European Journal of Clinical Nutrition (2002) 56, Suppl 3, S57–S59

ß 2002 Nature Publishing Group All rights reserved 0954–3007/02 $25.00

ORIGINAL COMMUNICATION
Probiotics as a help in children suffering from
malnutrition and diarrhoea
B Solis1, S Samartı́n1, S Gómez1, E Nova1, B de la Rosa1 and A Marcos1*
1
Instituto de Nutrición y Bromatologı́a (CSIC), Edificio Instituto del Frı́o, Madrid, Spain

Malnutrition is associated with a significant impairment of cell-mediated immunity, phagocyte function, immunoglobulin A
concentrations and cytokine production. This situation — which is unfortunately very frequent in infants and children from
developing countries — leads to a high risk of infection, and often to episodes of diarrhoea, hence aggravating the nutritional
status. Fermented milks are known to exert a beneficial influence on the host’s health. They act by modulating gut microflora,
regulating any alteration of gut mucosa and stimulating immune response. A number of studies have shown that probiotics
shorten the duration of diarrhoea and prevent recurrence of other episodes. Furthermore, probiotics can prevent diarrhoea from
infection in infants with malnutrition. In addition, it has been shown that cytokines could be used as biological markers of both
impaired immune system and the immune stimulation of probiotics. The aim of this review is to update the effect of fermented
milks in situations of malnutrition and diarrhoea as a consequence of infection as well as the role of cytokines produced by
fermented milks in these deficient conditions.
European Journal of Clinical Nutrition (2002) 56, Suppl 3, S57 – S59. doi:10.1038=sj.ejcn.1601488

Keywords: malnutrition; diarrhoea; children; probiotics

Causes for malnutrition in developing countries measles, all of them linked to malnutrition (Assefa et al,
Natural disasters, immigrations and wars contribute to 2001). This situation is similar to the one existing 100 y ago
increase the prevalence of malnutrition. Hunger and mal- in wealthy countries. However, diarrhoea is still a public
nutrition are among the most devastating problems facing health problem in developed countries where 20% of chil-
the world’s poor and needy, and they continue to compro- dren suffer from it (Kozak & Mc Carthy, 1998).
mise the health and seriously jeopardize the development of The humanitarian situation in Afghanistan has been
the world’s poorest nations. Nearly 30% of humanity, mainly deteriorating for more than 3 y because of the civil war.
in developing countries — infants, children, adolescents, With the recent events, the international community is
adults and elderly people — currently suffer from one or predicting a severe worsening of the country’s current situa-
more of the major forms of malnutrition. In a world that tion (Assefa et al, 2001).
has both the resources and the knowledge to end such great In Morocco, the mortality rate due to diarrhoea in chil-
catastrophes, this is a continuing travesty of the fundamen- dren under 5 y old is 21%, while the mortality rate due to
tal human right to adequate food and nutrition, and free- respiratory problems is only 11%. Children from this age
dom from hunger and malnutrition (WHO, 2000). group present an average of eight episodes of acute diarrhoea
The tragic consequences of malnutrition include death, per year (Ministère de la Santé Publique du Maroc, 1992).
disability, stunted mental and physical growth, and their In fact, a large number of intestinal alterations are due to a
consequent drain on socio-economic development. For lack of hygiene or consumption of contaminated foods or
example, more than half of 10 million deaths among water with bacteria or viruses such as Rotavirus, E. coli or
under-5-y old children each year in developing countries Campylobacter. The aetiology is diverse and goes from
are associated with diarrhoea, respiratory tract infections and viruses, especially Rotavirus, more frequently in winter, to
parasites like Entamoeba histolytica and Giardia lamblia, to
some bacteria such as Escherichia coli, Shigella, Campylobacter,
Vibrio cholera and Aeromonas. During the last few years,
*Correspondence: A Marcos, Instituto de Nutrición y Bromatologı́a,
Edificio Instituto del Frı́o, c=Ramiro de Maeztu s=n, 28040 Madrid, Spain. Rotavirus has taken the lead among illness producers all
E-mail: [email protected] over the world (Cama, et al, 1999).
 Probiotics in malnourished children with diarrhoea
B Solis et al
S58
Work done in the past 30 y has confirmed that impaired infections. Thus, many investigators have evaluated the
immunity is a critical adjunct factor in malnutrition-asso- effect of yoghurt on the immune responses of animals and
ciated infection (Figure 1). This concept applies not only to humans.
young children in developing countries but also to all age
groups in all populations of the world, especially those
patients with a variety of primary debilitating diseases Effects of probiotics on the immune system
(Chandra, 1997). There have been a large number of studies which have
shown that probiotics are able to improve and co-operate
with various lines of host defenses. Human studies examin-
Benefits of probiotics in the struggle against ing the immunostimulatory effects of LAB focused primarily
diarrhoea on the effect of yoghurt consumption on ex vivo indicators of
Probiotics are microorganisms that have a favourable influ- immune response, such as PBMC cytokine production, pha-
ence on physiologic and pathological processes of the host gocytic activity, specific humoral immune response, T lym-
by their effect on the modulation of the immune function. phocyte (CD4 þ and CD8 þ ) function, and NK cell activity
In fact, probiotics such as Lactobacillus acidophilus and Bifi- (Meydani & Ha, 2000).
dobacterium bifidum have been shown to influence different It has been shown that phagocytic leukocyte activity of
aspects of the immune system (Erickson & Hubbard, 2000). human blood cells, particularly granulocytes, is enhanced by
Lactic acid bacteria (LAB) have been intensively investi- the ingestion of fermented milk supplemented with Lacto-
gated as a dietary adjunct for gastrointestinal disorders in bacillus acidophilus La1 and Bifidobacterium bifidum Bb12 for 3
animals and humans. Probiotic functional foods can weeks (Schiffrin et al, 1995).
improve specific physiologic functions in the human gastro- A large number of studies have shown that lactic-acid
intestinal tract and the host immune defence, thereby redu- bacteria can influence cytokine production by immunocom-
cing the risk of contracting illnesses. This conclusion is based petent cells in animals and humans. Specifically, the lactic-
on more recent in vitro and in vivo studies. acid bacteria contained in conventional yoghurt have been
LAB of human gut origin are thought to be adapted to the reported to significantly enhance interferon-g production,
intestinal environment and preferentially selected as probio- and a loss of activity seems to occur after heat treatment of
tic micro-organisms. Although the specific properties of the bacteria (Solys-Pereira et al, 1997). Consumption of
probiotic micro-organisms are not characterized and vali- fermented milk containing Lactobacillus bulgaricus and Strep-
dated in well-designed multicenter clinical trials, the survival tococcus thermophilus by humans with eating disorders has
of probiotic bacteria in the gastro-intestinal ecosystem and been reported to stimulate cytokine production of PBMCs
adhesion to the intestinal mucosa is regarded as a prerequi- (Marcos et al, 1996). The production of proinflammatory
site for transient colonization, stimulation of the immune cytokines, such as tumour necrosis factor a, and interleukin
system, and for antagonistic activity against enteropatho- 6 by a monocytic line culture is also stimulated by Strepto-
gens. coccus thermophilus and Lactobacillus bulgaricus (Marin et al,
Certain LAB species are found not only as components of 1998), which reflects the stimulation of non-specific immu-
the human intestinal microflora but also of the man-made nity.
ecosystems present in fermented food. That’s why fermented In relation to humoral response, an enhanced sIgA pro-
milks containing viable LAB are known to be beneficial duction has been observed during probiotic treatment (Per-
to health, acting as prophylaxis against intestinal digon et al, 1995).

Figure 1 Benefits of probiotics on populations suffering from malnutrition, infection and diarrhoea.

European Journal of Clinical Nutrition

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European Journal of Clinical Nutrition