Prebiotic and probiotic fortified milk in prevention of morbidities among children: community-based, randomized, double-blind, controlled trial

• Published in: PloS one Vol. 5; no. 8; p. e12164
• Main Authors: Sazawal, Sunil, Dhingra, Usha, Hiremath, Girish, Sarkar, Archana, Dhingra, Pratibha, Dutta, Arup, Verma, Priti, Menon, Venugopal P, Black, Robert E
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13-08-2010; Public Library of Science (PLoS)
• Subjects: Animals; Babies; Baby foods; Bacteria; Bifidobacterium - physiology; Bifidobacterium animalis; Bifidobacterium lactis; Biochemistry; Child care; Child, Preschool; Children; Children & youth; Clinical trials; Communities; Confidence intervals; Consent; Day care centers; Developing countries; Diarrhea; Diarrhea - epidemiology; Diarrhea - prevention & control; Disease prevention; Diseases; Double-Blind Method; Double-blind studies; Dysentery; Epidemiology; Fever; Food, Fortified - microbiology; Health aspects; Health care; Humans; Illiteracy; Illnesses; Incidence; Infant; Infections; Infectious Diseases; Intensive care; Lactobacillus; Lactobacillus acidophilus; Lactobacillus reuteri; LDCs; Medical research; Milk; Milk - microbiology; Milk fever; Morbidity; Nosocomial infections; Nutrition; Nutrition/Deficiencies; Nutrition/Malnutrition; Oligosaccharides - pharmacology; Pediatrics; Pediatrics and Child Health; Pediatrics and Child Health/Adolescent Medicine; Pediatrics and Child Health/Child Development; Prebiotics; Preschool children; Probiotics; Public health; Public Health and Epidemiology; Public Health and Epidemiology/Global Health; Randomization; Respiratory Tract Infections - epidemiology; Respiratory Tract Infections - prevention & control; Streptococcus thermophilus; Time; Urban Population; Waterborne diseases; Yogurt; United States > US; Maryland; Baltimore Maryland; India
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0012164

Recent reviews suggest common infectious diseases continue to be a major cause of death among preschool children in developing countries. Identification of feasible strategies to combat this disease burden is an important public health need. We evaluated the efficacy of adding prebiotic oligosaccharide and probiotic Bifidobacterium lactis HN019 to milk, in preventing diarrhea, respiratory infections and severe illnesses, in children aged 1-4 years as part of a four group study design, running two studies simultaneously.
In a community based double-masked, randomized controlled trial, children 1-3 years of age, willing to participate, were randomly allocated to receive either control milk (Co; n = 312) or the same milk fortified with 2.4 g/day of prebiotic oligosaccharide and 1.9x10(7) colony forming unit (c.f.u)/day of probiotic Bifidobacterium lactis HN019 (PP; n = 312). Children were followed up for 1 year providing data for 1-4 years. Biweekly household surveillance was conducted to gather information on compliance and morbidity. Both study groups were comparable at baseline; compliance to intervention was similar. Overall, there was no effect of prebiotic and probiotic on diarrhea (6% reduction, 95% Confidence Interval [CI]: -1 to 12%; p = 0.08). Incidence of dysentery episodes was reduced by 21% (95% CI: 0 to 38%; p = 0.05). Incidence of pneumonia was reduced by 24% (95% CI: 0 to 42%; p = 0.05) and severe acute lower respiratory infection (ALRI) by 35% (95% CI: 0 to 58%; p = 0.05). Compared to children in Co group, children in PP group had 16% (95% CI: 5 to 26%, p = 0.004) and 5% (95% CI: 0 to 10%; p = 0.05) reduction in days with severe illness and high fever respectively.
Milk can be a good medium for delivery of prebiotic and probiotic and resulted in significant reduction of dysentery, respiratory morbidity and febrile illness. Overall, impact of diarrhea was not significant. These findings need confirmation in other settings.