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NTR 340 Applications in Human Nutrition
Prebiotic/ Probiotic Research Evaluation Questionnaire
INSTRUCTOR NOTE: It is your responsibility to type your responses into the text fields provided in this
form. You should NOT cut and paste your work from other sources into this form. Your work must
needs to use a uniform font, size, and format because these characteristics are included in the Writing
Style Criteria for grading (see Grading Rubric).
Please note that if you cut and paste from other sources your submission may revert back to the original
configuration of the source. Therefore it highly recommended that you use this form as your working
document. Type your responses into the text boxes provided. Save your work frequently. Your work
will be processed through Safe Assignment. Teaching staff are aware the percentage match indicated
through SafeAssignment will include the questions located in this Questionnaire. This will be taken into
account when evaluating the authenticity of original work.
Research Protocol Questions:
1. What is the name of the product and the company name?
The product is Lifeway Lowfat Kefir: Cultured lowfat milk smoothie
2. What is the full corporate contact information?
Lifeway Foods Inc.,
6431 West Oakton St.
Morton Grove, IL 60053
Tel (877)281-3874
Fax (877) 967-6558
www.Lifeway.net
3. Indicate the full title of your primary research article.
Fermented milk supplemented with probiotics and prebiotics can effectively alter the intestinal
microbiota and immunity of host animals.
4. What are the supposed benefits/functions of the product?
The benefits listed on the product include:
Enhanced the feelings of well-being and may support the immune system and balance digestive
health.

According to the website Kefir can bring the body’s ecosystem into equilibrium and assists with
both digestion and immunity.
5. What is the identification for the specific bacterial strain(s)? Please be specific. If there are more
than one type of strain, list all of them.
There are 12 probiotic strains of live lactic acid bacteria, which are: Lactobacillus reuteri,
Lactobacillus casei, Lactobacillus lactis, Lactobacillus acidohilophilus, Bifidobacterium lactis,
Lactobacillus rhamnosus, Bifidobacterium longum, Leuconostoc cremoris, Bifidobacterium
breve, Streptococcus diacetylactis, Streptococcus florentinus, Lactobacillus plantarum
6. What is the number of viable organisms stated for the product? It will usually be provided in the unit
of measure known as Colony Forming Units (CFU). This may be indicated per serving size, by capsule, by
dose.
The number of viable organisms stated for the product are seven to ten billion CFU’s per 1 cup
serving
7. What is the supposed mechanism of how the product works? Please be specific to receive full credit.
For example: "Product stimulates proliferation of bifidobacteria in the gut and this helps to replenish
flora post-antibiotic treatment. This reduces gastrointestinal distress associated with treatment."
This product claims that it will provide an equilibrium of the ecosystem in the body and will
assist in providing digestive health and immunity. Kefir has an increased rated of digestibility
and is able to encourage other foods to be digested due to the acidity and enzymes in the
product. It contains a large amount of lactic bacteria which hinders anaerobic decomposition
and disease causing microbes.
8. What is the recommended dose or serving size? What special instructions, if any, are stated to
consume the product?
The serving size is 1 cup with no other special instructions on the product label.
9. What contra-indications, if any, exist for this product? Why do these contra-indications exist?
Instructor Note: In other words who should NOT take this product and why?
According to the company website, there are no contra-indications listed. However, according
to the WebMD site, it is possible that those with weakened immune systems may be more likely to have
an infection arise from the bacteria and yeast in Kefir. There is also a caution for pregnancy women
which goes against what the product website says. The contra-indication exists to protect those people
who may not be able to consume the product and be healthy. Other websites had to be used to find
contra-indications or side effects for this product and may not be accurate.

10. How should the product be stored?
Examples: The product should be stored away from sunlight and at room temperature.
The product should be refrigerated at 40 degrees Fahrenheit or below
The product should be refrigerated. No other specifications were given on the product. A
refrigerator should be kept between 36-46 degrees Fahrenheit.
11. What is the shelf life or expiration?
The shelf life or expiration of the product purchased on November 8, 2014 is December 31,
2014. The shelf life is at least 6-8 weeks.
12. What type of study design is your article? Explain some of the basic characteristics of your study
that are associated with the definition of this particular study design.
Example: The study is a cohort study. It qualifies as a cohort study because it follows a group ….
The study is a randomized control trial utilizing both human subjects and mice for a period of
two weeks. Human subjects were volunteers selected according to strict criteria. There were randomly
divided into test and control groups. Mice were randomly divided into 4 groups: control, test milk, low
dose, and high dose.
13. In general, what are the potential advantages of your type of study design from a general point of
view?
INSTRUCTOR NOTE: The Duke University Medical Library video (mentioned Step-By-Step Instructions)
provides some examples of advantages and disadvantages of various study designs.
In general, the potential advantages of this type of study design from a general point of view is
that it is the best design for proving efficacy. This also provides control over bias. Other key
benefits include over exposure is controlled.
14. In general, what are the potential disadvantages/ limitations of your type of study design?
INSTRUCTOR NOTE: The Duke University Medical Library video (mentioned Step-By-Step Instructions)
provides some examples of advantages and disadvantages of various study designs.
In general, the potential disadvantages or limitations of this type of study design is that
expensive. For this reason this study design can be time consuming. There are additional ethical
concerns for this type of study design because it is difficult to test or measure the outcomes on
humans unless they are recently deceased.I

15. What is the funding source for the research? How could the funding source present a bias or conflict
of interest? If the funding source is not indicated, report “Not stated”.
Not stated
16. In your own words state the overall purpose of the study.
The purpose of the study was to determine the strong health encouraging effects of synbiotic
fermented milk with the prebiotics and probiotics on both humans and animals.
17. Summarize the inclusion criteria for the population: [number of participants, age, gender, ethnicity,
disease/health state, IRB summary, etc.].
INSTRUCTOR NOTE: Your article may not clearly state each of these. It is your job to explain to the "lay
person" who was involved in the study in detail but in a simple manner which does not look like it was
"cut and pasted" from the abstract or digital text of the full article.
50 healthy men and 50 healthy women between the ages of 30-40 years of age. The human
subjects were randomly placed into the test group or the control group. 40 male mice were placed
randomly into one of four groups: control, milk, low dose, high dose. 240 female mice were randomly
placed into the same groupings as the male mice and after a period of time each group was broken
down into five subgroups to test for immunological responses.
18. Summarize the exclusion criteria. In other words describe the characteristics of subjects who were
NOT eligible to participate in the study.
Men and women were to be healthy and not using antibiotics. There could not have a history of
gastrointestinal disease in the previous month. They could not be on any medication that could affect
their judgment or functions. They could not have any severe cardiovascular, cerebrovascular, liver,
kidney or psychological disorders. They had to agree to complete the test efficiently.
19. Outline the research protocol. In other words, describe “What happened?”- In doing so, summarize
the basic types of questions a reporter or astute reader would examine
(Who?, What?, Where?, When?, How?)
INSTRUCTOR NOTE: DO NOT CUT AND PASTE THE ABSTRACT! Your response must use active reading
and paraphrasing into your own words. Your work may be matched with the hard-copy of the article.
The assignment will also be processed through the Blackboard SafeAssignment feature. It is unethical to
attempt to complete an assignment of this nature by cutting and pasting from the abstract.
Men and women volunteers were placed randomly into either a control group or test
group. They were in these groups for two weeks. The control group maintained their diet for a

period of 14 days while the test group was given the fermented milk supplement at 480 g/day
during the same time period. All volunteers were given medical examinations at both the
beginning and end of the trial. The tests included mental condition, sleep. Blood pressure, feces,
urine, blood biochemical indices, chest x-ray, and type-B ultrasound of the liver, gallbladder,
spleen, and kidneys.
The male mice were kept for a week in 12 hour dark-light conditions with temperature
at 21 to 22 degrees C and 40% humidity. After one week, they were randomly divided into their
four groups and fed sterile water (control), test milk, or 0.4 g/10 g of weight (low dose), or 0.8
g/10 g of weight through a gastric tube for a period of 14 days. Fresh fecal matter was analyzed.
The female mice were kept in similar conditions as the male mice and then separated into their
four groups. One group was used for organ weight, another for DTH, a third for PFC, and the last
for HC50 values. The females were divided into 5 groups a fed differently. The control group was
fed deionized water, the test sample, low dose was 0.08 g/10 g of weight, medium dose 0.8 g/
10 g of weight, or 2.4 g/10 g of weight. The test was given through a gastric tube for 30 days.
Blood samples were taken by enucleation of the eyeball in the mice to calculate HC50. Fluid
from the intraperitoneal cavity was removed from the mice to observe macrophages and
determine the phagocytosis ratio. Another group had their liver and spleen weighed to calculate
the phagocytic index. The fourth group of mice had their spleens to measure NK cell activity
20. List the dependent variable(s). Dependent variables are known as the “outcomes”.
INSTRUCTOR NOTE: Outcome measures are not the same as “results”.
The outcome measures were the effects of the milk on intestinal bacteria composition in both
human subjects and the mice. The other outcome measure was the effect of the milk on
immune regulation in the mice.
21. State how the dependent variables (outcomes) are measured. In other words what type of lab
values, measurements, surveys etc. are used for measurement?
The variables were measured in fecal matter. For immune response, the T-lymphocyte
proliferation and DTH, humoral immunity was estimated by the PFC assay and HC50 value.
Nonspecific immunity was measured by the phagocytosis of chicken RBC by peritoneal
macrophages, carbon clearance, and NK cell activity.
22. List the independent variable(s). The independent variables are the specific intervention(s) or
procedure(s) that are used.
The independent variable were the intervention of providing the fermented milk with the
starter culture.

23. State how the independent variables are measured. In other words what type of lab values,
measurements, surveys etc. are used for measurement?
The independent variable was measured by calculating exactly how much of the strains of the
bacteria were in the fecal matter of the test subjects.
24. Describe the results or conclusions that were reached. What is the “bottom line” about what was
found in the study?
INSTRUCTOR NOTE: You should sum up the bottom line in a way that is straight-forward and clear. You
can cite some simple statistics which summarize the findings. This is not a statistics class therefore you
should keep any statistical summary very straight-forward and simple.
This study found that the probiotic strains were increased in the fecal matter of the test subjects
and that the fermented milk can positively modify the intestinal flora. Mice were used in lieu of
human subjects for immunological analyses and cannot be interpreted and then extrapolated to
humans. The SFM in humans was able to be duplicated in the mice. In the immunological studies
of the mice the DTH, HC50, and PFC were all increased. T-lymphocyte proliferation, peritoneal
macrophage phagocytosis, carbon clearance, and NK cell activity were not significantly different
from the beginning of the trial. The fermented milk may have affected the humoral and cellular
immunity in the mice.
25. In your opinion answer the questions “Who cares, and, so what?”
INSTRUCTOR NOTE: You are being asked to comment on YOUR perceived value of this study. There is
not really a right or wrong answer to these questions. This question is a simple way to uncover a basic
understanding of the outcome measures. Outcome measures look at what is the value and applicability
of the research in the real world. The author may or may not state the outcome measures in a clear
manner. You can re-iterate the author’s view or draw your own conclusion. If the author does not state
the outcome (which is often the case) state so and offer your own opinion.
Fictitious Example of “WHO CARES”: The population that cares is clinicians who treat patients with
Chrohns disease.
Fictitious Example of “SO WHAT”: The author did not state any outcome measures. In my opinion the
researcher found that large doses of probiotic supplements lead to increased amounts of beneficial flora
in the intestinal tract as demonstrated by lab measures. However the doses were so high that 100% of
the research subjects experienced acute diarrhea. Therefore more research is needed before any
practical guidelines can be established for patient care.
Clinicians, and other medical professionals that work with patients with gut related issues are
going to be the ones who care about a study of this type.
In my opinion the researchers discovered that probiotic supplements increase the intestinal
flora that was able to be measured in the laboratory through collection of fresh fecal matter

and measurement of the organs of the mice that were anesthetized. This research did not
utilize a significant amount of test subjects or continue the trial for a longer period of time to
really make clear recommendations for the use of fermented milk in humans. More studies
should be completed especially for the immunological effects in humans as the researchers
stated.
26. Perform a search for either the Medical Nutrition Therapy (MNT) or the basic healthy diet
recommendations for the health issue this product claims to support. Provide a basic outline of the
healthy diet or MNT. Do you think this product could be a substitute for a healthy diet or the Medical
Nutrition Therapy? Why or why not?
INSTRUCTOR NOTE: Utilize a reliable source of information to guide your search. You can use a textbook
or web-based source. You do not need to provide a full citation for the source. Please identify your
source in your response.
For example: “According to the Merck Manual, the normal routine care for Irritable Bowel Syndrome
[IBS] consists of _____________. Common nutritional strategies for prevention of IBS are __________
According to the Merck Manual Ulcerative colitis consists of bloody diarrhea with variable
strength and intervals. There are minor abdominal cramps along with blood and mucus in the stool of
the patient. In severe cases stools may be watery or have mucus along with blood and pus. Common
nutritional strategies for prevention of ulcerative colitis include avoiding raw fruits and vegetables which
will lessen the damage to the already inflamed colonic mucosa. Severe cases may need to be
hospitalized. Probiotics might be protective to the colon.
27. What do you think of the marketing for the product? Please comment from the point of view of
whether it seems geared to credible information or sensationalism.
The market of the product is focused on the consumer and uses sensationalism. The marketing
mentions that the product is beneficial based on research but does not give references. If the consumer
only views the information on the container and not the website they will be simply using the product
based on what is on it. Their website doesn’t have much on it, however, there is a little more
information on their website but there were not any references to peer-reviewed journals that could be
viewed.
28. Would you recommend this product to a loved one? Why or why not?
Based on my review of this product and the research article and others that I read, I would
recommend this product to a loved one. Fermented milk products such as the Kefir beverage is
supported by research in this trial and others. The results of these studies are published in peer-
reviewed journals such as the Journal of Dairy Science which is where my article came from. My loved
ones could benefit from the kefir product in helping to balance their body’s ecosystem.

Reference
Wang S, Zhu H, Lu C, et al. Fermented milk supplemented with probiotics and prebiotics can effectively
alter the intestinal microbiota and immunity of host animals. J. Dairy Sci. 2012;95:4813-4822.

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