Suplementos nutricionales como inmunomoduladores en niños: una revisión de la literatura
Contenido principal del artículo
Resumen
DOI: 10.1016/j.rcpe.2016.09.002
Introducción
Las enfermedades infecciosas y alérgicas son las principales causas de morbimortalidad en la primera infancia en Colombia. Entre las opciones estudiadas para su prevención y control, se encuentran los suplementos nutricionales a base de probióticos, elementos de traza, antioxidantes y ácidos grasos de cadena larga.
Métodos
Se realizó una revisión de la literatura en las bases de datos PubMed y EMBASE, buscando estudios que relacionaran el uso de suplementos nutricionales y el desempeño del sistema inmunitario en niños. Se emplearon los términos: “Dietary supplements” AND “Immune System” AND (“infant” OR “child” OR “adolescent”).
Resultados
La búsqueda inicial arrojó un total de 255 referencias, 54 de las cuales se utilizaron para extraer información. Hay un número importante de publicaciones sobre los beneficios de los ácidos grasos de cadena larga, micronutrientes y probióticos para el sistema inmunitario de los niños, y miden diversos desenlaces (muchos de ellos «intermedios») y con tamaños de muestra pequeños.
Conclusiones
El uso de suplementos nutricionales podría tener un beneficio para el paciente pediátrico desde el punto de vista inmunológico. Se requieren más estudios sobre el tema.
Descargas
Detalles del artículo
Licencia Creative Commons
Atribución-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0)
Usted es libre de:
Compartir - copiar y redistribuir el material en cualquier medio o formato.
Adaptar - remezclar, transformar y construir a partir del material
La licencia no puede revocar estas libertades en tanto se sigan los términos de la licencia.
- Atribución — Usted debe dar crédito de manera adecuada, brindar un enlace a la licencia, e indicar si se han efectuado cambios. Puede hacerlo en cualquier forma razonable, pero no de forma tal que sugiera que usted o su uso tienen el apoyo del licenciante.
- NoComercial — Usted no puede hacer uso del material con propósitos comerciales.
- CompartirIgual— Si remezcla, transforma o crea a partir del material, debe distribuir su contribución bajo la misma licencia del original.
- No hay restricciones adicionales — No puede aplicar términos legales ni medidas tecnológicas que restrinjan legalmente a otras a hacer cualquier uso permitido por la licencia.
Citas
2. M.J. Rebollo Suplementos nutricionales en pediatría Rev Chil Nutr., 29 (2002), pp. 294-299
3. E. Ramiro-Puig,F. Pérez-Cano,C. Castellote,A. Franch,M. Castell El intestino: pieza clave del sistema inmunitario Rev Eso Enferm Dig., 100 (2008), pp. 29-34
4. M.M. Grönlund,H. Arvilommi,P. Kero,O.P. Lehtonen,E. Isolauri Importance of intestinal colonisation in the maturation of humoral immunity in early infancy: a prospective follow up study of healthy infants aged 0-6 months Arch Dis Child Fetal Neonatal Ed., 83 (2000), pp. F186-F192 Medline
5. F. Purchiaroni,A. Tortora,M. Gabielli,F. Bertucci,G. Gigange,G. Ianiro The role of intestinal microbiota and the immune system Eur Rev Med Pharmacol Sci., 17 (2013), pp. 323-333 Medline
6. R-L. Jan,Y-L. Lin,H-H. Chen,J-Y. Wang Randomized placebo-controlled trial of lactobacillus on asthmatic children with allergic rhinitis Pediatr Pulmonol., 45 (2010), pp. 1111 1120 http://dx.doi.org/10.1002/ppul.21296 Medline
7. G. Ciprandi,A. Vizzaccaro,I. Cirillo,M. Tosca Bacillus clausii effects in children with allergic rhinitis Allergy., 60 (2005), pp. 702-703 http://dx.doi.org/10.1111/j.1398-9995.2005.00722.x Medline
8. G. Ciprandi,A. Vizzaccaro,I. Cirillo,M.A. Tosca Bacillus clausii exerts immuno-modulatory activity in allergic subjects: a pilot study Eur Ann Allergy Clin Immunol., 37 (2005), pp. 129-134 Medline
9. A. Flinterman,E. Knol,A. Van Ieperen-van Dijk,H. Timmerman,A. Knulst,C. Bruijnzeel-Koomen Probiotics have a different immunomodulatory potential in vitro versus ex vivo upon oral administration in children with food allergy Int Arch Allergy Immunol., 143 (2007), pp. 237-244 http://dx.doi.org/10.1159/000099467 Medline
10. H. Saneian,Z. Pourmoghaddas,H. Roohafza,A. Gholamrezaei Synbiotic containing Bacillus coagulans and fructo-oligosaccharides for functional abdominal pain in children Gastroenterol Hepatol., 8 (2015), pp. 56-65
11. A. Ouwehand,M. Nermes,M.C. Collado,N. Rautonen,S. Salminen,E. Isolauri Specific probiotics alleviate allergic rhinitis during the birch pollen season World J Gastroenterol., 15 (2009), pp. 3261-3268 Medline
12. S. Prescott,J. Dunstan,J. Hale,L. Breckler,H. Lehmann,S. Weston Clinical effects of probiotics are associated with increased interferon-gamma responses in very young children with atopic dermatitis Clin Exp Allergy., 35 (2005), pp. 1557-1564 http://dx.doi.org/10.1111/j.1365-2222.2005.02376.x Medline
13. A. Shafiei,M. Moin,Z. Pourpak,M. Gharagozlou,A. Aghamohammadi,A. Aghamohamadi Synbiotics could not reduce the scoring of childhood atopic dermatitis (SCORAD): a randomized double blind placebo-controlled trial Iran J Allergy Asthma Immunol., 10 (2011), pp. 21-28 http://dx.doi.org/010.01/ijaai.2128 Medline
14. S. Prescott,J. Wiltschut,A. Taylor,L. Westcott,W. Jung,H. Currie Early markers of allergic disease in a primary prevention study using probiotics: 2.5-year follow-up phase Allergy., 63 (2008), pp. 1481-1490 http://dx.doi.org/10.1111/j.1398-9995.2008.01778.x Medline
1. A.L. Taylor,J. Hale,J. Wiltschut,H. Lehmann,J. Dunstan,S. PrescottEffects of probiotic supplementation for the first 6 months of life on allergen- and vaccine-specific immune responses Clin Exp Allergy., 36 (2006), pp. 1227-1235 http://dx.doi.org/10.1111/j.1365-2222.2006.02553.x Medline
2. C. West,O. Hernell,Y. Andersson,M. Sjöstedt,M-L. Hammarström Probiotic effects on T-cell maturation in infants during weaning Clin Exp Allergy., 42 (2012), pp. 540-549 http://dx.doi.org/10.1111/j.1365-2222.2011.03941.x Medline
3. A. Taylor,J. Hale,B. Hales,J. Dunstan,W. Thomas,S. Prescott FOXP3 mRNA expression at 6 months of age is higher in infants who develop atopic dermatitis, but is not affected by giving probiotics from birth Pediatr Allergy Immunol., 18 (2007), pp. 10-19 http://dx.doi.org/10.1111/j.1399-3038.2007.00624.x Medline
4. M. Raes,P. Scholtens,P. Alliet,K. Hensen,H. Jongen,G. Boehm Exploration of basal immune parameters in healthy infants receiving an infant milk formula supplemented with prebiotics Pediatr Allergy Immunol., 21 (2010), pp. e377-e385 http://dx.doi.org/10.1111/j.1399-3038.2009.00957.x Medline
5. T. Fujii,Y. Ohtsuka,T. Lee,T. Kudo,H. Shoji,H. Sato Bifidobacterium breve enhances transforming growth factor beta1 signaling by regulating Smad7 expression in preterm infants J Pediatr Gastroenterol Nutr., 43 (2006), pp. 83 88 http://dx.doi.org/10.1097/01.mpg.0000228100.04702.f8 Medline
6. C.E. West,M-L. Hammarström,O. Hernell Probiotics during weaning reduce the incidence of eczema Pediatr Allergy Immunol., 20 (2009), pp. 430-437 http://dx.doi.org/10.1111/j.1399-3038.2009.00745.x Medline
7. M. Baron A patented strain of Bacillus coagulans increased immune response to viral challenge Postgrad Med., 121 (2009), pp. 114-118 http://dx.doi.org/10.3810/pgm.2009.03.1971 Medline
8. M. Nermes,J. Kantele,T. Atosuo,S. Salminen,E. Isolauri Interaction of orally administered Lactobacillus rhamnosus GG with skin and gut microbiota and humoral immunity in infants with atopic dermatitis Clin Exp Allergy., 41 (2011), pp. 370-377 http://dx.doi.org/10.1111/j.1365-2222.2010.03657.x Medline
9. S. Rautava,H. Arvilommi,E. Isolauri Specific probiotics in enhancing maturation of IgA responses in formula-fed infants Pediatr Res., 60 (2006), pp. 221 224 http://dx.doi.org/10.1203/01.pdr.0000228317.72933.db Medline
10. M. Rinne,M. Kalliomaki,H. Arvilommi,S. Salminen,E. Isolauri Effect of probiotics and breastfeeding on the bifidobacterium and lactobacillus/enterococcus microbiota and humoral immune responses J Pediatr., 147 (2005), pp. 186-191 http://dx.doi.org/10.1016/j.jpeds.2005.03.053 Medline
11. M. Wada,S. Nagata,M. Saito,T. Shimizu,Y. Yamashiro,T. Matsuki Effects of the enteral administration of Bifidobacterium breve on patients undergoing chemotherapy for pediatric malignancies Support Care Cancer., 18 (2010), pp. 751 759 http://dx.doi.org/10.1007/s00520-009-0711-6 Medline
12. L. Galpin,M. Manary,K. Fleming,C-N. Ou,P. Ashorn,R. Shulman Effect of Lactobacillus GG on intestinal integrity in Malawian children at risk of tropical enteropathy Am J Clin Nutr., 82 (2005), pp. 1040-1045 Medline
13. J. Hol,E. Van Leer,B. Elink-Schuurman,L. De Ruiter,J. Samsom,W. Hop The acquisition of tolerance toward cow's milk through probiotic supplementation: a randomized, controlled trial J Allergy Clin Immunol., 121 (2008), pp. 1448-1454 http://dx.doi.org/10.1016/j.jaci.2008.03.018 Medline
14. E. Loo,G. Llanora,Q. Lu,M. Aw,B. Lee,L. Shek Supplementation with probiotics in the first 6 months of life did not protect against eczema and allergy in at-risk asian infants: A 5-year follow-up Int Arch Allergy Immunol., 163 (2014), pp. 25 28 http://dx.doi.org/10.1159/000356338 Medline
15. M. Jørgensen,A. Fisker,E. Sartono,A. Andersen,C. Erikstrup,I. Lisse The effect of at-birth vitamin A supplementation on differential leucocyte counts and in vitro cytokine production: an immunological study nested within a randomised trial in Guinea-Bissau Br J Nutr., 109 (2013), pp. 467-477 http://dx.doi.org/10.1017/S0007114512001304 Medline
16. K. Long,T. Estrada-Garcia,J. Rosado,J. Ignacio Santos,M. Haas,M. Firestone The effect of vitamin A supplementation on the intestinal immune response in Mexican children is modified by pathogen infections and diarrhea J Nutr., 136 (2006), pp. 1365-1370 Medline
17. V. Giacomet,A. Vigano,V. Manfredini,C. Cerini,G. Bedogni,S. Mora Cholecalciferol supplementation in HIV-infected youth with vitamin D insufficiency: effects on vitamin D status and T-cell phenotype: a randomized controlled trial HIV Clin Trials., 14 (2013), pp. 51-60 http://dx.doi.org/10.1310/hct1402-51 Medline
18. A. Carr,S. Bozonet,J. Pullar,J. Simcock,M. Vissers A randomized steady-state bioavailability study of synthetic versus natural (kiwifruit-derived) vitamin C Nutrients., 5 (2013), pp. 3684-3695 http://dx.doi.org/10.3390/nu5093684 Medline
19. A. De Azevedo Paiva,P.H. Rondó,L. Rehder Vaz-de-Lima,C. De Freitas Oliveira,M. Ueda,C. Gonçalves-Carvalho The impact of vitamin A supplementation on the immune system of vitamin A-deficient children Int J Vitam Nutr Res., 80 (2010), pp. 188-196 http://dx.doi.org/10.1024/0300-9831/a000017 Medline
20. E. Hyppönen,A-L. Hartikainen,U. Sovio,M-R. Järvelin,A. Pouta Does vitamin D supplementation in infancy reduce the risk of pre-eclampsia Eur J Clin Nutr., 61 (2007), pp. 1136-1139 http://dx.doi.org/10.1038/sj.ejcn.1602625 Medline
21. K. Weisse,S. Winkler,F. Hirche,G. Herberth,D. Hinz,M. Bauer Maternal and newborn vitamin D status and its impact on food allergy development in the German LINA cohort study Allergy., 68 (2013), pp. 220-228 http://dx.doi.org/10.1111/all.12081 Medline
22. P. Di Filippo,A. Scaparrotta,D. Rapino,A. Cingolani,M. Attanasi,M.I. Petrosino Vitamin D supplementation modulates the immune system and improves atopic dermatitis in children Int Arch Allergy Immunol., 166 (2015), pp. 91-96 http://dx.doi.org/10.1159/000371350 Medline
23. D. Kaempf,O. Linderkamp Do healthy premature infants fed breast milk need vitamin E supplementation: alpha- and gamma-tocopherol levels in blood components and buccal mucosal cells Pediatr Res., 44 (1998), pp. 54-59 http://dx.doi.org/10.1203/00006450-199807000-00009 Medline
24. R. Raqib,S.K. Roy,M.J. Rahman,T. Azim,S.S. Ameer,J. Chisti Effect of zinc supplementation on immune and inflammatory responses in pediatric patients with shigellosis Am J Clin Nutr., 79 (2004), pp. 444-450 Medline
25. M. Rahman,P. Sarker,S. Roy,S. Ahmad,J. Chisti,T. Azim Effects of zinc supplementation as adjunct therapy on the systemic immune responses in shigellosis Am J Clin Nutr., 81 (2005), pp. 495-502 Medline
26. A. Sheikh,S. Shamsuzzaman,S. Ahmad,D. Nasrin,S. Nahar,M. Alam Zinc influences innate immune responses in children with enterotoxigenic Escherichia coli-induced diarrhea J Nutr., 140 (2010), pp. 1049-1056 http://dx.doi.org/10.3945/jn.109.111492 Medline
27. C. Damsgaard,L. Lauritzen,T. Kjaer,P. Holm,M-B. Fruekilde,K. Michaelsen Fish oil supplementation modulates immune function in healthy infants J Nutr., 137 (2007), pp. 1031-1036 Medline
28. C. Field,J. Van Aerde,S. Goruk,M. Clandinin Effect of feeding a formula supplemented with long-chain polyunsaturated fatty acids for 14 weeks improves the ex vivo response to a mitogen and reduces the response to a soy protein in infants at low risk for allergy J Pediatr Gastroenterol Nutr., 50 (2010), pp. 661 669 http://dx.doi.org/10.1097/MPG.0b013e3181b99cd5 Medline
29. A. Panchaud,A. Sauty,Y. Kernen,L. Decosterd,T. Buclin,O. Boulat Biological effects of a dietary omega-3 polyunsaturated fatty acids supplementation in cystic fibrosis patients: a randomized, crossover placebo-controlled trial Clin Nutr., 25 (2006), pp. 418-427 http://dx.doi.org/10.1016/j.clnu.2005.10.011 Medline
30. N. Vaisman,Y. Zaruk,I. Shirazi,N. Kaysar,V. Barak The effect of fish oil supplementation on cytokine production in children Eur Cytokine Netw., 16 (2005), pp. 194-198 Medline
31. V. Mazurak,V. Lien,C. Field,S. Goruk,K. Pramuk,M. Clandinin Long-chain polyunsaturated fat supplementation in children with low docosahexaenoic acid intakes alters immune phenotypes compared with placebo J Pediatr Gastroenterol Nutr., 46 (2008), pp. 570-579 http://dx.doi.org/10.1097/MPG.0b013e31816a62eb Medline
32. M. López-Alarcón,M. Bernabe-García,O. Del Valle,G. González-Moreno,A. Martínez-Basilea,R. Villegas Oral administration of docosahexaenoic acid attenuates interleukin-1β response and clinical course of septic neonates Nutrition., 28 (2012), pp. 384 390 http://dx.doi.org/10.1016/j.nut.2011.07.016 Medline
33. A. Lapillonne,N. Pastor,W. Zhuang,D. Scalabrin Infants fed formula with added long chain polyunsaturated fatty acids have reduced incidence of respiratory illnesses and diarrhea during the first year of life BMC Pediatr., 14 (2014), pp. 168 http://dx.doi.org/10.1186/1471-2431-14-168 Medline
34. L. Malan,J. Baumgartner,P. Calder,M. Zimmermann Smuts C. n-3 Long-chain PUFAs reduce respiratory morbidity caused by iron supplementation in iron-deficient South African schoolchildren: a randomized, double-blind, placebo-controlled intervention Am J Clin Nutr., 101 (2015), pp. 668-679 http://dx.doi.org/10.3945/ajcn.113.081208 Medline
35. A. Forsberg,T. Abrahamsson,B. Björkstén,M. Jenmalm Pre- and post-natal Lactobacillus reuteri supplementation decreases allergen responsiveness in infancy Clin Exp Allergy., 43 (2013), pp. 434-442 http://dx.doi.org/10.1111/cea.12082 Medline
36. S.M. Ahmad,R. Raqib,F. Qadri,C.B. Stephensen The effect of newborn vitamin A supplementation on infant immune functions: Trial design, interventions, and baseline data Contemp Clin Trials., 39 (2014), pp. 269-279 http://dx.doi.org/10.1016/j.cct.2014.09.004 Medline
37. M. Van de Pol,R. Lutter,B. Smids,E. Weersink,J. Van der Zee Synbiotics reduce allergen-induced T-helper 2 response and improve peak expiratory flow in allergic asthmatics Allergy., 66 (2011), pp. 39-47 http://dx.doi.org/10.1111/j.1398-9995.2010.02454.x Medline
38. A. Martínez-Cañavate,S. Sierra,F. Lara-Villoslada,J. Romero,J. Maldonado,J. Boza A probiotic dairy product containing L. gasseri CECT5714 and L. coryniformis CECT5711 induces immunological changes in children suffering from allergy Pediatr Allergy Immunol., 20 (2009), pp. 592-600 http://dx.doi.org/10.1111/j.1399-3038.2008.00833.x Medline
39. V. Rosenfeldt,E. Benfeldt,S.D. Nielsen,K.F. Michaelsen,D.L. Jeppesen,N.H. Valerius Effect of probiotic Lactobacillus strains in children with atopic dermatitis J Allergy Clin Immunol., 111 (2003), pp. 389-395 Medline
40. S. Gerasimov,V. Vasjuta,O. Myhovych,L. Bondarchuk Probiotic supplement reduces atopic dermatitis in preschool children: a randomized, double-blind, placebo-controlled, clinical trial Am J Clin Dermatol., 11 (2010), pp. 351-361 http://dx.doi.org/10.2165/11531420-000000000-00000 Medline
41. E. Pohjavuori,M. Viljanen,R. Korpela,M. Kuitunen,M. Tiittanen,O. Vaarala Lactobacillus GG effect in increasing IFN-gamma production in infants with cow's milk allergy J Allergy Clin Immunol., 114 (2004), pp. 131-136 http://dx.doi.org/10.1016/j.jaci.2004.03.036 Medline
42. H. Morita,F. He,M. Kawase,A. Kubota,M. Hiramatsu,J-I. Kurisaki Preliminary human study for possible alteration of serum immunoglobulin E production in perennial allergic rhinitis with fermented milk prepared with Lactobacillus gasseri TMC0356 Microbiol Immunol., 50 (2006), pp. 701-706 Medline
N. Kiraly,A. Balde,I.M. Lisse,H.B. Eriksen,P. Aaby,C.S. Benn Vitamin A supplementation and risk of atopy: long-term follow-up of a randomized trial of vitamin A supplementation at six and nine months of age BMC Pediatr., 13 (2013), pp. 190 http://dx.doi.org/10.1186/1471-2431-13-190 Medline