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Nutrients May 2022A low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet (LFD) is claimed to improve functional gastrointestinal symptoms (FGSs). However,... (Meta-Analysis)
Meta-Analysis Review
A Low-FODMAP Diet Provides Benefits for Functional Gastrointestinal Symptoms but Not for Improving Stool Consistency and Mucosal Inflammation in IBD: A Systematic Review and Meta-Analysis.
BACKGROUND
A low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet (LFD) is claimed to improve functional gastrointestinal symptoms (FGSs). However, the role of LFD in inflammatory bowel disease (IBD) patients with FGSs remains unclear.
OBJECTIVE
To systematically assess the efficacy of LFD in IBD patients with FGSs.
METHODS
Six databases were searched from inception to 1 January 2022. Data were synthesized as the relative risk of symptoms improvement and normal stool consistency, mean difference of Bristol Stool Form Scale (BSFS), Short IBD Questionnaire (SIBDQ), IBS Quality of Life (IBS-QoL), Harvey-Bradshaw index (HBi), Mayo score, and fecal calprotectin (FC). Risk of bias was assessed based on study types. A funnel plot and Egger's test were used to analyze publication bias.
RESULTS
This review screened and included nine eligible studies, including four randomized controlled trials (RCTs) and five before-after studies, involving a total of 446 participants (351 patients with LFD vs. 95 controls). LFD alleviated overall FGSs (RR: 0.47, 95% CI: 0.33-0.66, = 0.0000) and obtained higher SIBDQ scores (MD = 11.24, 95% CI 6.61 to 15.87, = 0.0000) and lower HBi score of Crohn's disease (MD = -1.09, 95% CI -1.77 to -0.42, = 0.002). However, there were no statistically significant differences in normal stool consistency, BSFS, IBS-QoL, Mayo score of ulcerative colitis, and FC. No publication bias was found.
CONCLUSIONS
LFD provides a benefit in FGSs and QoL but not for improving stool consistency and mucosal inflammation in IBD patients. Further well-designed RCTs are needed to develop the optimal LFD strategy for IBD.
Topics: Diet, Carbohydrate-Restricted; Fermentation; Gastrointestinal Diseases; Humans; Inflammation; Inflammatory Bowel Diseases; Irritable Bowel Syndrome; Leukocyte L1 Antigen Complex; Mucositis; Quality of Life
PubMed: 35631213
DOI: 10.3390/nu14102072 -
Advances in Nutrition (Bethesda, Md.) Oct 2022Evidence regarding the effect of isomaltulose on glycemic and insulinemic responses is still conflicting, which limits isomaltulose's application in glycemic management.... (Meta-Analysis)
Meta-Analysis
Evidence regarding the effect of isomaltulose on glycemic and insulinemic responses is still conflicting, which limits isomaltulose's application in glycemic management. The purpose of this study was to comprehensively evaluate its effectiveness and evidence quality. We systematically searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) prior to October 2021. RCTs were eligible for inclusion if they enrolled adults to oral intake of isomaltulose or other carbohydrates dissolved in water after an overnight fast and compared their 2-h postprandial glucose and insulin concentrations. The DerSimonian-Laird method was used to pool the means of the circulating glucose and insulin concentrations. Both random-effects and fixed-effects models were used to calculate the weighted mean difference in postprandial glucose and insulin concentrations in different groups. Subgroup, sensitivity, and meta-regression analyses were also conducted. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of evidence. Finally, 11 RCTs (n = 175 participants) were included. The trials were conducted in 4 countries (Japan, Brazil, Germany, and the Netherlands), and all of the enrolled participants were >18 y of age with various health statuses (healthy, type 2 diabetes, impaired glucose tolerance, and hypertension). Moderate evidence suggested that oral isomaltulose caused an attenuated glycemic response compared with sucrose at 30 min. Low evidence suggested that oral isomaltulose caused an attenuated but more prolonged glycemic response than sucrose and an attenuated insulinemic response. Low-to-moderate levels of evidence suggest there may be more benefit of isomaltulose for people with type 2 diabetes, impaired glucose tolerance, or hypertension; older people; overweight or obese people; and Asian people. The study was registered on PROSPERO (International Prospective Register of Systematic Reviews) as CRD42021290396 (available at https://www.crd.york.ac.uk/prospero/).
Topics: Adult; Aged; Blood Glucose; Diabetes Mellitus, Type 2; Glucose; Glucose Intolerance; Humans; Hypertension; Insulin; Isomaltose; Randomized Controlled Trials as Topic; Sucrose; Water
PubMed: 35595510
DOI: 10.1093/advances/nmac057 -
PloS One 2022Pain management is currently important in neonatal intensive care unit (NICU). The superiority in pain relief of the combined oral sucrose (OS) and nonnutritive sucking... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pain management is currently important in neonatal intensive care unit (NICU). The superiority in pain relief of the combined oral sucrose (OS) and nonnutritive sucking (NNS) to other single intervention has not been well established. The administration of sucrose has been considered to potentially induce adverse events, which has been controversial. This study aims to investigate the combined effects and safety in comparison with other single intervention methods, including NNS, OS alone, breast milk and oral glucose.
METHODS
We searched databases including Medline (via Pubmed), Embase (via Ovid), web of science, and Cochrane Library for randomized controlled trials from Jan 1, 2000 to Mar 31, 2021. The data were analyzed in the meta-analysis using Review manager Version 5.3. Pain score was the primary outcome in this meta-analysis. The adverse events were assessed qualitatively.
RESULTS
A total of 16 studies were eligible in the meta-analysis. The results demonstrated a significant reduction in pain score in the NNS+OS group compared with NNS alone (SMD = -1.69, 95%CI, -1.69,-0.65) or sucrose alone (SMD = -1.39, 95% CI, -2.21,-0.57) during the painful procedures. When compared NNS+OS with breast milk, no significant difference was detected (SMD = -0.19, 95% CI: -0.5, 0.11).
CONCLUSION
The combined effects of NNS and OS might be superior to other single intervention method. However, the effects might be mild for moderate-to-severe pain.
Topics: Female; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Pain; Pain Management; Pain Measurement; Sucking Behavior; Sucrose
PubMed: 35522649
DOI: 10.1371/journal.pone.0268033 -
PloS One 2022Rifaximin and lactulose are widely used in patients with hepatic encephalopathy (HE); however, data on whether the combined use of rifaximin and lactulose could yield... (Meta-Analysis)
Meta-Analysis
Rifaximin and lactulose are widely used in patients with hepatic encephalopathy (HE); however, data on whether the combined use of rifaximin and lactulose could yield additional benefits for patients with HE are limited and inconclusive. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the treatment effectiveness of rifaximin plus lactulose versus lactulose alone in patients with HE. Electronic databases (PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure) were searched for eligible RCTs from their inception until November 2020. Relative risks (RRs) with 95% confidence intervals (CIs) were applied to calculate pooled effect estimates for the treatment effectiveness of rifaximin plus lactulose versus lactulose alone by using the random-effects model. Sensitivity, subgroup, and publication bias analyses were also performed. We included 7 RCTs enrolling 843 patients with HE. We noted that the use of rifaximin plus lactulose was associated with an increased incidence of effective rate than lactulose alone (RR, 1.30; 95% CI, 1.10-1.53; P = 0.002). Moreover, the use of rifaximin plus lactulose was associated with a reduced risk of mortality as compared with lactulose alone (RR, 0.57; 95% CI, 0.41-0.80; P = 0.001). This study found that the use of rifaximin in combination with lactulose could provide additional benefits in terms of increased effective rate and decreased mortality than lactulose alone in patients with HE.
Topics: Combined Modality Therapy; Hepatic Encephalopathy; Humans; Lactulose; Rifaximin; Treatment Outcome
PubMed: 35471992
DOI: 10.1371/journal.pone.0267647 -
Frontiers in Oral Health 2022The aim of this systematic review of published literature was to answer the research question, "What is the difference in the level of plaque quantity, in adults and...
BACKGROUND
The aim of this systematic review of published literature was to answer the research question, "What is the difference in the level of plaque quantity, in adults and children who chew sugar-free gum (SFG), compared with those who do not chew SFG, who do not chew gum, or who use alternatives such as probiotics or fluoride varnish?".
METHODS
The systematic review [registered on PROSPERO 2018 (CRD42018094676)] included studies on adults and children with chewing of SFG as the main intervention, where "sugar" referred to monosaccharides and disaccharides. Included studies were in English and corresponded to primary research published between 1946 and 2020. The search conducted spanned all relevant databases using both Medical Subject Headings (MESH) and free text with combinations of "chewing gum," "sugar-free," "caries," "xerostomia," "periodontal disease."
RESULTS
Eight articles included plaque quantity as part of their outcomes. Meta-analysis showed that SFG significantly reduced plaque quantity (effect size-0.778; 95% CI-1.167 to-0.39). The correlation between the baseline and the end of study data was assumed to be 0.95 for the control and 0.65 for the SFG group. A sensitivity analysis was conducted with the pre- to post-test correlation, set at 0.95 for the SFG group. This gave an effect size of-1.098 (95% CI-1.539 to-0.656) with = 89.73%. When looking more specifically at xylitol gum, the results of the meta-analysis showed that it significantly reduced plaque quantity (effect size-0.743; 95% CI-1.148 to-0.338). There was a high degree of heterogeneity between studies with = 86.0%.
CONCLUSION
There is some evidence that chewing sugar-free gum, in particular xylitol SFG, reduces the quantity of plaque in the oral cavity in comparison to non SFG chewing or no chewing controls. Further research with improved design, lengthier timeframes and higher number of participants should be considered.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=94676.
PubMed: 35434703
DOI: 10.3389/froh.2022.845921 -
Nutrients Mar 2022The purpose of this systematic review was to understand Indian mothers' milk composition and report changes in it over the past 100 years. A review was conducted in... (Review)
Review
The purpose of this systematic review was to understand Indian mothers' milk composition and report changes in it over the past 100 years. A review was conducted in accordance with PRISMA and registered with PROSPERO (CRD42022299224). All records published between 1921 and 2021 were identified by searching databases Google Scholar, ResearchGate, PubMed, and the Cochrane Database of Systematic Reviews. All observational, interventional, or supplementation studies reporting macronutrients (protein, fat, lactose) in milk of Indian mothers, delivering term infants, were included. Publications on micronutrients, preterm, and methods were excluded. Milk was categorized into colostrum, transitional, and mature. In all, 111 records were identified, of which 34 were included in the final review. Fat ranged from 1.83 to 4.49 g/100 mL, 2.6 to 5.59 g/100 mL, and 2.77 to 4.78 g/100 mL in colostrum, transitional, and mature milk, respectively. The protein was higher in colostrum (1.54 to 8.36 g/100 mL) as compared to transitional (1.08 to 2.38 g/100 mL) and mature milk (0.87 to 2.33 g/100 mL). Lactose was lower in colostrum (4.5-6.47 g/100 mL) as compared to transitional (4.8-7.37 g/100 mL) and mature milk ranges (6.78-7.7 g/100 mL). The older studies (1950-1980) reported higher fat and protein in colostrum as compared to subsequent time points. There were variations in maternal nutritional status, diet, socioeconomic status, and regions along with study design specific differences of time or methods of milk sampling and analysis. Additionally, advancements in methods over time make it challenging to interpret time trends. The need for conducting well-designed, multicentric studies on nutrient composition of Indian mother's milk using standardized methods of sampling and estimation for understanding the role of various associated factors cannot be undermined.
Topics: Colostrum; Female; Humans; Infant; Infant, Newborn; Lactation; Lactose; Milk, Human; Mothers; Nutrients; Pregnancy
PubMed: 35406008
DOI: 10.3390/nu14071395 -
Frontiers in Pharmacology 2022Probiotic and low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet are two commonly used management approaches for patients with... (Review)
Review
Probiotic and low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet are two commonly used management approaches for patients with irritable bowel syndrome (IBS). We aimed to evaluate the most effective combinations and components among different probiotics or low FODMAP diet through component network meta-analysis (NMA). We searched Embase, Ovid Medline, and Web of Science from inception to 21 January 2021. Randomized controlled trials (RCTs) examining the efficacy of probiotics and low FODMAP diet for IBS were included, with placebo, sham diet, or conventional treatments as controls. Binary outcomes were compared among treatments using the relative ratio (RR). A minimally contextualized framework recommended by the GRADE group was used to evaluate the certainty of evidence. The primary efficacy outcome was the relief of global IBS symptoms, and the secondary efficacy outcome was the reduction in IBS symptom scores or abdominal pain scores. We included 76 RCTs (n = 8058) after screening 1940 articles. Eight RCTs were classified as low risk of bias. Standard network meta-analysis (NMA) showed that (RR 1.74, 95% CI 1.22-2.48) and (RR 1.76, 95% CI 1.01-3.07) were the most effective for the primary efficacy outcome (high certainty evidence); component NMA showed that (RR 5.67, 95% CI 1.88 to 17.08, = 0.002) and (RR 1.42, 95% CI 1.07 to 1.91, = 0.017) were among the most effective components. The results of standard NMA and CNMA analysis of the improvement of overall IBS symptom scores or abdominal pain scores were consistent with this finding. was the most effective component for the relief of IBS symptoms; and were possibly effective and need further verification. website, identifier registration number.
PubMed: 35355730
DOI: 10.3389/fphar.2022.853011 -
Neurogastroenterology and Motility Oct 2022Evidence for the management of pediatric functional abdominal pain disorders (FAPD) is lacking. The aim of this systematic review was to update evidence on the efficacy...
BACKGROUND
Evidence for the management of pediatric functional abdominal pain disorders (FAPD) is lacking. The aim of this systematic review was to update evidence on the efficacy and safety of implementing low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) dietary restrictions for the management of children with FAPD.
METHODS
The Cochrane Library, EMBASE, and MEDLINE databases were searched up to October 2021 for randomized controlled trials (RCTs) that compared the use of a low-FODMAP diet with any comparator in children aged 3-18 years with FAPD. The primary outcome was abdominal pain intensity.
KEY RESULTS
Five RCTs assessing the effects of a low-FODMAP diet were included. An effect of a low-FODMAP diet on abdominal pain intensity was only found in two trials. In one trial, there was a decrease in abdominal pain intensity on a 0-10 point Visual Analogue Scale (VAS) between low-FODMAP and gastrointestinal protective diet groups after 2 months (mean difference, MD 1.77, 95% confidence interval, CI, 1.23 to 2.31, n = 60). In another trial, there was a difference in abdominal pain intensity during the 3-day intervention between the low-FODMAP and typical Singaporean diet groups (MD -1.36 cm, 95% CI -2.38 to -0.34, n = 10) measured using a 0-10 cm VAS.
CONCLUSIONS & INTERFERENCES
There is insufficient evidence for or against the efficacy and safety of using a low-FODMAP diet for the management of children with FAPD.
Topics: Abdominal Pain; Child; Diet, Carbohydrate-Restricted; Disaccharides; Fermentation; Humans; Irritable Bowel Syndrome; Monosaccharides; Oligosaccharides
PubMed: 35231146
DOI: 10.1111/nmo.14345 -
BMC Pregnancy and Childbirth Feb 2022The objective of the FeminFER project was to assess the value of ferric carboxymaltose following a multicriteria decision analysis in obstetrics and gynaecology in Spain.
BACKGROUND
The objective of the FeminFER project was to assess the value of ferric carboxymaltose following a multicriteria decision analysis in obstetrics and gynaecology in Spain.
METHODS
Ferric carboxymaltose (FCM) and ferrous sulphate were evaluated using the EVIDEM framework. Ten stakeholders participated to collect different perspectives. The framework was adapted considering evidence retrieved with a PICO-S search strategy and grey literature. Criteria/subcriteria were weighted by level of relevance and an evidence-based decision-making exercise was developed in each criterion; weights and scores were combined to obtain the value of intervention relative to each criterion/subcriterion, that were further combined into the Modulated Relative Benefit-Risk Balance (MRBRB).
RESULTS
The most important criterion favouring FCM was Compared Efficacy/Effectiveness (0.183 ± 0.07), followed by Patient Preferences (0.059 ± 0.10). Only Direct medical costs criterion favoured FS (-0.003 ± 0.03). MRBRB favoured FCM; 0.45 ± 0.19; in a scale from -1 to + 1.
CONCLUSIONS
In conclusion, considering the several criteria involved in the decision-making process, participants agreed with the use of FCM according to its MRBRB.
Topics: Anemia, Iron-Deficiency; Decision Support Techniques; Female; Ferric Compounds; Ferrous Compounds; Humans; Maltose; Pregnancy; Pregnancy Complications, Hematologic; Risk Assessment; Spain; Stakeholder Participation
PubMed: 35216553
DOI: 10.1186/s12884-022-04481-w -
Paediatric Drugs Mar 2022Parenteral iron is generally considered safe in adults, and severe adverse events are extremely rare. Ferric carboxymaltose (FCM), a third-generation parenteral iron...
BACKGROUND
Parenteral iron is generally considered safe in adults, and severe adverse events are extremely rare. Ferric carboxymaltose (FCM), a third-generation parenteral iron product, is not licensed for pediatric use.
OBJECTIVE
The aim of this study was to present our data on the safety of FCM in children with iron deficiency (ID) and/or iron deficiency anemia (IDA) and to investigate through a systematic literature review articles reporting on the safety of FCM use in children with ID/IDA.
PATIENTS AND METHODS
Safety data regarding children treated with FCM for ID/IDA from four pediatric departments in Greece over a 26-month period are presented. Additionally, a literature search was performed in PubMed, Scopus, and Google Scholar on December 4, 2021 for articles reporting on the use of FCM in children with ID/IDA. Review articles, guidelines, case reports/case series, and reports on the use of FCM for conditions other than ID/IDA were excluded. Identified articles were screened for all reported adverse events (AE) that were graded according to the Common Terminology Criteria for Adverse Events, version 5.0.
RESULTS
In our cohort, 37 children with ID/IDA received 41 FCM infusions. All infusions were tolerated well. In addition, 11 articles reporting 1231 infusions of FCM in 866 children were identified in the literature. Among them, 52 (6%) children developed AE that were graded as mild or moderate (grades I-III).
CONCLUSIONS
Our patient cohort and this literature review provide further evidence for the good safety profile of FCM in children, although well-designed prospective clinical trials with appropriate safety endpoints are still required.
Topics: Adult; Child; Ferric Compounds; Greece; Humans; Maltose; Prospective Studies
PubMed: 35083718
DOI: 10.1007/s40272-022-00491-5