Synbiotics, probiotics or prebiotics in infant formula for full term infants: a systematic review

Abstract

BackgroundSynbiotics, probiotics or prebiotics are being added to infant formula to promote growth and development in infants. Previous reviews (2007 to 2011) on term infants given probiotics or prebiotics focused on prevention of allergic disease and food hypersensitivity. This review focused on growth and clinical outcomes in term infants fed only infant formula containing synbiotics, probiotics or prebiotics.MethodsCochrane methodology was followed using randomized controlled trials (RCTs) which compared term infant formula containing probiotics, prebiotics or synbiotics to conventional infant formula with / without placebo among healthy 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. Where appropriate, meta-analysis was performed; heterogeneity was explored using subgroup and sensitivity analyses. If studies were too diverse a narrative synthesis was provided.ResultsThree synbiotic studies (N = 475), 10 probiotics studies (N = 933) and 12 prebiotics studies (N = 1563) were included. Synbiotics failed to significantly increase growth in boys and girls. Use of synbiotics increased stool frequency, had no impact on stool consistency, colic, spitting up / regurgitation, crying, restlessness or vomiting. Probiotics in formula also failed to have any significant effect on growth, stool frequency or consistency. Probiotics did not lower the incidence of diarrhoea, colic, spitting up / regurgitation, crying, restlessness or vomiting. Prebiotics in formula did increase weight gain but had no impact on length or head circumference gain. Prebiotics increased stool frequency but had no impact on stool consistency, the incidence of colic, spitting up / regurgitation, crying, restlessness or vomiting. There was no impact of prebiotics on the volume of formula tolerated, infections and gastrointestinal microflora. The quality of evidence was compromised by imprecision, inconsistency of results, use of different study preparations and publication bias.Authors’ conclusionsThere 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.

Prebiotics in infant formula

“…41 Prebiotics in formula increased weight gain but had no impact on length or head circumference. 22,42 However, the quality of this evidence is compromised by imprecision, inconsistency of results, use of different study preparations and publication bias. 42 With a GOS/FOS mixture, growth was normal and similar to a standard infant formula.…”

“…22,42 However, the quality of this evidence is compromised by imprecision, inconsistency of results, use of different study preparations and publication bias. 42 With a GOS/FOS mixture, growth was normal and similar to a standard infant formula. 38,43 A multi-center, randomized, double-blind, placebo-controlled trial including 1130 healthy term infants showed a similar mean weight, length and head circumference, skin fold thicknesses and arm circumference evolution in all infants.…”

Human Gut Microbiota and Obesity During Development

“…In addition, a large number of clinical trials in term of infants have shown controversial results related to the increase in Biidobacteria in feces due to supplementation of infant formula with GOS and FOS. A systematic review published by Rao et al [78] reported that some of the randomized controlled trials (RCTs) showed a trend of increasing Biidobacteria counts in formula supplemented fed infants, and another systematic review published by Mugambi et al [81] failed to show the increase in Biidobacteria or Lactobacillus or the decrease of pathogens in infants fed with prebiotic supplemented formula.…”

“…Prebiotics are able to change gut metabolic activity, bring stool consistency, and defecation frequency closer to that of breastfed infants. Other outcomes included beter weight gain and softer stools, and a signiicant reduction in stool pH for infants who received prebiotic supplementation [78,81]. Moreover, prebiotics have been used to prevent or treat obesity.…”

The Human Microbiome. Early Life Determinant of Health Outcomes

“…A different approach could be administration of live microorganisms, as has been attempted with probiotic and synbiotic preparations containing a small number of allegedly beneficial bacteria. Although these preparations are currently widely used, their benefit for allergic diseases (34) or for infant health in general (35) has not been clearly established. Moreover, a recent, large, placebo-controlled, randomized trial of the use of lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhea due to Clostridium difficile showed no benefit (36).…”