BackgroundAntibiotics alter the microbial balance commonly resulting in antibiotic-associated diarrhea (AAD). Probiotics may prevent AAD via providing gut barrier, restoration of the gut microflora, and other potential mechanisms of action. ObjectivesThe primary objectives were to assess the e icacy and safety of probiotics (any specified strain or dose) used for the prevention of AAD in children. Search methodsMEDLINE, Embase, CENTRAL, CINAHL, and the Web of Science (inception to 28 May 2018) were searched along with registers including the ISRCTN and Clinicaltrials.gov. We also searched the NICE Evidence Services database as well as reference lists from relevant articles. Selection criteriaRandomized, parallel, controlled trials in children (0 to 18 years) receiving antibiotics, that compare probiotics to placebo, active alternative prophylaxis, or no treatment and measure the incidence of diarrhea secondary to antibiotic use were considered for inclusion. Data collection and analysisStudy selection, data extraction, and risk of bias assessment were conducted independently by two authors. Dichotomous data (incidence of AAD, adverse events) were combined using a pooled risk ratio (RR) or risk di erence (RD), and continuous data (mean duration of diarrhea) as mean di erence (MD), along with corresponding 95% confidence interval (95% CI). We calculated the number needed to treat for an additional beneficial outcome (NNTB) where appropriate. For studies reporting on microbiome characteristics using heterogeneous outcomes, we describe the results narratively. The certainty of the evidence was evaluated using GRADE. Main resultsThirty-three studies (6352 participants) were included. Probiotics assessed included Bacillus spp., Bifidobacterium spp., Clostridium butyricum, Lactobacilli spp., Lactococcus spp., Leuconostoc cremoris, Saccharomyces spp., orStreptococcus spp., alone or in combination. The risk of bias was determined to be high in 20 studies and low in 13 studies. Complete case (patients who did not complete the studies were not included in the analysis) results from 33 trials reporting on the incidence of diarrhea show a precise benefit from probiotics compared to active, placebo or no treatment control.Probiotics for the prevention of pediatric antibiotic-associated diarrhea (Review)

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ObjectiveTo determine the relative efficacy of structured named diet and health behaviour programmes (dietary programmes) for prevention of mortality and major cardiovascular events in patients at increased risk of cardiovascular disease.DesignSystematic review and network meta-analysis of randomised controlled trials.Data sourcesAMED (Allied and Complementary Medicine Database), CENTRAL (Cochrane Central Register of Controlled Trials), Embase, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and ClinicalTrials.gov were searched up to September 2021.Study selectionRandomised trials of patients at increased risk of cardiovascular disease that compared dietary programmes with minimal intervention (eg, healthy diet brochure) or alternative programmes with at least nine months of follow-up and reporting on mortality or major cardiovascular events (such as stroke or non-fatal myocardial infarction). In addition to dietary intervention, dietary programmes could also include exercise, behavioural support, and other secondary interventions such as drug treatment.Outcomes and measuresAll cause mortality, cardiovascular mortality, and individual cardiovascular events (stroke, non-fatal myocardial infarction, and unplanned cardiovascular interventions).Review methodsPairs of reviewers independently extracted data and assessed risk of bias. A random effects network meta-analysis was performed using a frequentist approach and grading of recommendations assessment, development and evaluation (GRADE) methods to determine the certainty of evidence for each outcome.Results40 eligible trials were identified with 35 548 participants across seven named dietary programmes (low fat, 18 studies; Mediterranean, 12; very low fat, 6; modified fat, 4; combined low fat and low sodium, 3; Ornish, 3; Pritikin, 1). At last reported follow-up, based on moderate certainty evidence, Mediterranean dietary programmes proved superior to minimal intervention for the prevention of all cause mortality (odds ratio 0.72, 95% confidence interval 0.56 to 0.92; patients at intermediate risk: risk difference 17 fewer per 1000 followed over five years), cardiovascular mortality (0.55, 0.39 to 0.78; 13 fewer per 1000), stroke (0.65, 0.46 to 0.93; 7 fewer per 1000), and non-fatal myocardial infarction (0.48, 0.36 to 0.65; 17 fewer per 1000). Based on moderate certainty evidence, low fat programmes proved superior to minimal intervention for prevention of all cause mortality (0.84, 0.74 to 0.95; 9 fewer per 1000) and non-fatal myocardial infarction (0.77, 0.61 to 0.96; 7 fewer per 1000). The absolute effects for both dietary programmes were more pronounced for patients at high risk. There were no convincing differences between Mediterranean and low fat programmes for mortality or non-fatal myocardial infarction. The five remaining dietary programmes generally had little or no benefit compared with minimal intervention typically based on low to moderate certainty evidence.ConclusionsModerate certainty evidence shows that programmes promoting Mediterranean and low fat diets, with or without physical activity or other interventions, reduce all cause mortality and non-fatal myocardial infarction in patients with increased cardiovascular risk. Mediterranean programmes are also likely to reduce stroke risk. Generally, other named dietary programmes were not superior to minimal intervention.Systematic review registrationPROSPERO CRD42016047939

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BACKGROUND: Several lines of evidence show that abdominal fat is strongly associated with insulin resistance and dysglycemia (impaired glucose tolerance - IGT or type 2 diabetes mellitus - T2DM). However, which component of abdominal fat, subcutaneous or intra-abdominal, has a major impact on the development of insulin resistance and dysglycemia is still a matter of debate. The aim of this review is to summarize the best available evidence on the contribution of subcutaneous and/or intra-abdominal adipose tissues to the incidence of impaired glucose tolerance and/or type 2 diabetes mellitus, in adults as well as to determine which type of abdominal fat is a better predictor of these metabolic disorders. METHODS: A search of published articles on PUBMED (1966 to June 2013), EMBASE (1980 to June 2013), LILACS (1982 to June 2013) and Central Cochrane databases was conducted to identify studies evaluating the relationship between intra-abdominal and/or subcutaneous adipose tissue and the incident IGT or T2DM). Cohort studies examining the association between intra-abdominal and/or subcutaneous adipose tissue values and the prospective development of impaired glucose tolerance or type 2 diabetes mellitus (estimated risk) were included in this review. Data extraction and risk of bias assessments were performed in duplicate by 2 reviewers. Random-effects meta-analyses were performed to pool OR estimates from individual studies to assess the association between intra-abdominal and/or subcutaneous adipose tissue values at baseline and the risk of development of impaired glucose tolerance or type 2 diabetes mellitus. Statistical heterogeneity was assessed using the I2 statistics. The risk of bias was assessed by examining the sample selected, recruitment method, completeness of follow up and blinding according to the guidelines for assessing quality in prognostic studies proposed by Hayden (29) and the MOOSE (30) statement, and adapted by us. RESULTS: Five relevant studies were suitable for this review. The analysis showed that both VAT and abdominal SAT measurements at baseline were strong predictors of incident impaired glucose tolerance or type 2 diabetes mellitus, in minimally adjusted models. However, when other confounding variables besides age, sex and ethnicity were taken into account, VAT, but not SAT, measurements pose a high risk of the incident IGT or T2DM in a wide range of age and ethnic backgrounds (Japanese-, Hispanic-, African-Americans and Canadians). CONCLUSIONS: In conclusion, the present results provide some evidence that VAT imposes more risk to the development of IGT and T2DM than abdominal SAT. However, more studies are necessary to confirm these results and to address the issue of changes in VAT and abdominal SAT and their predictive value regarding IGT and type 2 diabetes developments.

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