Children with newly diagnosed celiac disease (CeD) who receive a multispecies probiotic have a greater and faster increase in their BMI, compared with placebo. These findings were published in Digestive and Liver Disease.
Among children with newly diagnosed CeD, time to recovery after transitioning to a strict gluten-free diet (GFD) could depend, in part, on intestinal microbiota. As such, a probiotic treatment may help in the recovery process for those with microbiota imbalances.
This prospective, double-blind, randomized, placebo-controlled, multicenter study was conducted between 2018 and 2020 in Italy. Children (N=96) aged between 2 and 16 years, who were newly diagnosed with CeD, were randomly assigned to receive a strict GFD plus an oral probiotic (n=47) or placebo (n=49) sachet daily for 12 weeks. The active intervention comprised Lactobacillus paracasei, Lactobacillus plantarum, Bi- fidobacterium animalis subsp. lactis, Bifidobacterium breve, and Bifidobacterium breve. The primary outcomes were the changes in Validated Disease Specific Symptom Index for Celiac Disease (VDSS) score, BMI Z-score, and levels of immunoglobulin (Ig)A anti-tissue transglutaminase (tTG), hemoglobin, ferritin, vitamin D, and fecal calprotectin.
The probiotic and placebo recipients comprised 53.2% and 57.1% girls; they were aged median 8.09 (IQR, 5.22-10.75) and 7.50 (IQR, 3.88-11.71) years; they had a BMI of 16.59 (IQR, 14.20-18.43) and 16.46 (IQR, 15.21-20.30) kg/m2; and, 57.4% and 67.3% were symptomatic, respectively.
At 3 and 6 months, VDSS scores decreased significantly from baseline (P <.001) among both groups, but no significant group differences were observed (P = .327). Similarly, IgA anti-tTG levels increased from baseline among both groups (P <.001) but did not differ between groups (P =.242).
At 3 (P = .009) and 6 (P <.001) months, BMI Z-scores increased significantly compared with baseline among all participants. However, there was a significant time-by-group interaction (P = .032), which indicated that the probiotic recipients had a higher and faster increase in BMI Z-score compared with placebo recipients.
Hemoglobin levels did not change from baseline at 3 months and were significantly increased by month 6 (P <.001), but no group differences were observed. Ferritin levels were increased at 6 months relative to baseline (P = .002) and were also similar between groups. For vitamin D, significant increases were observed at month 3 (P = .039) compared with baseline and remained stable through month 6.
No significant changes in fecal calprotectin were detected in this study.
In the fecal analysis, no group-specific alpha metrics distributions, Beta diversity matrices, or clustering between groups were observed. Overall, 5 bacterial phyla, 41 families, and 97 genera were detected.
This study may have been limited as 17 of the original participants dropped out of the study, primarily due to the COVID-19 pandemic.
These data indicated that a multispecies probiotic associated with an increase in BMI Z-score among children newly diagnosed with CeD. “[T]his study suggests that supplementation with a multispecies probiotic, coupled with the GFD, is safe and may accelerate weight recovery in children with growth retardation at diagnosis of CeD,” the study authors wrote.
Disclosure: This research was supported by Noos s.r.l. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
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