JPGN Journal Club: April 2025
Spring!
The snowdrops are in their glory, the crocuses are a gaudy carpet, at least as this note is being compiled.
Little darling, it’s been a long, cold, lonely winter, but here comes – no, not the Sun, instead, JPGN Journal Club, led by Dr Jake Mann.
Please visit https://www.espghan.org/knowledge-center to examine the offerings, and don’t forget the Helsinki annual meeting, May 14-17, of ESPGHAN.
Your podcast team will be there. Stop by, please, with your thanks, congratulations, suggestions, and love-offerings centred on chocolate; meet us in person, say hello!
Jake’s choices for discussion todayFrom J Pediatr Gastroenterol Nutr, by Iramain et al., writing from Hospital de Clínicas, Faculty of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay:
“Lactobacillus reuteri Protectis DSM 17938 at high doses versus placebo in children with acute gastroenteritis in a Pediatric Emergency Department”
From Science, by Gracner et al., with co-authors at institutions in Canada, the USA, and Mexico – should I write “North USA, USA, and Mexico”? Or “North USA, USA, and South USA”? Or, which I’d prefer, “Canada, South Canada, and Mexico”? Everything is so fluid these days –
“Exposure to sugar rationing in the first 1000 days of life protected against chronic disease.”
Study SummariesThe JPGN article reports a study of a commercial probiotic, BioGaia’s Protectis DSM 17938, which contains a patented strain of L. reuteri, in children aged less than 5 years who required emergent care for acute gastroenteritis and who were either mildly or moderately dehydrated. (The text hints that some children were admitted to hospital for care and that some were sent home, but provides no details.)
Two demographically similar cohorts were assembled, one given placebo (n=70) and one given Protectis (n=62). Over 5 days, numbers of stools daily fell more quickly among children given Protectis, whose disorder also resolved more quickly overall, than among children given placebo. The differences in favour of probiotic use reached statistical significance. The authors conclude that the BioGaia product can be useful in clinical settings.
The authors introduce their work with the claim:
“There are many adjuvants therapeutic strategies for treatment, including probiotics, however, their efficacy is still debated” (sic),
which might for some readers raise an eyebrow. L. reuteri has been studied forward and backward for more than thirty years, with documentation of efficacy and safety. Indeed, the BioGaia website (https://www.biogaiagroup.com/science/clinical-studies) states:
“To date, more than 260 clinical studies using BioGaia’s human strains of L. reuteri have been performed on approximately 22,000 individuals of all ages. Results have been published in more than 250 articles in scientific journals (Dec 2023).”
Might one wonder which deficiency in knowledge of L. reuteri this study has plugged?
In September 1953, sugar rationing ended in Britain. The article from Science describes differences in development of type 2 diabetes mellitus (T2DM) and hypertension between those who in utero were exposed to levels of sugar now recommended, that is, those born before rationing ended, and those born thereafter – when consumption of sugar nationwide doubled. (The authors took care to account for, and to exclude, contributions from shifts in dietary content of fat and of protein.)
To quote:
“The sample included 60,183 participants born between October 1951 and March 1956, aged 51 to 66 when surveyed. Adults conceived in the 1000 days before September 1953 were classified as “rationed” (born October 1951 to June 1954, n=38,155), and adults conceived after were classified as “never rationed” (born July 1954 to March 1956, n=22,028).”
And further:
“We found that early-life exposure to sugar rationing led to a reduction in T2DM and hypertension risk by about 35 and 20% and delayed the onset of these diseases by about 4 and 2 years, respectively.”
The longer the postnatal experience of sugar rationing, the more slowly these disorders developed. Sugar consumption variability did not seem to affect incidence of other disorders, helping to exclude non-specific effects.
Whilst data in UK Biobank, on which this study drew for subject recruitment, are generally derived from a relatively affluent tranche of Britishers, the authors claim that study design obviated concerns regarding applicability of any conclusions to broader segments of society.
Perhaps the principal audience for this work consists in obstetricians and perinatologists rather than in specialists in paediatric nutrition, in that in utero exposure to low-sugar diets was more protective than was postnatal exposure. However, since maternal consumption of sugar affects the exposure to sugar of the nursing infant, the work seems likely to be of interest to paediatricians in general.
LiteratureIramain R et al. Lactobacillus reuteri Protectis DSM 17938 at high doses versus placebo in children with acute gastroenteritis in a Pediatric Emergency Department. J Pediatr Gastroenterol Nutr 2025 Mar 3. PMID: 40026275 DOI: 10.1002/jpn3.70026 Online ahead of print
Gracner T et al. Exposure to sugar rationing in the first 1000 days of life protected against chronic disease. Science 2024 Nov 29;386(6725):1043-1048. PMID: 39480913 DOI: 10.1126/science.adn5421 Epub 2024 Oct 31