title: Cow's milk and rice fermented with Lactobacillus paracasei CBA L74 prevent infectious diseases in children: A randomized controlled trial.
abstract: Fermented foods have been proposed for the prevention of infectious diseases. We evaluated the efficacy of fermented foods in reducing common infectious diseases (CIDs) in children attending daycare.
  
  
  
  Prospective randomized, double-blind, placebo-controlled trial (registered under Clinical Trials.gov identifier NCT01909128) on healthy children (aged 12-48 months) consuming daily cow's milk (group A) or rice (group B) fermented with Lactobacillus paracasei CBA L74, or placebo (group C) for three months during the winter season. The main study outcome was the proportion of children who experienced at least one CID. All CIDs were diagnosed by family pediatricians. Fecal concentrations of innate (α- and β-defensins and cathelicidin LL-37) and acquired immunity biomarkers (secretory IgA) were also evaluated.
  
  
  
  377 children (193 males, 51%) with a mean (SD) age of 32 (10) months completed the study: 137 in group A, 118 in group B and 122 in group C. Intention-to-treat analysis showed that the proportion of children who experienced at least one CID was lower in group A (51.8%) and B (65.9%) compared to group C (80.3%). Per-protocol analysis showed that the proportion of children presenting upper respiratory tract infections was lower in group A (48.2%) and group B (58.5%) compared with group C (70.5%). The proportion of children presenting acute gastroenteritis was also lower in group A (13.1%) and group B (19.5%) compared with group C (31.1%). A net increase of all fecal biomarkers of innate and acquired immunity was observed for groups A and B compared to group C. Moreover, there was a negative association between fecal biomarkers and the occurrence of CID.
  
  
  
  Dietary supplementation with cow's milk or rice fermented with L. paracasei CBA L74 prevents CIDs in children attending daycare possibly by means of a stimulation of innate and acquired immunity.
authors.affiliation: Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Nocerino
authors.affiliation: Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Lorella
authors.initials: L
authors.lastname: Paparo
authors.affiliation: Department of Gynecology-Obstetrics and Perinatal Medicine, University of Rome "La Sapienza", Rome, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Terrin
authors.affiliation: Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Vincenza
authors.initials: V
authors.lastname: Pezzella
authors.affiliation: Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Amoroso
authors.affiliation: Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Linda
authors.initials: L
authors.lastname: Cosenza
authors.affiliation: Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Cecere
authors.affiliation: Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: De Marco
authors.affiliation: Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Micillo
authors.affiliation: Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Albano
authors.affiliation: Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Nugnes
authors.affiliation: Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Pasqualina
authors.initials: P
authors.lastname: Ferri
authors.affiliation: Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ciccarelli
authors.affiliation: Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Giaccio
authors.affiliation: Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Spadaro
authors.affiliation: Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Ylenia
authors.initials: Y
authors.lastname: Maddalena
authors.affiliation: ENT Unit, Ospedale Spirito Santo di Pescara, Pescara, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Berni Canani
authors.affiliation: Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy; European Laboratory for the Investigation of Food Induced Diseases (ELFID), University of Naples "Federico II", Naples, Italy; CEINGE - Advanced Biotechnologies, University of Naples "Federico II", Naples, Italy. Electronic address: berni@unina.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Berni Canani
mesh_terms: D000208:Acute Disease; D000818:Animals; D023181:Antimicrobial Cationic Peptides / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D002417:Cattle; D002675:Child, Preschool; D003141:Communicable Diseases / Q000453:epidemiology*; D004032:Diet; D004311:Double-Blind Method; D005243:Feces / Q000737:chemistry / Q000382:microbiology; D005260:Female; D005285:Fermentation; D005759:Gastroenteritis / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007223:Infant; D000069980:Lacticaseibacillus paracasei / Q000378:metabolism*; D008297:Male; D008892:Milk / Q000382:microbiology*; D012275:Oryza / Q000382:microbiology*; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000517:prevention & control; D023084:alpha-Defensins / Q000378:metabolism; D023083:beta-Defensins / Q000378:metabolism; D054804:Cathelicidins
chemical_list: D023181:Antimicrobial Cationic Peptides; D015415:Biomarkers; D023084:alpha-Defensins; D023083:beta-Defensins; D054804:Cathelicidins
keywords: Acquired immunity; Acute gastroenteritis; Innate immunity; Probiotics; Upper respiratory tract infections