Prebiotics in infants for prevention of allergic disease and food hypersensitivity

David A Osborn; John KH Sinn

doi:10.1002/14651858.CD006474.pub2

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Analysis 1.1

Comparison 1 Prebiotic versus no prebiotic, Outcome 1 Eczema.

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Analysis 1.2

Comparison 1 Prebiotic versus no prebiotic, Outcome 2 Growth in weight (g/day).

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Analysis 1.3

Comparison 1 Prebiotic versus no prebiotic, Outcome 3 Growth in length (cm/week).

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Analysis 1.4

Comparison 1 Prebiotic versus no prebiotic, Outcome 4 Growth in head circumference (cm/week).

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Analysis 1.5

Comparison 1 Prebiotic versus no prebiotic, Outcome 5 Feed intolerance resulting in formula discontinuation.

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Analysis 2.1

Comparison 2 Prebiotic versus no prebiotic in formula fed infants at high risk of allergy or food hypersensitivity, Outcome 1 Eczema.

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Analysis 3.1

Comparison 3 Prebiotic versus no prebiotic in formula fed infants not selected for risk of allergy or food hypersensitivity, Outcome 1 Eczema.

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Analysis 4.1

Comparison 4 Specific prebiotic versus no prebiotic, Outcome 1 Eczema.

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Analysis 4.2

Comparison 4 Specific prebiotic versus no prebiotic, Outcome 2 Growth in weight (g/day).

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Analysis 4.3

Comparison 4 Specific prebiotic versus no prebiotic, Outcome 3 Growth in length (cm/week).

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Analysis 4.4

Comparison 4 Specific prebiotic versus no prebiotic, Outcome 4 Growth in head circumference (cm/week).

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Analysis 4.5

Comparison 4 Specific prebiotic versus no prebiotic, Outcome 5 Feed intolerance resulting in formula discontinuation.

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Analysis 5.1

Comparison 5 Specific prebiotic versus other prebiotic, Outcome 1 Eczema.

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Analysis 5.2

Comparison 5 Specific prebiotic versus other prebiotic, Outcome 2 Growth in weight (g/day).

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Analysis 5.3

Comparison 5 Specific prebiotic versus other prebiotic, Outcome 3 Growth in length (cm/week).

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Analysis 5.4

Comparison 5 Specific prebiotic versus other prebiotic, Outcome 4 Feed intolerance resulting in formula discontinuation.

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Comparison 1. Prebiotic versus no prebiotic

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Eczema Show forest plot	2	432	Risk Ratio (M‐H, Fixed, 95% CI)	0.69 [0.40, 1.17]

1.1 Infant incidence	2	432	Risk Ratio (M‐H, Fixed, 95% CI)	0.69 [0.40, 1.17]
2 Growth in weight (g/day) Show forest plot	5		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

2.1 Term infants	3	416	Mean Difference (IV, Fixed, 95% CI)	0.93 [0.02, 1.84]
2.2 Preterm infants	2	86	Mean Difference (IV, Fixed, 95% CI)	‐1.78 [‐4.05, 0.48]
3 Growth in length (cm/week) Show forest plot	4		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

3.1 Term infants	2	252	Mean Difference (IV, Fixed, 95% CI)	0.01 [‐0.02, 0.04]
3.2 Preterm infants	2	86	Mean Difference (IV, Fixed, 95% CI)	0.17 [0.14, 0.19]
4 Growth in head circumference (cm/week) Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

4.1 Term infants	1	206	Mean Difference (IV, Fixed, 95% CI)	‐0.01 [‐0.02, 0.00]
4.2 Preterm infants	1	56	Mean Difference (IV, Fixed, 95% CI)	‐0.01 [‐0.02, 0.00]
5 Feed intolerance resulting in formula discontinuation Show forest plot	1	226	Risk Ratio (M‐H, Fixed, 95% CI)	1.81 [0.82, 3.99]

Comparison 1. Prebiotic versus no prebiotic

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Comparison 2. Prebiotic versus no prebiotic in formula fed infants at high risk of allergy or food hypersensitivity

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Eczema Show forest plot	1	206	Risk Ratio (M‐H, Fixed, 95% CI)	0.42 [0.21, 0.84]

1.1 Infant incidence	1	206	Risk Ratio (M‐H, Fixed, 95% CI)	0.42 [0.21, 0.84]

Comparison 2. Prebiotic versus no prebiotic in formula fed infants at high risk of allergy or food hypersensitivity

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Comparison 3. Prebiotic versus no prebiotic in formula fed infants not selected for risk of allergy or food hypersensitivity

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Eczema Show forest plot	1	226	Risk Ratio (M‐H, Fixed, 95% CI)	1.62 [0.62, 4.26]

1.1 Infant incidence	1	226	Risk Ratio (M‐H, Fixed, 95% CI)	1.62 [0.62, 4.26]

Comparison 3. Prebiotic versus no prebiotic in formula fed infants not selected for risk of allergy or food hypersensitivity

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Comparison 4. Specific prebiotic versus no prebiotic

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Eczema Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 FOS / GOS formula versus placebo formula (Infant incidence)	1	206	Risk Ratio (M‐H, Fixed, 95% CI)	0.42 [0.21, 0.84]
1.2 Polydextrose and GOS versus control	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	2.67 [1.00, 7.12]
1.3 Polydextrose, GOS and lactulose versus control	1	152	Risk Ratio (M‐H, Fixed, 95% CI)	0.6 [0.15, 2.42]
2 Growth in weight (g/day) Show forest plot	5		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

2.1 FOS / GOS formula versus placebo formula	2	236	Mean Difference (IV, Fixed, 95% CI)	0.88 [‐0.12, 1.88]
2.2 Acidic oligosaccharide with FOS / GOS formula versus placebo formula	1	30	Mean Difference (IV, Fixed, 95% CI)	1.90 [‐3.34, 7.14]
2.3 Acidic oligosaccharide formula versus placebo formula	1	31	Mean Difference (IV, Fixed, 95% CI)	‐2.40 [‐7.70, 2.90]
2.4 Polydextrose and GOS formula versus control fomula	1	116	Mean Difference (IV, Fixed, 95% CI)	0.90 [‐1.18, 2.98]
2.5 Polydextrose, GOS and lactulose formula versus control formula	1	106	Mean Difference (IV, Fixed, 95% CI)	0.90 [‐1.32, 3.12]
2.6 FOS formula versus placebo formula	1	56	Mean Difference (IV, Fixed, 95% CI)	‐4.60 [‐8.24, ‐0.96]
3 Growth in length (cm/week) Show forest plot	4		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

3.1 GOS / FOS formula versus placebo formula	2	236	Mean Difference (IV, Fixed, 95% CI)	0.01 [‐0.01, 0.03]
3.2 Acidic oligosaccharide with GOS / FOS formula versus placebo formula	1	30	Mean Difference (IV, Fixed, 95% CI)	0.0 [‐0.16, 0.16]
3.3 Acidic oligosaccharide formula versus placebo formula	1	31	Mean Difference (IV, Fixed, 95% CI)	‐0.04 [‐0.22, 0.14]
3.4 FOS formula versus placebo formula	1	56	Mean Difference (IV, Fixed, 95% CI)	0.30 [0.27, 0.33]
4 Growth in head circumference (cm/week) Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

4.1 GOS / FOS formula versus placebo formula	1	206	Mean Difference (IV, Fixed, 95% CI)	‐0.01 [‐0.02, 0.00]
4.2 FOS formula versus placebo formula	1	56	Mean Difference (IV, Fixed, 95% CI)	‐0.01 [‐0.02, 0.00]
5 Feed intolerance resulting in formula discontinuation Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

5.1 Polydextrose and GOS versus control	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.32 [0.52, 3.36]
5.2 Polydextrose, GOS and lactulose versus control	1	152	Risk Ratio (M‐H, Fixed, 95% CI)	2.29 [1.00, 5.24]

Comparison 4. Specific prebiotic versus no prebiotic

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Comparison 5. Specific prebiotic versus other prebiotic

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Eczema Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Polydextrose and GOS versus polydextrose, GOS and lactulose	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	4.45 [1.32, 14.98]
2 Growth in weight (g/day) Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

2.1 GOS / FOS + acidic OS formula versus GOS / FOS formula	1	31	Mean Difference (IV, Fixed, 95% CI)	4.30 [‐0.56, 9.16]
2.2 Polydextrose and GOS versus polydextrose, GOS and lactulose	1	106	Mean Difference (IV, Fixed, 95% CI)	0.0 [‐2.08, 2.08]
3 Growth in length (cm/week) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

3.1 GOS / FOS + acidic OS formula versus GOS / FOS formula	1	31	Mean Difference (IV, Fixed, 95% CI)	0.04 [‐0.15, 0.23]
4 Feed intolerance resulting in formula discontinuation Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

4.1 Polydextrose and GOS versus polydextrose, GOS and lactulose	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	0.58 [0.27, 1.22]

Comparison 5. Specific prebiotic versus other prebiotic

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