Effect of Probiotics on Diarrhea in Children With Severe Acute Malnutrition: A Randomized Controlled Study in Uganda
Benedikte Grenov1, Hanifa Namusoke, Betty Lanyero
1*Department of Nutrition, Exercise, and Sports, University of Copenhagen, Denmark †Mwanamugimu Nutrition Unit, Department of Pediatrics and Child Health, Mulago National Referral Hospital, Kampala, Uganda.
Insights
Probiotics did not reduce diarrhea in hospitalized children with severe acute malnutrition (SAM). However, the blend of Bifidobacterium animalis subsp lactis and Lactobacillus rhamnosus reduced diarrhea days by 26% during outpatient treatment for SAM.
Area of Science:
- Pediatric Nutrition
- Gastroenterology
- Microbiology
Background:
- Severe acute malnutrition (SAM) in children is often associated with gastrointestinal issues like diarrhea.
- Probiotics are investigated for their potential to modulate gut health and reduce infectious complications in vulnerable populations.
Purpose of the Study:
- To evaluate the efficacy of a specific probiotic blend in managing diarrhea among children with SAM.
- To assess the impact of probiotics on both inpatient and outpatient treatment phases for SAM.
Main Methods:
- A randomized, double-blind, placebo-controlled trial involving 400 children with SAM.
- Participants received daily doses of Bifidobacterium animalis subsp lactis and Lactobacillus rhamnosus or a placebo.
- Outcomes were assessed separately for inpatient hospitalization and an 8- to 12-week outpatient follow-up period.
Main Results:
- No significant difference in diarrhea duration was observed during inpatient treatment between probiotic and placebo groups.
- Probiotic supplementation led to a significant reduction in diarrhea days during the outpatient treatment phase (-2.2 days).
- No effects were noted on diarrhea incidence, severity, pneumonia, weight gain, or recovery rates.
Conclusions:
- The probiotic blend showed no benefit for diarrhea during hospitalization of children with SAM.
- A significant reduction in diarrhea days was observed with probiotics during the outpatient treatment phase.
- Further research is warranted to explore the role of probiotics in the follow-up care of SAM patients and community-based malnutrition treatment.
Objectives:
The aim of the study was to assess the effect of probiotics on diarrhea during in- and outpatient treatment of children with severe acute malnutrition (SAM).
Methods:
A randomized, double-blind, placebo-controlled study was conducted involving 400 children admitted with SAM. Patients received 1 daily dose of a blend of Bifidobacterium animalis subsp lactis and Lactobacillus rhamnosus (10 billion colony-forming units, 50:50) or placebo during hospitalization followed by an 8- to 12-week outpatient treatment period, depending on patients' recovery rate. All outcomes were reported for in- and outpatient treatment separately. The primary outcome was number of days with diarrhea during hospitalization. Secondary outcomes included other diarrhea outcomes, pneumonia, weight gain, and recovery.
Results:
There was no difference in number of days with diarrhea between the probiotic (n = 200) and placebo (n = 200) groups during inpatient treatment (adjusted difference +0.2 days, 95% confidence interval -0.8 to 1.2, P = 0.69); however, during outpatient treatment, probiotics reduced days with diarrhea (adjusted difference -2.2 days 95% confidence interval -3.5 to -0.3, P = 0.025). There were no effects of probiotics on diarrhea incidence and severity or pneumonia, weight gain or recovery during in- or outpatient treatment. Twenty-six patients died in the probiotic versus 20 in the placebo group (P = 0.38).
Conclusions:
Bifidobacterium animalis subsp lactis and Lactobacillus rhamnosus had no effect on diarrhea in children with SAM during hospitalization, but reduced the number of days with diarrhea in outpatient treatment by 26%. Probiotics may have a role in follow-up of hospitalized children with SAM or in community-based treatment of malnourished children, but further studies are needed to confirm this.
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