Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
BMC Pediatr. 2024 Nov 6;24(1):702. doi: 10.1186/s12887-024-05179-y.
Malnutrition remains a significant concern in many societies. This study systematically reviewed the effects of probiotics, prebiotics, and synbiotics on anthropometric measures in malnourished children, focusing on changes in weight, height, and respiratory infections (primary outcomes), and head circumference, hemoglobin, hematocrit, and body mass index (BMI) as secondary outcomes.
This systematic review and meta-analysis involved searching various databases in both Persian and English, including Scopus, Web of Science Core Collection, Cochrane Library, Science Direct, and PubMed up to October 5, 2024. Non-randomized controlled trials (RCTs) were excluded. The Cochrane Handbook Risk of Bias Version 2 tool was used to assess risk of bias, and RevMan 5.3 software was employed for analysis. Subgroup analyses were conducted based on the type of supplement received. Meta-regression was applied to identify factors influencing results, and the GRADE approach was used to evaluate evidence certainty.
Twelve studies with a total of 3,086 children (aged up to 6 years, equally distributed between boys and girls) were included. All children were malnourished without underlying illnesses. Limitations of the study included variations in intervention type, dose, duration, and timing of outcome measurement. Meta-analysis revealed that probiotics, prebiotics, and synbiotics may increase weight (6 trials, mean difference: 0.33 kg, 95% CI: 0.15 to 0.50, low certainty of evidence), while probiotics and synbiotics may increase height compared to control groups (5 trials, mean difference: 0.44 cm, 95% CI: 0.02 to 0.85, low certainty of evidence). However, probiotics and synbiotics did not show a statistically significant effect on lower respiratory tract infections (5 trials, risk ratio: 0.84, 95% CI: 0.68 to 1.04, moderate certainty of evidence). Meta-regression indicated that intervention type, sample size, and follow-up duration were not significant moderators for outcomes related to weight, height, or respiratory infections.
The current evidence suggests that probiotics, prebiotics, and synbiotics supplements may help manage malnutrition-related outcomes in malnourished children, but further research with stronger study designs is needed to confirm these findings due to the low certainty of evidence.
在许多社会中，营养不良仍然是一个严重的问题。本研究系统地综述了益生菌、益生元和合生元对营养不良儿童人体测量指标的影响，重点关注体重、身高和呼吸道感染的变化（主要结局），以及头围、血红蛋白、红细胞压积和体重指数（BMI）作为次要结局。
本系统评价和荟萃分析涉及在波斯语和英语的各种数据库中进行搜索，包括 Scopus、Web of Science 核心合集、Cochrane 图书馆、Science Direct 和 PubMed，截至 2024 年 10 月 5 日。排除了非随机对照试验（RCT）。使用 Cochrane 手册风险偏倚版本 2 工具评估风险偏倚，并使用 RevMan 5.3 软件进行分析。根据所接受的补充类型进行亚组分析。应用元回归分析确定影响结果的因素，并使用 GRADE 方法评估证据确定性。
共纳入 12 项研究，总计 3086 名儿童（年龄最大 6 岁，男女各半）。所有儿童均营养不良，无潜在疾病。研究的局限性包括干预类型、剂量、持续时间和结局测量时间的差异。荟萃分析表明，益生菌、益生元和合生元可能增加体重（6 项试验，平均差异：0.33kg，95%CI：0.15 至 0.50，证据确定性低），而益生菌和合生元可能比对照组增加身高（5 项试验，平均差异：0.44cm，95%CI：0.02 至 0.85，证据确定性低）。然而，益生菌和合生元对下呼吸道感染没有显示出统计学上的显著影响（5 项试验，风险比：0.84，95%CI：0.68 至 1.04，证据确定性中等）。元回归分析表明，干预类型、样本量和随访时间对体重、身高或呼吸道感染相关结局不是显著的调节因素。
目前的证据表明，益生菌、益生元和合生元补充剂可能有助于管理营养不良儿童的营养不良相关结局，但由于证据确定性低，需要进行设计更强的研究来证实这些发现。
