7 MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH NATIONAL INSTITUTE OF NUTRITION PHAM THI THU THE EFFECTS OF LACTOBACILLUS CASEI SHIROTA ON THE NUTRITIONAL STATUS, DIGESTIVE AND ACUTE RESPIRATO[.]
Trang 1NATIONAL INSTITUTE OF NUTRITION
PHAM THI THU
-THE EFFECTS OF LACTOBACILLUS CASEI SHIROTA ON
THE NUTRITIONAL STATUS, DIGESTIVE AND ACUTE RESPIRATORY INFECTIONS IN CHILDREN 3-5 YEARS OF AGE IN 4 COMMUNES, THANH HOA PROVINCE
Major: Nutrition Code: 9720401
THE ABSTRACT OF THESIS
HA NOI – 2022
Trang 31 Assoc.Prof Dr Nguyen Ngoc Sang
2 Assoc.Prof Dr Truong Tuyet Mai
Time: date month year 2022
The dissertation can be found at:
- The library of National
- The library of National institute of Nutrition
Trang 41 Pham Thi Thu, Truong Tuyet Mai, Nguyen Ngoc Sang, HoangThi Hang (2021) Evaluating the effectiveness of supplementing
Lactobacillus casei Shirota (LcS) on children 3-5 years of age with
functional constipation in 4 communes, Thanh Hoa province
Journal of Vietnamese Medicine, 509(2): 170-175
2 Pham Thi Thu, Truong Tuyet Mai, Nguyen Ngoc Sang, TranThi Thu Trang (2022) Nutritional status and some related factors
in children 3-5 years of age in 4 communes, Thanh Hoa province
in 2017 Vietnam Medical Journal, 514(2): 230-234.
3 Truong Tuyet Mai, Pham Thi Thu, Hoang Thi Hang, Tran ThiThu Trang, Shintaro Yui, Akira Shigehisa, Vu Thuy Tien, TruongViet Dung, Phan Bich Nga, Nguyen Trong Hung, Le Danh Tuyen(2020) Efficacy of probiotics on digestive disorders and acuterespiratory infections: a controlled clinical trial in youngVietnamese children European Journal of Clinical Nutritionhttps://doi.org/10.1038/s41430-020-00754-9
Trang 5The malnutrition is a serious public health problem globally,mainly occurring in Africa and Asia Malnutrition in children under 5years old not only slows physical and intellectual development, but alsoincreases the risk of acute respiratory infections, diarrhea orconstipation for a long time, forming a pathological spiral, affecting thechildren's growth and development, even leading to death
One of the methods to support the treatment of constipation,diarrhea, strengthen the body's resistance and bring lasting effects is the
use of probiotics Lactobacillus casei Shirota (LcS) is a strain of
beneficial bacteria that has been studied and used in Japan since 1935.LcS has been studied for its effects in relation to immunity anddigestion In Vietnam, there are currently no studies evaluating the
effectiveness of Lactobacillus casei Shirota on nutritional status,
digestive health and ARI in children 3-5 years of age Therefore, weconducted a research with 3 objectives:
1 To describe the nutrition situation, digestion and acute respiratory infection in children 3-5 years of age in 4 communes of Thanh Hoa province, 2017.
2 To evaluate of the effectiveness of Lactobacillus casei Shirota supplementation on the incidence of constipation, diarrhea and acute respiratory infections in children 3-5 years of age in 4 communes of Thanh Hoa province.
3 To evaluate of the effectiveness of Lactobacillus casei Shirota supplementation on improving constipation and nutritional status in children 3-5 years of age with functional constipation in 4 communes
of Thanh Hoa province
Trang 6New contributions of doctoral thesis :
This is the first work in the country that has identified thenutritional status, digestion and acute respiratory infections in children3-5 years of age in 4 communes of Thanh Hoa province in 2017 withthe percentage of underweight, stunting and waisting is 11.2%, 15.7%
and 2.0% The study demonstrated the effectiveness of Lactobacillus
casei Shirota on the incidence of constipation in children 3-5 years of
age after 12 weeks of intervention, in the intervention group theincidence of constipation was significantly lower than the control group(1.3% vs 10.4%) The results of the study also showed the effectiveness
of Lactobacillus casei Shirota in improving constipation in children 3-5
years of age with functional constipation
The dissertation structure:
The dissertation has 120 pages with the structure as follows: theintroduction and objectives: 3 pages; overview (literature review): 32pages; methods: 21 pages; results: 30 pages; discussion: 31 pages;conclusions and recommendations: 3 pages The dissertation has 37tables, 9 figures, and 181 references
Chapter I: OVERVIEW 1.1 The nutritional status, digestive and acute respiratory infections
Malnutrition remains a major public health concern for childrenunder 5 years old in many low- and middle-income countries as itremains the leading cause of death among children in many countries.The according to the WHO report 2020, about 144 million childrenunder 5 years old are stunted, 47 million children are wasting and 14.3million children are severely malnourished Malnutrition remains asignificant public health problem in Vietnam According to the survey
Trang 7results on the nutritional status of children, the rate of underweightmalnutrition in Vietnam has decreased but is still high The direct cause
of malnutrition is believed to be children's lack of food, impropereating, and disease of infections (diarrhea and ARI), prolongedconstipation can all lead to malnutrition and vice versa Malnutritionmakes children susceptible to infections and this vicious cyclecontinues without appropriate intervention or management
Diarrhea and ARI are among the top 10 causes of hospitalizationand death in children under 5 years old, while constipation is a commonand challenging problem in children, with serious implications affectchildren's emotions, psychology and quality of life, accounting for
nearly 1-4% of school-age children.
1.2 The role of probiotics in gastrointestinal and immune health
Probiotics help supplement beneficial bacteria to create a balance
of bacteria in the digestive system, helping digestion better Probitoticcompetes with harmful bacteria in the colon, creating a membrane thatprevents bacteria, fungi and viruses from penetrating, protecting thebody's digestive system against pathogenic bacteria
The presence of a healthy and diverse gut microbiota is critical toachieving or maintaining a normal bowel function, which cansignificantly reduce intestinal transit time and increase bowel frequencyand improve stool consistency Therefore, probiotics can be considered
as natural and safe agents for the relief of functional constipation inadults and children
Probiotics are considered safe for the prevention and treatment ofantibiotic-associated diarrhea and infectious diarrhea The mechanism
of action is a combination of direct competition with pathogenicbacteria in the intestine and stimulation of local immunity Daily
Trang 8supplementation of LcS-containing beverages may play a role in theprevention of acute diarrhea and may reduce acute respiratoryinfections and disease severity in preschool-aged children.
1.3 The intervention studies on the effect of Lactobacillus casei
Shirota supplementation on nutritional status, gastrointestinal and acute respiratory infections.
The numerous studies have shown that supplementation with
Lactobacillus casei Shirota significantly reduces the length of stool
retention in the intestines, increases the frequency of bowel movements,and improves stool consistency Therefore, probiotics can beconsidered as natural and safe agents for the relief of functionalconstipation in adults and children
Probiotics have been extensively studied in recent years for theprevention and treatment of diarrhea, especially in children Effect of
intervention with Lactobacillus casei Shirota on the incidence of
diarrhea depends on the subject and duration of the intervention
The studies have shown that certain strains of probiotic bacteriacan improve immune function by increasing IgA counts, increasing orimproving phagocytosis, and increasing the proportion of Tlymphocytes and natural killer cells Several studies indicate thatLactobacillus casei Shirota (LcS) is beneficial for immune status.However, several studies have also shown that daily intake offermented milk containing LcS has no statistically or clinicallysignificant effect on protection against respiratory symptoms
The research results show that the impact of probiotics on thegrowth of weight and height of children is not still consistent
Trang 9CHAPTER 2: METHODS 2.1 Study subjects, setting and study period
- Criteria for selecting study subjects for objective 1,2: Children aged
3-5 years of age, attending preschool, parents or main caregivers ofchildren who agree to participate in the study and do not have mentalillness, the child did not give up one of the study stages Criteria forselecting study subjects for objective 3: children selected fromobjective 2, diagnosed as functional constipation Exclusion criteria forobjective 2;3: Children with severe malnutrition, severe diseases (acuterespiratory infections, acute diarrhea ), children using probiotics out ofthe program, children with birth defects, chronic liver and kidneydiseases , digest
- Study setting: The cross-sectional study and intervention study in 4
communes: Yen Thai commune, Dinh Thanh commune, Yen Dinhdistrict (intervention group) and Van Thang commune, Cong Chinhcommune, Nong Cong district (control group), Thanh Hoa province
- Study period: Cross-sectional study from June 2017 to Augusst 2017;interventional study from November 2017 to January 2018, data entryand analyses, and complete the dissertation from February 2018 toDecember 2021
2.2 Study design: The study was divided into two phases
- Phase 1: A cross-sectional descriptive study
- Phase 2: A controlled community intervention study This study wasconducted on two groups The control group is a group of children whoeat normally at home and kindergarten, without using the supplement
Lactobacillus casei Shirota for 12 weeks The intervention group is a
group of children who eat normally at home and kindergarten, but was
Trang 10allowed to use 1 box of products containing 6.5 billion Lactobacillus
casei Shirota per day (65ml/box) x 7 days per week x 12 weeks.
2.3 Sample size
- For objective 1: Cross-sectional descriptive study, the minimumsample size is 225 children/commune x 4 communes=1020 children.Actually studied 1136 children
- For objective 2: A controlled community intervention study, theminimum sample size is 506 children/group x 2 groups = 1012children In fact, 1036 children were studied
- For objective 3: A controlled community intervention study, theminimum sample size is 90 children/group In fact, 216 children werestudied
2.4 Sampling method
The purposely selected 2 communes Yen Thai, Dinh Thanh, YenDinh district as the intervention group and 2 communes Van Thang andCong Chinh in Nong Cong district as the control group
Trang 11Flow chart summary of the study 2.5 The methods of data collection and assessment
- General information and information on digestive status, acuterespiratory infections, eating and drinking status of children at the time
Screening investigation
1136 children 3-5 years old in 4 communes in 2
districts of Yen Dinh and Nong Cong, Thanh Hoa
province
493 children in the intervention group meet the analysis criteria (108 children with constipation)
510 children in the
intervention group meet
the analysis criteria
(108 children with
constipation)
M oni tor the dis eas e sit uat ion dai ly
Investigation (T16)
Disease, anthropometry, food consumption frequency
8
drop
out
25 drop out
Investigation (T12)
Disease, anthropometry
Investigation (T8)
Disease, anthropometry, food consumption frequency
Control group
(Nong Cong district)
518 children (108 children with constipation)
Investigation (T4)
Disease, anthropometry, food consumption frequency
The end of the intervention,
Trang 12of the survey were collected by interviewing parents or main caregiverswith pre-designed interview questions.
- The current health status of children at the time of the survey wascollected through medical examination by the pediatrician
- Digestive status, acute respiratory infections, children's eating anddrinking status every day during the 12 weeks of intervention and after
4 weeks of stopping the intervention were directly monitored, collectedand synthesized by supervisors from teacher's dalily logbook of thechild's illness and eating status and mother's dalily logbook of thechild's illness and eating status
- Collecting anthropometric data of children at different times throughweighing and measuring children's height
- Assess the characteristics of the child's stool based on the BristolStool Scale tool
- Evaluate children with functional constipation according to ROME IIIcriteria
- Evaluation of diarrhea and acute respiratory infections according toIMCI
- Cumulative incidence = Number of children infected in a certainperiod of time/total number of children without disease at the beginning
Trang 13- Assessment of nutritional status of children: according to the WHOgrowth classification in 2006.
2.6 Research implementation
Organizing product drinking in the intervention group: Organized intoconcentrated drinking points at Kindergarten when children go toKindergarten by supervisors and teachers who are in charge of directlydistributing products to children, Once a day, after lunch On Saturdaysand Sundays, children don't go to school or if they are sick, supervisorsand collaborator transfer LcS supplement products in cold bottles totake home for children to drink or supervisors, teachers guide parents/the children's family members come to Kindergarten to bring them back
to drink, ensure that the children are used continuously, and that thetested products are always preserved in the best conditions Give thechild to drink once a day, after lunch
- To evaluate the effectiveness of the intervention, using the followingindexes: ARR (absolute risk reduction): NNT: (the number of patientsyou need to treat to prevent one additional bad outcome)
2.8 Research ethics
The study was approved by the Ethical Review Board inBiomedical Research of the National Institute of Nutrition according toDecision No 778/QD-VDD dated June 26, 2017
Trang 14Chapter III RESEARCH RESULTS 3.1 The nutrition situation, digestion and acute respiratory infection in children 3-5 years of age in 4 communes of Thanh Hoa province.
Table 3.1 The Malnutrition stastus in 4 communes of Thanh Hoa
province
Malnutrition
Yen Dinh district Nong Cong district
Total(n=1136)(%)
Van Thang(n=297)(%)
Cong Chinh(n=291)(%)
Table 3.2 The percentage of children with constipation, diarrhea, acute
respiratory infections in 4 communes of Thanh Hoa province
Disease
Yen Dinh district Nong Cong district
Total(n=1136)
Van Thang(n=297)(%)
Cong Chinh(n=291)(%)
ARI 56(21.5) 59(20.5) 75(25.3) 50(17.2) 240(21.1) 0.119
Trang 15(p) χ 2 test compare rates of constipation, diarrhea, acute respiratory infections
among research communes
The percentage of constipation, diarrhea and ARI in 4 communeswere 24.6%, 8.8% and 21.2%
3.2 The efficacy of Lactobacillus casei Shirota on the cumulative
incidence of constipation, diarrhea, and acute respiratory infections during the 12 weeks of intervention and after 4 weeks of stopping the intervention.
Table 3.3 The efficacy of Lactobacillus casei Shirota on the
cumulative incidence of constipation during the 12 weeks ofintervention and after 4 weeks of stopping the intervention
Time Intervention group(n = 510) Control group(n = 493 ) p
(p)χ2 test compare percentages of 2 groups at the same time
The percentage of children with the cumulative incidence ofconstipation in the intervention group was significantly lower than thecontrol group after 4.8,12 weeks of intervention and after 4 weeks ofstopping the intervention, 16.3% vs 28.3%; 20.6% vs 36.5%; 21.7% vs43.1% and 22.7% vs 51.6% The difference was statistically significantwith p<0.001