Table 2 Effects of probiotics on child growth

Author, year

Sample details

Outcomes and units of measurement

Results

Country

Type of study

Quality

Firmansyah et al. 2009 [29]

Intervention:

Outcome:

Outcome

Intervention

Control

Mean difference (CI)

p-value

Indonesia

Age: 12 months

Weight, Length, Head circumference, Body Mass Index (BMI)

Sample size

161

153

RCT

Sample size: 199

Weight (g/day)

7.57 ± 4.13

6.64 ± 4.08

0.93 (0.12-1.95)

0.025

Quality:

Control:

Units of measurement:

Change in weight-for-age

0.11 ± 0.40

0.02 ± 0.40

0.09 (0.01-0.18)

0.036

Unclear risk of bias for allocation concealment

Age: 12 months

Weight:

Weight (g)

9711 ± 1142

9643 ± 1218

Not reported

Not reported

Sample size: 194

Weight gain (g/day)

Length (cm)

77.8 ± 3.0

77.9 ± 3.4

Not reported

Not significant

Change in weight-for-age after 4 months

Head circumference (cm)

46.3 ± 1.3

46.4 ± 1.4

Not reported

Not significant

Weight (g)

BMI (kg/m²)

16.0

15.9

Not reported

Not reported

Length: Length after 4 months (cm)

Head circumference: Head circumference after 4 months (cm)

BMI: kg/m²

Scalabrin et al. 2009 [33]

Intervention:

Outcome:

Outcome

Intervention 1- EHF + P

Intervention 2 - PHF + P

Control EHF

Mean difference

p-value

USA

Age: 14 days

Weight, Length, Head

Sample size

63

77

70

RCT

Sample size:

circumference

Weight gain (g/day)

28.4 ± 0.67

26.8 ± 0.76

27.6 ± 0.72

Not reported

Not Significant

Quality:

-Extensively hydrolysed formula with probiotic (EHF + P): 94

Units of measurement:

Length (cm/day)

0.11 ± 0.002

0.11 ± 0.002

0.11 ± 0.002

No difference

Low risk of bias for all parameters

-Partially hydrolysed formula with probiotic (PHF + P): 98

Weight:

Head circumference (cm/day)

0.05 ± 0.001

0.05 ± 0.001

0.05 ± 0.001

No difference

Weight gain (g/day)

ANOVA, 1-tailed t-tests

Control:

Length: change in length (cm/day)

Age: 14 days

Sample size: Extensively hydrolysed formula without probiotic (EHF): 94

Head circumference:

Change in head circumference (cm/day)

Saavedra et al. 2004 [32]

Intervention:

Outcome:

Outcome

Intervention 1 (HS)

Intervention 2 (LS)

Control

Mean difference

p-value

USA

Age: 3–24 months

Weight and Height

Sample size

39

39

40

RCT

Sample size:

Units of measurement:

Change in weight-for-age

0.09 ± 0.64

0.06 ± 0.72

0.16 ± 0.69

Not reported

Not significant

Quality:

-High Supplement probiotic in formula (HS): 39

Weight:

Change in weigh-for-length

0.40 ± 0.85

0.53 ± 1.10

0.45 ± 0.75

Not reported

Not significant

Unclear risk of bias in allocation concealment

-Low Supplement probiotic in formula (LS): 39

change in weight-for-age z-score

Change in height-for-age

−0.06 ± 0.44

−0.09 ± 0.60

−0.04 ± 0.59

Not reported

Not significant

Control- formula

change in weight-for-length score

Age: 3–24 months

Height:

Sample size: 40

change in height- for-age z-score

Gibson et al. 2009 [30]

Intervention:

Outcome:

Outcome

Intervention

Control

Mean difference

p-value

Australia

Age: <10 days

Weight, Length, Head Circumference, BMI

Sample size:

62

62

RCT

Sample size: 72

Units of measurement:

Weight gain (g/day)

M(24) 33 · 6 ± 7 · 5

M(19) 31 · 6 ± 7 · 7

1.5 (−0.08-3.1)

Not significant

Quality:

Control:

Weight : Weight gain (g/day)

F(31) 28 · 1 ± 5 · 8

F(24) 26 · 5 ± 4 · 9

Low risk of bias in all parameters

Age: <10 days Sample size: 70

Length: Length gain (mm/month)

Length gain (mm/month)

M(24) 35 ± 3 · 7

M(19) 37 · 3 ± 4 · 9

Not reported

Not significant

Head circumference: Change in head circumference (mm/month)

F(27) 32 · 8 ± 4

F(23) 32 ± 4 · 6

BMI: change in BMI per month (kg/cm²/month)

Head circumference (mm/month)

M(23) 18 ± 2 · 4

M(19) 17 · 5 ± 3 · 4

Not reported

Not significant

F(29) 16 · 1 ± 2 · 7

F(24) 16 ± 3

BMI (kg/cm²/month)

M(24) 1 · 1 ± 0 · 6

M(19) 1 ± 0 · 5

Not reported

Not significant

F(27) 0 · 9 ± 0 · 5

F(23) 0 · 8 ± 0 · 4

ANOVA correcting for sex

Zeigler et al. 2003 [34]

Intervention:

Outcome:

Outcome

Intervention (RP + P)

Intervention (RP)

Control

Mean difference

p-value

USA

Age: 6–10 days

Weight and Height

Sample size

28

27

C:33

RCT

Sample size:

Units of measurement:

Weight gain (g/day)

28.13 ± 4.63^§

29.3 ± 5.41^§

31.05 ± 5.88^§

Not Reported

0.229

Quality:

RP + P

Weight: g/day

The risk of bias in adequate sequence generation, allocation concealment and blinding was unclear while there was a high risk of bias in reporting of incomplete outcome data

(Bifidobacterium lactis in reduced protein formula): 40

Length: mm/day

M 13 32.1 ± 5.2

M 8 32.0 ± 4.7

M 19 32.2 ± 5.2

F 15 24.7 ± 4.9

F 19 28.2 ± 5.8

F 14 29.5 ± 6.9

RP (Reduced protein formula): 40

Length gain (mm/day)

M 13 1.14 ± 0.11

M 8 1.14 ± 0.09

M19 1.16 ± 0.09

Not reported

0.377

F 15 1.02 ± 0.07

F 19 1.06 ± 0.10

F14 1.07 ± 0.14

Control:

Age: 6–10 days

Sample size

Normal protein formula: 42

Puccio et al. 2007 [31]

Intervention:

Outcomes:

Outcome

Intervention

Control

Mean difference (90% CI)

p-value

Italy

Age: <14 days

Weight, height, head circumference

Sample size

42

55

RCT

Sample size: 65

Units of measurement:

Weight (g/day)

Not reported

Not reported

0.50 (−1.48 ± 2.48)

Not reported

Quality: Risk of bias was unclear in both adequate sequence generation and allocation concealment

Control:

Weight: weight gain (g/day)

Height (mm/month)

M 35.1 ± 4.2

M: 35 ± 4.4

Not reported

0.1

Age: <14 days

Height: change in height (mm/month)

F 32.2 ± 4.3

F : 32.2 ± 4.6

0.1

Sample size: 69

Head circumference: Change in head circumference (mm/month)

Head circumference (mm/month)

M: 17.9 ± 2.7

M : 17.4 ± 2.9

Not reported

>0.1 for all

F: 16.0 ± 2.8

F: 15.5 ± 3.0

Huet et al., 2006 [35]

Intervention:

Outcomes:

Outcome

Intervention

Control

Mean difference

p-value

France

Age: 1–28 days

Weight, Height, Head circumference

Sample size

117

86

CCT

Sample size: 117

Units of measurement:

Weight gain (g/day)

29.6 ± 6.6

29.8 ± 6.3

Not reported

Not significant

Quality: The study had high risk of bias in adequate sequence generation, allocation concealment and blinding.

Control:

Weight: weight gain (g/day)

Height (cm/day)

0.110 ± 0.018

0.111 ± 0.018

Not reported

Not significant

Age: 1-28 days

Height: height gain (cm/day)

Head circumference(mm/day)

0.56 ± 0.12

0.55 ± 0.12

Not reported

Not significant

Sample size: 86

Head circumference: change in head circumference (mm/day)

Gil-Campos et al. 2011 [27]

Intervention:

Outcomes:

Outcome

Intervention

Control

Mean difference

p-value

Spain

Age: 1 month

Weight, Height, Head Circumference

Sample size

61

60

RCT

Sample size: 71

Units of measurement:

Weight gain (g/day)

24.8 ± 5.1

25.3 ± 6.0

Not reported

Not significant

Quality: There was low risk of bias in all parameters.

Control:

Weight: weight gain (g/day), weight at 6 months (kg), weight-for-age z-scores at 6 months

Length gain (mm/day)

0.96 ± 0.3

0.90 ± 0.2

Not reported

Not significant

Age: 1 month

Length: Length gain (mm/day), Length at 6 months (cm), Length for age z-scores at 6 months

Head Circumference (mm/day)

0.43 ± 0.1

0.421 ± 0.1

Not reported

Not significant

Weight at 6 months (kg)

8.0 ± 0.9

7.9 ± 1.0

Not reported

Not significant

Sample size: 66

Head Circumference: Head Circumference at 6 months (cm), Head circumference z-scores at 6 months

Length at 6 months (cm)

68.1 ± 3.4

66.6 ± 2.5

Not reported

0.038

Head Circumference at 6 months (cm)

43.7 ± 1.6

43.7 ± 1.3

Not reported

Not significant

Weight for age z-scores at 6 months

Not reported

Not reported

Not reported

p = 0.061

Length for age z-scores at 6 months

Not reported

Not reported

Not reported

p = 0.021

Head circumference z-scores at 6 months

Not reported

Not reported

Not reported

p = 0.453

Section 2: In under-nourished children

Author, year

Sample details

Outcomes and units of measurement

Results

Country

Type of study

Quality

Nutritional status

Sazawal et al. 2010 [16] India

Intervention:

Outcomes:

Outcome

Intervention

Control

Mean difference

p-value

RCT

Age: 1–3 years

Weight, height

Sample size

257

245

Quality: The risk of bias was low for all parameters

Sample size: 312

Units of measurement:

Weight gain (g/year)

2,130 ± 590

2,000 ± 590

130 (30–230)

0.02

None severely malnourished

Control:

Weight: weight gain (g/year), change in weight for age z-score

Change in weight-for-age z-score

0.34 ± 0.54

0.26 ± 0.54

0.08 (−0.02 to 0.17)

0.12

Nutritional status

Normal

Age: 1–3 years

Height (cm/year)

8.49 ± 1.41

8.28 ± 1.35

0.20 (−0.04 to 0.45)

0.09

I: 107 (34.3%) C: 95 (30.4%)

Sample size: 312

Height: height gain (cm/year), change in height for age z-score after one year

change in height for age z-score after 1 year

0.21 ± 0.42

0.18 ± 0.49

0.03 (−0.06 to 0.10)

0.55

Wasted

Difference in weight/height

0.44 ± 0.65

0.34 ± 0.63

0.09 (−0.01 to 0.21)

0.09

I: 15 (4.8%) C: 14 (4.5%)

Stunted

I: 137 (43.9%) C: 157 (50.3%)

Wasted and stunted

I: 53 (17.0%) C: 46 (14.7%)

Saran et al., 2002 [13]

Intervention:

Outcomes:

Outcome

Intervention

Control

Mean difference

p-value

India

Age: 2–5 years

Weight, height

Sample size

50

50

Non-randomised controlled trial

Sample size: 50

Units of measurement:

Weight (g/6 months)

1,290 ± 730

810 ± 840

0.002

Not reported

Quality: high risk of bias for adequate sequence generation, allocation concealment and blinding.

Control:

Weight: weight gain (g per 6 months)

Height: (cm/6months)

3.21 ± 1.48

1.74 ± 0.80

Not reported

0.0001

Nutritional status

Stunted (height for age) and matched in both groups

Age: 2–5 years

Height: height gain (cm per 6 months)

Sample size: 50

He et al., 2005 [12]

Intervention:

Outcomes:

Outcome

Intervention

Control

Mean difference

p-value

China

Age: 3–5 years

Weight, height

Sample size

201

201

RCT

Sample size: 201

Gram per 3, 6 and 9 months

700 ± 430

490 ± 350

Not reported

0.01

Quality:

Control:

Units of measurement: Weight: Weight gain (g per 3, 6 and 9 months), Change in weight-for-age at 3, 6 and 9 months

980 ± 620

800 ± 600

0.01

There was an unclear risk of bias in adequate sequence generation and high risk of bias in both allocation concealment and blinding

Age: 3–5 years

1,420 ± 760

1,200 ± 670

0.01

Sample size: 201

Change in weight-for-age at 3, 6 and 9 months

0.139 ± 0.228

0.031 ± 0.184

0.01

Nutritional status

Undernourished - weight for age and/or height for age were below reference values

Height: change in height for age z-scores at 9 months

0.058 ± 0.306

−0.047 ± 0.28

0.01

0.078 ± 0.365

−0.043 ± 0.28

0.01

Change in height for age z-scores at 9 months

0.123 ± 0.168

0.077 ± 0.175

Not reported

<0.01

Surono et al. 2011 [28] Indonesia

Intervention:

Outcomes: Weight

Outcome

Intervention

Control

Mean difference

p-value

RCT

Age: 15–54 months

Units of measurement:

Sample size

37

39

Sample size: 39

Weight: Mean gain in bodyweight after 90 days

Mean bodyweight gain (g)

1280 ± 940

990 ± 990

Not reported

Not reported

Quality:

Control:

There was an unclear risk of bias in adequate sequence generation, allocation concealment and blinding.

Age: 15–54 monthss

Nutritional status

Underweight

Sample size: 40

I: 20 C: 20

Severe Underweight

I: 7 C:10

Normal Bodyweight

I:10

C:9