Elderly tends to be more susceptible to infections and chronic diseases. Malnutrition, immunosenescence, and changes in the gut microbiota affect susceptibility to the elderly. Several studies have shown that there is a change in the composition and variability of gut microbiota as we grow older. These changes are considered to increasing the risk of infection and play a role in the pathogenesis of various diseases in elderly. Supplementation of probiotics is expected to overcome the microbiota changes in the elderly and therefore improve the health of the elderly. In this review we will discuss about normal gut microbiota, changes in gut microbiota in the elderly, and effects of probiotics, prebiotics and synbiotics supplementation in the elderly. We will also review recent studies on the health benefits of probiotics for the elderly immune system as a new strategy for healthy aging. Recent data suggests that supplementation of probiotics can increase the immunity of the elderly. Further research is needed so that probiotic supplementation can be applied in clinical setting as a supporting therapy to improve the health of the elderly.
Aim of the study Patients with minimal hepatic encephalopathy (MHE) have no recognizable clinical symptoms of hepatic encephalopathy (HE), but the mild cognitive and psychomotor deficits have been shown to negatively affect their daily functioning and quality of life. Treatment with probiotics has shown benefit in some clinical trials. This review aimed to systematically analyze the efficacy of probiotics in the treatment of MHE. Material and methods A systematic search of the electronic databases PubMed, Science Direct, and Cochrane Library was conducted for randomized controlled trials (RCTs) in adult patients with MHE who had been given probiotics intervention. The primary outcomes were reversal of MHE and improvement of neuropsychometric tests, while the secondary outcome was the reduction of serum ammonia. Results Nine RCTs involving 776 MHE patients were included, consisting of 311 patients receiving probiotics and 465 patients receiving comparator (placebo or no treatment, lactulose, L-ornithine L-aspartate [LOLA], or rifaximin). The meta-analysis showed that probiotics significantly reversed MHE (OR = 3.95, p < 0.0001, 95% CI: 2.05 to 7.60) compared with placebo or no treatment. Probiotics also significantly reduced serum ammonia compared with placebo (pooled mean difference –25.94, p = 0.04, 95% CI: –50.21 to –1.66). However when compared to lactulose and LOLA, probiotics did not show a significant difference in reversal of MHE or reduction of serum ammonia levels. Conclusions Probiotics were more effective in reversal of MHE and reduced serum ammonia levels in patients with MHE compared to placebo or no treatment, but not more effective than lactulose or LOLA.
Cardiovascular disease (CVD) is the leading cause of death in chronic kidney disease (CKD) patients. Elevated homocysteine levels in CKD patients were thought to be one of the causes. Folic acid supplementation, which was known to improve anemia in CKD patients, can also reduce homocysteine levels, which would reduce cardiovascular events. In this review we will discuss the pathophysiology of hyperhomocysteinemia in CKD patients and studies that explain the role of folic acid to lower homocysteine levels that can also lower the risk of CVD in CKD patients. There are some conflicting results among available studies, but folic acid still seems reasonable to be considered as a suitable supplementary therapy in individuals with CKD after a thorough evaluation of the patient's folate status.
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