Probiotics in Crohn's disease remission: a systematic review

Crohn's disease (CD) is an inflammatory condition that can affect the entire gastrointestinal tract due to an exacerbated and inadequate immune system response. Objective. This study aimed to conduct a systematic review, through clinical trials, about the use of probiotics in humans with CD. Materials and methods. Research was carried out in the PubMed, Scopus and Science Direct databases using the keywords "Crohn's disease" and "probiotics". We conducted the review by searching clinical trials published from 2000 to December 2019. Results. Of 2,164 articles found, only nine were considered eligible for this review. The studies investigated patients with CD at different stages of the pathology, and in three studies the potential effect of probiotics in the active phase was observed; in two, in the remission phase; and in four, after intestinal surgery. The sample size of the studies ranged from 11 to 165 individuals and the age of the participants between 5 and 71 years. Gram-positive bacteria were used in six clinical interventions and in two studies yeasts were used. As for the significant results obtained with the treatment with probiotics, in one study there was beneficial clinical effects in patients and, in another, there was an improvement in intestinal permeability. Conclusion. Currently, it is not possible to establish a recommendation for probiotic therapy to control CD due to the few clinical trials with significant results. There is a need for more research on clinical intervention with probiotics in CD to clarify the action, define doses and time of use(AU)

La enfermedad de Crohn (EC) es una afección inflamatoria que puede afectar todo el tracto gastrointestinal debido a una respuesta del sistema inmunitario exacerbada e inadecuada. Objetivo. Realizar una revisión sistemática, a través de ensayos clínicos, sobre el uso de probióticos en humanos con EC. Materiales y métodos. La investigación se realizó en las bases de datos PubMed, Scopus y Science Direct utilizando las palabras clave "enfermedad de Crohn" y "probióticos". La revisión se hizo en ensayos clínicos publicados desde 2000 hasta diciembre 2019. Resultados. De 2164 artículos encontrados, solo nueve fueron considerados elegibles. Los estudios investigaron pacientes con EC en diferentes etapas de la patología, y en tres estudios se observó el efecto potencial de los probióticos en la fase activa; en dos, en remisión; y en cuatro, tras cirugía intestinal. El tamaño de la muestra fue entre 11 y 165 individuos y la edad entre 5 y 71 años. Se utilizaron bacterias grampositivas en seis intervenciones clínicas y en dos estudios se utilizaron levaduras. En cuanto a los resultados significativos obtenidos con el tratamiento con probióticos, en un estudio hubo efectos clínicos beneficiosos en los pacientes y, en otro, hubo una mejora en la permeabilidad intestinal. Conclusión. Actualmente, no es posible establecer una recomendación de terapia con probióticos para el control de la EC debido a los pocos ensayos clínicos con resultados significativos. Existe la necesidad de más investigación sobre la intervención clínica con probióticos en EC para aclarar la acción, definir dosis y tiempo de uso(AU)

Contagem de carboidratos, estado nutricional e perfil metabólico em adolescentes com diabetes mellitus tipo 1 / Carbohydrate counting, nutritional status and metabolic profile of adolescents with type 1 diabetes mellitus

OBJETIVOS: Avaliar o efeito de um programa de contagem de carboidratos sobre parâmetros antropométricos, de composição corporal, bioquímicos e de consumo alimentar em adolescentes com diabetes mellitus tipo 1 em uso de insulina.MÉTODOS: Ensaio clínico randomizado que incluiu adolescentes entre 10 e 19 anos, em tratamento para diabetes mellitus tipo 1 com associação de insulinas de ação rápida (regular) e intermediária (Neutral Protamine Hagedorn). Os participantes receberam orientação nutricional e foram acompanhados durante quatro meses, sendo divididos em grupo intervenção (GI), com contagem de carboidratos, e grupo controle (GC), sem contagem de carboidratos. No início e no final do programa os pacientes foram avaliados em relação ao índice de massa corporal, circunferência da cintura, percentual de gordura corporal e parâmetros bioquímicos: hemoglobina glicada, glicemia de jejum, glicemia pós-prandial e perfil lipídico. O consumo alimentar foi avaliado a cada quinze dias por meio do recordatório de 24 horas. Para a comparação intragrupo foram utilizadosos testes T-pareado e Wilcoxon e para a comparação intergrupo os testes t Student e Mann-Whitney. O nível de significância adotado foi o de 5%.RESULTADOS: Participaram do estudo 28 adolescentes, 14 em cada grupo. O GI diminuiu significativamente a hemoglobina glicada (p=0,002) e a ingestão de lipídeos (p=0,002), e aumentou a ingestão de carboidratos (p=0,005). O GC aumentou a hemoglobina glicada (p=0,024). O GI apresentou menor valor de glicemia de jejum (p=0,033) e da hemoglobina glicada (p<0,001) em relação ao GC. Ambos os grupos diminuíram a ingestão calórica. Os parâmetros antropométricos permaneceram estáveis e não houve diferença entre os grupos.CONCLUSÕES:A contagem de carboidratos associada ao uso das insulinas Neutral Protamine Hagedorn e Regular favoreceu o controle glicêmico, permitiu flexibilidade na ingestão de carboidratos, diminuiu a ingestão calórica e não influenciou na composição corporal.

AIMS: To evaluate the effect of a carbohydrate counting program on the anthropometric measurements, body composition, biochemical parameters anddietary intake of adolescentswithtype 1 diabetes mellitususing insulin.METHODS: A randomized clinical trial included adolescents between 10 and 19 years in treatment for type 1 diabetes with association of fast-acting insulin (regular) and intermediate-acting insulin (Neutral Protamine Hagedorn). The participants received nutritional counseling and were followed for four months, being divided into intervention group (IG), with carbohydrate counting, and control group (CG), without carbohydrate counting. At the beginning and end of the program, patients were evaluated for body mass index, waist circumference, body fat percentage and biochemical parameters: glycated hemoglobin, fasting glucose, postprandial glucose and lipid levels. Dietary intake was assessed every two weeks through the 24-hour recall. For intragroup comparison T-paired and Wilcoxon tests were used, and for intergroup comparison Student t and Mann-Whitney tests were used. The significance level was 5%.RESULTS: The study included 28 adolescents, 14 in each group. The IG significantly decreased glycated hemoglobin (p=0.002) and lipid intake (p=0.002), and increased carbohydrate intake (p=0.005). The CG increased glycated hemoglobin (p=0.024). The IG showed lower fasting glucose value (p=0.033) and glycated hemoglobin (p <0.001) compared to the CG. Both groups decreased caloric intake. Anthropometric parameters were stable and there was no difference between groups.CONCLUSIONS: Carbohydrate counting together with Neutral Protamine Hagedorn and Regular insulins favored glycemic control, allowed flexibility in carbohydrate intake, decreased caloric intake, and had no effect on body composition.