Tenth year reenrollment randomized trial investigating the effects of childhood probiotics and calcium supplementation on height and weight at adolescence.

Evania Astella Setiawan, Davrina Rianda, Muzal Kadim, Fenny Susanto, Frans J Kok, Anuraj H Shankar, Rina Agustina

Journal: Scientific reports 2021;11(1):11860

PMID: 34088920

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In combination, probiotics and calcium may help to support gut health and aid growth in early life. This 10 year follow up of 238 children from a previous randomised control trial aimed to determine the long-term effects of probiotic and calcium supplementation on growth during adolescence. The use of probiotics and calcium had no effect on changes in height, weight, or body mass for age. When more analyses were performed the use of Lactobacillus casei was shown to influence changes in body mass for age but only in females. Interestingly those in the probiotic group had poorer gut health than those who were not supplemented. It was concluded that in females, the use of probiotics and calcium during early life may decrease the risk of obesity later in life due to improved body mass. However, this warrants further research. This study could be used by health care professionals to understand that the use of probiotics and calcium in early life may have long-term benefits such as risk reduction of metabolic diseases.

Abstract

Microbiota and its modification with specific probiotics in early life could provide long term health benefits. Probiotics and calcium strengthen intestinal integrity and may support linear growth. This study investigated the long-term effects of childhood probiotics and calcium supplementation on growth in adolescence. We re-enrolled 238 adolescents aged 11-18 years from 494 children 10-years after 6-months of supplementation with either low-lactose milk fortified with low levels of calcium (LC, ∼50 mg/day, n = 53/124), with regular levels of calcium (RC, ∼440 mg/day, n = 70/126), or with regular calcium + 5 x 10 CFU/day Lactobacillus reuteri DSM 17938 (Reuteri, n = 55/124), or regular calcium + 5 x 10 CFU/day L. casei CRL 431 (Casei, n = 60/120). Changes in height-for-age z-score (HAZ) and body mass index-for-age z-score (BMIZ) were determined from the end of intervention to re-enrollment. General linear models were used to assess the effects on HAZ and BMIZ of group, gender, living area, maternal education, family income, physical activity, diet quality, nutritional status, and gut integrity as determined by urinary lactulose/mannitol ratio (L:M). Adolescent mean age was 15.3 years, mean HAZ was - 1.11, mean BMIZ was - 0.2 and median L:M (n = 155) was 0.23. Changes in HAZ and BMIZ were not significantly different between Casei, Reuteri, LC compared to RC. However, a significant decrease in BMIZ was observed among female adolescents in the Casei compared to RC group (- 0.5 SD, 95% CI - 0.8 to - 0.003, p = 0.048). Childhood probiotic and calcium supplementation may therefore selectively affect female adolescents.Clinical trial registration: This follow-up study has been registered at www.clinicaltrials.gov , Registry name: Rina Agustina, Registration number: NCT04046289, First Registration Date 06/08/19. web link: https://www.clinicaltrials.gov/ct2/show/NCT04046289 .

Address: Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No.6, Jakarta, 10430, Indonesia.; Human Nutrition Research Center, Indonesian Medical Education and Research Institute (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.; Department of Pediatric, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.; Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands.; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.; Eijkman-Oxford Clinical Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia.; Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No.6, Jakarta, 10430, Indonesia. [email protected].; Human Nutrition Research Center, Indonesian Medical Education and Research Institute (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. [email protected].
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