Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Sep 26, 2015; 5(3): 157-163
Published online Sep 26, 2015. doi: 10.5662/wjm.v5.i3.157
Early probiotics to prevent childhood metabolic syndrome: A systematic review
Haribalakrishna Balasubramanian, Sanjay Patole
Haribalakrishna Balasubramanian, Sanjay Patole, Department of Neonatal Paediatrics, KEM Hospital for Women, Subiaco, Perth WA 6008, Australia
Sanjay Patole, Centre for Neonatal Research and Education, University of Western Australia, Perth WA 6008, Australia
Author contributions: Patole S was responsible for concept and design of the study, initial literature search and revision of the manuscript; Balasubramanian H was responsible for acquisition and interpretation of data and wrote the first draft of the manuscript; both authors approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author Prof. Sanjay Patole at olof.skoldenberg@ki.se.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sanjay Patole, Professor, Department of Neonatal Paediatrics, KEM Hospital for Women, 374 Bagot Road, Subiaco, Perth WA 6008, Australia. sanjay.patole@health.wa.gov.au
Telephone: +61-8-93401260
Received: January 27, 2015
Peer-review started: January 28, 2015
First decision: March 6, 2015
Revised: April 5, 2015
Accepted: June 18, 2015
Article in press: June 19, 2015
Published online: September 26, 2015
Processing time: 231 Days and 15.9 Hours
Abstract

AIM: To conduct a systematic review of studies on early probiotic supplementation to prevent childhood metabolic syndrome (MS).

METHODS: Using the Cochrane systematic review strategy we searched PubMed, EMBASE, CENTRAL, CINAHL, and the conference proceedings of the Pediatric American Society meetings and trial registries in December 2014. Randomised controlled trials (RCTs) and non RCTs of probiotic supplementation to the mother and/or infant for a minimum duration of 4 wk were selected. Of these, studies that reported on MS or its components (obesity, raised blood pressure, hyperglycemia, dyslipidemia) in children between 2-19 years were to be eligible for inclusion in the review. Risk of bias (ROB) in selected RCTs and quality assessment of non-RCT studies were to be assessed by the Cochrane ROB assessment table and New Castle Ottawa scale.

RESULTS: There were no studies on early probiotic administration for prevention of childhood MS (CMS). Follow up studies of two placebo controlled RCTs (n = 233) reported on the effects of early probiotics on one or more components of MS in children aged 2-19 years. Meta-analysis of those two studies could not be performed due to differences in the patient population, type of outcomes studied and the timing of their assessment. Assessment of childhood metabolic outcomes was not the primary objective of these studies. The first study that assessed the effects of prenatal and postnatal supplementation of Lactobacillus rhamnosus GG on body mass index till 10 years, did not report a significant benefit. In the second study, Lactobacillus paracasei 19 was supplemented to healthy term infants from 4-13 mo. No significant effect on body mass index, body composition or metabolic markers was detected.

CONCLUSION: Current evidence on early probiotic administration to prevent CMS is inadequate. Gaps in knowledge need to be addressed before large RCTs can be planned.

Keywords: Metabolic syndrome; Obesity; Probiotic; Infant; Perinatal; Children

Core tip: Metabolic syndrome (MS) is a state of dysregulated glucose and lipid metabolism. The global health burden due to increasing prevalence of MS in children and adolescents, warrants urgent preventive interventions. Altered gut microbiota has been implicated in the pathogenesis of MS. The role of maternal and/or infant probiotic supplementation in improving metabolic health of the offspring is being researched. We provide a systematic review of this evidence. Gaps in the knowledge and issues regarding selection of patient population, probiotic intervention and outcomes for future trials have been discussed.