OBJECTIVES:
Probiotic supplementation has been proposed as a
therapeutic intervention to improve
growth outcomes in
children with
undernutrition. The objective of this
review is to synthesize the current evidence on
probiotic supplementation for promotion of
growth in undernourished
children.
METHODS:
We searched
MEDLINE, Cochrane CENTRAL, CINAHL, Embase,
LILACS, and Scopus for randomized controlled trials (RCTs) that administered
probiotics or eligible comparators to undernourished
children below 5 years of age. Our primary outcomes of interest were weight-for-age, height-for-age, and weight-for-height at the longest follow-up points reported. Random-effects
meta-analysis was used to calculate standardized mean differences (SMD) for continuous outcomes and
risk ratios for dichotomous outcomes. The Grading of Recommendations Assessment, Development and Evaluation criteria were used to assess certainty of the evidence.
RESULTS:
Nine RCTs with 5295
children in total were included. Durations of
treatment ranged from 1 month to 1 year. Pooled analyses from 7 studies showed that
probiotics may have little to no effect on weight-for-age (SMD 0.05 standard deviation [SD], 95% CI -0.04 to 0.13, n = 2115
children; low-certainty evidence) and height-for-age (SMD -0.04 SD, 95% CI -0.14 to 0.07, n = 1357
children; low-certainty evidence). The evidence was very uncertain about the effect on weight-for-height.
CONCLUSIONS:
Probiotics may have little to no effect on
anthropometry in undernourished
children, though there is considerable heterogeneity among the trials reviewed thus far. The interaction between
gut microbiota and
human nutrition is complex, and further
research is needed to determine how the
gut microbiome may contribute to
undernutrition and how
probiotics may
affect growth in this
vulnerable population.
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