A Community-based Randomized Double Blind Controlled Trial of Lactobacillus paracasei and Bifidobacterium lactis on Reducing Risk for Diarrhea and Fever in Preschool Children in an Urban Slum in India.

Aims: The aim of the study was to determine the effect of probiotics on diarrhea and fever in preschool children in a community setting in a developing country. Study Design: Double blind randomized controlled trial. Place and Duration of Study: The study was performed in Addagutta; a slum of Hyderabad (India), from July 2010 to April 2011. Methodology: Healthy preschool children (2-5 years, n=379) in an Urban Slum in India. Three randomly allocated groups of children received either of the two probiotics (Lactobacillus paracasei Lpc-37 and Bifidobacterium lactis HN019) or the placebo for a period of 9 months and were assessed for weight gain, linear growth and incidence of diarrhea and fever. Results: Neither of the tested probiotics; L. paracasei Lpc-37 or B. lactis HN019 had any influence on weight gain or linear growth. There was no significant difference between the groups in incidence of diarrhea and fever when assessing the whole study period. However, during the wet season, in the months of August and September, incidence of diarrhea was significantly higher in placebo group (16.9%) compared to L. paracasei Lpc- 37 (11.7 %) and B. lactis HN019 groups (8.4 %). Similarly, the incidence of fever was significantly higher in the month of August in the placebo group (11.5%) compared to the L. paracasei Lpc-37 group (7%) and B. lactis HN019 group (7.3%). Probiotic supplementation had no effect on fecal calprotectin, but fecal IgA and serum interleukin 8 were decreased significantly in the B. lactis HN019 group compared to placebo. Consumption of L. paracasei Lpc-37 lead to increased levels of fecal L. paracasei. Conclusion: During the rainy season, when incidence of fever and diarrhea was highest, the administered probiotics reduced the incidence of these symptoms. Over the whole study period, the probiotics did, however, not influence incidence of diarrhea or fever.

Pattern of Growth Faltering and Recovery in Under-5 Children in India Using WHO Growth Standards - A Study on First and Third National Family Health Survey.

Objective: To examine the pattern of growth faltering in preschool children, using World Health Organization (WHO) growth standards 2006 from the available datasets of first and third National Family Health Survey (NFHS 1 and 3). Design: Data-analysis of two large-scale cross-sectional surveys done at a gap of 15 years. Setting: General community. Subjects: Preschool children included in NFHS 1 (n = 37,768) and NFHS 3 (n = 41,306). Main outcome measures: Weight for age Z-scores (WAZ), height for age Z scores (HAZ) and weight for height Z scores (WHZ) based on WHO growth standards for the first four years of life. Results: Mean WAZ score at ‘0’ month during first and third surveys were -1.15 (n=268) and -0.76 (n=184), respectively. Of the total growth faltering in weight for age Z (WAZ) score by the end of third year, 55% and 44% of the growth faltering was already present at birth for the first and third survey, respectively. There was no change in weight for height Z (WHZ) score for the first three years during both the surveys. Conclusions: A good part of the total growth faltering in India has already taken place at birth. Much of the growth faltering in early life can be attributed to faltering in HAZ scores or stunting. Understanding the causal role of stunting and its prevention as well as improving birth weight appears to be the key for better efficacy of public health programs in preventing under-5 malnutrition in India.

Hospital Based Nutrition Rehabilitation of Severely Undernourished Children Using Energy Dense Local Foods.

Objective: To examine the catch up growth in severely wasted children using energy dense local foods at a hospital based nutrition rehabilitation unit. Design: Retrospective cohort. Setting: In-patient ward at a tertiary care government pediatric hospital in Hyderabad. Patients: Children with severe malnutrition (n=309) admitted to nutrition ward from January 2001 to December 2005. Intervention: A diet based on energy dense local foods along with multivitamin-multimineral supplements. Main outcome measures: Catch up growth (g/kg/day) during each week of hospital stay. Results: Mean age of the children was 25 months (range 2-60). Their baseline weight for height (WHZ) Z score was –4.1. Mean weight gain was moderate (5g/kg/day) and baseline WHZ score had a significant negative relationship to the weight gain. The prevalence of morbidities was high and the commonest morbidity was fever. Weight gain was higher by almost 40% in the absence of morbidities in any week. Conclusions: The diet based on local energy dense foods was found to be suitable for the nutrition rehabilitation of severely malnourished children though the rate of weight gain was moderate.