Morais Mauro Batista de, Jacob Cristina Miuki Abe
Departamento de Pediatria, Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, SP, Brazil.
J Pediatr (Rio J). 2006 Nov;82(5 Suppl):S189-97. doi: 10.2223/JPED.1559.
To review the effects of probiotics and prebiotics in clinical pediatric practice.
MEDLINE was searched, especially for articles that addressed their practical application, in the form of reviews, clinical trials and meta-analyses. Articles that had already been analyzed by the authors were also included.
Scientific literature on probiotics and prebiotics has remarkably increased in the last 10 years. Their mechanisms of action have been experimentally investigated. Studies indicate that probiotics can act by competing with pathogens, modifying the intestinal environment by reduction in pH, as a result of fermentation products, interacting and modulating local and systemic inflammatory and immune response, among others. Clinical trials and meta-analyses show that probiotics seem to contribute towards the prevention of acute diarrhea and of antibiotic-associated diarrhea, in addition to shortening the duration of acute diarrhea. However, the data are inconsistent and there are no studies confirming their efficacy in terms of cost-benefit ratio. Preliminary studies show that probiotics in early life can reduce the occurrence of atopic dermatitis. The addition of prebiotics to infant formulas is associated with the change in the profile of the intestinal microbiota compared to infants fed milk formulas without prebiotics.
Evidence indicates that new studies should be carried out about probiotics, prebiotics and symbiotics. The specific clinical effects that each probiotic or prebiotic may cause must be considered.
回顾益生菌和益生元在儿科临床实践中的作用。
检索MEDLINE，特别查找以综述、临床试验和荟萃分析形式阐述其实际应用的文章。作者已经分析过的文章也纳入其中。
过去10年里，关于益生菌和益生元的科学文献显著增加。对其作用机制进行了实验研究。研究表明，益生菌可通过与病原体竞争、因发酵产物使pH值降低从而改变肠道环境、相互作用并调节局部和全身炎症及免疫反应等方式发挥作用。临床试验和荟萃分析表明，益生菌似乎有助于预防急性腹泻和抗生素相关性腹泻，还能缩短急性腹泻的病程。然而，数据并不一致，且尚无研究证实其成本效益比方面的疗效。初步研究表明，生命早期使用益生菌可降低特应性皮炎的发生率。与喂养不含益生元的牛奶配方奶的婴儿相比，在婴儿配方奶中添加益生元与肠道微生物群谱的变化有关。
有证据表明，应针对益生菌、益生元和合生元开展新的研究。必须考虑每种益生菌或益生元可能产生的具体临床效果。
