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The efficacy of fermented foods in the treatment and management of diarrhoeal diseases: A systematic review and meta-analysis.
Olayanju, A, Mellor, D, Khatri, Y, Pickles, N
Nutrition and health. 2023;29(1):71-83
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According to World Health Organisation (WHO), diarrhoeal disease is the second leading cause of death among children under the age of 5 in the world. The WHO’s recommendation for the treatment of diarrhoea is oral rehydration solution (ORS), consisting of a solution of clean water, sugar and salt along with a 10-14 day supplemental treatment course of dispersible 20 mg zinc tablets. The aim of this study was to evaluate the available evidence with respect to the efficacy of fermented foods and beverages in comparison with unfermented or heat-treated products, including dairy and cereal products, focussing on the treatment of diarrhoea in infants. This study is a systematic review and meta-analysis of seven randomised controlled trials. Results show that administering fermented foods during an episode of diarrhoea in infants under five years of age, may reduce the duration of the disease in comparison to the control groups. There was no clear effect on daily stool frequency, but duration of hospitalisation was reduced following administration of fermented foods. Authors conclude that fermented foods may be helpful in the treatment of diarrhoea in infants up to the age of five. Thus, more good quality trials are required to investigate the complex matrix of fermented food products, other than dairy foods, in the management, particularly treatment of gastrointestinal diseases such as diarrhoea.
Abstract
Background: Diarrhoeal disease is a major cause of global infant mortality, and compromises the ability of many countries with respect to achieving sustainable development goals. The WHO's recommendation of Oral Rehydration Solution (ORS) and zinc in the management of this disease, may not be readily available. Consideration and assessment of cultural practices in its management has been an area of increased interest over the last decade. Aim: This study aims to systematically evaluate efficacy of the consumption of traditional fermented foods as functional products for the treatment and management of diarrhoea. Methods: Following PRISMA guidelines, a systematic review was conducted of electronic databases (Cochrane Library, Ovid Medline and Pubmed) databases with no restrictions on language and publication date for RCTs that investigated the effect of consumption of fermented foods on the treatment of diarrhoea in children under five years of age. Results: Seven RCTs were included. Meta-analysis showed that compared to control, consumption of fermented foods significantly reduced mean duration of diarrhoea, -0.61 days; (95% CI, -1.04, -0.18); length of hospitalization, -0.35 days (95% CI, -0.69, -0.02); but not mean daily frequency of stool -2.00 (95% CI,-7.03, 3.04). Conclusion: Limited available evidence suggests that consumption of fermented foods may help reduce duration and severity of symptoms as a treatment of diarrhoea. More high quality research needs to be undertaken to investigate the efficacy of fermented food as an effective alternative to ORS as a potential WHO recommendation for management of diarrhoeal disease.
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Effect of Fructooligosaccharides Supplementation on the Gut Microbiota in Human: A Systematic Review and Meta-Analysis.
Dou, Y, Yu, X, Luo, Y, Chen, B, Ma, D, Zhu, J
Nutrients. 2022;14(16)
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Fructooligosaccharide is a prebiotic fibre that undergoes fermentation in the gut, due to which it can cause gas and bloat. Additionally, this prebiotic fibre ferments to produce short-chain fatty acids, which are beneficial for the body. This systematic review and meta-analysis included eight randomised controlled trials investigating the effects of fructooligosaccharide on gut microbial composition. Short-term supplementation with fructooligosaccharide altered the gut’s microbial composition without causing any adverse effects. Bifidobacterium spp. levels were elevated in those who consumed fructooligosaccharide supplements than those who did not. Supplementation with fructooligosaccharide did not significantly change harmful bacteria such as Bacteroides and Enterobacteriaceae levels. In addition, a higher dosage of 7.5–15 g/d of fructooligosaccharide supplementation for a period of more than four weeks was found to be beneficial. Healthcare professionals can use these results to understand better how fructooligosaccharide modulates beneficial gut bacteria such as Bifidobacterium spp. However, there is a need for more robust studies since the number of currently available studies is limited, and the exact health implications of fructooligosaccharide supplementation need to be evaluated further.
Abstract
Background: Numerous studies have investigated the effects of the supplementation of fructooligosaccharides (FOS) on the number of bacteria in the gut that are good for health, but the results have been inconsistent. Additionally, due to its high fermentability, supplementation of FOS may be associated with adverse gastrointestinal symptoms such as bloating and flatulence. Therefore, we assessed the effects of FOS interventions on the composition of gut microbiota and gastrointestinal symptoms in a systematic review and meta-analysis. Design: All randomized controlled trials published before 10 July 2022 that investigated the effects of FOS supplementation on the human gut microbiota composition and gastrointestinal symptoms and met the selection criteria were included in this study. Using fixed or random-effects models, the means and standard deviations of the differences between the two groups before and after the intervention were combined into weighted mean differences using 95% confidence intervals (CIs). Results: Eight studies containing 213 FOS supplements and 175 controls remained in this meta-analysis. Bifidobacterium spp. counts significantly increased during FOS ingestion (0.579, 95% CI: 0.444-0.714) in comparison with that of the control group. Subgroup analysis showed greater variation in Bifidobacterium spp. in adults (0.861, 95% CI: 0.614-1.108) than in infants (0.458, 95% CI: 0.297-0.619). The increase in Bifidobacterium spp. counts were greater in the group with an intervention duration greater than 4 weeks (0.841, 95% CI: 0.436-1.247) than an intervention time less than or equal to four weeks (0.532, 95% CI: 0.370-0.694), and in the group with intervention doses > 5 g (1.116, 95% CI: 0.685-1.546) the counts were higher than those with doses ≤ 5 g (0.521, 95% CI: 0.379-0.663). No differences in effect were found between FOS intervention and comparators in regard to the abundance of other prespecified bacteria or adverse gastrointestinal symptoms. Conclusions: This is the first meta-analysis to explore the effect of FOS on gut microbiota and to evaluate the adverse effects of FOS intake on the gastrointestinal tract. FOS supplementation could increase the number of colonic Bifidobacterium spp. while higher dose (7.5-15 g/d) and longer duration (>4 weeks) showed more distinct effects and was well tolerated.