Study: Prebiotics and Probiotics in Young Children

reference

Sazawal S, Dhingra U, Hiremath G, et al. Effects of Bifidobacterium lactis HN019 and addition of prebiotic oligosaccharide to milk on iron status, anemia and growth in children aged 1 to 4 years.J Pediatr Gastroenterol Nutr. June 30, 2010. [Epub ahead of print]

design

Double-blind, randomized, controlled, community-based trial.

Participant

624 children aged 1-4 years in New Delhi were randomized to receive either control milk or fortified milk. Hematological parameters were assessed at baseline and at the end of the study. Height and weight were measured at baseline, mid-study, and end of the study.

Study medications and dosage

Participants received either control milk or milk fortified with additional 1.9 x 107 colony-forming units of Bifidobacterium lactis HN019 and 2.4 g/day of prebiotic oligosaccharides for one year.

Key findings

Consumption of the milk enriched with prebiotics and probiotics reduced the risk of anemia and iron deficiency by 45% and increased weight gain by 0.13 kg/year compared to controls.

Effects on practice

According to the World Health Organization (WHO), 47.4% of preschool-age children and 25.4% of school-age children worldwide suffer from anemia. It is believed that around half of these anemias are due to iron deficiency. In the United States, the WHO does not consider anemia a public health problem, with only 3.1% of preschool children classified as anemic.¹However, poor, minority, and immigrant children and young children are still at risk of iron deficiency with and without anemia.²

This study by Sazawal suggests a possible solution to the global problem of nutritional deficiencies and, in particular, provides new insights into the treatment and prevention of anemia. The beneficial effects of probiotics in the treatment of diarrhea are well documented, although it appears that they may have a more widespread physiological effect than previously thought.³In a parallel study, milk fortified with prebiotics and probiotics reduced the number of episodes of dysentery, severe illness and high fever. A healthy ratio of beneficial gut bacteria in infancy has also been shown to protect against overweight and obesity later in life.^{4, 5}and associated with a reduced risk of gestational diabetes.⁶

Regarding the role of probiotics in the treatment of anemia, relevant studies show that children given an iron-fortified fermented milk drink with added Lactobacillus acidophilus had higher red blood cell counts and were more likely to have improved hemoglobin levels with increased iron intake.⁷These studies provide evidence for the use of Lactobacillus acidophilus and Bifidobacterium lactis to prevent anemia in children.

What may be more relevant to our patients in the United States and the growing obesity trend is the association between increased BMI and decreased iron status.

What may be more relevant to our patients in the United States and the growing obesity trend is the association between increased BMI and decreased iron status. According to a 2004 Pediatrics article, overweight and obese children are about twice as likely to suffer from iron deficiency.⁸Probiotic supplementation in children can be expected to provide many benefits, including a stronger immune system and a reduction in the risk of obesity and iron deficiency. One explanation is that the large amounts of calcium in milk may have a protective effect against the development of obesity, type 2 diabetes, metabolic syndrome and ischemic cardiovascular disease by reducing intestinal fat absorption.⁹It may be worth considering a similar intervention with fortified milk in obese children to counteract not only the development of such conditions but also the associated risk of iron deficiency.

While anemia certainly impairs cognitive development, Lozoff et al. also shown a connection between iron deficiency with and without anemia and poorer behavior in infants.¹⁰A relatively simple intervention like the one described in this study could have profound effects on infants' social and emotional development.

This study not only highlights the importance of gut bacteria, but also reminds us of the importance of prebiotics. A trial of probiotic-only infant formula did not improve infant growth, and Laparra et al. showed that adding inulin as a prebiotic to Lactobacillus acidophilus increased iron absorption from beans, but when added, it decreased iron absorptionBifidobacterium infantis.^{11, 12}

Probiotics continue to represent a safe and non-invasive intervention that should be considered not only for gastrointestinal disorders, but also as adjunctive therapy for anemia or risk of anemia.