title: Randomized trial of probiotics and calcium on diarrhea and respiratory tract infections in Indonesian children.
abstract: OBJECTIVE
  To investigate the effects of calcium and probiotics on the incidence and duration of acute diarrhea and acute respiratory tract infections (ARTIs) in low-socioeconomic communities of Jakarta, Indonesia.
  
  
  METHODS
  We conducted a 6-month, double-blind, placebo-controlled study in 494 healthy children aged 1 to 6 years who received low-lactose milk with low calcium content (LC; ∼50 mg/day; n = 124), regular calcium content (RC; ∼440 mg/day; n = 126), RC with 5.10(8) colony-forming units per day of Lactobacillus casei CRL431 (casei; n = 120), or RC with 5.10(8) colony-forming units per day of Lactobacillus reuteri DSM17938 (reuteri; n = 124). Number and duration of diarrhea and ARTIs episodes were primary and secondary outcomes, respectively.
  
  
  RESULTS
  Incidence of World Health Organization-defined diarrhea (≥3 loose/liquid stools in 24 hours) was not significantly different between RC and LC (relative risk [RR]: 0.99 [95% confidence interval (CI): 0.62-1.58]), between casei and RC (RR: 1.21 [95% CI: 0.76-1.92]), or between reuteri and RC (RR: 0.76 [95% CI: 0.46-1.25]) groups. Incidence of all reported diarrhea (≥2 loose/liquid stools in 24 hours) was significantly lower in the reuteri versus RC group (RR: 0.68 [95% CI: 0.46-0.99]). Irrespective of the definition used, reuteri significantly reduced diarrhea incidence in children with lower nutritional status (below-median height-and-weight-for-age z score). None of the interventions affected ARTIs.
  
  
  CONCLUSIONS
  RC milk, alone or with L casei, did not reduce diarrhea or ARTIs in Indonesian children. L reuteri may prevent diarrhea, especially in children with lower nutritional status.
authors.affiliation: SEAMEO RECFON (Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition), University of Indonesia, Jakarta, Indonesia.
authors.forename: Rina
authors.initials: R
authors.lastname: Agustina
authors.forename: Frans J
authors.initials: FJ
authors.lastname: Kok
authors.forename: Ondine
authors.initials: O
authors.lastname: van de Rest
authors.forename: Umi
authors.initials: U
authors.lastname: Fahmida
authors.forename: Agus
authors.initials: A
authors.lastname: Firmansyah
authors.forename: Widjaja
authors.initials: W
authors.lastname: Lukito
authors.forename: Edith J M
authors.initials: EJ
authors.lastname: Feskens
authors.forename: Ellen G H M
authors.initials: EG
authors.lastname: van den Heuvel
authors.forename: Ruud
authors.initials: R
authors.lastname: Albers
authors.forename: Ingeborg M J
authors.initials: IM
authors.lastname: Bovee-Oudenhoven
mesh_terms: D000818:Animals; D002136:Calcium, Dietary / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003114:Colony-Forming Units Assay; D003430:Cross-Sectional Studies; D003906:Developing Countries; D003967:Diarrhea / Q000453:epidemiology / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015994:Incidence; D007214:Indonesia; D007223:Infant; D007780:Lacticaseibacillus casei; D052200:Limosilactobacillus reuteri; D008297:Male; D008892:Milk / Q000382:microbiology; D019936:Probiotics / Q000008:administration & dosage*; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D002136:Calcium, Dietary