Prebiotics for People with Cystic Fibrosis

Overview

Journal Cochrane Database Syst Rev

Publisher Wiley

Specialties General Medicine
Health Services

Date 2023 Sep 27

PMID 37753791

Authors

Neil C Williams

Jacob Jayaratnasingam

Andrew P Prayle

Sarah J Nevitt

Alan R Smyth

Affiliations

Soon will be listed here.

Abstract

Background: Cystic fibrosis (CF) is a multisystem disease; the importance of growth and nutritional status is well established given their implications for lung function and overall survivability. Furthermore, it has been established that intestinal microbial imbalance and inflammation are present in people with CF. Oral prebiotics are commercially available substrates that are selectively utilised by host intestinal micro-organisms and may improve both intestinal and overall health.

Objectives: To evaluate the benefits and harms of prebiotics for improving health outcomes in children and adults with CF.

Search Methods: We searched the Cochrane Cystic Fibrosis Trials Register compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews. Date of last search: 19 October 2022. We also searched PubMed and online trials registries. Date of last search: 13 January 2023.

Selection Criteria: Randomised controlled trials (RCTs) and quasi-RCTs assessing the efficacy of prebiotics in children and adults with CF. We planned to only include the first treatment period from cross-over RCTs, regardless of washout period.

Data Collection And Analysis: We did not identify any relevant trials.

Main Results: We did not identify any relevant trials for inclusion in this review.

Authors' Conclusions: This review did not find any evidence for the use of prebiotics in people with CF. Until such evidence is available, it is reasonable for clinicians to follow any local guidelines and to discuss the use of dietary prebiotics with their patients. Large and robust RCTs assessing the dietary prebiotics of inulin or galacto-oligosaccharides or fructo-oligosaccharides, or any combination of these, are needed. Such studies should be of at least 12 months in duration and assess outcomes such as growth and nutrition, gastrointestinal symptoms, pulmonary exacerbations, lung function, inflammatory biomarkers, hospitalisations, intestinal microbial profiling, and faecal short-chain fatty acids. Trials should include both children and adults and aim to be adequately powered to allow for subgroup analysis by age.

Citing Articles

Prebiotics for people with cystic fibrosis.

Williams N, Jayaratnasingam J, Prayle A, Nevitt S, Smyth A Cochrane Database Syst Rev. 2023; 9:CD015236.

PMID: 37753791 PMC: 10523429. DOI: 10.1002/14651858.CD015236.pub2.

References

Dhaliwal J, Leach S, Katz T, Nahidi L, Pang T, Lee J . Intestinal inflammation and impact on growth in children with cystic fibrosis. J Pediatr Gastroenterol Nutr. 2014; 60(4):521-6. DOI: 10.1097/MPG.0000000000000683. View

Fuchs H, Borowitz D, Christiansen D, Morris E, Nash M, Ramsey B . Effect of aerosolized recombinant human DNase on exacerbations of respiratory symptoms and on pulmonary function in patients with cystic fibrosis. The Pulmozyme Study Group. N Engl J Med. 1994; 331(10):637-42. DOI: 10.1056/NEJM199409083311003. View

Tomas J, Mulet C, Saffarian A, Cavin J, Ducroc R, Regnault B . High-fat diet modifies the PPAR-γ pathway leading to disruption of microbial and physiological ecosystem in murine small intestine. Proc Natl Acad Sci U S A. 2016; 113(40):E5934-E5943. PMC: 5056107. DOI: 10.1073/pnas.1612559113. View

Antosca K, Chernikova D, Price C, Ruoff K, Li K, Guill M . Altered Stool Microbiota of Infants with Cystic Fibrosis Shows a Reduction in Genera Associated with Immune Programming from Birth. J Bacteriol. 2019; 201(16). PMC: 6657602. DOI: 10.1128/JB.00274-19. View

Lee J, Leach S, Katz T, Day A, Jaffe A, Ooi C . Update of faecal markers of inflammation in children with cystic fibrosis. Mediators Inflamm. 2012; 2012:948367. PMC: 3439990. DOI: 10.1155/2012/948367. View

Anderson J, Tierney A, Miles C, Kotsimbos T, King S . Probiotic use in adults with cystic fibrosis is common and influenced by gastrointestinal health needs: A cross-sectional survey study. J Hum Nutr Diet. 2022; 35(3):444-454. DOI: 10.1111/jhn.12991. View

de Freitas M, Moreira E, Tomio C, Moreno Y, Daltoe F, Barbosa E . Altered intestinal microbiota composition, antibiotic therapy and intestinal inflammation in children and adolescents with cystic fibrosis. PLoS One. 2018; 13(6):e0198457. PMC: 6014676. DOI: 10.1371/journal.pone.0198457. View

Gibson G, Roberfroid M . Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. J Nutr. 1995; 125(6):1401-12. DOI: 10.1093/jn/125.6.1401. View

McDonald C, Bowser E, Farnham K, Alvarez J, Padula L, Rozga M . Dietary Macronutrient Distribution and Nutrition Outcomes in Persons with Cystic Fibrosis: An Evidence Analysis Center Systematic Review. J Acad Nutr Diet. 2020; 121(8):1574-1590.e3. DOI: 10.1016/j.jand.2020.03.016. View

10.

Coffey M, Garg M, Homaira N, Jaffe A, Ooi C . Probiotics for people with cystic fibrosis. Cochrane Database Syst Rev. 2020; 1:CD012949. PMC: 6984633. DOI: 10.1002/14651858.CD012949.pub2. View

11.

Gibson G, McCartney A, Rastall R . Prebiotics and resistance to gastrointestinal infections. Br J Nutr. 2005; 93 Suppl 1:S31-4. DOI: 10.1079/bjn20041343. View

12.

Marsland B, Trompette A, Gollwitzer E . The Gut-Lung Axis in Respiratory Disease. Ann Am Thorac Soc. 2015; 12 Suppl 2:S150-6. DOI: 10.1513/AnnalsATS.201503-133AW. View

13.

Hill C, Guarner F, Reid G, Gibson G, Merenstein D, Pot B . Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014; 11(8):506-14. DOI: 10.1038/nrgastro.2014.66. View

14.

Li L, Somerset S . The clinical significance of the gut microbiota in cystic fibrosis and the potential for dietary therapies. Clin Nutr. 2014; 33(4):571-80. DOI: 10.1016/j.clnu.2014.04.004. View

15.

Dinan T, Cryan J . The Microbiome-Gut-Brain Axis in Health and Disease. Gastroenterol Clin North Am. 2017; 46(1):77-89. DOI: 10.1016/j.gtc.2016.09.007. View

16.

Whisner C, Castillo L . Prebiotics, Bone and Mineral Metabolism. Calcif Tissue Int. 2017; 102(4):443-479. PMC: 5851694. DOI: 10.1007/s00223-017-0339-3. View

17.

Stallings V, Stark L, Robinson K, Feranchak A, Quinton H . Evidence-based practice recommendations for nutrition-related management of children and adults with cystic fibrosis and pancreatic insufficiency: results of a systematic review. J Am Diet Assoc. 2008; 108(5):832-9. DOI: 10.1016/j.jada.2008.02.020. View

18.

Sutherland R, Katz T, Liu V, Quintano J, Brunner R, Tong C . Dietary intake of energy-dense, nutrient-poor and nutrient-dense food sources in children with cystic fibrosis. J Cyst Fibros. 2018; 17(6):804-810. DOI: 10.1016/j.jcf.2018.03.011. View

19.

de Freitas M, Moreira E, Oliveira D, Tomio C, da Rosa J, Moreno Y . Effect of synbiotic supplementation in children and adolescents with cystic fibrosis: a randomized controlled clinical trial. Eur J Clin Nutr. 2017; 72(5):736-743. DOI: 10.1038/s41430-017-0043-4. View

20.

Vernocchi P, Del Chierico F, Russo A, Majo F, Rossitto M, Valerio M . Gut microbiota signatures in cystic fibrosis: Loss of host CFTR function drives the microbiota enterophenotype. PLoS One. 2018; 13(12):e0208171. PMC: 6283533. DOI: 10.1371/journal.pone.0208171. View