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Study on Safety and Efficacy of Inulin and Oligofructose in Neonates

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Study on Safety and Efficacy of Inulin and Oligofructose in Neonates STUDY ON SAFETY AND EFFICACY OF INULIN AND OLIGOFRUCTOSE IN NEONATES. Mariona Gispert Llauradó Dipòsit Legal: T 50-2015 ADVERTIMENT. L'accés als continguts d'aquesta tesi doctoral i la seva utilització ha de respectar els drets de la persona autora. Pot ser utilitzada per a consulta o estudi personal, així com en activitats o materials d'investigació i docència en els termes establerts a l'art. 32 del Text Refós de la Llei de Propietat Intel·lectual (RDL 1/1996). Per altres utilitzacions es requereix l'autorització prèvia i expressa de la persona autora. En qualsevol cas, en la utilització dels seus continguts caldrà indicar de forma clara el nom i cognoms de la persona autora i el títol de la tesi doctoral. No s'autoritza la seva reproducció o altres formes d'explotació efectuades amb finalitats de lucre ni la seva comunicació pública des d'un lloc aliè al servei TDX. Tampoc s'autoritza la presentació del seu contingut en una finestra o marc aliè a TDX (framing). Aquesta reserva de drets afecta tant als continguts de la tesi com als seus resums i índexs. ADVERTENCIA. El acceso a los contenidos de esta tesis doctoral y su utilización debe respetar los derechos de la persona autora. Puede ser utilizada para consulta o estudio person al, así como en actividades o materiales de investigación y docencia en los términos establecidos en el art. 32 del Texto Refundido de la Ley de Propiedad Intelectual (RDL 1/1996). Para otros usos se requiere la autorización previa y expresa de la persona autora. En cualquier caso, en la utilización de sus contenidos se deberá indicar de forma clara el nombre y apellidos de la persona autora y el título de la tesis doctoral. No se autoriza su reproducción u otras formas de explotación efectuadas con fines lucrativos ni su comunicación pública desde un sitio ajeno al servicio TDR. Tampoco se autoriza la presentación de su contenido en una ventana o marco ajeno a TDR (framing). Esta reserva de derechos afecta tanto al contenido de la tesis como a sus resúmenes e índices. WARNING. Access to the contents of this doctoral thesis and its use must respect the rights of the author. It can be used for reference or private study, as well as research and learning activities or materials in the terms established by the 32nd article of the Spanish Consolidated Copyright Act (RDL 1/1996). Express and previous authorization of the author is required for any other uses. In any case, when using its content, full name of the author and title of the thesis must be clearly indicated. Reproduction or other forms of for profit use or public communication from outside TDX service is not allowed. Presentation of its content in a window or frame external to TDX (framing) is not authorized either. These rights affect both the content of the thesis and its abstracts and indexes. UNIVERSITAT ROVIRA I VIRGILI STUDY ON SAFETY AND EFFICACY OF INULIN AND OLIGOFRUCTOSE IN NEONATES. Mariona Gispert Llauradó Dipòsit Legal: T 50-2015 MARIONA GISPERT LLAURADÓ Study on safety and efficacy of inulin and oligofructose in neonates MARIONA GISPERT LLAURADÓ Unitat de Recerca en Pediatria, Nutrició i Desenvolupament Humà Universitat Rovira I Virgili EUROPEAN THESIS European Thesis Thesis LLauradó European Gispert Mariona Universitat Rovira i Virgili UNIVERSITAT ROVIRA I VIRGILI STUDY ON SAFETY AND EFFICACY OF INULIN AND OLIGOFRUCTOSE IN NEONATES. Mariona Gispert Llauradó Dipòsit Legal: T 50-2015 Mariona Gispert Llauradó STUDY ON SAFETY AND EFFICACY UNIVERSITAT ROVIRA I VIRGILI STUDY ON SAFETY AND EFFICACY OF INULIN AND OLIGOFRUCTOSE IN NEONATES. Mariona Gispert Llauradó OF INULIN AND OLIGOFRUCTOSE IN NEONATES Dipòsit Legal: T 50-2015 EUROPEAN THESIS Directed by Dra. Verònica Luque Moreno Co‐directed by Dra. Natàlia Ferré Pallàs Departament de Medicina i Cirurgia Unitat de Recerca en Pediatria, Nutrició i Desenvolupament Humà Reus 2014 UNIVERSITAT ROVIRA I VIRGILI STUDY ON SAFETY AND EFFICACY OF INULIN AND OLIGOFRUCTOSE IN NEONATES. Mariona Gispert Llauradó Dipòsit Legal: T 50-2015 UNIVERSITAT ROVIRA I VIRGILI STUDY ON SAFETY AND EFFICACY OF INULIN AND OLIGOFRUCTOSE IN NEONATES. Mariona Gispert Llauradó Dipòsit Legal: T 50-2015 UNIVERSITAT ROVIRA I VIRGILI STUDY ON SAFETY AND EFFICACY OF INULIN AND OLIGOFRUCTOSE IN NEONATES. Mariona Gispert Llauradó Dipòsit Legal: T 50-2015 AGRAIMENTS Amb aquestes línies m’agradaria donar les gràcies a totes aquelles persones que amb la seva ajuda han col∙laborat en la realització d’aquest treball. UNIVERSITAT ROVIRA I VIRGILI STUDY ON SAFETY AND EFFICACY OF INULIN AND OLIGOFRUCTOSE IN NEONATES. Mariona Gispert Llauradó Dipòsit Legal: T 50-2015 En primer lloc, a les persones de la meva unitat, el motor del meu dia a dia en el treball i amb els que he compartit mése qu feina: A les meves directores de tesi i amigues, Natàlia i Verònica. A tú Natàlia, gràcies per estar sempre apunt per escoltar‐me i donar‐me un cop de mà amb tot. I gràcies també, per la teva admirable manera de ser, senzilla, transparent i sempre amb un somriure. I a tú Vero, gràcies per tot el que m’has ensenyat i he pogut aprendre de tu, pel teu suport incondicional i per creure sempre en mi. Aquesta tesi és tant meva com teva! Saps que ets un referent per a mi, t'admiro com a professional, però encara més com a persona. I com no, a les meves dos nenes, Carmeta i Marta. A tú Carmeta gràcies pel genial dueto Bambinol, la teva paciència i dedicació plena a l’estudi, saps que sense tu aquesta tesi no hagués estat possible i t’ho agrairé sempre. I a tu Marta mil gràcies pels teus savis consells i per ser‐hi sempre, en tot moment. Us trobo a faltar! I per últim, m’agradaria donar les gràcies al Ricardo i al Joaquín. Gràcies per tot el suport i la confiança que heu dipositat en mi al llarg d’aquests ‐ 7 ‐ anys. I gràcies també, per l’equip tant maco que entre els dos heu sabut crear, és un plaer poder treballar així! També voldria agrair aquesta tesi a tots els participants de l’estudi Bambinol, als bebès i als seus pares que amb molta amabilitat i paciència UNIVERSITAT ROVIRA I VIRGILIvan accedir a participar en l’estudi. STUDY ON SAFETY AND EFFICACY OF INULIN AND OLIGOFRUCTOSE IN NEONATES. Mariona Gispert Llauradó Dipòsit Legal: T 50-2015 Gràcies a tots els companys de l’Hospital de Sant Joan de Reus i l’hospital Joan XXIII de Tarragona que ens han ajudat d’una manera o altre. Sobretot a les infermeres, auxiliars, pediatres i als treballadors del Biobanc dels dos centres. I per últim m’agradaria dedicar aquesta tesi a la meva , família la meva gran família. Gràcies mama, papa i parelles. Gràcies als meus avis, als meus germans, i a totes aquelles persones, que en un moment o altre, hi sigueu o no presents ara i aquí, m’heu donat suport en aquest llarg camí. Us estimo! I com no, moltes gràcies a tú, al meu pilar, per tot el que dia a dia compartim plegats. ‐ 8 ‐ INDEX Page LIST OF TABLES 13 LIST OF FIGURES 17 LIST OF ABBREVIATIONS 19 UNIVERSITAT ROVIRA I VIRGILI STUDY ON SAFETY AND EFFICACY OF INULIN AND OLIGOFRUCTOSE IN NEONATES. Mariona Gispert Llauradó SUMMARY 21 Dipòsit Legal: T 50-2015 1. INTRODUCTION 23 1.1. Intestinal Microbiota 26 1.1.1. Definition/ Description of Intestinal microbiota 26 1.2. Functional Food 30 1.3. Prebiotics 34 1.3.1. The concept of prebiotic 34 1.3.2. Effect of prebiotics in human health 39 1.3.3. Candidate ingredients to be considered prebiotics 44 1.4. Inulin and Oligofructose 46 1.4.1. Introduction to inulin and oligofructose concept 46 1.4.2. Natural occurrence of inulin 47 1.4.3. Industrial production of inulin and oligofructose 49 1.4.4. Chemical structure and physical properties of inulin 50 and oligofructose 1.4.5. Food applications of inulin and oligofructose 53 1.4.6. Orafti Synergy 1® 54 1.5. Effect of prebiotics/ non‐digestible carbohydrates in 55 newborns 1.5.1. Development of intestinal microbiota in infants 55 ‐ 9 ‐ 1.5.2. Human Milk Oligosaccharides and its benefits in 58 newborns 1.5.3. Effects of inulin and/or oligofructose in newborns 60 2. HIPOTHESIS 67 3. OBJECTIVES 71 UNIVERSITAT ROVIRA I VIRGILI STUDY ON SAFETY AND EFFICACY4. METHODSOF INULIN AND OLIGOFRUCTOSE IN NEONATES. 75 Mariona Gispert Llauradó Dipòsit Legal: T 50-2015 4.1. Study design 77 4.2. Study population 79 4.3. Administration of test products 81 4.4. Monitoring and handling of adverse events 85 4.5. Assessment procedures 88 4.5.1. Data collection methods 89 4.6. Statistical 97 4.6.1. Sample size calculation 97 4.6.2. Data management 97 4.6.3. Analyses 98 4.7. Ethical conduct of the clinical trial 103 4.8. Quality control and monitoring 104 5. RESULTS 107 5.1. Baseline data 109 5.1.1. Baseline characteristics 109 5.1.2. Sociodemographic characteristics 110 5.2. Study sample follow‐up and withdrawal analyses 113 5.3. Cross‐sectional and longitudinal analyses 119 5.3.1. Formula intake 119 ‐ 10 ‐ 5.3.2. Anthropometrical evaluation 121 5.3.3. Urinary laboratory analyses 125 5.3.4. Serum laboratory analyses 129 5.3.5. Study formula acceptance 131 5.3.6. Bowel function and digestive symptoms 132 UNIVERSITAT ROVIRA I VIRGILI 5.3.7. Infant’s illness 139 STUDY ON SAFETY AND EFFICACY OF INULIN AND OLIGOFRUCTOSE IN NEONATES. Mariona Gispert Llauradó 5.3.8.
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