Efficacy of prebiotic, probiotic and synbiotic administration in improving growth in children aged 0-59 months living in low- and middle-income countries: a systematic review and meta-analysis

Efficacy of prebiotic, probiotic and synbiotic administration in improving growth in children aged 0-59 months living in low- and middle-income countries: a systematic review and meta-analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Efficacy of prebiotic, probiotic and synbiotic administration in improving growth in children aged 0-59 months living in low- and middle-income countries: a systematic review and meta-analysis Marietou Khouma, Mamadou Diallo, Doudou Sow, Aicha Djigal, Ndeye Sokhna Diop, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4355418/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Feb, 2025 Read the published version in BMC Pediatrics → Version 1 posted 13 You are reading this latest preprint version Abstract Background Poor growth is one of the major obstacles to human development, affecting millions of children under the age of 5 years, particularly those living in low- and middle-income countries. The objective of this review was to evaluate the efficacy of administering pre-, pro- or synbiotics on the growth of children aged 0–59 months living in LMICs. Methods Google scholar, Pubmed, clinical trial.org and Science Direct databases were searched in April 2023 for randomised controlled trials of pre-, pro- or synbiotics that evaluated growth in under fives in LMICs. The primary outcome were weight and height gain. Secondary outcomes were head circumference, body mass index gain and Z score. Random-effects meta-analysis was used to calculate mean differences for continuous outcomes. Grading of Recommendations Assessment, Development and Evaluation criteria was used to assess certainty of the evidence. Results Eight trials involving 1375 children under 5 years of age were identified. Meta-analysis of 6 RCTs (n = 991 children) revealed a significant difference in favor of the experimental group (n = 579) compared the control group (n = 412) for weight gain: (MD = 0.33 kg, 95% CI 0.11 to 0.55); low-certainty evidence. Sub-group analysis revealed that, pre-, pro, or synbiotics may be more effective in malnourished that healthy children (p = 0.003). Meta-analysis of height gain for 4 RCTs (n = 845) found that there was no significant difference between the experimental group (n = 496) and the control group (n = 349) (MD = 0.31 cm; 95% CI -0.36 to 0.98); low-certainty evidence. In sub-group analysis, prebiotics had a greater impact on height gain than synbiotics (p = 0.03). In the only study reporting an increase in head circumference (n = 32 children), this was not improved by the administration of synbiotics. However, administration of synbiotics to undernourished children significantly improved BMI gain. Conclusion The evidence for the administration of pre-, pro- or synbiotics on the growth of children in LMICs is weak. Administration of pre-, pro- or synbiotics may improve weight gain and synbiotics may improve BMI, particularly in malnourished children. Further research is needed due to the small number of studies, short duration of administration and small sample size. Prebiotics Probiotics Synbiotics Children Growth LMIC Full Text Additional Declarations No competing interests reported. Supplementary Files SYSTEMATICREVIEWSupplementaryfiguresandtables.docx Cite Share Download PDF Status: Published Journal Publication published 27 Feb, 2025 Read the published version in BMC Pediatrics → Version 1 posted Editorial decision: Revision requested 01 Oct, 2024 Reviews received at journal 12 Sep, 2024 Reviewers agreed at journal 11 Sep, 2024 Reviewers agreed at journal 11 Sep, 2024 Reviews received at journal 19 Jul, 2024 Reviewers agreed at journal 15 Jul, 2024 Reviewers agreed at journal 14 Jul, 2024 Reviewers agreed at journal 12 Jul, 2024 Reviewers invited by journal 04 Jul, 2024 Editor assigned by journal 01 Jun, 2024 Editor invited by journal 15 May, 2024 Submission checks completed at journal 15 May, 2024 First submitted to journal 01 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4355418","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":304040896,"identity":"30e53f4a-af15-44f8-99ad-1ebd731e71bf","order_by":0,"name":"Marietou 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Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Prebiotics, Probiotics, Synbiotics, Children, Growth, LMIC","lastPublishedDoi":"10.21203/rs.3.rs-4355418/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4355418/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePoor growth is one of the major obstacles to human development, affecting millions of children under the age of 5 years, particularly those living in low- and middle-income countries. The objective of this review was to evaluate the efficacy of administering pre-, pro- or synbiotics on the growth of children aged 0\u0026ndash;59 months living in LMICs.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eGoogle scholar, Pubmed, clinical trial.org and Science Direct databases were searched in April 2023 for randomised controlled trials of pre-, pro- or synbiotics that evaluated growth in under fives in LMICs. The primary outcome were weight and height gain. Secondary outcomes were head circumference, body mass index gain and Z score. Random-effects meta-analysis was used to calculate mean differences for continuous outcomes. Grading of Recommendations Assessment, Development and Evaluation criteria was used to assess certainty of the evidence.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eEight trials involving 1375 children under 5 years of age were identified. Meta-analysis of 6 RCTs (n\u0026thinsp;=\u0026thinsp;991 children) revealed a significant difference in favor of the experimental group (n\u0026thinsp;=\u0026thinsp;579) compared the control group (n\u0026thinsp;=\u0026thinsp;412) for weight gain: (MD\u0026thinsp;=\u0026thinsp;0.33 kg, 95% CI 0.11 to 0.55); low-certainty evidence. Sub-group analysis revealed that, pre-, pro, or synbiotics may be more effective in malnourished that healthy children (p\u0026thinsp;=\u0026thinsp;0.003). Meta-analysis of height gain for 4 RCTs (n\u0026thinsp;=\u0026thinsp;845) found that there was no significant difference between the experimental group (n\u0026thinsp;=\u0026thinsp;496) and the control group (n\u0026thinsp;=\u0026thinsp;349) (MD\u0026thinsp;=\u0026thinsp;0.31 cm; 95% CI -0.36 to 0.98); low-certainty evidence. In sub-group analysis, prebiotics had a greater impact on height gain than synbiotics (p\u0026thinsp;=\u0026thinsp;0.03). In the only study reporting an increase in head circumference (n\u0026thinsp;=\u0026thinsp;32 children), this was not improved by the administration of synbiotics. However, administration of synbiotics to undernourished children significantly improved BMI gain.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe evidence for the administration of pre-, pro- or synbiotics on the growth of children in LMICs is weak. Administration of pre-, pro- or synbiotics may improve weight gain and synbiotics may improve BMI, particularly in malnourished children. Further research is needed due to the small number of studies, short duration of administration and small sample size.\u003c/p\u003e","manuscriptTitle":"Efficacy of prebiotic, probiotic and synbiotic administration in improving growth in children aged 0-59 months living in low- and middle-income countries: a systematic review and meta-analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-24 19:16:22","doi":"10.21203/rs.3.rs-4355418/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-01T05:10:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-12T06:54:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"100285288104135037536986953004787387466","date":"2024-09-12T00:36:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"19415381139753605763337125112124092804","date":"2024-09-11T17:32:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-19T11:50:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"67544872127513546709275971685013765160","date":"2024-07-16T00:13:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"177404576436835107847108493153107654236","date":"2024-07-15T01:52:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"63223625832259597998556322721756660723","date":"2024-07-12T21:19:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-05T01:13:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-01T10:50:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-05-15T17:00:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-15T16:47:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2024-05-01T17:25:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cc2d9e70-f35a-4e1a-b69a-87c11eff3d73","owner":[],"postedDate":"May 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-03T16:06:19+00:00","versionOfRecord":{"articleIdentity":"rs-4355418","link":"https://doi.org/10.1186/s12887-025-05503-0","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2025-02-27 15:58:10","publishedOnDateReadable":"February 27th, 2025"},"versionCreatedAt":"2024-05-24 19:16:22","video":"","vorDoi":"10.1186/s12887-025-05503-0","vorDoiUrl":"https://doi.org/10.1186/s12887-025-05503-0","workflowStages":[]},"version":"v1","identity":"rs-4355418","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4355418","identity":"rs-4355418","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}