Postnatal probiotic supplementation can prevent and optimize treatment of childhood asthma and atopic disorders: a systematic review of randomized controlled trials

Background: Although several randomized controlled trials (RCTs) published over the past 5 years show that prenatal or postnatal probiotics may prevent or optimize the treatment of childhood asthma and atopic disorders, findings from the systematic reviews and meta-analyses of these studies appear inconsistent. More recent RCTs have focused on postnatal probiotics, and linked specific probiotic strains to better disease outcomes. Objective: This systematic review aimed to determine if postnatal probiotics are as effective as prenatal probiotics in preventing or treating childhood asthma and atopic disorders. Methods: We searched the PubMed, Medline, Google Scholar, and EMBASE databases for RCTs published within the past 5 years (from 2017 to 2022). We included only full-text RCTs on human subjects published in or translated into the English language. We retrieved relevant data items with a preconceived data-extraction form and assessed the methodological quality of the selected RCTs using the Cochrane Collaboration's tool for assessing the risk of bias in randomized trials. We qualitatively synthesized the retrieved data to determine any significant differences in study endpoints of the probiotic and placebo groups. Results: A total of 1,320 participants (688 and 632 in the probiotic and placebo groups) from six RCTs were investigated. One RCT showed that early Lactobacillus rhamnosus GG (LGG) led to a reduction in the cumulative incidence rate of asthma. Another study demonstrated that mixed strains of Lactobacillus paracasei and Lactobacillus fermentum could support clinical improvement in children with asthma while one trial reported a significant reduction in the frequency of asthma exacerbations using a mixture of Ligilactobacillus salivarius and Bifidobacterium breve. Three trials showed that a combination of LGG and Bifidobacterium animalis subsp lactis, Lactobacillus rhamnosus alone, and a probiotic mixture of Lactobacillus LOCK strains improved clinical outcomes in children with atopic dermatitis and cow-milk protein allergy. Conclusions: Postnatal strain-specific probiotics (in single or mixed forms) are beneficial in preventing and treating atopic dermatitis and other allergies. Similarly, specific strains are more effective in preventing asthma or improving asthma outcomes. We recommend more interventional studies to establish the most useful probiotic strain in these allergic diseases

Validation of antihypertensive drug requirement to measure the severity of hypertension and the efficacy of lifestyle intervention

Background/objective: The ongoing pandemic of non-communicable diseases, with systemic arterial hypertension at the forefront, mandates urgent attention to the aetiopathogenic mechanism rather than continuing to rely on suppressive drug therapies. Lifestyle interventions (such as diet, sleep and exercise) may have substantial impact on blood pressure control in hypertension. However this may not be evident in clinical trials of lifestyle intervention if the blood pressure was previously controlled by drugs. We therefore sought to develop an alternative method of measuring the impact of lifestyle intervention, rather than rely on blood pressure measurement alone. Methods: The open trial of a personalized food avoidance dietary approach to stop hypertension was approved by the UNTH ethics committee. The Antihypertensive Drug Treatment Requirement (ADTR) score was calculated as the total number of defined unitary dosages of antihypertensive drugs times adherence +/- 0.1 accordingly for each mm Hg that average systolic pressure either exceeds 120 mm Hg (AOBP or home BP, whichever higher) or goes below 100 mm Hg Hg (AOBP or home BP, whichever lower). The dietary compliance score was based on the frequency of major/ minor dietary indiscretion (as per the PFADASH guidelines) i.e. less than (= GOOD) or more than (= POOR) once a month/ once a fortnight, respectively. Normality of data distribution was assessed by computing Shapiro-Wilk statistics. Cronbach's alpha reliability coefficient was used to assess internal consistency of ADTR measurements. Results: Bi-quarterly Shapiro – Wilk statistics for AdhRx scores and ADTR scores showed more than 80% likelihood of being normally distributed at 5% significance level (i.e. 13 out of 16 data sets tested). Cronbach's alpha reliability coefficient was 0.980. This confirmed consistency of the ADTR measurement scale. For three study participants who improved to Good compliance (after dietary counseling) and four participants who failed to improve, Good compliance was associated with lower ADTR scores, but the differences between Good (mean ADTR of 1.07+0.82) and Poor (3.81+3.15) were not statistically significant (p = 0.210). For the three study participants who transited from Poor to Good compliance (in response to counseling), there was a high degree of negative correlation (i.e. decline of drug requirement) which was statistically significant in two of them (p<0.05). However, in the study participants who failed to improve their dietary compliance, there was a relative lack of correlation (with higher p values). The overall pattern is consistent with a negative association between dietary compliance and ADTR score. Conclusion: We conclude that ADTR scores are useful and valid tools to assess the impact of dietary interventions which address the aetiopathogenic mechanism in essential hypertension. This enables differentiation between blood pressure lowering by drugs and that due to dietary intervention