Effects of Probiotics and Calcium Supplementation on Growth, Development, and Metabolic Parameters
Condition: Stunting; Obesity; Cognitive Function 1, Social; Depression; Behavior; Dyslipidemias; Insulin Resistance; Permeability; Increased
MeSH terms: Insulin Resistance; Dyslipidemias
Study type: Observational

Summary: 
      Stunting is still a major problem in developing countries, including Indonesia, and has been
      associated with impaired development. Stunted children have also a higher risk of metabolic
      syndrome in adulthood. The gut microbiota, as a part of intestinal integrity, may promote
      intake of nutrient during childhood. Probiotics supplementation may optimize the balance of
      gut microbiota and further improve child growth during the window period. Furthermore,
      calcium could also improve child growth by increasing the resistance to intestinal infection.
      However, the long-term effects of gut microbiota optimization during childhood using
      probiotics and calcium on growth, development, and the metabolic condition has not widely
      studied.
    

Detailed description: 
      This study was a 10-year follow-up study of randomized controlled trials of 6-month
      probiotics and calcium supplementation of Lactobacillus reuteri DSM 17938 or Lactobacillus
      casei CRL 431 in children aged 1-6 years (n=494) living in urban low socioeconomic
      communities of East Jakarta in 2007-2008. We re-enrolled the subjects to assess the long-term
      effects of probiotics and calcium supplementation on growth, development, and metabolic
      parameters at the age of 11-17 years.

      Healthy children (n = 238) were included in this follow-up study. Each subject previously
      assigned to one intervention group: low-lactose milk with a low calcium content (LC = 53), a
      regular calcium content (RC = 70), regular calcium with L. reuteri DSM 17938 (n = 55), and
      regular calcium with L. casei CRL 431 (n = 60).

      Anthropometric measurements were performed by measuring the weight and height of the
      subjects, and further combining the results to report BMI-for-age z-score. Height was also
      plotted to the chart of the World Health Organization (WHO) Child Growth Standards. Gut
      integrity was assessed with the lactulose-mannitol ratio using high-performance liquid
      chromatography (HPLC) method. Cognitive function, symptoms related to depression, behaviour,
      and serum brain-derived neurotrophic factors (BDNF) of the adolescents were evaluated used to
      investigate the effects of supplementation on development. We quantified lipid profile and
      Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) as metabolic parameters using
      the vein blood sample. The metabolic parameters were measured in at least three groups of
      intervention.
    

Intervention name(s): Low Calcium Milk; Regular Calcium Milk; Probiotic 1; Probiotic 2
Intervention type(s): Dietary Supplement; Dietary Supplement; Dietary Supplement; Dietary Supplement
Intervention description(s): 50 mg calcium/day; 400 mg/day; regular calcium milk + probiotic; regular calcium milk + probiotic
Intervention MeSH terms: Calcium, Dietary; Calcium Carbonate; Calcium
Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Low-socioeconomic urban communities representing flooding and non-flooding areas of East
        Jakarta, Indonesia.