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Study design of a randomized-controlled trial investigating the effects of probiotic supplementation on induction of prediabetes remission to normoglycemia in adults with prediabetes. / BACKGROUND: Patients with prediabetes are at a high risk of developing type 2 diabetes (T2D) and the current strategies to prevent the progression of prediabetes to T2D are difficult to implement at the population level. Recently, the role of gut microbiota has emerged as a possible link to metabolic disease. The modulation of the gut microbiota in individuals with prediabetes through probiotic supplementation may improve metabolic dysfunction and induce remission of prediabetes to normoglycemia. OBJECTIVES: The primary objective of this trial is to determine the effect of 900 billion CFU/day of VSL#3®, a multi-strain probiotic supplement for 20 weeks, on induction of drug-free remission to normoglycemia (HbA1c<6.0%) in adults with prediabetes compared to placebo 20 weeks post-randomization. METHODS: In a randomized, triple-blind, controlled multi-centre trial, 568 adults with prediabetes will undergo a 2-week run-in after which they will be randomly allocated to 20 weeks of either 900 billion CFUs of VSL#3® per day or placebo. Prediabetes remission will be measured using HbA1C at week 20 and 32. Change in insulin resistance (HOMA-IR), beta-cell function (HOMA-B), weight, BMI, waist circumference and fecal relative abundance of bacteria will be measured from baseline at week 20 and 32. Exploratory regression analyses will involve a multiple logistic regression model to assess whether the change in relative abundance of the Rosburia genus from baseline at week 20 is an independent predictor of drug-free prediabetes remission at week 20. DISCUSSION: Individuals with prediabetes are at high risk of developing T2D and the induction of prediabetes remission would be important to patients and clinicians. The role of microbiota in metabolic processes presents the potential for therapeutic applications of probiotics. If successful, probiotics would offer a therapeutic option for reversing prediabetes to normoglycemia that is simple, cheap and easy to incorporate into standard clinical care. / Thesis / Master of Science (MSc) / BACKGROUND: Patients with prediabetes are at a high risk of developing type 2 diabetes (T2D) and the current strategies to prevent the progression of prediabetes to T2D are difficult to apply at the population level. Recently, the role of gut bacteria has emerged as a possible link to metabolic disease. Changing the gut microbiota in people with prediabetes through probiotic supplements may improve metabolic function and result in remission of prediabetes to normal glucose control. OBJECTIVES: The primary objective of this study is to determine the effect of VSL#3®, a probiotic supplement, for 20 weeks, on induction of drug-free remission to normal glucose control in adults with prediabetes compared to placebo, 20 weeks after randomization. METHODS: In a randomized, triple-blind, controlled multi-centre trial, 568 adults with prediabetes will be randomly assigned to 20 weeks of either VSL#3® per day or placebo. Prediabetes remission will be measured using HbA1C at week 20 and 32. Change in insulin resistance (HOMA-IR), beta-cell function (HOMA-B), weight, BMI, waist circumference and fecal bacteria will be measured from baseline at week 20 and 32. DISCUSSION: Individuals with prediabetes are at high risk of developing T2D and the induction of prediabetes remission would be important to patients and clinicians. The role of gut bacteria in metabolic health presents the potential for probiotics to be therapy options. If successful, probiotics would be simple, cheap and easy to incorporate into standard clinical care.

Diseases affecting shrimp contribute to billions of dollars of economic loss yearly to the aquaculture industry. Recently, one of the primary causative agents of disease has been Vibrio parahaemolyticus; in 2009, a new strain causing Early Mortality Syndrome (EMS) or acute hepatopancreatic necrosis disease (AHPND) in shrimp emerged. Shrimp losses attributed to pathogens can be greatly reduced through probiotic use, which are known to act as natural immune enhancers and promote pathogen resistance. However, research on probiotic treatment against EMS disease is lacking. The overall project goal was to improve intensive shrimp production through direct application of probiotics in aquaculture feeds. The value of probiotics for the shrimp industry was evaluated by (1) reducing severity or mortality of V. parahaemolyticus disease in shrimp, (2) qPCR confirmation of Bacillus spore germination in shrimp gut, and (3) probiotic effectiveness evaluation for improving disease resistance. The virulence of several Vibrio spp. strains was examined and it was concluded the V. parahaemolyticus strain identified as the causative agent of EMS was the most lethal; EMS-infected shrimp exhibited 100% mortality within 36-hours of feed inoculation. The number of bacterial cells added to feed directly correlated with pathogenicity and only cells, not filtrate, was capable of causing death. Probiotic strains were evaluated and it was concluded that probiotic strains A, A/B blend, and B were the best candidates for promoting disease resistance against EMS. This research will provide the shrimp farming industry with information vital to developing a means for reducing economic loss from Vibrio-infected shrimp. / Master of Science in Life Sciences

High-fat diets and obesity have been linked to unfavorable changes in gut bacteria and increased leakage of bacterially-derived lipopolysaccharide (endotoxin) from the intestinal tract into circulation, which is associated with low-grade inflammation, metabolic dysregulation and degradation of tight-junction proteins between intestinal cells. Probiotic supplementation is the practice of ingesting live strains of bacteria that are proposed to have a beneficial effect on the host by enriching the intestine with healthy bacteria. The purpose of this project was to determine if probiotic supplementation would prevent increased inflammatory tone, decreased oxidative capacity, and decreased tight-junction protein expression associated with high-fat feeding and elevated endogenous endotoxin. Male C57BL/6J mice were fed either a control (CD, 10% fat) or high-fat (HFD, 60% fat) diet for 4 weeks while receiving a daily oral gavage of water (C-VSL#3, HF-VSL#3) or probiotics (C+VSL#3, HF+VSL#3) equivalent to 1.2 billion live cultures. Changes in body weight, body composition, respiratory exchange ratio, energy expenditure, and glucose and insulin tolerance were measured in live mice. Markers of metabolic function were measured in whole muscle homgenates and mitochondria isolated from red and white skeletal muscle. Plasma endotoxin was measured in blood collected from fasted mice at the time of euthanization. The large and small intestines were collected and mRNA levels of tight-junction proteins and markers of nutrient sensing were measured. To determine a possible protective effect against endogenous LPS, a second cohort of mice were given an intraperitoneal injection of 0.1µg/kg LPS or saline to induce endotoxemia after four weeks of the aforementioned feeding protocol. Markers of metabolic function and inflammation were measured in mitochondria, skeletal muscle and liver. VSL#3 supplementation improved glucose homeostasis and markers of inflammation while enhancing nutrient sensing in the gut. / Ph. D.

The prophylactic use of antibiotics is rapidly being phased out of poultry operations. Diseases such as coccidiosis are extremely costly, and typically prevented with coccidiostats and antibiotics. New regulation banning antibiotics is mandating a search for new alternatives, such as probiotics and phytogenic feed additives (PFAs). Two separate studies were performed to evaluate the performance and microbial profiles of commercial broilers fed either PFAs or Eimeria challenged broilers fed probiotics. During the probiotics study, 1056 day-old male Ross broiler chicks were assigned to one of 6 treatments, 8 replicates per treatment, with 22 birds per floor pen in a 2x3 factorial arrangement, with DFM mix and coccidiosis challenge being the main factors. Treatments included a non-infected control (NC), a non-infected low level DFM-fed group (DL), a non-infected high level DFM-fed group (DH), an infected control (PC), an infected low level DFM-fed group (DL+), and an infected high level DFM-fed group (DH+). Performance measurements were taken on d0, d7, d14, d21, and d28. Mucosal scrapings from the ileum were obtained on d7, d14, d21, and d28 to determine microbial profiles. On d15, birds in the three infected groups were challenged with a mixed inoculum containing Eimeria maxima, E. tenella, and E. acervulina. Lesion scores were assessed on d21. Body composition was analyzed via Dual Energy X-Ray Absorptiometry (DXA) on d28. Results indicated a trend (P < 0.1) toward improved D28 body composition, lower Clostridium in DFM-fed challenged broilers compared to PC, and higher Bacillus in DH compared to DH+. Results were not significant for BW, BWG, FI, or lesion scores. The second study evaluated the effects of PFA provided as a dietary supplement over a 6-week period on performance and immune responses in broilers. In total, 1056 day-old male chicks were randomly assigned to 8 replicate pens (22 birds/pen) with 6 treatments including a standard corn/wheat basal diet, a basal with antibiotics, and 4 various combinations of PFA (PHY 1, 2, 3, and 4). Performance was assessed on day 7 (D7), 14, 28, and 42. Starter diet was fed D0-14, grower D14-28, and finisher D28-42. Microbial profiling was assessed on D7, 14, and 42, and body composition measured on D42 using Dual Energy X-Ray Absorptiometry (DXA). Results varied by week, but cumulatively, body weight gain (BWG) per bird was higher in PHY1 and 4, statistically similar to AGP and CTRL. With feed conversion ratio (FCR), PHY2 was higher than any other treatment between D0-42, while all other treatments were similar. PCR results were not statistically significant; however, DXA results indicated a higher lean to fat ratio in birds from PHY1-4 when compared to AGP, indicating an overall leaner bird in PHY treatments. The results of these studies suggest that diets supplemented with DFMs or PFAs result in improved broiler performance. / Master of Science / The prophylactic use of antibiotics is rapidly being phased out of poultry operations. Diseases such as coccidiosis are extremely costly, and typically prevented with coccidiostats and antibiotics. New regulation banning antibiotics is mandating a search for new alternatives, such as probiotics and phytogenic feed additives (PFAs). Two separate studies were performed to evaluate the performance and microbial profiles of commercial broilers fed either PFAs or Eimeria challenged broilers fed probiotics. During the probiotics study, 1056 day-old male Ross broiler chicks were assigned to one of 6 treatments, 8 replicates per treatment, with 22 birds per floor pen in a 2x3 factorial arrangement, with DFM mix and coccidiosis challenge being the main factors. Treatments included a non-infected control (NC), a non-infected low level DFM-fed group (DL), a non-infected high level DFM-fed group (DH), an infected control (PC), an infected low level DFM-fed group (DL+), and an infected high level DFM-fed group (DH+). Performance measurements were taken on d0, d7, d14, d21, and d28. Mucosal scrapings from the ileum were obtained on d7, d14, d21, and d28 to determine microbial profiles. On d15, birds in the three infected groups were challenged with a mixed inoculum containing Eimeria maxima, E. tenella, and E. acervulina. Lesion scores were assessed on d21. Body composition was analyzed via Dual Energy X-Ray Absorptiometry (DXA) on d28. Results indicated a trend (P < 0.1) toward improved D28 body composition, lower Clostridium in DFM-fed challenged broilers compared to PC, and higher Bacillus in DH compared to DH+. Results were not significant for BW, BWG, FI, or lesion scores. The second study evaluated the effects of PFA provided as a dietary supplement over a 6-week period on performance and immune responses in broilers. In total, 1056 day-old male chicks were randomly assigned to 8 replicate pens (22 birds/pen) with 6 treatments including a standard corn/wheat basal diet, a basal with antibiotics, and 4 various combinations of PFA (PHY 1, 2, 3, and 4). Performance was assessed on day 7 (D7), 14, 28, and 42. Starter diet was fed D0-14, grower D14-28, and finisher D28-42. Microbial profiling was assessed on D7, 14, and 42, and body composition measured on D42 using Dual Energy X-Ray Absorptiometry (DXA). Results varied by week, but cumulatively, body weight gain (BWG) per bird was higher in PHY1 and 4, statistically similar to AGP and CTRL. With feed conversion ratio (FCR), PHY2 was higher than any other treatment between D0-42, while all other treatments were similar. PCR results were not statistically significant; however, DXA results indicated a higher lean to fat ratio in birds from PHY1-4 when compared to AGP, indicating an overall leaner bird in PHY treatments. The results of these studies suggest that diets supplemented with DFMs or PFAs result in improved broiler performance.

Background - Irritable bowel syndrome (IBS) is a poorly understood functional gastrointestinal disorder and is a major cause of abdominal discomfort and gut dysfunction. IBS symptoms encompass abdominal pain, bloating, flatulence and irregular bowel movements such as constipation, diarrhoea and alternating bowels, bloating, flatulence and irregular bowel movements. Physiological studies have shown that manipulation of the intestinal microbiota by antibiotics, prebiotics or probiotics can affect intestinal functions in the pathogenesis of IBS. The probiotic concept suggests that supplementation of the intestinal microbiota with the right type and number of live microorganisms can improve gut microbiota composition and promote health in IBS sufferers. Aim - The aim of the main clinical trial is to determine whether ingestion of fermented milk containing Bifidobacterium animalis DN-173010 is associated with improved defecation frequency, stool consistency and quality of life in black South African females with constipation-predominant IBS (IBS-C). Methods - A pilot and process evaluation approach was employed during the current study to examine and understand the feasibility of implementing the study and to explore the facilitating implementation of the main clinical trial. Twenty black female participants, aged 18-60, with IBS-C were recruited from the practices of gastroenterologists, specialist physicians and medical doctors in Soweto. Participants fulfilling the Rome III criteria for IBS-C and inclusion criteria were randomized into two groups to participate in a 4-week, double blind, placebo controlled study. The placebo group received unflavoured sweetened, white base yoghurt and the intervention group received similar yoghurt with the probiotic, Bifidobacterium animalis DN-173010 [>3,4X10⁷ CFU/g]. Participants were required to record their bowel movements daily and IBS symptoms weekly in questionnaires during the four-week study period. Quality of life was assessed at baseline and at the end of the treatment period. Participants visited the study unit weekly to collect the placebo or probiotic study products and return the completed questionnaires during the study period. Results - Seventeen participants completed the study (eight intervention and nine placebo). There were not significant differences in IBS symptoms between the two groups, but differences were observed overtime within groups. The severity of abdominal pain score within both groups was statistically significant (p=0.004), and the number of days with pain was also statistically significant (p=0.00001). The frequency of normal stools reported was statistically significant different compared to all the other stool types (constipation and loose stools) throughout the four-week study period in both the intervention and placebo group. There was no significant difference in the quality of life between the intervention group compared to the placebo group. Conclusion - Process evaluation allows for the monitoring of a programme and corrections of problems as they occur. The intervention is feasible to implement, acceptable and safe to participants. The study indicates that consumption of the probiotic Bifidobacterium animalis DN-173010 for four weeks is not superior to the placebo in relieving IBS symptoms. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2014

Background - Irritable bowel syndrome (IBS) is a poorly understood functional gastrointestinal disorder and is a major cause of abdominal discomfort and gut dysfunction. IBS symptoms encompass abdominal pain, bloating, flatulence and irregular bowel movements such as constipation, diarrhoea and alternating bowels, bloating, flatulence and irregular bowel movements. Physiological studies have shown that manipulation of the intestinal microbiota by antibiotics, prebiotics or probiotics can affect intestinal functions in the pathogenesis of IBS. The probiotic concept suggests that supplementation of the intestinal microbiota with the right type and number of live microorganisms can improve gut microbiota composition and promote health in IBS sufferers. Aim - The aim of the main clinical trial is to determine whether ingestion of fermented milk containing Bifidobacterium animalis DN-173010 is associated with improved defecation frequency, stool consistency and quality of life in black South African females with constipation-predominant IBS (IBS-C). Methods - A pilot and process evaluation approach was employed during the current study to examine and understand the feasibility of implementing the study and to explore the facilitating implementation of the main clinical trial. Twenty black female participants, aged 18-60, with IBS-C were recruited from the practices of gastroenterologists, specialist physicians and medical doctors in Soweto. Participants fulfilling the Rome III criteria for IBS-C and inclusion criteria were randomized into two groups to participate in a 4-week, double blind, placebo controlled study. The placebo group received unflavoured sweetened, white base yoghurt and the intervention group received similar yoghurt with the probiotic, Bifidobacterium animalis DN-173010 [>3,4X10⁷ CFU/g]. Participants were required to record their bowel movements daily and IBS symptoms weekly in questionnaires during the four-week study period. Quality of life was assessed at baseline and at the end of the treatment period. Participants visited the study unit weekly to collect the placebo or probiotic study products and return the completed questionnaires during the study period. Results - Seventeen participants completed the study (eight intervention and nine placebo). There were not significant differences in IBS symptoms between the two groups, but differences were observed overtime within groups. The severity of abdominal pain score within both groups was statistically significant (p=0.004), and the number of days with pain was also statistically significant (p=0.00001). The frequency of normal stools reported was statistically significant different compared to all the other stool types (constipation and loose stools) throughout the four-week study period in both the intervention and placebo group. There was no significant difference in the quality of life between the intervention group compared to the placebo group. Conclusion - Process evaluation allows for the monitoring of a programme and corrections of problems as they occur. The intervention is feasible to implement, acceptable and safe to participants. The study indicates that consumption of the probiotic Bifidobacterium animalis DN-173010 for four weeks is not superior to the placebo in relieving IBS symptoms. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2014

Bakgrund: Ett lämpligt näringsintag är viktigt för främjandet och bevarandet av både den allmänna och orala hälsan. Karies är en multifaktoriell sjukdom där kosten har en betydelsefull roll. Kosten kan bidra till både kariesförekomst och kariesprevention. Functional food definieras som ”livsmedel som ger hälsovinster utöver basnutritionen” och ”livsmedel som har en eller flera tillsatser som modifierats för att bidra till en hälsosam kosthållning”. Syfte: Syftet med studien var att kartlägga kunskapsnivån och tillämpningen av information till patienterna om Functional food i det kariesförebyggande arbetet inom Folktandvården, Landstinget Kronoberg. Metod: Enkätstudiens urval bestod av tandläkare, tandhygienister och tandsköterskor, totalt 106 deltagare, från 17 olika Folktandvårdskliniker tillhörande allmäntandvården i Landstinget Kronoberg. Enkäten bestod av 24 frågor som bedömdes enligt ett graderat poängsättningssystem. Resultatet redovisades deskriptivt med hjälp av tabeller och diagram. Statistiska analyser utfördes med hjälp chitvåtest. Resultat: Majoriteten av deltagarna kategoriserades i grupperna: låg kunskapsnivå samt låg till medelhög tillämpningsnivå av Functional food i det kariesförebyggande arbetet. Merparten av deltagarna hade ett stort intresse av att få ytterligare kunskap. Slutsats: Tandvårdspersonalen önskade mer kunskap om Functional food för en ökad tillämpning i patientarbetet, givet att vetenskaplig evidens uppnås. / Background: An adequate nutrition is essential for the promotion and maintenance of the general and oral health. Dental caries is a multifactorial disease in which diet is a important factor. Functional foods are defined as "foods that provide health benefits beyond basic nutrition" and "foods that has one or more additives, modified to contribute to a healthy diet". Aim: The aim of the study was to identify the level of knowledge and application regarding information to patients about Functional food in caries prevention work in Public dental services, County Council of Kronoberg. Method: The survey included 106 participants consisted of dentists, dental hygienists and dental nurses from 17 different Public dental services. The survey consisted of 24 questions. The results were presented descriptive, with tables and charts, as well as statistically analyzes using chi-square tests. Results: The majority of participants were categorized into the groups: low level of knowledge and medium or low application level of Functional food in the caries prevention work. Most of the participants had a great interest in obtaining additional knowledge. Conclusion: Dental professionals would like to get more knowledge about Functional food for an increased application in patient care, provided that scientific evidence is obtained.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Background: Synbiotics, probiotics and prebiotics are being added to infant formula. This study was an in-depth evaluation of research on infants fed infant formula containing synbiotics, probiotics or prebiotics and was carried out in two phases. Phase one included two systematic reviews that assessed if synbiotics, probiotics or prebiotics led to improved growth and clinical outcomes in formula fed full term and preterm infants. Phase two included two studies: A systematic review compared the methodological quality and outcomes of industry and non-industry sponsored randomized controlled trials (RCTs) and a descriptive study evaluated how the food industry applies the knowledge and evidence gained from probiotics, prebiotics or synbiotics research in infants. The research questions were: Does the consumption of probiotics, prebiotics or synbiotics supplemented infant formula lead to improved clinical outcomes in infants? Is there an association between source of funding and methodological quality, clinical outcomes and author’s conclusions in trials using probiotics, prebiotics or synbiotics supplemented formula in infants? Does the food industry use the evidence gained through probiotics, prebiotics and synbiotics research trials on infants for the benefit of the general paediatric population? The hypotheses were: Consumption of probiotics, prebiotics or synbiotics by infants leads to improved clinical outcomes; The source of funding in research trials using probiotics, prebiotics or synbiotics supplemented formula in infants is associated with outcomes in favour of the sponsor’s products and authors’ conclusions; Methodological qualities of non-industry sponsored trials are equivalent to industry sponsored trials; Evidence gathered through probiotics, prebiotics and synbiotics research is implemented by the food industry. Methods: Phase one: Both systematic reviews on preterm and full term infants: Cochrane methodology was followed using RCTs which compared preterm or full term formula containing probiotics, prebiotics or synbiotics to conventional infant formula with / without placebo among healthy preterm or full term infants. The mean difference (MD) and corresponding 95% confidence intervals (CI) were reported for continuous outcomes, risk ratio (RR) and corresponding 95% CI for dichotomous outcomes. Phase two: In the systematic review, Cochrane methodology was used to assess the risk of bias of included RCTs. Association between source of funding and risk of bias, clinical outcomes and conclusions were assessed. In the descriptive study, all listed companies that manufacture infant food products with added synbiotics, probiotics or prebiotics for infants were identified and invited to participate. A letter of invitation was sent and if they expressed willingness to take part in the study, a questionnaire with a written consent form was sent. Descriptive statistics and associations between categorical variables were to be tested using a Chi-square test. Results: Phase one: Review on preterm infants: 8 studies were included. Probiotics increased stool frequency with no effect on other clinical outcomes. Prebiotics increased stool frequency and bifidobacteria counts only. Review on full term infants: 25 studies were included. Synbiotics improved stool frequency but had no effect on other clinical outcomes. Probiotics did not have an effect on any clinical outcome. Prebiotics increased weight gain and stool frequency with no effect on other outcomes. Phase two: Systematic review: 67 studies were included, majority were funded by food industry. There was no significant association between the source of funding and four domains (sequence generation, allocation concealment, blinding, selective reporting), majority of reported clinical outcomes or authors’ conclusions. Source of funding was significantly associated with two domains (incomplete outcome data, free of other bias), antibiotic use and conclusions on weight gain. Descriptive study: 25 companies were identified and invited to participate. No company agreed to participate in the survey for different reasons. Conclusions Phase one: Review on preterm infants: There is not enough evidence to state that supplementation with probiotics or prebiotics results in improved growth and clinical outcomes in exclusively formula fed preterm infants. Review on full term infants: There is not enough evidence to state that supplementation of term infant formula with synbiotics, probiotics or prebiotics does result in improved growth or clinical outcomes in term infants. There is no data available to establish if synbiotics are superior to probiotics or prebiotics. Phase two: Systematic review: In RCTs on infants fed infant formula containing probiotics, prebiotics or synbiotics, the source of funding does not influence majority of outcomes in favour of the sponsors’ products. More non-industry funded research is needed to further assess the impact of funding on reported clinical outcomes and authors’ conclusions. Descriptive study: Due to companies refusing to participate in this study, no conclusion could be drawn on how the food industry applies evidence gained through probiotics, prebiotics or synbiotics research on infants. More transparency is needed from the infant formula manufactures on how they apply the evidence gained from probiotic, prebiotic or synbiotic research on infants. / AFRIKAANSE OPSOMMING: Agtergrond Synbiotika, probiotika en prebiotika word gereeld by baba formule gevoeg. Hierdie studie was 'n in-diepte evaluering van navorsing oor babas gevoed met formule melk wat synbiotika, probiotika of prebiotika bevat en is uitgevoer in twee fases. Fase een het twee sistematiese oorsigte ingesluit wat die rol van synbiotika, probiotika en prebiotika op verbeterde groei en kliniese uitkomste van formule gevoede volterm babas en vroeg gebore babas evalueer het. Fase twee het bestaan uit twee studies: 'n sistematiese oorsig wat die metodologiese kwaliteit en uitkomste van die bedryf en nie-bedryf geborgde ewekansige gekontroleerde proewe (RCTs) evalueer het, asook 'n beskrywende studie wat die kennis en toepassing van bewyse oor die effektiewiteit van probiotika, prebiotika of synbiotika in die voedsel industrie bestudeer het. Die hipotese stellings was: verbruik van probiotika, prebiotika of synbiotika by babas lei tot verbeterde kliniese uitkomste; die bron van befondsing vir synbiotics, probiotika of prebiotika navorsing beïnvloed uitkomste ten gunste van die borg se produkte; bewyse ingesamel deur middel van probiotika, prebiotika en synbiotika navorsing word geïmplementeer deur die voedselindustrie. Metodes Fase een: Beide sistematiese oorsigte op volterm en premature babas: Cochrane metodes is gevolg deur ewekansige, gekontroleerde studies wat vol termyn of premature formule met probiotika, prebiotika of synbiotika met konvensionele baba formule met / sonder plasebo onder gesonde volterm of premature babas bestudeer. Die gemiddelde verskil (MD) en die ooreenstemmende 95% vertrouensintervalle is gebruik vir deurlopende uitkomste, risiko verhouding (RR) en die ooreenstemmende 95% CI vir tweeledige uitkomste. Fase twee: In die sistematiese oorsig is Cochrane metodiek gebruik om die risiko van vooroordeel van ingesluite ewekansige, gekontroleerde studies te evalueer. Assosiasie tussen bron van befondsing en die risiko van vooroordeel, asook kliniese uitkomste en gevolgtrekkings was beoordeel. In die beskrywende studie, is alle genoteerde maatskappye wat babavoeding produkte vervaardig met bygevoegde synbiotika, probiotika of prebiotika vir babas geïdentifiseer en uitgenooi om deel te neem. 'n Uitnodigingsbrief is vir die relevante maatskappye gestuur om hul bereidwilligheid om deel te neem te bevestig. Indien hulle wel bereid was om deel te neem was 'n vraelys met 'n skriftelike toestemming vorm gestuur. Beskrywende statistiek en assosiasies tussen kategoriese veranderlikes was getoets met behulp van 'n Chi-kwadraat toets. Resultate Fase een: Oorsig oor premature babas: 8 studies was ingesluit. Probiotika verhoog stoelgang frekwensie met geen effek op ander kliniese uitkomste. Prebiotika verhoog ook stoelgang frekwensie en slegs bifidobakteriële tellings. Oorsig oor die vol termyn babas: 25 studies was ingesluit. Synbiotika verbeter stoelgang frekwensie, maar het geen effek op ander kliniese uitkomste gehad nie. Probiotika het nie 'n effek op enige kliniese uitkoms gehad nie. Prebiotika verhoog gewigstoename en stoelgang frekwensie met geen effek op ander uitkomste. Fase twee: Sistematiese oorsig: 67 studies was ingesluit, en die meerderheid was befonds deur die voedsel bedryf. Daar was geen beduidende assosiasie tussen die bron van befondsing en vier gebiede (toekenningsvolgorde, toekenningsverberging, studie verblinding, selektiewe verslaggewing), en die meerderheid van gerapporteerde kliniese uitkomste of skrywers se gevolgtrekkings. Die bron van befondsing was beduidend verbind met twee gebiede (onvolledige uitslag data, vry van ander vooroordeel), antibiotika gebruik en gevolgtrekkings op gewigstoename. Beskrywende studie: 25 maatskappye is geïdentifiseer en genooi om deel te neem. Geen maatskappy het ingestem om deel te neem aan die studie om verskillende redes. Gevolgtrekkings Fase een: Oorsig oor premature babas: Daar is nie genoeg bewyse dat die aanvulling met probiotika of prebiotika resultate in verbeterde groei en kliniese uitkomste in uitsluitlik formule gevoede premature babas tot gevolg het nie. Oorsig oor die volle termyn babas: Daar is nie genoeg bewyse om te sê dat die aanvulling van term baba formule met synbiotika, probiotika of prebiotika lei tot verbeterde groei of kliniese uitkomste in termyn babas. Daar is geen inligting beskikbaar om te stel of synbiotika beter is as probiotika of prebiotika nie. Fase twee: Sistematiese oorsig: In studies op babas gevoed met formule melk wat probiotika, prebiotika of synbiotika bevat het, het die bron van befondsing nie meerderheid van die uitkomste in die guns van die borge se produkte beïnvloed nie. Meer nie-industrie befondsde navorsing is nodig om verder die impak van befondsing op kliniese uitkomste en skrywers se gevolgtrekkings te evalueer. Beskrywende studie: Aangesien al die maatskappy deelname geweier het, kon geen gevolgtrekking gemaak word of die voedsel bedryf bewyse oor die gebruik van probiotika, prebiotika of synbiotika toepas nie. Meer deursigtigheid is nodig van die formule vervaardigers oor hoe hulle die bewyse oor die gebruik van probiotika, prebiotika of synbiotika toepas.