Probiotics for pediatric diarrhea and constipation: an umbrella meta-analysis – BMC Pediatrics

Report on the Efficacy of Probiotics and Their Contribution to Sustainable Development Goals

Introduction: Probiotics as a Tool for Global Health and Sustainable Development

An extensive body of scientific literature, comprising systematic reviews and meta-analyses, underscores the significant role of probiotics in managing pediatric gastrointestinal health. These findings have profound implications for achieving several United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being). By providing low-cost, effective interventions for common childhood ailments, probiotics also contribute to SDG 2 (Zero Hunger) by improving nutrient absorption and SDG 1 (No Poverty) by reducing the economic burden of disease on families.

Probiotics and the Advancement of SDG 3: Good Health and Well-being

The primary impact of probiotics aligns with SDG Target 3.2, which aims to end preventable deaths of newborns and children under five years of age. Diarrheal disease remains a leading cause of child mortality, and the evidence strongly supports the use of probiotics as a key intervention.

Management of Acute Gastroenteritis and Diarrhea

• Numerous meta-analyses confirm that probiotics, particularly strains like Lactobacillus rhamnosus GG and Saccharomyces boulardii, effectively reduce the duration and severity of acute diarrhea in children.
• Studies have demonstrated the efficacy of various probiotic species, including Lactobacillus acidophilus, Lactobacillus reuteri, and Bacillus clausii, in treating acute infectious diarrhea, including cases caused by rotavirus.
• The application of probiotics is shown to be beneficial even in cases of dehydration, highlighting their utility in comprehensive clinical management.

Prevention and Mitigation of Antibiotic-Associated Diarrhea (AAD)

• A significant body of evidence supports the use of probiotics for the prevention of AAD in the pediatric population. This is crucial for maintaining the gut microbiome during necessary antibiotic treatments.
• Specific strains of Lactobacillus and Saccharomyces boulardii have been identified as effective in preventing AAD and associated complications like Clostridium difficile-associated diarrhea.
• This intervention supports antimicrobial stewardship by mitigating the adverse effects of antibiotics, thereby promoting better treatment adherence and overall health outcomes.

Addressing Other Gastrointestinal Conditions

• Probiotics have shown a positive effect on functional constipation in children, improving quality of life and reducing reliance on other medications.
• Research indicates that probiotic supplementation can enhance the efficacy of Helicobacter pylori eradication therapy in children, improving treatment success rates and reducing side effects.
• The modulation of the gut microbiota through probiotics is increasingly recognized for its role in the microbiota-gut-brain axis, impacting overall neurological and mental well-being.

Interconnected Impacts on Other Sustainable Development Goals

Contribution to SDG 2 (Zero Hunger)

Gastrointestinal health is intrinsically linked to nutritional status. By improving gut function, probiotics support SDG Target 2.2, which aims to end all forms of malnutrition.

• A healthy gut microbiota, supported by probiotics, enhances the intestinal barrier and improves the absorption of essential nutrients from food.
• By reducing the incidence and duration of diarrheal diseases, probiotics help prevent the cycle of malnutrition and infection that disproportionately affects vulnerable children.

Synergy with SDG 6 (Clean Water and Sanitation)

While access to clean water and sanitation is fundamental to preventing diarrheal diseases, probiotics serve as a critical secondary intervention to build resilience in populations where these resources are not yet universally available.

• Probiotics can help mitigate the health impacts of exposure to waterborne pathogens by strengthening the host’s immune defenses and intestinal barrier.
• They represent a practical therapeutic strategy that complements large-scale public health infrastructure projects.

Mechanisms of Action and Methodological Framework

Key Probiotic Mechanisms of Action

The clinical benefits of probiotics are attributed to several well-documented biological mechanisms:

1. Immunomodulation: Probiotics interact with the gut immune system to regulate inflammatory responses and enhance host defense against pathogens.
2. Strengthening Intestinal Barrier Function: They improve the integrity of the intestinal epithelial lining, reducing permeability to harmful substances and pathogens.
3. Competitive Exclusion: Probiotics compete with pathogenic bacteria for nutrients and adhesion sites on the intestinal wall, inhibiting their growth.
4. Production of Antimicrobial Substances: Many probiotic strains produce beneficial compounds, such as short-chain fatty acids (SCFAs) and bacteriocins, that create an environment unfavorable to pathogens.

Foundation of Evidence

The recommendations for probiotic use are based on high-level evidence derived from rigorous scientific methodologies. The analyzed literature consistently relies on:

• Systematic Reviews and Meta-Analyses: These studies synthesize data from multiple randomized controlled trials to provide a robust assessment of efficacy and safety.
• Methodological Assessment Tools: The quality of evidence is often evaluated using established frameworks like AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews) and GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) to ensure reliability.
• Umbrella Reviews: This approach compiles evidence from multiple meta-analyses to provide a comprehensive overview of the state of research on a particular topic.

Analysis of Sustainable Development Goals (SDGs)

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article, which is a list of references for a scientific study, primarily focuses on the treatment and prevention of gastrointestinal diseases like diarrhea and constipation in children through the use of probiotics. Based on these topics, the following SDGs are addressed:

• SDG 3: Good Health and Well-being: This is the most directly relevant SDG. The references consistently discuss health interventions (“Probiotics for prevention and treatment of diarrhea,” “treating acute gastroenteritis in children,” “prevention of antibiotic-associated diarrhea”). The core subject is improving health outcomes, particularly for children, by managing and preventing common but potentially fatal diseases like acute diarrhea.
• SDG 2: Zero Hunger: This goal is indirectly connected. Target 2.2 specifically aims to end all forms of malnutrition. Diarrheal diseases are a leading cause of malnutrition in children under five, as they prevent the proper absorption of nutrients, leading to wasting and stunting. By focusing on effective treatments for diarrhea, the research contributes to breaking the cycle of diarrhea and malnutrition.
• SDG 6: Clean Water and Sanitation: This goal is also indirectly connected. Many of the diseases mentioned, such as acute infectious diarrhea and gastroenteritis, are water-borne illnesses resulting from inadequate sanitation and contaminated water sources. While the article focuses on treatment (probiotics) rather than prevention through infrastructure, it addresses the health consequences that arise when SDG 6 targets are not met. The need for such treatments highlights the global burden of diseases related to poor water and sanitation.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the focus of the referenced studies, several specific SDG targets can be identified:

1. Target 3.2: End preventable deaths of newborns and children under 5 years of age.
   • Explanation: Acute diarrhea is one of the leading causes of mortality in children under five globally. The numerous references to treating “acute diarrhea in children” (e.g., references 4, 17, 24, 25, 26) show a clear focus on managing a primary cause of child mortality. Effective treatments like probiotics directly contribute to reducing deaths from this preventable and treatable illness.
2. Target 3.3: End the epidemics of… water-borne diseases and other communicable diseases.
   • Explanation: Acute gastroenteritis and infectious diarrhea are communicable, often water-borne, diseases. The research cited in the article (e.g., references 6, 18, 23, 33) explores methods to combat these diseases. By investigating the efficacy of probiotics, the scientific community is working towards better control and management of these widespread health issues, which aligns with the goal of ending their epidemic status.
3. Target 2.2: End all forms of malnutrition… including… targets on stunting and wasting in children under 5 years of age.
   • Explanation: There is a well-established link between recurrent diarrheal episodes and childhood malnutrition (wasting and stunting). The article’s focus on preventing and reducing the duration of diarrhea helps ensure that children can absorb necessary nutrients for healthy growth. Therefore, improving gastrointestinal health, as discussed in the references, is a crucial step in preventing malnutrition.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

The article does not explicitly state official SDG indicators, but the clinical outcomes measured in the referenced studies serve as proxy indicators for progress towards the SDG targets.

• Implied Indicator for Target 3.2 & 3.3: Incidence and duration of diarrheal diseases in children.
  • Explanation: The official SDG indicator for Target 3.2 is the under-5 mortality rate (Indicator 3.2.1). The referenced studies measure outcomes that are direct contributors to this rate. Titles like “Efficacy of probiotic use in acute diarrhea in children” and “probiotics for treating acute gastroenteritis” imply the measurement of clinical indicators such as:
    • The number of new cases of diarrhea (incidence).
    • The length of each diarrheal episode (duration).
    • The success rate of treatments.

    Reducing these clinical metrics directly contributes to lowering the under-5 mortality rate from diarrheal diseases and reflects progress in combating water-borne diseases (Indicator 3.3.2).

• Implied Indicator for Target 2.2: Prevalence of gastrointestinal health issues that cause malnutrition.
  • Explanation: The official indicators are the prevalence of stunting (2.2.1) and wasting (2.2.2) in children. The research on “functional constipation in children” (references 9, 27, 52) and overall gut health (“The microbiota-gut-brain-axis theory,” reference 3) implies a focus on improving digestive function. Healthy digestion is essential for nutrient absorption. Therefore, the frequency and successful treatment of gastrointestinal disorders can be seen as an indirect measure of efforts to reduce the prevalence of malnutrition.

4. Summary Table of SDGs, Targets, and Indicators

Source: bmcpediatr.biomedcentral.com