益生菌健康功能及機(jī)制研課件

EffectsofProbioticsonHumanHealthandMechnismsTong-CunZhang,Ph.DTianjinUniv.ofScience&TechnologyEffectsofProbioticsonHumanOutlineWhatareprobiotics？Howdotheywork？CurrentproposedusesandalookatsomeoftheevidenceIssuesinprescribingtheiruseOutlineWhatareprobiotics？Probioticsconcept

Probioticsaredefinedas‘livingmicro-organisms,whichuponingestionincertainnumbersexerthealthbenefitsbeyondgeneralnutrition’Intensiveresearchareaintheworld……..Probioticsconcept

ProbioticsProbioticsLactobacillussp.reutericaseiramnosusacidophilusStreptococcussp.Bifidobacteriumsp.infantislactislongumbreveSacharomycesboulardii(non-human)ProbioticsLactobacillussp.益生菌健康功能及機(jī)制研課件益生菌健康功能及機(jī)制研課件

AcidtoleranceBiletoleranceCellsurfacehydrophobicityProtoplastregenerationAntimicrobialactivityCholesterolremovalandbilesaltdeconjugationGutcolonizationLactoseremovalProteaseandaminopeptidaseactivityProbioticsattributesAcidtoleranceProbioticsattr益生菌健康功能及機(jī)制研課件益生菌健康功能及機(jī)制研課件Probiotics:ProposedusesInfectiousdiarrheaAntibiotic-associateddiarrheaIBD,IBS,andpouchitisNecrotizingEnterocolitisBacterialvaginosisRecurrentUTI’sAtopicdiseasesImmunesystemenhancementHpyloriinfectionsDentalcariesRadiationinduceddiarrheaCardiovascularriskreductionConstipationRheumatoidarthritisProbiotics:ProposedusesInfecProbiotics:ProposedusesRatingtheEvidenceFlochetal(2006)NaturalStandard(2006)InfectiousdiarrheaABAntibiotic-associateddiarrheaACDiarrheapreventionBBIBSCBAtopicdermatitis/AllergyB?B/CRatings:A:strongB:goodC:fairFloch,etal.RecommendationsforProbioticUse.JClinGastro.40(3).2006Probiotics:ProposedusesRatinProbiotics:ProposedusesRatingtheEvidenceFlochetal(2006)NaturalStandard(2006)UlcerativecolitisCBCrohn’sdiseaseCHpyloriinfectionCANECCBacterialvaginosisCCUTI’sCRatings:A:strongB:goodC:fairFloch,etal.RecommendationsforProbioticUse.JClinGastro.40(3).2006Probiotics:ProposedusesRatinProbiotics:theevidenceAntibiotic-associateddiarrhea:D’Souzaetal(BMJ2002)Systematicreviewof9placebo-controlledstudies(2inchildren)Variousprobiotics(4usesSBouladarii)60%reductioninantibioticassociateddiarrheacomparedwithplacebo(OR0.37,95%CI0.26-0.53)Vanderhoofetal(JPediatr1999)202children,6mo-10yr,otitis/pharyngitis,amox/amox-clavOralantibioticsinanoutpatientsettingfor10daysLactobacillusGG,10(<12kg)or20(>12kg)billioncfu’sfor10dRatedstoolconsistencyandfrequency26%ofcontrolsand8%ofLGGhaddiarrheaOfthosewithdiarrhea,5.9daysinplacebo,4.7daysinLGGProbiotics:theevidenceProbiotics:theevidenceInfectiousdiarrhea:VanNieletal(Peds2002)Systematicreviewof9studies(alloutsideUS,1-36months)Variousprobiotics(4usedLGG)Meanreductionindiarrheaof0.7days(95%CI:0.3-1.2)1.6fewerstoolsinLGGgroups(95%CI:0.7-2.6)DoseresponsecurvewithhigherLGGdoseTwoothermeta-analysesalsoshowedbenefits,particularlywithLGGAllenetal.CochraneDatabaseSystRev,2004Szajewskaetal.JPediatrGastroenterolNutr,2001Probiotics:theevidenceProbiotics:theevidencePreventionofinfectionsindaycare:Weizmanetal(Peds2005)Double-blind,placebo-controlledRCT14daycarecentersinIsrael,4-10monthsofageFormulawithBlactis,Lreuteri,ornoprobiotics(nobreastfeeding)Meanintake:1billionorgsInterventionandfollow-uptotaled12weeksBothprobioticgroupshad:FewerfebrileepisodesFewerdiarrheaepisodesShorterdiarrheaepisodesNodifferenceinrateordurationofrespiratorillnessesLreuterigroupdidsignificantlybetterthanBlactisgroupProbiotics:theevidenceProbiotics:theevidenceAtopicdisease:Kalliomakietal(Lancet2001)LGG,10billcfu’s,giventomother’swithafamilyhxofafirstdegreerelativewithanatopiccondition(asthma,eczema,allergicrhinitis).Mothersfor2-4weeksbeforedelivery,theninfantsorlactatingmothersforthefirst6months.Outcome:atopicdiseaseat2yrs.Frequencyofeczemareducedfrom46%to23%(RR0.51,CI:0.32-0.84)Kalliomakietal(Lancet2003)4yrfollowupstudy(54of68controls,53of64intervention)Relativeriskreductionforatopiceczemaof0.57(95%CI:0.33-0.97)Probiotics:theevidence益生菌健康功能及機(jī)制研課件益生菌健康功能及機(jī)制研課件益生菌健康功能及機(jī)制研課件益生菌健康功能及機(jī)制研課件益生菌健康功能及機(jī)制研課件Probiotics:prescribingWhichorganismtouse?Whichproduct?Forwhatconditions?Whatdose?ForHowlong?Anysideeffectstobeawareof?Howmuchdoesitcost?Probiotics:prescribingTakehomepoints… Goodevidencefor:InfectiousdiarrheaAntibx-assocdiarrheaPromisingevidencefor:PreventionofinfectiousdiarrheaPreventionofatopicconditionsotheruses?Inthefuturewemaybeusingprobioticsasweuseantibioticstoday:withspecificstrainsusedforcertainclinicalsituationsguidedbycontrolledstudiesPrescribingLactobacillusGGbeststudiedtodateCombinationproductsnotwellstudied,butmayworkaswell10billionorganisms/dKeepinfridgeGiveincoolfood/drink2%riskbloating/gasTakehomepoints… GoodevidencBacteriocinBioactivepeptidesShortchainfattyacidsNeutralizationofdietarycarcinogensFreeaminoacidsOrganicacidsβ-GalactosidaseactivityOligosaccharidesCholesterolassimilationSurvivalandadhesioncompetitionswithpathogenicbacteriaAntioxidantImmunostimulatoryProbioticsBacteriocinBioactivepeptidesS益生菌健康功能及機(jī)制研課件益生菌健康功能及機(jī)制研課件益生菌健康功能及機(jī)制研課件益生菌健康功能及機(jī)制研課件益生菌健康功能及機(jī)制研課件PotentialBenefitsofPrebioticsPotentialBenefitsofPrebioti益生菌健康功能及機(jī)制研課件ProblemsNodoubleblindcontroltestsabouttheeffectsGenomesofProbioticsarestillunclearResearchMethodsneedtobeimprovedNolotsofValidatemarkersusedforassessingprobioticfunctionProblemsNodoubleblindcontroQuestions？？？

QuestionsEffectsofProbioticsonHumanHealthandMechnismsTong-CunZhang,Ph.DTianjinUniv.ofScience&TechnologyEffectsofProbioticsonHumanOutlineWhatareprobiotics？Howdotheywork？CurrentproposedusesandalookatsomeoftheevidenceIssuesinprescribingtheiruseOutlineWhatareprobiotics？Probioticsconcept

Probioticsaredefinedas‘livingmicro-organisms,whichuponingestionincertainnumbersexerthealthbenefitsbeyondgeneralnutrition’Intensiveresearchareaintheworld……..Probioticsconcept

ProbioticsProbioticsLactobacillussp.reutericaseiramnosusacidophilusStreptococcussp.Bifidobacteriumsp.infantislactislongumbreveSacharomycesboulardii(non-human)ProbioticsLactobacillussp.益生菌健康功能及機(jī)制研課件益生菌健康功能及機(jī)制研課件

AcidtoleranceBiletoleranceCellsurfacehydrophobicityProtoplastregenerationAntimicrobialactivityCholesterolremovalandbilesaltdeconjugationGutcolonizationLactoseremovalProteaseandaminopeptidaseactivityProbioticsattributesAcidtoleranceProbioticsattr益生菌健康功能及機(jī)制研課件益生菌健康功能及機(jī)制研課件Probiotics:ProposedusesInfectiousdiarrheaAntibiotic-associateddiarrheaIBD,IBS,andpouchitisNecrotizingEnterocolitisBacterialvaginosisRecurrentUTI’sAtopicdiseasesImmunesystemenhancementHpyloriinfectionsDentalcariesRadiationinduceddiarrheaCardiovascularriskreductionConstipationRheumatoidarthritisProbiotics:ProposedusesInfecProbiotics:ProposedusesRatingtheEvidenceFlochetal(2006)NaturalStandard(2006)InfectiousdiarrheaABAntibiotic-associateddiarrheaACDiarrheapreventionBBIBSCBAtopicdermatitis/AllergyB?B/CRatings:A:strongB:goodC:fairFloch,etal.RecommendationsforProbioticUse.JClinGastro.40(3).2006Probiotics:ProposedusesRatinProbiotics:ProposedusesRatingtheEvidenceFlochetal(2006)NaturalStandard(2006)UlcerativecolitisCBCrohn’sdiseaseCHpyloriinfectionCANECCBacterialvaginosisCCUTI’sCRatings:A:strongB:goodC:fairFloch,etal.RecommendationsforProbioticUse.JClinGastro.40(3).2006Probiotics:ProposedusesRatinProbiotics:theevidenceAntibiotic-associateddiarrhea:D’Souzaetal(BMJ2002)Systematicreviewof9placebo-controlledstudies(2inchildren)Variousprobiotics(4usesSBouladarii)60%reductioninantibioticassociateddiarrheacomparedwithplacebo(OR0.37,95%CI0.26-0.53)Vanderhoofetal(JPediatr1999)202children,6mo-10yr,otitis/pharyngitis,amox/amox-clavOralantibioticsinanoutpatientsettingfor10daysLactobacillusGG,10(<12kg)or20(>12kg)billioncfu’sfor10dRatedstoolconsistencyandfrequency26%ofcontrolsand8%ofLGGhaddiarrheaOfthosewithdiarrhea,5.9daysinplacebo,4.7daysinLGGProbiotics:theevidenceProbiotics:theevidenceInfectiousdiarrhea:VanNieletal(Peds2002)Systematicreviewof9studies(alloutsideUS,1-36months)Variousprobiotics(4usedLGG)Meanreductionindiarrheaof0.7days(95%CI:0.3-1.2)1.6fewerstoolsinLGGgroups(95%CI:0.7-2.6)DoseresponsecurvewithhigherLGGdoseTwoothermeta-analysesalsoshowedbenefits,particularlywithLGGAllenetal.CochraneDatabaseSystRev,2004Szajewskaetal.JPediatrGastroenterolNutr,2001Probiotics:theevidenceProbiotics:theevidencePreventionofinfectionsindaycare:Weizmanetal(Peds2005)Double-blind,placebo-controlledRCT14daycarecentersinIsrael,4-10monthsofageFormulawithBlactis,Lreuteri,ornoprobiotics(nobreastfeeding)Meanintake:1billionorgsInterventionandfollow-uptotaled12weeksBothprobioticgroupshad:FewerfebrileepisodesFewerdiarrheaepisodesShorterdiarrheaepisodesNodifferenceinrateordurationofrespiratorillnessesLreuterigroupdidsignificantlybetterthanBlactisgroupProbiotics:theevidenceProbiotics:theevidenceAtopicdisease:Kalliomakietal(Lancet2001)LGG,10billcfu’s,giventomother’swithafamilyhxofafirstdegreerelativewithanatopiccondition(asthma,eczema,allergicrhinitis).Mothersfor2-4weeksbeforedelivery,theninfantsorlactatingmothersforthefirst6months.Outcome:atopicdiseaseat2yrs.Frequencyofeczemareducedfrom46%to23%(RR0.51,CI:0.32-0.84)Kalliomakietal(Lancet2003)4yrfollowupstudy(54of68controls,53of64intervention)Relativeriskreductionforatopiceczemaof0.57(95%CI:0.33-0.97)Probiotics:theevidence益生菌健康功能及機(jī)制研課件益生菌健康功能及機(jī)制研課件益生菌健康功能及機(jī)制研課件益生菌健康功能及機(jī)制研課件益生菌健康功能及機(jī)制研課件Probiotics:prescribingWhichorganismtouse?Whichproduct?Forwhatconditions?Whatdose?ForHowlong?Anysideeffectstobeawareof?Howmuchdoesitcost?Probiotics:prescribingTakehomepoints… Goodevidencefor:InfectiousdiarrheaAntibx-assocdiarrheaPromisingevidencefor:Prev