Showing papers by "Arthur C. Ouwehand published in 2016"

Probiotic approach to prevent antibiotic resistance

Abstract: Probiotics are live microorganisms, mainly belonging to the genera Lactobacillus and Bifidobacterium, although also strain of other species are commercialized, that have a beneficial effect on the host. From the perspective of antibiotic use, probiotics have been observed to reduce the risk of certain infectious disease such as certain types of diarrhea and respiratory tract infection. This may be accompanied with a reduced need of antibiotics for secondary infections. Antibiotics tend to be effective against most common diseases, but increasingly resistance is being observed among pathogens. Probiotics are specifically selected to not contribute to the spread of antibiotic resistance and not carry transferable antibiotic resistance. Concomitant use of probiotics with antibiotics has been observed to reduce the incidence, duration and/or severity of antibiotic-associated diarrhea. This contributes to better adherence to the antibiotic prescription and thereby reduces the evolution of resistance. To what extent probiotics directly reduce the spread of antibiotic resistance is still much under investigation; but maintaining a balanced microbiota during antibiotic use may certainly provide opportunities for reducing the spread of resistances. Key messages Probiotics may reduce the risk for certain infectious diseases and thereby reduce the need for antibiotics. Probiotics may reduce the risk for antibiotic-associated diarrhea Probiotics do not contribute to the spread of antibiotic resistance and may even reduce it.

Probiotic use in at-risk populations

Abstract: Objective To inform health care providers about quality standards for manufacture of probiotic products being recommended for at-risk patient populations. Summary Probiotics are used in a variety of clinical settings, sometimes in at-risk populations for therapeutic endpoints. Although probiotics might not be approved as drugs, they are sometimes used for the prevention or treatment of disease. In the United States, and many regions of the world, probiotic products are marketed as dietary supplements (not drugs) and are therefore subject to different manufacturing and quality control standards than approved drugs are. Health care providers need to be assured that probiotic products used in at-risk populations are safe for this use. Pharmacists should require certificates of analysis, which document quality standards, from manufacturers of products stocked in hospital formularies or other pharmacies dispensing to at-risk people. Although responsible manufacturers use stringent quality standards on their processes and finished products, using a third party to verify compliance with manufacturing and accuracy of product labeling adds assurance to end users that the product is of high quality. Conclusion It is in patients' best interest to use probiotics in the prevention and treatment of conditions when the evidence is convincing. To protect high-risk patients, probiotic products should meet stringent microbiological standards. Product testing results should be available for review before recommending probiotic products to at-risk individuals. For products used in at-risk populations, manufacturers should provide this information or participate in a third-party verification program that certifies compliance.

Irritable bowel syndrome symptom severity improves equally with probiotic and placebo

Abstract: Aim To determine the effects of Lactobacillus acidophilus NCFM on irritable bowel syndrome (IBS) symptoms and quality of life (QoL). Methods In this randomized triple-blind trial, adult IBS volunteers who were recruited according to Rome III criteria received 109 or 1010 colony-forming units of NCFM or placebo daily for 12 wk. IBS Symptom Severity Score (IBS-SSS), which constituted the primary outcome, and secondary outcomes, including individual IBS symptoms, IBS-related QoL questionnaire, anxiety and depression, defecation frequency, and stool consistency, were assessed at baseline at the end of the 8-wk run-in period, after 4 and 12 wk of intervention, and after a 4-wk washout. Results A total of 340 of 391 randomized volunteers completed the trial. IBS-SSS improved over 12 wk of treatment in all treatment groups, decreasing by a mean ± SD of 44.0 ± 80.2, 50.8 ± 82.4, and 48.3 ± 72.2 in the placebo, active low-dose, and active high-dose groups, respectively. Similarly, secondary outcomes did not differ between treatment groups. However, in a post hoc analysis of volunteers with moderate to severe abdominal pain at baseline (VAS > 35/100), the treatment significantly reduced the sensation of abdominal pain. Pain scores fell by 20.8 ± 22.8, 29.4 ± 17.9, and 31.2 ± 21.9 in the placebo, active low-dose, and active high-dose groups, respectively (P value for placebo vs combined active doses = 0.0460). Conclusion NCFM alleviates moderate to severe abdominal pain, consistent with earlier observations of this strain mitigating visceral pain through increased analgesic receptor expression.

Polydextrose: Physiological Function, and Effects on Health

Abstract: Polydextrose (PDX) is a non-digestible oligosaccharide used widely across most sectors of the food industry. It is a randomly linked glucose oligomer containing small amounts of sorbitol and citric acid. The random bonds in PDX prevent mammalian digestive enzymes from readily hydrolyzing the molecule and it has a reported energy value of 1 kcal/g. These properties have led to the acceptance in many countries that PDX provides similar physiological effects as other dietary fibers and has shown prebiotic potential. Dietary intervention with prebiotics has been shown to selectively stimulate the growth and/or activity of one or a limited number of intestinal bacteria associated with several physiological benefits on health. Therefore, the objective of this review was a survey of the literature on the effect of supplementation with PDX in health, and to list the benefits for maintaining health and/or reducing the development of diseases.

Contemporary meta-analysis of short-term probiotic consumption on gastrointestinal transit

Abstract: AIM: To determine the efficacy of probiotic supplementation on intestinal transit time (ITT) in adults and to identify factors that influence these outcomes. METHODS: We conducted a systematic review of randomized controlled trials of probiotic supplementation that measured ITT in adults. Study quality was assessed using the Jadad scale. A random effects meta-analysis was performed with standardized mean difference (SMD) of ITT between probiotic and control groups as the primary outcome. Meta-regression and subgroup analyses examined the impact of moderator variables on SMD of ITT. RESULTS: A total of 15 clinical trials with 17 treatment effects representing 675 subjects were included in this analysis. Probiotic supplementation was moderately efficacious in decreasing ITT compared to control, with an SMD of 0.38 (95%CI: 0.23-0.53, P < 0.001). Subgroup analyses demonstrated statistically greater reductions in ITT with probiotics in subjects with vs without constipation (SMD: 0.57 vs 0.22, P < 0.01) and in studies with high vs low study quality (SMD: 0.45 vs 0.00, P = 0.01). Constipation (R2 = 38%, P < 0.01), higher study quality (R2 = 31%, P = 0.01), older age (R2 = 27%, P = 0.02), higher percentage of female subjects (R2 = 26%, P = 0.02), and fewer probiotic strains (R2 = 20%, P < 0.05) were predictive of decreased ITT with probiotics in meta-regression. Medium to large treatment effects were identified with B. lactis HN019 (SMD: 0.67, P < 0.001) and B. lactis DN-173 010 (SMD: 0.54, P < 0.01) while other probiotic strains yielded negligible reductions in ITT relative to control. CONCLUSION: Probiotic supplementation is moderately efficacious for reducing ITT in adults. Probiotics were most efficacious in constipated subjects, when evaluated in high-quality studies, and with certain probiotic strains.

Gut microbial activity as influenced by fiber digestion: dynamic metabolomics in an in vitro colon simulator

Abstract: Understanding the interaction between the gut microbial activity and the host is essential, and in vitro models are being used to test and develop hypotheses regarding the impact of food components/drugs on the human gut ecosystem. However, while in vitro models provide excellent possibilities for dynamic investigations, studies have commonly been restricted to analyses of few, targeted metabolites. In the present study, we employed NMR-based metabolomics combined with multilevel data analysis as a tool to characterize the impact of polydextrose (PDX) fiber on the in vitro derived fecal metabolome. This approach enabled us to identify and quantify the fiber-induced response on several fecal metabolites; we observed higher levels of butyrate, acetate, propionate, succinate, N-acetyl compound and a lower level of amino acids (leucine, valine, isoleucine, phenylalanine, and lysine), valerate, formate, isovalerate and trimethylamine among the PDX-treated sample compared to the control samples. In addition, by the application of multilevel data analysis we were able to examine the specific inter-individual variations, and caprylic acid was identified to be the main marker of distinct microbial compositions among the subjects. Our work is expected to provide a useful approach to understand the metabolic impact of potential prebiotic compounds and get deeper insight into the molecular regulation of gut-microbe activities in the complex gut system.

Normative values for stool frequency and form using Rome III diagnostic criteria for functional constipation in adults: systematic review with meta-analysis

Abstract: When designing clinical trials focused on functional constipation therapies, understanding the normative values of populations selected using the Rome III criteria is important for estimating baseline symptom severity, and for power analysis and sample size calculations. The objective of this review was to determine normative ranges for stool frequency and form in adults with functional constipation (Rome III criteria). Eligible studies reported stool frequency or form; random effects meta-analysis was performed with subgroup analyses to explore sources of heterogeneity. A total of 25 studies (43 groups, 2292 subjects) were included. Pooled estimates were 2.7 (95% CI 2.4-3.0) for weekly stools and 2.4 (95% CI 2.1-2.6) for stool form (Bristol scale). Heterogeneity was high for both outcomes (both I2=96%, P<0.001). Subgroup analysis revealed that weekly bowel movement frequency was higher in larger than in smaller studies (3.1 vs. 2.3, P<0.001) and in studies conducted in Europe compared with those in the Americas (3.1 vs. 2.2, P=0.02). For stool form, the use of a daily diary versus subject recall was the sole explanatory variable (2.5 vs. 2.1, P<0.05). We conclude that adults with functional constipation have significant variation in stool frequency and form, explained in part by geography and study design.

Use of Essential Oils in Poultry Production

Abstract: The ban of antibiotics as growth promoters in animal feed in many countries and the consumer demand for natural alternatives have increased interest in essential oils (EOs) in recent years. EOs have several properties to support their use in poultry feed, which include antioxidant, antiseptic, and insect repellent. In addition, EOs have been reported to increase digestive enzyme secretion and improve immune response to diseases. Several trials have shown positive effects of EOs on nutrient utilization and poultry performance. However, it appears that the degree of response may be influenced by the level and type of EO used, and the health status of the animal. In vitro and in vivo studies showed that specific EO blends may help to reduce incidences of subclinical necrotic enteritis and coccidiosis. Dietary supplementation of EO was reported to convey antioxidant benefits during meat storage. There is scarcity in animal trials studying the effects of EOs as an insect repellent in animal feed. The regulatory constraints on the use of EOs in the United States and European Union are also briefly discussed in this chapter. Systematic investigations on the relationship of EOs with bird performance and gut health are warranted to design an optimal animal response to EOs.

Probiotics and Antibiotic Use

Abstract: Diarrhea is a typical target for probiotics. In particular, probiotics appear to be effective in reducing the risk for side effects of antibiotic use. In this chapter we summarize the effect of probiotics in general and a combination of four probiotic strains in particular have on maintaining intestinal microbiota composition and reducing risk for antibiotic-associated diarrhea (AAD). Meta-analyses confirm the benefits probiotics can provide as an adjunct to antibiotics. Despite their success, it is difficult to make reference to these benefits in many jurisdictions. In Europe especially, it is important that reference to alternative endpoints is made, such as maintenance or restoration of microbiota composition or reduction of AAD causing pathogens. This is important, not only for improving quality of life for patients using antibiotics, but also from a health economic perspective; the cost of probiotics is relatively small compared to the cost of side effects caused by antibiotics