The goal of this clinical trial is to compare healthy children between 1 to 3 years old. The main question it aims to answer is 1. Is there an effect towards fecal quality after consuming milk formula supplemented with the triple Bifidobacteria strains (Bifidobacterium longum BB536, Bifidobacterium breve M-16V, and Bifidobacterium longum subsp. infantis M-63)? 2. Is there an effect towards short-chain fatty acid composition after consuming milk formula supplemented with the triple Bifidobacteria strains (Bifidobacterium longum BB536, Bifidobacterium breve M-16V, and Bifidobacterium longum subsp. infantis M-63)? 3. Is there an effect towards clinical profile after consuming milk formula supplemented with the triple Bifidobacteria strains (Bifidobacterium longum BB536, Bifidobacterium breve M-16V, and Bifidobacterium longum subsp. infantis M-63)? The clinical trial period started off with all the participants consuming a milk formula three times a day, for 14 days as a baseline period. Afterwards, the participants were randomly assigned to one of two groups: probiotic and placebo. Following the baseline period, participants in the probiotic group consumed formulated milk supplemented with the triple Bifidobacteria strains, while the placebo group ingested the same formulated milk without adding triple Bifidobacteria strains for 90 days. Researchers will compare the probiotic and placebo groups to see if there are any effects towards the fecal quality, short-chain fatty acid level and clinical profile after consuming the milk formula.
This clinical trial is a study of 3 strains of Bifidobacterium was conducted in infants aged 1-3 years in Indonesia. The general objective of this study was to determine the benefits of combined supplementation of Bifidobacteria strains (B. longum BB536, B. breve M-16V, and B. longum subsp. infantis M-63) in healthy children aged 1-3 years. The study is conducted for 104 days with a baseline period of 14 days and continued with an intervention period of 90 days. Participants is divided into two groups, which are the intervention group and the placebo group. The study will be conducted using a double-blind randomized, placebo-controlled trial design. A total of 100 participants will be selected based on inclusion and exclusion criteria. During the screening period (day 0), socialization of the research and signing of informed consent will be carried out for participants who are willing to participate. Participants were asked not to consume fermented milk products, probiotics and prebiotic fortified food/drinks while participating in research activities. During the baseline period (Day 14), the participants were asked to consume control milk and, represented by their parents, were also asked to fill out research diaries in the form of diet records, records of probiotic products and prebiotic fortified food/drinks consumed, type and frequency of bowel movements, health complaints felt (discomfort, headaches, stomachaches, respiratory tract-related illnesses and fever), medication consumption records, days where the participants refused to eat. Participants were asked to collect research documents and collect stool samples on day 14 +/- 1. During the intervention period, from day 15 to day 104, participants consumed 36 grams of the test product or placebo dissolved in 180 ml per serving with a consumption frequency of 3 times per day. Product consumption will be recorded in the product consumption logbook and on the subject's diary record form. Once every 2 weeks a health profile measurement (weight, height, arm circumference, head circumference, skinfold thickness) and sleep quality will be measured. Participants were asked to collect research documents and stool samples on day 104 +/- 1 with the same procedure as in the baseline period.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
TRIPLE
Enrollment
103
Formula milk with triple Bifidobacterium strain containing Bifidobacterium longum BB536 (6.9 x 10\^7 CFU/serving), Bifidobacterium breve M16-V (6.9 x 10\^7 CFU/serving), Bifidobacterium longum subsp. infantis M-63 (6.9 x 10\^7 CFU/serving).
Formula milk without any addition of probiotic strain
PAUD Hiber Rotowijayan
Yogyakarta, Special Region of Yogyakarta, Indonesia
Paud Kunir Ceria Tegalgendu Kotagede
Yogyakarta, Special Region of Yogyakarta, Indonesia
Puskesmas Mlati 2
Yogyakarta, Indonesia
Paud Bodeh
Yogyakarta, Indonesia
Paud Gamping Lor
Yogyakarta, Indonesia
Paud Matahari Mejing 3
Yogyakarta, Indonesia
Paud Pereng Dawe
Yogyakarta, Indonesia
Paud Pereng Kembang
Yogyakarta, Indonesia
Paud Sembung
Yogyakarta, Indonesia
Paud Sumber
Yogyakarta, Indonesia
Fecal characteristics
Observed the shape, color and consistency of fecal samples that will be combined to be reported as fecal type according to the Bristol Stool Chart
Time frame: Before and after intervention period (day 13 and day 105)
Fecal pH
The pH of obtained fecal samples were measured using potential of hydrogen (pH) meter
Time frame: Before and after intervention period (day 13 and day 105)
Bacterial colony characteristics
From the fecal samples obtained, direct plating using the selective media for Bifidobacterium (Bifidobacterium Selective Medium or BSM) and Enterobacteriaceae (MacConkey Agar) is conducted. Colony bacterial characterization is based on the cell morphology and Gram strain characteristics under the microscope.
Time frame: Before and after intervention period (day 13 and day 105)
Bifidobacterium's cell count
The cell number is a total of Bifidobacteria cells obtained from DNA extraction of stool samples counted using quantitative PCR (qPCR). Cell count will be expressed in colony forming unit per gram (CFU/g).
Time frame: Before and after intervention period (day 13 and day 105)
Enterobactericaeae's cell count
The cell number is a total of Enterobacteriaceae's cells obtained from DNA extraction of stool samples counted using quantitative PCR (qPCR). Cell count will be expressed in colony forming unit per gram (CFU/g)
Time frame: Before and after intervention period (day 13 and day 105)
Short chain fatty acids analysis
The analysis includes the measurement of acetate, propionate, and butyrate. The analysis uses gas chromatography method.
Time frame: Before and after intervention period (day 13 and day 105)
Biomarker of immune systems
The analysis on immune systems' biomarker uses the fecal water obtained from diluting the fecal samples into phosphate buffer. The fecal water is then added with protease inhibitor to keep fecal samples stable during the analysis. The immune system analyzed are interleukin 6 (IL6), interleukin 8 (IL8), interleukin 10 (IL10) and secretory immunoglobulin A (SIgA). All immune systems are read using the enzyme-linked Immunosorbent Assay (ELISA) Reader BioRad iMark.
Time frame: Before and after intervention period (day 13 and day 105)
Defecation frequency records
Participants, represented by their parents or guardian, record their defecation frequency in a daily record.
Time frame: Everyday during the research period (104 days)
Dietary pattern records
Participants, represented by their parents or guardian, record their dietary patterns in a daily record. The dietary pattern recorded includes type and portion of the foods, snacks and beverages.
Time frame: Four days every two weeks, consists of two weekdays and two weekend days during the research period
Health complaint and medical records
Participants, represented by their parents or guardian, record their health complaint and medical records in a daily record.
Time frame: Everyday during the research period (104 days)
Health profile record
Participants, represented by their parents or guardian, filled a questionnaire about recent respiratory health conditions.
Time frame: Before and after intervention period (day 13 and day 105)
Gastrointestinal disorder record
Participants, represented by their parents or guardian, filled a questionnaire about recent gastrointestinal health conditions.
Time frame: Before and after intervention period (day 13 and day 105)
Sleep quality
Participants, represented by their parents or guardian, filled a questionnaire about recent history of the participant's sleep quality.
Time frame: Before and after intervention period (day 13 and day 105)
Behaviour assesment
Participants, represented by their parents or guardian, filled a questionnaire about how the participants behave especially how they express their emotions.
Time frame: Before and after intervention period (day 13 and day 105)
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Development screening
Participants, represented by their parents or guardian, filled a questionnaire about recent gastrointestinal health conditions. The Ages and Questionnaires (ASQ-3) were used based on the participant's current age.
Time frame: Before and after intervention period (day 13 and day 105)
Psychosocial problems
Participants, represented by their parents or guardian, filled a questionnaire about possible psychosocial problems. The Pediatric Symptom Checklist (PSC) was used for this measure.
Time frame: Before and after intervention period (day 13 and day 105)
Weight
The participants were measured for their weight in kilograms.
Time frame: Once every two weeks for 105 days
Height
The participants were measured for their height in cm.
Time frame: Once every two weeks for 105 days
Body Mass Index (BMI)
The measurement of weight and height were combined into BMI and expressed in kg/m\^2
Time frame: Once every two weeks for 105 days
Arm circumference
The participants were measured for their arm circumference in cm.
Time frame: Once every two weeks for 105 days
Head circumference
The participants were measured for their head circumference in cm.
Time frame: Once every two weeks for 105 days
Subcutaneous fat thickness
The participants were measured for their subcutaneous fat thickness in mm.
Time frame: Once every two weeks for 105 days
Triceps thickness
The participants were measured for their triceps thickness in mm.
Time frame: Once every two weeks for 105 days
Medical check up
An on-site medical professional will check the health condition of the participant.
Time frame: Once every two weeks for 105 days