bacteria. Few studies have analysed the benefits of yogurt consumption on health outcomes during paediatric age. Recent epidemiological studies evaluating the nutritional impact of yogurt have demonstrated its significant contribution to nutrients intakes among children. Thus, consuming yogurt is a strategy to achieve recommended nutrient intake and healthier dietary choices, with potential impact on obesity and cardiometabolic outcome in children. Yogurt's effects on paediatric infectious diseases, gastrointestinal diseases and atopic-related disorders are ascribed to the specific probiotic strain administered. Interestingly, the benefits of yogurt consumption are most likely due to effects mediated through the gut microbiota and the enhancement of innate and adaptive immune responses. Therefore, supplementing standard yogurt cultures with probiotic strains could be useful to promote health at different paediatric ages, although more evidence is needed regarding the strain-related effects and their interplay within the paediatric immune system.

Effects of Lacidophilin Tablets, Yogurt, and Bifid Triple Viable Capsules on the Gut Microbiota of Mice with Antibiotic-Associated Diarrhea

Antibiotic-associated diarrhea (AAD) is a common morbidity caused by antibiotic use and is characterized by the dysbiosis of the gut microbiota. Several clinical trials have shown that probiotics can prevent AAD. This study aimed at investigating the effects of Lacidophilin tablets (LB), yogurt (YG), and bifid triple viable capsules (BT) on the gut microbiota of mice with AAD. Mice with diarrhea were randomly allocated to treatment groups or the control group and were treated with either LB, YG, BT, or vehicle control. The body weight, diarrhea scores, cecum index, and cecal length were determined. Fecal samples of all mice were analyzed using 16S rRNA high-throughput sequencing. The results showed that LB, YG, and BT significantly decreased the diarrhea scores and inhibited increases in the cecum index and cecal length induced by AAD. In addition, they significantly changed the composition and richness of the gut microbiota. Specifically, they increased the abundance of the phylum Firmicutes and decreased the abundance of the phyla Bacteroidetes and the family Bacteroidaceae. Treatment with LB and YG also decreased the abundance of the phylum Proteobacteria and only LB could mediate the reduced levels of Lactobacillaceae in AAD mice. At the genus level, YG and BT treatment decreased the abundance of Bacteroides or Parasutterella. To our surprise, only LB treatment dramatically increased the abundance of Lactobacillus and decreased that of potential pathogens, such as Bacteroides, Parabacteroides, and Parasutterella, to almost normal values. Our findings indicate that LB, YG, and BT ameliorated diarrhea by regulating the composition and structure of the gut microbiota and that LB plays an important role in regulating the gut microbiota.

The prospects of employing probiotics in combating COVID-19

Unanticipated pathogenic risk and emerging transmittable diseases can result from interspecies exchanges of viruses among animals and humans. The emergence of the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causing coronavirus disease-19 (COVID-19) pandemic has recently exemplified this mechanism. Cough, fever, fatigue, headache, sputum production, hemoptysis, dyspnea, diarrhea, and gastrointestinal disorders are the characteristic features of the disease. The most prevalent and serious manifestation of the infection tends to be pneumonia. The new strains of SARS-CoV-2 with more infectivity have been emerging at regular intervals. There is currently no World Health Organization-approved particular drug for COVID-19. Besides, developing novel antivirals would take much time. Thus, repurposing the application of natural products can provide alternatives and can facilitate medication against COVID-19 as well as can slow down the aggressive progression of the disease before the arrival of approved drugs. Probiotics have long been known for their positive effects on the gut microbiome and impact on immune responses. Particularly, their involvement against viral diseases, especially those of the upper and lower respiratory tract, is of current interest for their prospective application against COVID-19. In this review, we comprehensively address the mode of action of probiotics and their possible intervention against coronavirus diseases correlating with their efficacy against viral diseases. In this regard, we explored recently published relevant research and review articles in MEDLINE/PubMed related to COVID-19 and the effects of probiotics on viral infections.

Regulatory effect of non-starch polysaccharides from purple sweet potato on intestinal microbiota of mice with antibiotic-associated diarrhea

Antibiotic treatment causes antibiotic-associated diarrhea (AAD), which is usually accompanied by disorders of the intestinal flora, aggravating the patient's condition. Recently, more attention has been devoted to the ability of plant polysaccharides to improve the body's flora and enhance immunity. However, reports on whether purple sweet potato polysaccharides (PSPPs) can improve AAD are scarce. This study aimed to extract a non-starch polysaccharide from purple sweet potato and analyze its structure and ability to regulate the intestinal flora of mice with AAD. The diarrhea model was established via intragastric administration of lincomycin and different concentrations of PSPPs (0.1 g kg-1, 0.2 g kg-1, and 0.4 g kg-1) to Balb/C mice. The results showed that PSPP was a pyran polysaccharide with 1 → 2, 1 → 2, 6, 1 → 4, 1 → 4, 6 glycosidic bonds in an α-configuration. In vivo experiments showed that PSPP could relieve diarrhea and improve the structural damage in the ileum caused by lincomycin hydrochloride. In addition, treatment with PSPPs decreased the levels of IL-1β, IL-6 and TNF-α but increased the level of IL-10 in the intestines of mice (p < 0.01). The results of 16S rRNA sequencing showed that PSPPs changed the composition and diversity of the intestinal flora of mice with AAD. In addition, PSPP treatment increased the content of short-chain fatty acids (p < 0.01). These results revealed that PSPPs regulated the intestinal flora, balanced fatty acid metabolism, and relieved the symptoms of diarrhea to a certain extent in mice.

Risk and Protective Factors for Gastrointestinal Symptoms associated with Antibiotic Treatment in Children: A Population Study

PURPOSE

Gastrointestinal symptoms are often related to antibiotic treatment. Their incidence, risk and protective conditions in children are not well defined and represent the aims of this study.

METHODS

We prospectively enrolled inpatient children submitted to antibiotic treatment. Indication, type, dose and duration of treatment, probiotic supplementation and gastrointestinal symptoms were recorded at recruitment, after two and four weeks. Antibiotic-associated diarrhea (AAD) was defined as the presence of at least 3 loose/liquid stools within 14 days from antibiotic onset.

RESULTS

AAD occurred in 59/289 (20.4%) of patients, with increased risk in children younger than 3 years (relative risk [RR]=4.25), in lower respiratory (RR=2.11) and urinary infections (RR=3.67), intravenous administration (RR=1.81) and previous AAD episodes (RR=1.87). Abdominal pain occurred in 27/289 (9.3%), particularly in children >6 years (RR=4.15), with previous abdominal pain (RR=7.2) or constipation (RR=4.06). Constipation was recorded in 23/289 (8.0%), with increased risk in children having surgery (RR=2.56) or previous constipation (RR=7.38). Probiotic supplementation significantly reduced AAD (RR=0.30) and abdominal pain (RR=0.36). Lactobacillus rhamnosus GG (LGG) and L. reuteri significantly reduced AAD (RR=0.37 and 0.35) and abdominal pain (RR=0.37 and 0.24).

CONCLUSION

AAD occurred in 20.4% of children, with increased risk at younger age, lower respiratory and urinary tract infections, intravenous treatment and previous AAD. LGG and L. reuteri reduced both AAD and associated abdominal pain.

The role of yogurt in food-based dietary guidelines

In the modern food technology era, one of the aims of food safety and quality is to eliminate or reduce the number of microorganisms in food. This may now be changing. In particular, the importance of live microorganisms as beneficial food constituents is now being recognized. Microorganisms present in food that contribute to the human diet include not only viable bacteria but also metabolites and bioactive components. Yogurt is one of the most biologically active foods consumed by humans. It is an excellent source of proteins, vitamins, and minerals. Additionally, the nutritional value is especially high relative to cost. Potential nutritional benefits are also associated with the ingestion of the bacteria that are ordinarily present at the time of consumption. Thus, yogurt serves as a major source of live bacteria in the human diet, as well as a delivery vehicle for added probiotic bacteria. Yogurt may provide a simple and affordable solution for enhancing the nutritional value of the diet, including the intake of live bacteria and their metabolites. A further benefit may be obtained when yogurt is used as a carrier for specific probiotic bacteria and/or prebiotic compounds. These factors suggest that yogurt could have a more visible role in food-based dietary guidelines.

Chinese yam (Dioscorea opposita Thunb.) alleviates antibiotic-associated diarrhea, modifies intestinal microbiota, and increases the level of short-chain fatty acids in mice

Antibiotic-associated diarrhea (AAD) is a common adverse effect of antibiotic treatment. The study was to evaluate effects of Chinese yam (Dioscorea opposita Thunb.) on AAD, and changes of intestinal microbiota and short-chain fatty acids (SCFA). AAD model was established using Balb/c mice by gavage with ampicillin for 5 days, followed by a 10-day administration of low, medium, and high dosage of Chinese yam, containing allantoin (4.35 mg/g) and polysaccharides (85.51 mg/g). The results showed that Chinese yam accelerated the recovery from acute diarrhea, reverse AAD-induced body weight loss and cecal enlargement. The high-dosage Chinese yam increased probiotic Bifidobacteria and Lactobacilli by 47% and 21% and decreased potential pathogen Enterococcus and Clostridium perfringens by 8% and 27% on day 15 (P < .05). Bacterial community analysis revealed that Chinese yam contributed to repair the ampicillin-induced intestinal microbiota disorder, enrich the abundance of Bacteroides spp. and Clostridium spp. Additionally, Chinese yam supplementation increased the production of SCFA.

Comparative effectiveness and safety of interventions for acute diarrhea and gastroenteritis in children: A systematic review and network meta-analysis

BACKGROUND

Many interventions have shown effectiveness in reducing the duration of acute diarrhea and gastroenteritis (ADG) in children. Yet, there is lack of comparative efficacy of interventions that seem to be better than placebo among which, the clinicians must choose. Our aim was to determine the comparative effectiveness and safety of the pharmacological and nutritional interventions for reducing the duration of ADG in children.

METHODS

Data sources included Medline, Embase, CENTRAL, CINAHL, LILACS, and Global-Health up to May 2017. Eligible trials compared zinc (ZN), vitamin A, micronutrients (MN), probiotics, prebiotics, symbiotics, racecadotril, smectite(SM), loperamide, diluted milk, lactose-free formula(LCF), or their combinations, to placebo or standard treatment (STND), or among them. Two reviewers independently performed screening, review, study selection and extraction. The primary outcome was diarrhea duration. Secondary outcomes were stool frequency at day 2, diarrhea at day 3, vomiting and side effects. We performed a random effects Bayesian network meta-analysis to combine the direct and indirect evidence for each outcome. Mean differences and odds ratio with their credible intervals(CrI) were calculated. Coherence and transitivity assumptions were assessed. Meta-regression, subgroups and sensitivity analyses were conducted to explore the impact of effect modifiers. Summary under the cumulative curve (SUCRA) values with their CrI were calculated. We assessed the evidence quality and classified the best interventions using the Grading of Recommendations, Assessment, Development & Evaluation (GRADE) approach for each paired comparison.

RESULTS

A total of 174 studies (32,430 children) proved eligible. Studies were conducted in 42 countries of which most were low-and middle-income countries (LMIC). Interventions were grouped in 27 categories. Most interventions were better than STND. Reduction of diarrhea varied from 12.5 to 51.1 hours. The combinations Saccharomyces boulardii (SB)+ZN, and SM+ZN were considered the best interventions (i.e., GRADE quality of evidence: moderate to high, substantial superiority to STND, reduction in duration of 35 to 40 hours, and large SUCRA values), while symbiotics (combination of probiotics+prebiotics), ZN, loperamide and combinations ZN+MN and ZN+LCF were considered inferior to the best and better than STND [Quality: moderate to high, superior to STND, and reduction of 17 to 25 hours]. In subgroups analyses, effect of ZN was higher in LMIC and was not present in high-income countries (HIC). Vitamin A, MN, prebiotics, kaolin-pectin, and diluted milk were similar to STND [Quality: moderate to high]. The remainder of the interventions had low to very-low evidence quality. Loperamide was the only intervention with more side effects than STND [Quality: moderate].

DISCUSSION/CONCLUSION

Most interventions analyzed (except vitamin A, micronutrients, prebiotics, and kaolin-pectin) showed evidence of superiority to placebo in reducing the diarrhea. With moderate-to high-quality of evidence, SB+ZN and SM+ZN, demonstrated the best combination of evidence quality and magnitude of effect while symbiotics, loperamide and zinc proved being the best single interventions, and loperamide was the most unsafe. Nonetheless, the effect of zinc, SB+ZN and SM+ZN might only be applied to children in LMIC. Results suggest no further role for studies comparing interventions against no treatment or placebo, or studies testing loperamide, MN, kaolin-pectin, vitamin A, prebiotics and diluted milk.

PROSPERO REGISTRATION

CRD42015023778.

Nanosized food additives impact beneficial and pathogenic bacteria in the human gut: a simulated gastrointestinal study

Nanotechnology provides the food industry with new ways to modulate various aspects of food. Hence, engineered nanoparticles (NPs) are increasingly added to food and beverage products as functional ingredients. However, the impact of engineered as well as naturally occurring NPs on both commensal and pathogenic microorganisms within the gastrointestinal tract (GI) is not fully understood. Here, well-defined synthetic NPs and bacterial models were used to probe nanoparticle–bacteria interactions, from analytical to in situ to in vitro. NP–bacteria complexation occurred most efficiently for small NPs, independent of their core material or surface charge, but could be reduced by NPs’ steric surface modifications. Adsorption to bacteria could also be demonstrated for naturally occurring carbon NPs isolated from beer. Complex formation affected the (patho)biological behavior of both the NPs and bacteria, including their cellular uptake into epithelial cells and phagocytes, pathogenic signaling pathways, and NP-induced cell toxicity. NP–bacteria complex formation was concentration-dependently reduced when the NPs became coated with biomolecule coronas with sequential simulation of first oral uptake and then the GI. However, efficient NP adsorption was restored when the pH was sufficiently low, such as in simulating the conditions of the stomach. Collectively, NP binding to enteric bacteria may impact their (patho)biology, particularly in the stomach. Nanosized-food additives as well as naturally occurring NPs may be exploited to (rationally) shape the microbiome. The information contained in this article should facilitate a “safe by design” strategy for the development and application of engineered NPs as functional foods ingredients.

Engineered or naturally occurring nanoparticles could potentially affect the bacteria in the gut. A study led by Dana Westmeier and Roland Stauber from University Medical Center of Mainz, Germany probed the nanoparticle–bacteria interactions in situ. They found that NP–bacteria complex occurred most efficiently for small NPs, independent of their core material or surface charge. The complex formation affected the (patho)biological behavior of both the NPs and bacteria, particularly under conditions that simulate the stomach. The result shows that both engineered and naturally occurring nanoparticles could be exploited to shape the gut microbiome. The study can offer guidelines for future development and application of nanoparticles in food industry.

Review of the role of probiotics in gastrointestinal diseases in adults

BACKGROUND

Probiotics may act as biological agents that modify the intestinal microbiota and certain cytokine profiles, which can lead to an improvement in certain gastrointestinal diseases.

OBJECTIVES

To conduct a review of the evidence of the role of probiotics in certain gastrointestinal diseases in adults.

SEARCH METHODS

Review conducted using appropriate descriptors, filters and limits in the PubMed database (MEDLINE).

SELECTION CRITERIA

The MeSH terms used were Probiotics [in the title] AND Gastrointestinal Diseases, with the following limits or filters: Types of study: Systematic Reviews, Meta-Analysis, Guideline, Practice Guideline, Consensus Development Conference (and Consensus Development Conference NIH), Randomized Controlled Trial, Controlled Clinical Trial and Clinical Trial; age: adults (19 or older); language: English and Spanish; in humans, and with at least one abstract.

DATA COLLECTION AND ANALYSIS

Full texts of all the Systematic Reviews and meta-analyses directly related to the review's objective were obtained, as well as the Randomised Controlled Trials of the studies that were considered relevant and of sufficient quality for this review.

MAIN RESULTS

Certain probiotics, different for each process, have proven to be effective and beneficial in cases of acute infectious diarrhoea, antibiotic-associated diarrhoea, Clostridium difficile-associated diarrhoea, pouchitis and Helicobacter pylori infection eradication.

AUTHORS' CONCLUSIONS

Although some probiotics have not demonstrated any benefit, there are certain gastrointestinal diseases in which the use of probiotics, true biological agents, can be recommended.

Safety of Bifidobacterium animalis Subsp. Lactis (B. lactis) Strain BB-12-Supplemented Yogurt in Healthy Children

OBJECTIVES

Probiotics are live microorganisms that may provide health benefits to the individual when consumed in sufficient quantities. For studies conducted on health or disease endpoints on probiotics in the United States, the Food and Administration has required those studies to be conducted as investigational new drugs. This phase I, double-blinded, randomized, controlled safety study represents the first requirement of this pathway. The purpose of the study was to determine the safety of Bifidobacterium animalis subsp. lactis (B lactis) strain BB-12 (BB-12)-supplemented yogurt when consumed by a generally healthy group of children. The secondary aim was to assess the effect of BB-12-supplemented yogurt on the gut microbiota of the children.

METHODS

Sixty children ages 1 to 5 years were randomly assigned to consume 4 ounces of either BB-12-supplemented yogurt or nonsupplemented control yogurt daily for 10 days. The primary outcome was to assess safety and tolerability, as determined by the number of reported adverse events.

RESULTS

A total of 186 nonserious adverse events were reported, with no significant differences between the control and BB-12 groups. No significant changes due to probiotic treatment were observed in the gut microbiota of the study cohort.

CONCLUSIONS

BB-12-supplemented yogurt is safe and well-tolerated when consumed by healthy children. The present study will form the basis for future randomized clinical trials investigating the potential effects of BB-12-supplemented yogurt in different disease states.

Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Children

This article provides recommendations, developed by the Working Group (WG) on Probiotics of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition, for the use of probiotics for the prevention of antibiotic-associated diarrhea (AAD) in children based on a systematic review of previously completed systematic reviews and of randomized controlled trials published subsequently to these reviews. The use of probiotics for the treatment of AAD is not covered. The recommendations were formulated only if at least 2 randomized controlled trials that used a given probiotic (with strain specification) were available. The quality of evidence (QoE) was assessed using the Grading of Recommendations Assessment, Development, and Evaluation guidelines. If the use of probiotics for preventing AAD is considered because of the existence of risk factors such as class of antibiotic(s), duration of antibiotic treatment, age, need for hospitalization, comorbidities, or previous episodes of AAD diarrhea, the WG recommends using Lactobacillus rhamnosus GG (moderate QoE, strong recommendation) or Saccharomyces boulardii (moderate QoE, strong recommendation). If the use of probiotics for preventing Clostridium difficile-associated diarrhea is considered, the WG suggests using S boulardii (low QoE, conditional recommendation). Other strains or combinations of strains have been tested, but sufficient evidence is still lacking.

The scale of the evidence base on the health effects of conventional yogurt consumption: findings of a scoping review

BACKGROUND

The health effects of conventional yogurt have been investigated for over a century; however, few systematic reviews have been conducted to assess the extent of the health benefits of yogurt.

OBJECTIVE

The aim of this scoping review was to assess the volume of available evidence on the health effects of conventional yogurt.

METHODS

The review was guided by a protocol agreed a priori and informed by an extensive literature search conducted in November 2013. Randomized controlled trials were selected and categorized according to the eligibility criteria established in the protocol.

RESULTS

213 studies were identified as relevant to the scoping question. The number of eligible studies identified for each outcome were: bone health (14 studies), weight management and nutrition related health outcomes (81 studies), metabolic health (6 studies); cardiovascular health (57 studies); gastrointestinal health (24 studies); cancer (39 studies); diabetes (13 studies), Parkinson's disease risk (3 studies), all-cause mortality (3 studies), skin complaints (3 studies), respiratory complaints (3 studies), joint pain/function (2 studies); the remaining 8 studies reported a variety of other outcomes. For studies of a similar design and which assessed the same outcomes in similar population groups, we report the potential for the combining of data across studies in systematic reviews.

CONCLUSIONS

This scoping review has revealed the extensive evidence base for many outcomes which could be the focus of systematic reviews exploring the health effects of conventional yogurt consumption.