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A review of dose-responses of probiotics in human studies

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The probiotic definition requires the administration of an ‘adequate amount’ in order to obtain a health benefit. What that amount should be is not indicated. Here, an overview is given of studies that investigated the dose-response relation of probiotics in human interventions. Studies were divided in; meta-analyses, meta-analyses on specific probiotic strains, and studies testing two or more doses of a probiotic (combination) in the same study. Meta-analyses on the effect of probiotics on antibiotic associated diarrhoea (AAD) suggest a dose-response effect; for Clostridium difficile-associated diarrhoea on the other hand no dose-response was observed. For other end-points; such as necrotising enterocolitis, prevention of atopic dermatitis and slow intestinal transit, no dose-response relation was identified in meta-analyses. For prophylaxis in colorectal cancer and relief of irritable bowel syndrome, no dose-response relation was determined. However, for blood pressure, a meta-analysis observed that higher doses (greater than 1011 cfu) were more effective than lower doses. Meta-analyses of specific strains suggest a break-point for effectiveness of Lactobacillus rhamnosus GG in the treatment of acute gastroenteritis in children; no dose-response was observed for two other probiotics assessed. Studies comparing two or more doses indicate that faecal recovery and risk reduction of AAD follow a positive dose-response relationship. Other end-points such as immune markers, general health, and bowel function did not exhibit clear dose-response relations. For AAD, the findings are very compelling; both meta-analyses and dedicated dose-response studies observe a positive correlation between dose and AAD risk. These findings do not allow for extrapolation, but suggest that studying higher doses for this end-point would be worthwhile. The lack of a clear dose-response for other end-points, does not mean it does not exist; present data does just not allow drawing any conclusions.
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Keywords: Bifidobacterium; Lactobacillus; antibiotic associated diarrhoea; dose-response

Document Type: Research Article

Publication date: April 26, 2017

More about this publication?
  • Beneficial Microbes is a peer-reviewed scientific journal with a specific area of focus: the promotion of the science of microbes beneficial to the health and wellbeing of man and animal. The journal contains original research papers and critical reviews in all areas dealing with beneficial microbes in both the small and large intestine, together with opinions, a calendar of forthcoming beneficial microbes-related events and book reviews. The journal takes a multidisciplinary approach and focuses on a broad spectrum of issues, including safety aspects of pro- & prebiotics, regulatory aspects, mechanisms of action, health benefits for the host, optimal production processes, screening methods, (meta)genomics, proteomics and metabolomics, host and bacterial physiology, application, and role in health and disease in man and animal. Beneficial Microbes is intended to serve the needs of researchers and professionals from the scientific community and industry, as well as those of policy makers and regulators.
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