Knowledge, Use and Perceptions of Probiotics and Prebiotics in Hospitalized PatientsMelanie Betz1, Anne Uzueta2, Heather Rasmussen1, Mary Gregoire1, Cassie Vanderwall1, Gretchen Witowich1

1Clinical Nutrition, Rush University Medical Center, Chicago, IL 60612, 2Clinical Nutrition, Advocate Christ Medical Center, Oak Lawn, IL 60453

Introductiono The digestive tract of humans is the habitat for trillions of microbes that significantly affect host physiology and health, and modification of the gut microbiota through dietary means has been shown to beneficially impact human health and disease.

oProbiotics and prebiotics are dietary compounds that have shown the ability to modify gut microbiota.

o A probiotic is a live microorganism that, when administered in adequate amounts, confers a health benefit on the host.

o A prebiotic is a fiber that beneficially affects the host by selectively stimulating the growth of bacteria in the gut.

o Recent research has focused on the efficacy of probiotics and prebiotics for different health conditions. Despite the increase in research as well as the market for probiotics and prebiotics in recent years, little is known about the current use, knowledge and perceptions of these products in hospitalized patients.

Objectiveso To gain a better understanding of knowledge, use and perceptions of hospital patients are taking probiotic and prebiotic products.

o To compare differences in use and perceptions of probiotics and prebiotics based on patient demographics.

Methodso This study used a descriptive, cross-sectional survey method to verbally administer questionnaires to 200 hospitalized patients at Rush University Medical Center and Advocate Christ Medical Center in Chicago, Illinois (67% response rate).

oThe questionnaire contained three sections: demographic, past medical history and probiotic and prebiotic questions.

o Patients completed a cognitive screen and consented before the questionnaire was administered. Results were electronically recorded using Survey MonkeyTM .

ResultsoThe sample was 58% female and 56% Caucasian with a mean age of 56 years and 46% completing ≤12 years of education.

o 73% of the sample was familiar with the concept probiotic compared to 52% familiar with the prebiotic concept after probiotic and prebiotic definitions were read.

oThe most common health conditions believed to be benefitted by probiotics and prebiotics were digestion/gut health (85% for probiotics and prebiotics), constipation (80% and 74%), diarrhea (75% and 71%) and immune health (68% and 72%).

o Most common reasons to consume probiotics were to try them (36.2%) and digestion/gut health (33.3%). Diarrhea, immune health and digestion/gut health were most improved by probiotic consumption; diarrhea and overweight or obesity were least improved.

o Most common reasons to consume prebiotics were to try them (43%), for overweight or obesity (29%) and digestion/gut health (17%). Health conditions not on the handout, digestion/gut health and immune health were most improved by prebiotic consumption; diarrhea and general health were least improved.

o 34% believed probiotics improved their health “quite a bit” or “very much,” similar to 33% for prebiotics.

o TV/radio (57% for probiotics and 37% for prebiotics) and family/friends (46% and 51%) had the largest impact on both probiotic and prebiotic product consumption. Dietitians impacted 10% of probiotic and 21% of prebiotic consumption.

o 90% of patients responded with “not at all” or “a little” to the statement “probiotics are harmful”. 95% responded with these choices to “prebiotics are harmful.”

Figure 2. Patient Mean Responses to Probiotic and Prebiotic Perception Questions

Responses based on 5-point scale (1=Not at all, 2=A little, 3=Somewhat, 4=Quite a bit, 5=Very much)

Conclusion This study demonstrated that patients at two large, urban medical centers are mostly unfamiliar with probiotics and prebiotics. Probiotics are better recognized by inpatients compared to prebiotics. Many patients are consuming products containing probiotics and prebiotics. Inpatients are consuming probiotics mostly for gastrointestinal reasons and prebiotics to help reduce overweight and obesity followed by gastrointestinal health. Patient education is necessary to ensure that both probiotics and prebiotics are being consumed safely and for health conditions supported by research.

Table1. Medical center patient probiotic and prebiotic product consumptionProbiotics n %a Prebiotics n %b

Consumption practice Consumption practice

Ever consumed probioticsc 105 52.5 Ever consumed prebioticsd 76 38.0

Currently consuming 83 41.0 Currently consuming 62 31.0

Product Product Yogurt 113 72.0 Kashi Go Lean CrunchTM 32 26.2 ActiviaTM

YoPlusTM Yoplait yogurt9316

59.210.3

Skinny CowTM ice cream 32 26.2 sandwiches

GoodBelly® yogurt 4 2.5 Ensure® with FOS 20 16.4

LowellTM Polish yogurt 1 0.6 Luna bar® 19 15.6

Dairy drink DanActiveTM dairy drink

3116

19.710.2

South Beach Diet® bars Other

162

13.21.6

Kefir 12 7.7 Breakstone’s® LiveActive 1 0.8 ActiviaTM dairy drink 1 0.6 cottage cheese Other (unspecified) 1 0.6 Pill 11 7.0 Florajen® 1 0.6 Florastor® 1 0.6 Other (pills 9 5.8 unspecified) Cereals 2

21.31.3 ViveTM Kashi

aPercent total based on 157 responsesbPercent total based on 122 responsescSignificantly more females were consuming probioticsdSignificant difference found based on education; highest education group had the highest percent consumption of prebiotics

Figure 3. Health Conditions Believed Benefitted by Pro/Prebiotics

Figure 1. Percentage of Patients Familiar with Probiotic Term (left) and Prebiotic Term (right).

1 2 3 4 5

Pro/prebiotics are harmful

Pro/prebiotics are safer thanprescription drugs

Health claims on pro/prebioticpackages can be trusted

Prebiotics

Probiotics

Figure 2. Percentage of Patients Able to Correctly Define Probiotic (left) and Prebiotic (right).