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1.
Effect of nutritional support in patients with lower respiratory tract infection: Secondary analysis of a randomized clinical trial.
Baumgartner, A, Hasenboehler, F, Cantone, J, Hersberger, L, Bargetzi, A, Bargetzi, L, Kaegi-Braun, N, Tribolet, P, Gomes, F, Hoess, C, et al
Clinical nutrition (Edinburgh, Scotland). 2021;(4):1843-1850
Abstract
BACKGROUND In polymorbid patients with bronchopulmonary infection, malnutrition is an independent risk factor for mortality. There is a lack of interventional data investigating whether providing nutritional support during the hospital stay in patients at risk for malnutrition presenting with lower respiratory tract infection lowers mortality. METHODS For this secondary analysis of a randomized clinical trial (EFFORT), we analyzed data of a subgroup of patients with confirmed lower respiratory tract infection from an initial cohort of 2028 patients. Patients at nutritional risk (Nutritional Risk Screening [NRS] score ≥3 points) were randomized to receive protocol-guided individualized nutritional support to reach protein and energy goals (intervention group) or standard hospital food (control group). The primary endpoint of this analysis was all-cause 30-day mortality. RESULTS We included 378 of 2028 EFFORT patients (mean age 74.4 years, 24% with COPD) into this analysis. Compared to usual care hospital nutrition, individualized nutritional support to reach caloric and protein goals showed a similar beneficial effect of on the risk of mortality in the subgroup of respiratory tract infection patients as compared to the main EFFORT trial (odds ratio 0.47 [95%CI 0.17 to 1.27, p = 0.136] vs 0.65 [95%CI 0.47 to 0.91, p = 0.011]) with no evidence of a subgroup effect (p for interaction 0.859). Effects were also similar among different subgroups based on etiology and type of respiratory tract infection and for other secondary endpoints. CONCLUSION This subgroup analysis from a large nutrition support trial suggests that patients at nutritional risk as assessed by NRS 2002 presenting with bronchopulmonary infection to the hospital likely have a mortality benefit from individualized inhospital nutritional support. The small sample size and limited statistical power calls for larger nutritional studies focusing on this highly vulnerable patient population. CLINICAL TRIAL REGISTRATION Registered under ClinicalTrials.gov Identifier no. NCT02517476.
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2.
Soluble and Insoluble Yeast β-Glucan Differentially Affect Upper Respiratory Tract Infection in Marathon Runners: A Double-Blind, Randomized Placebo-Controlled Trial.
Mah, E, Kaden, VN, Kelley, KM, Liska, DJ
Journal of medicinal food. 2020;(4):416-419
Abstract
In a previous study, consumption of a dairy beverage incorporating insoluble β-glucan decreased upper respiratory tract infection (URTI) symptomatic days and severity in marathon runners. In this report, we extended our previous findings by presenting data on a dairy beverage containing soluble β-glucan and URTI in marathon runners. Healthy adults running in the 2017 Austin Marathon consumed dairy beverages (250 mL/day) containing 250 mg of insoluble (n = 69) or soluble (n = 76) baker's yeast β-glucan (Wellmune®) or placebo (n = 133) for the 45 days before, day of, and 45 days after the marathon (91 days total). Participants completed a daily online survey assessing compliance and URTI symptoms, which were evaluated using the Jackson Index and confirmed by the study physician. Total severity of URTI was significantly lower in the insoluble yeast β-glucan group compared to the placebo group, but was not different between the soluble yeast β-glucan group and placebo group. Severity ratings for nasal discharge were significantly lower in both the insoluble and soluble yeast β-glucan groups compared to the placebo group. Additionally, severity rating for sore throat was lower in the insoluble, but not the soluble yeast β-glucan group compared to the placebo group. The insoluble yeast β-glucan group, but not the soluble yeast β-glucan group also reported fewer URTI symptomatic days compared to the placebo group. The results suggest that soluble and insoluble yeast β-glucan, incorporated into a food matrix, differentially affected exercise-induced URTI in marathon runners.
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3.
Beverage Containing Dispersible Yeast β-Glucan Decreases Cold/Flu Symptomatic Days After Intense Exercise: A Randomized Controlled Trial.
Mah, E, Kaden, VN, Kelley, KM, Liska, DJ
Journal of dietary supplements. 2020;(2):200-210
Abstract
In this double-blind, randomized, placebo-controlled parallel study, we examined the effect of dairy-based beverages (250 mL/day) containing 250 mg of dispersible baker's yeast β-glucan (Wellmune) compared to a macronutrient- and calorie-matched control on upper respiratory tract infection (URTI) in marathon runners. Healthy adults running in the 2017 Austin Marathon consumed either β-glucan (N = 132) or control (N = 225) for the 45 days prior to, day of, and 45 days after the marathon (91 days total). Participants completed a daily online survey assessing compliance, training status, and URTI symptoms. URTI occurrence and severity were evaluated using the Jackson Index and confirmed by the study physician. No significant differences in average duration and number of URTI episodes were found between β-glucan and control. However, those who completed the study per protocol on the β-glucan beverage reported significantly fewer URTI symptomatic days (3.43 ± 6.44 days, max 27 days) compared to those on control beverage (3.84 ± 6.84 days, max 49 days). Total URTI severity was significantly lower for β-glucan (4.52 ± 1.61) compared to control (5.60 ± 2.23). Specifically, lower (p < .05) severity ratings for nasal discharge and sore throat were reported for β-glucan compared to control. Average missed postmarathon workout days due to URTI were significantly less for β-glucan (0.09 ± 0.38 days, max 2 days) compared to control (0.36 ± 1.40 days, max 10 days). Overall, consumption of dairy-based beverages containing dispersible yeast β-glucan decreased URTI symptomatic days, severity of specific URTI symptoms, and missed postmarathon workout days due to URTI, without affecting duration and number of URTI episodes.
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4.
Intake of 25-Hydroxyvitamin D3 May Reduce the Severity of Upper Respiratory Tract Infection: Post hoc Analysis of a Randomized, Double-Blind, Placebo-Controlled, Parallel Group Comparison Study.
Shimizu, Y, Ito, Y, Uotsu, N, Yui, K
Nutrients. 2020;(12)
Abstract
To evaluate the effects of 25-hydroxyvitamin D3 (25OHD) on symptoms at the onset of the upper respiratory tract infection (URTI) in subjects with insufficient or deficient serum 25-hydroxyvitamin D levels, we conducted a post hoc analysis of data from a randomized, placebo-controlled study; the subjects received 10 μg of 25OHD per day or a placebo for 16 weeks. The Wisconsin Upper Respiratory Symptom Survey-21 was used to determine URTI. The study endpoints included WURSS-21 scores, number of URTI events, and proportion of medication (antibiotics, antipyretic analgesics) usage. We found that the physical symptom scores for "Runny nose," "Sneezing," and "Head congestion" were significantly lower in the 25OHD group than in the placebo group; for all items except "Breathe easily, "the quality of life" scores were significantly improved in the 25OHD group. There was no significant difference in the number of URTI events or the proportion of medication use between the groups. Collectively, the findings of this study indicate that a sufficient 25OHD intake can reduce physical symptoms at the onset of upper respiratory tract infection, particularly nasal symptoms, and may improve the quality of life at the time of onset.
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5.
Influence of Dietary Advice Including Green Vegetables, Beef, and Whole Dairy Products on Recurrent Upper Respiratory Tract Infections in Children: A Randomized Controlled Trial.
van der Gaag, E, Brandsema, R, Nobbenhuis, R, van der Palen, J, Hummel, T
Nutrients. 2020;(1)
Abstract
BACKGROUND Since no treatment exists for children suffering from upper respiratory tract infections (URTIs) without immunological disorders, we searched for a possible tool to improve the health of these children. AIM: We evaluated whether dietary advice (based on food matrix and food synergy), including standard supportive care, can decrease the number and duration of URTIs in children with recurrent URTIs. DESIGN AND SETTING This study was a multicenter randomized controlled trial in two pediatric outpatient clinics in the Netherlands, with 118 children aged one to four years with recurrent URTIs. The dietary advice group received dietary advice plus standard supportive care, while the control group received standard supportive care alone for six months. The dietary advice consisted of green vegetables five times per week, beef three times per week, 300 mL whole milk per day, and whole dairy butter on bread every day. Portion sizes were age-appropriate. RESULTS AND CONCLUSION Children in the dietary advice group had 4.8 (1.6-9.5) days per month with symptoms of an URTI in the last three months of the study, compared to 7.7 (4.0-12.3) in the control group (p = 0.028). The total number of URTIs during the six-month study period was 5.7 (0.55) versus 6.8 (0.49), respectively (p = 0.068). The use of antibiotics was significantly reduced in the dietary advice group, as well as visits to a general practitioner, thereby possibly reducing healthcare costs. The results show a reduced number of days with symptoms of a URTI following dietary advice. The number of infections was not significantly reduced.
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6.
A Prospective Study on Child Morbidity and Gut Microbiota in Rural Malawi.
Kortekangas, E, Young, R, Cheung, YB, Fan, YM, Jorgensen, JM, Kamng'ona, AW, Chaima, D, Ashorn, U, Dewey, KG, Maleta, K, et al
Journal of pediatric gastroenterology and nutrition. 2019;(4):431-437
Abstract
OBJECTIVES The determinants of gut microbiota composition and its effects on common childhood illnesses are only partly understood, especially in low-income settings. The aim of the present study was to investigate whether morbidity predicts gut microbiota composition in Malawian children and whether microbiota predicts subsequent morbidity. We tested the hypothesis that common infectious disease symptoms would be predictive of lower microbiota maturity and diversity. METHODS We used data from 631 participants in a randomized-controlled nutrition intervention trial, in which a small-quantity lipid-based nutrient supplement was provided to pregnant and lactating mothers and their children at 6 to 18 months of age. Fecal samples were collected from the children at 6, 12, 18, and 30 months of age and analyzed using 16S rRNA sequencing. Microbiota variables consisted of measures of microbiota diversity (Shannon Index), microbiota maturity (microbiota-for-age z score), and the relative abundances of taxa. Morbidity variables included gastrointestinal and respiratory symptoms and fever. RESULTS Diarrhea and respiratory symptoms from 11 to 12 months were predictive of lower microbiota-for-age z score and higher Shannon Index, respectively (P = 0.035 and P = 0.023). Morbidity preceding sample collection was predictive of the relative abundances of several bacterial taxa at all time points. Higher microbiota maturity and diversity at 6 months were predictive of a lower incidence rate of fever in the subsequent 6 months (P = 0.007 and P = 0.031). CONCLUSIONS Our findings generally do not support the hypothesis that morbidity prevalence predicts a subsequent decrease in gut microbiota maturity or diversity in rural Malawian children. Certain morbidity symptoms may be predictive of microbiota maturity and diversity and relative abundances of several bacterial taxa. Furthermore, microbiota diversity and maturity may be associated with the subsequent incidence of fever.
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7.
Kikyo-to vs. Placebo on Sore Throat Associated with Acute Upper Respiratory Tract Infection: A Randomized Controlled Trial.
Ishimaru, N, Kinami, S, Shimokawa, T, Kanzawa, Y
Internal medicine (Tokyo, Japan). 2019;(17):2459-2465
Abstract
Objective Kikyo-to (KKT) is a fixed combination of glycyrrhiza root and platycodon root extracts. It is an herbal medicine traditionally used in Japan for relieving sore throat associated with acute upper respiratory tract infection (URTI). No controlled studies have yet demonstrated its effect, however. We investigated the efficacy of KKT on sore throat associated with acute URTI. Methods Patients with sore throat who were diagnosed with URTI at the General Medicine Department Office, Akashi Medical Center Hospital, between December 2017 and May 2018 were enrolled. Participants were randomly assigned to two groups at a 1:1 ratio, with stratification by age and sore throat score on a Visual Analogue Scale (VAS), to receive 2.5 g of either KKT or a placebo. Participants and investigators were blinded to group allocation. The primary outcome was the change in sore throat score on VAS 10 minutes after KKT administration. Secondary outcomes were the impact of the sore throat on daily life (none, mild, moderate, and severe) at 10 minutes after administration. Results Thirty-five participants were assigned to each group (n=70, total). The difference in the mean change of sore throat score according to VAS within 10 minutes between the two groups was not statistically significant (KKT 14.40 vs. placebo 17.00; p=0.39). The proportion of patients with a moderate or greater impact of their sore throat on their daily life was also not significantly different between the groups (KKT 22.9% vs. placebo 40.0%; p=0.20). Patients reported no side effects. Conclusion KKT did not significantly relieve sore throat associated with acute URTI compared with placebo.
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8.
Infection Status of Rural Schoolchildren and its Relationship with Vitamin D Concentrations.
Mandlik, R, Chiplonkar, S, Kajale, N, Khadilkar, V, Khadilkar, A
Indian journal of pediatrics. 2019;(8):675-680
Abstract
OBJECTIVES To assess the nutritional and infection status of rural schoolchildren and to study the relationship of infection status with serum 25(OH)D concentrations. METHODS This study was carried out in a primary school, in a rural setting, near Pune (18°N), Maharashtra. Data collected from 387 children included anthropometric, clinical, infection-related data (using a validated questionnaire) and dietary data (by 24-h recall method over 3 non-consecutive days, including a holiday) and serum 25(OH)D estimations (by ELISA). RESULTS Prevalence of underweight and stunting were 18% and 11% respectively. Upper respiratory tract infection (URTI) related symptoms were commonly reported. Episodes of URTI were found to be significantly and negatively correlated with serum 25(OH)D concentrations (rs = -0.14, p < 0.05) and lesser URTI episodes and duration were reported by children who were vitamin D sufficient as compared to those who were insufficient. No association of total infections was found with vitamin D status. CONCLUSIONS Moderate prevalence of underweight and stunting and frequent URTIs were observed in this population. Higher serum 25(OH)D concentrations and vitamin D sufficiency may be important for prevention of upper respiratory tract infections in rural children.
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9.
Effects of pidotimod and bifidobacteria mixture on clinical symptoms and urinary metabolomic profile of children with recurrent respiratory infections: a randomized placebo-controlled trial.
Santamaria, F, Montella, S, Stocchero, M, Pirillo, P, Bozzetto, S, Giordano, G, Poeta, M, Baraldi, E
Pulmonary pharmacology & therapeutics. 2019;:101818
Abstract
BACKGROUND Many preschool children develop recurrent respiratory tract infections (RRI). Strategies to prevent RRI include the use of immunomodulators as pidotimod or probiotics, but there is limited evidence of their efficacy on clinical features or on urine metabolic profile. OBJECTIVE To evaluate whether pidotimod and/or bifidobacteria can reduce RRI morbidity and influence the urine metabolic profile in preschool children. MATERIALS AND METHODS Children aged 3-6 years with RRI were enrolled in a four-arm, exploratory, prospective, randomized, double-blinded, placebo-controlled trial. Patients were randomly assigned to receive pidotimod plus bifidobacteria, pidotimod plus placebo, bifidobacteria plus placebo or double placebo for the first 10 days of each month over 4 consecutive months. Respiratory symptoms and infections were recorded with a daily diary by parents during the study. Metabolomic analyses on urine samples collected before and after treatment were performed. RESULTS Compared to placebo, children receiving pidotimod, alone or with bifidobacteria, had more symptom-free days (69 versus 44, p = 0.003; and 65 versus 44, p = 0.02, respectively) and a lower percentage of days with common cold (17% versus 37%, p = 0.005; and 15% versus 37%, p = 0.004, respectively). The metabolomic analysis showed that children treated with Pidotimod (alone or in combination with bifidobacteria) present, respect to children treated with placebo, a biochemical profile characterized by compounds related to the pathway of steroids hormones, hippuric acid and tryptophan. No significant difference in the metabolic profile was found between children receiving bifidobacteria alone and controls. CONCLUSIONS Preschool children with RRI treated with pidotimod have better clinical outcomes and a different urine metabolomic profile than subjects receiving placebo. Further investigations are needed to clarify the connection between pidotimod and gut microbiome.
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10.
Effect of High-Dose Vitamin D Supplementation on Upper Respiratory Tract Infection Symptom Severity in Healthy Children.
Hueniken, K, Aglipay, M, Birken, CS, Parkin, PC, Loeb, MB, Thorpe, KE, Dai, DWH, Laupacis, A, Mamdani, M, Mazzulli, T, et al
The Pediatric infectious disease journal. 2019;(6):564-568
Abstract
BACKGROUND Observational studies support the role of vitamin D in reducing viral upper respiratory tract infection (URTI) symptom severity in adults and children. This study assessed whether wintertime high-dose vitamin D supplementation (2000 IU/day) reduces URTI symptom severity compared with standard-dose (400 IU/day) supplementation in preschool children. Secondary objectives were to assess effects of high-dose supplementation on outpatient physician visits, emergency department (ED) visits and antibiotic prescriptions for URTI. METHODS This was a secondary analysis of a multisite randomized clinical trial involving 703 healthy 1- to 5-year-old children in Toronto, Canada. High-dose or standard-dose oral vitamin D was randomly assigned for 1 winter season. For each URTI, parents completed symptom checklists based on the Canadian Acute Respiratory and Flu Scale. Symptom severity, frequency of outpatient visits, ED visits and antibiotic prescriptions for URTI between groups were analyzed using negative binomial regression. RESULTS URTI symptom severity was not reduced in the high-dose vs. standard-dose group [incidence rate ratio (IRR) = 0.97; 95% confidence interval (CI): 0.76-1.23]. High-dose vitamin D did not decrease frequency of outpatient visits (IRR = 1.16; 95% CI: 0.84-1.60), ED visits (IRR = 1.17; 95% CI: 0.57-2.40) or antibiotic prescriptions (IRR=1.02; 95% CI: 0.61-1.72). Serum 25-hydroxyvitamin D was higher in the high-dose group (48.7 ng/mL; 95% CI: 46.9-50.5) than the standard-dose group (36.8 ng/mL; 95% CI: 35.4-38.2; P < 0.001). CONCLUSIONS High-dose vitamin D supplementation did not reduce URTI symptom severity, outpatient visits, ED visits or antibiotic prescriptions relative to standard-dose. These results do not support vitamin D supplementation above the standard recommended dose for reducing URTI symptoms in children.