Effects of Probiotics and Calcium Supplementation on Growth, Development, and Metabolic Parameters

NCT ID: NCT04046289

Last Updated: 2019-08-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

238 participants

Study Classification

OBSERVATIONAL

Study Start Date

2019-01-26

Study Completion Date

2019-07-05

Brief Summary

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Stunting is still a major problem in developing countries, including Indonesia, and has been associated with impaired development. Stunted children have also a higher risk of metabolic syndrome in adulthood. The gut microbiota, as a part of intestinal integrity, may promote intake of nutrient during childhood. Probiotics supplementation may optimize the balance of gut microbiota and further improve child growth during the window period. Furthermore, calcium could also improve child growth by increasing the resistance to intestinal infection. However, the long-term effects of gut microbiota optimization during childhood using probiotics and calcium on growth, development, and the metabolic condition has not widely studied.

Detailed Description

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This study was a 10-year follow-up study of randomized controlled trials of 6-month probiotics and calcium supplementation of Lactobacillus reuteri DSM 17938 or Lactobacillus casei CRL 431 in children aged 1-6 years (n=494) living in urban low socioeconomic communities of East Jakarta in 2007-2008. We re-enrolled the subjects to assess the long-term effects of probiotics and calcium supplementation on growth, development, and metabolic parameters at the age of 11-17 years.

Healthy children (n = 238) were included in this follow-up study. Each subject previously assigned to one intervention group: low-lactose milk with a low calcium content (LC = 53), a regular calcium content (RC = 70), regular calcium with L. reuteri DSM 17938 (n = 55), and regular calcium with L. casei CRL 431 (n = 60).

Anthropometric measurements were performed by measuring the weight and height of the subjects, and further combining the results to report BMI-for-age z-score. Height was also plotted to the chart of the World Health Organization (WHO) Child Growth Standards. Gut integrity was assessed with the lactulose-mannitol ratio using high-performance liquid chromatography (HPLC) method. Cognitive function, symptoms related to depression, behaviour, and serum brain-derived neurotrophic factors (BDNF) of the adolescents were evaluated used to investigate the effects of supplementation on development. We quantified lipid profile and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) as metabolic parameters using the vein blood sample. The metabolic parameters were measured in at least three groups of intervention.

Conditions

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Stunting Obesity Cognitive Function 1, Social Depression Behavior Dyslipidemias Insulin Resistance Permeability; Increased

Study Design

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Observational Model Type

COHORT

Study Time Perspective

CROSS_SECTIONAL

Study Groups

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Low Calcium

low calcium milk of 180 ml, twice daily for 24 weeks

Low Calcium Milk

Intervention Type DIETARY_SUPPLEMENT

50 mg calcium/day

Regular Calcium

regular calcium milk of 180 ml, twice daily for 24 weeks

Regular Calcium Milk

Intervention Type DIETARY_SUPPLEMENT

400 mg/day

Probiotic 1

regular calcium milk of 180 ml + probiotic, twice daily for 24 weeks

Probiotic 1

Intervention Type DIETARY_SUPPLEMENT

regular calcium milk + probiotic

Probiotic 2

regular calcium milk of 180 ml + probiotic, twice daily for 24 weeks

Probiotic 2

Intervention Type DIETARY_SUPPLEMENT

regular calcium milk + probiotic

Interventions

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Low Calcium Milk

50 mg calcium/day

Intervention Type DIETARY_SUPPLEMENT

Regular Calcium Milk

400 mg/day

Intervention Type DIETARY_SUPPLEMENT

Probiotic 1

regular calcium milk + probiotic

Intervention Type DIETARY_SUPPLEMENT

Probiotic 2

regular calcium milk + probiotic

Intervention Type DIETARY_SUPPLEMENT

Eligibility Criteria

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Inclusion Criteria

* Apparently healthy children aged 1-6 years, with emphasize on aged 2-5 years, living permanently in low socio-economic urban areas of East Jakarta for at least six months
* Parents are willing to sign the informed consent and give the supplements to the children for six months
* Capable and willing to drink liquid milk with a straw (acceptance to be tested at the screening by providing a sample drink and placebo straw to be consumed under supervision for two days)


* Healthy adolescent participated in the previous trial study willing to take part in the follow-up study

Exclusion Criteria

* Calcium intake exceeding 75% of the Recommended Dietary Allowance (RDA) for calcium (\<375 mg/d) based on a Food Frequency Questionnaire
* Currently breastfed children
* Siblings of already included children that are living in the same household, except if it is a twin sibling
* Severely malnourished with or without edema (weight-for-height Z-score of \<-3.00 SD)
* Symptoms of chronic/congenital diseases and disabilities, suspected Tuberculosis by clinical examination, and/or history of allergic disease.
* Taking (any) antibiotics during 2 weeks prior to the start of the study (children will be included after 3 weeks of last antibiotic intake
* Participation in another clinical trial at the same time or 2 months prior to the start of this study
* Both mothers and other caregivers present in the family are illiterate


* History of type 1 diabetes
* Taking the cholesterol-lowering drug, an anti-diabetic drug, or oral corticosteroid for more than 2 consecutive weeks in the last 3 months
* Pregnant
Minimum Eligible Age

11 Years

Maximum Eligible Age

17 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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SEAMEO Regional Centre for Food and Nutrition

OTHER

Sponsor Role collaborator

Wageningen University

OTHER

Sponsor Role collaborator

Indonesia University

OTHER

Sponsor Role lead

Responsible Party

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Rina Agustina

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Rina Agustina, PhD

Role: PRINCIPAL_INVESTIGATOR

HNRC IMERI; Department of Nutrition, Faculty of Medicine, Universitas Indonesia

Locations

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Human Nutrition Research Center, Indonesian Medical Education Research Institute; and Department of Nutrition, Faculty of Medicine, Universitas Indonesia

Jakarta Pusat, DKI Jakarta, Indonesia

Site Status

Countries

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Indonesia

References

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Agustina R, Kok FJ, van de Rest O, Fahmida U, Firmansyah A, Lukito W, Feskens EJ, van den Heuvel EG, Albers R, Bovee-Oudenhoven IM. Randomized trial of probiotics and calcium on diarrhea and respiratory tract infections in Indonesian children. Pediatrics. 2012 May;129(5):e1155-64. doi: 10.1542/peds.2011-1379. Epub 2012 Apr 9.

Reference Type BACKGROUND
PMID: 22492764 (View on PubMed)

Agustina R, Bovee-Oudenhoven IM, Lukito W, Fahmida U, van de Rest O, Zimmermann MB, Firmansyah A, Wulanti R, Albers R, van den Heuvel EG, Kok FJ. Probiotics Lactobacillus reuteri DSM 17938 and Lactobacillus casei CRL 431 modestly increase growth, but not iron and zinc status, among Indonesian children aged 1-6 years. J Nutr. 2013 Jul;143(7):1184-93. doi: 10.3945/jn.112.166397. Epub 2013 May 22.

Reference Type BACKGROUND
PMID: 23700339 (View on PubMed)

Agustina R, Rianda D, Setiawan EA. Relationships of Child-, Parents-, and Environment-Associated Determinants with Diet Quality, Physical Activity, and Smoking Habits Among Indonesian Urban Adolescents. Food Nutr Bull. 2022 Mar;43(1):44-55. doi: 10.1177/03795721211046145. Epub 2021 Oct 21.

Reference Type DERIVED
PMID: 34670443 (View on PubMed)

Setiawan EA, Rianda D, Kadim M, Meilianawati, Susanto F, Kok FJ, Shankar AH, Agustina R. Tenth year reenrollment randomized trial investigating the effects of childhood probiotics and calcium supplementation on height and weight at adolescence. Sci Rep. 2021 Jun 4;11(1):11860. doi: 10.1038/s41598-021-88819-y.

Reference Type DERIVED
PMID: 34088920 (View on PubMed)

Other Identifiers

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probiocal

Identifier Type: -

Identifier Source: org_study_id

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