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Evidence-Based Dermatology: Review | ONLINE FIRST

Effect of Nutrient Supplementation on Atopic Dermatitis in Children:  A Systematic Review of Probiotics, Prebiotics, Formula, and Fatty Acids

Negar Foolad, BA; Elizabeth A. Brezinski, BA; Elizabeth P. Chase, MD; April W. Armstrong, MD, MPH
JAMA Dermatol. 2013;149(3):350-355. doi:10.1001/jamadermatol.2013.1495.
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Objective To identify whether nutrient supplementation with probiotics, prebiotics, formula, or fatty acids prevents the development of atopic dermatitis (AD) or reduces the severity of AD in newborns to children younger than 3 years.

Data Sources We searched MEDLINE, Cochrane Central Register of Controlled Trials, and LILACS (Latin American and Caribbean Health Science Literature) from January 1, 1946, to August 27, 2012, and performed an additional manual search.

Study Selection Randomized controlled trials and cohort studies examining nutritional supplementation in prevention and amelioration of AD among children younger than 3 years.

Data Extraction Of 92 articles, 21 met inclusion criteria.

Data Synthesis In the 21 studies, a total of 6859 participants received supplements, which included infants or mothers who were either pregnant or breastfeeding; 4134 infants or mothers served as controls. Nutritional supplementation was shown to be an effective method in preventing AD (11 of 17 studies) or decreasing its severity (5 of 6 studies). The best evidence lies with probiotics supplementation in mothers and infants in preventing development and reducing severity of AD. Specifically, Lactobacillus rhamnosus GG was effective in long-term prevention of AD development. γ-Linolenic acid reduced severity of AD. Supplementation with prebiotics and black currant seed oil (γ-linolenic acid and ω-3 combination) was effective in reducing the development of AD. Conflicting findings were reported from different research groups that performed supplementation with an amino acid–based formula.

Conclusions Certain types of nutrient supplementation are beneficial in preventing AD development and reducing its severity. Future research elucidating the mechanisms underlying the actions of nutritional supplementation on AD is necessary.

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Figure 1. Flowchart of selected studies for systematic review.

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Figure 2. Metabolism of ω-3 and ω-6 fatty acids and the associated inflammatory responses. 5-LOX indicates 5-lipooxygenase pathway; AA, arachidonic acid; ALA, α-linolenic acid; COX, cyclo-oxygenase pathway; DGLA, dihomo-γ-linolenic acid; EPA, eicosapentaenoic acid; ETA eicosapentaenoic acid; GLA, γ-linolenic acid; LA, linoleic acid; LTB, leukotriene B; LTC, leukotriene C; LTD, leukotriene D; PGE, prostaglandin E; SDA, stearidonic acid; TXA, thromboxane. The ± sign indicates the range of proinflammatory to anti-inflammatory response. Modified from Linnamaa et al,25 with permission.

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