Nutrition 30 (2014) 666672

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Nutrition
journal homepage: www.nutritionjrnl.com

Applied nutritional investigation

Yacon effects in immune response and nutritional status of iron

and zinc in preschool children
Maria das Gracas Vaz-Tostes M.Sc. a, b, *, Mirelle Lomar Viana D.Sc. a,
Mariana Grancieri B.Sc. a, Tereza Ceclia dos Santos Luz B.Sc. a,
rio Graca Pedrosa D.Sc. a,
Heberth de Paula D.Sc. a, Roge
Neuza Maria Brunoro Costa Ph.D. a, b
a
b

Department of Pharmacy and Nutrition, Center for Agrarian Sciences, Federal University of Espirito Santo, Alto Universitario, Alegre, ES, Brazil
Department of Nutrition, Federal University of Vicosa, PH Holfs, Vicosa, MG, Brazil

a r t i c l e i n f o

a b s t r a c t

Article history:
Received 16 August 2013
Accepted 28 October 2013

Objective: The aim of this study was to evaluate the effect of yacon our on iron and zinc nutritional
status and immune response biomarkers in preschool children.
Methods: Preschool children ages 2 to 5 y were selected from two nurseries and were placed into a
control group (n 58) or a yacon group (n 59). The yacon group received yacon our in
preparations for 18 wk at a quantity to provide 0.14 g of fructooligosaccharides/kg of body weight
daily. Anthropometric parameters were measured before and after the intervention and dietary
intake was measured during the intervention. To assess iron and zinc status, erythrograms, serum
iron, ferritin, and plasma, and erythrocyte zinc were evaluated. Systemic immune response was
assessed by the biomarkers interleukin IL-4, IL-10, IL-6, and tumor necrosis factor-alfa (TNF-a).
Intestinal immune response was analyzed by secretory IgA (sIgA) levels before and after the
intervention. Statistical signicance was evaluated using the paired t test (a 5%).
Results: Before and after the study, the children presented a high prevalence of overweight and an
inadequate dietary intake of zinc and ber. The yacon group presented with lower hemoglobin,
mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration at the end of the
study (P < 0.05). Erythrocyte zinc was reduced in both groups at the end of the study (P < 0.05).
Yacon intake increased the serum levels of IL-4 and fecal sIgA (P < 0.05). The control group had
lower serum TNF-a after the study period (P < 0.05).
Conclusion: Yacon improved intestinal immune response but demonstrated no effect on the
nutritional status of iron and zinc in preschool children.
2014 Elsevier Inc. All rights reserved.

Keywords:
Yacon
Prebiotics
Nutritional status
Immune response

Introduction
Yacon (Smallanthus sonchifolius) originates from the Andean
region and has spread across South America and Europe. In
contrast with most roots, yacon stores its carbohydrates in

MGVT, MLV, and RGP were responsible for the conception and design of the
study, acquisition of data, analysis and interpretation of data, and drafting of the
article. MG and TCSL were responsible for acquisition, analysis, and interpretation of data. HP was responsible for hematologic analysis and interpretation of
data. NMBC was responsible for conception and design of the study, analysis and
interpretation of data, drafting of the article, critical revision of article for intellectual content, and approval of nal version to be submitted.
* Corresponding author. Tel.: 55 28 3552 8656; fax: 55 28 3552 8656.
E-mail address: mgvaztostes@gmail.com (M. G. Vaz-Tostes).
0899-9007/$ - see front matter 2014 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.nut.2013.10.016

fructooligosaccharides (FOS) and can contain 40% to 70% of its

FOS in its root dry matter [1,2].
FOS are fructose oligosaccharides joined by b-(2/1)
or b-(2/6) bonds with a prebiotic role [1]. Prebiotics are
non-digestible but fermentable oligosaccharides specically
designed to change the composition and affect the activity of one
or a limited number of bacteria of the intestine, with the goal of
promoting the health of the host [3]. In the colon, FOS acts as
a substrate for the growth of benecial bidobacteria and lactobacilli [4].
Recently, great interest has been focused on the positive effects of dietary fructooligosaccharides on mineral bioavailability.
Studies involving humans indicate that they promote greater
mineral bioavailability [57]. In agreement with these ndings,
studies performed in animals demonstrated changes in the

M. G. Vaz-Tostes et al. / Nutrition 30 (2014) 666672

667

Table 1
Prole of the study population, anthropometric parameters, and nutritional status of preschool children in the yacon and control groups before and after intervention

Age (mo)
Sex (%)
Male
Female

Anthropometric parameters
Weight (kg)
Height (cm)
BMI (kg/m2)
Nutritional status (%)
Slimness
Eutrophic
Risk for overweight
Overweight
Obesity/severe obesity

Yacon
n 41

Control
n 48

47  13

41  11

53
47

54
46

Before

After

Before

After

17.85  3.93
104.33  10.14
16.32  1.94

18.75  4.29*
107.65  10.0*
16.06  2.02*

16.39  2.85
99.96  7.73
16.32  1.38

17.25  3.17*
103.42  7.59*
16.04  1.66

2.08
62.50
22.92
12.50
0.00

2.08
64.58
16.67
16.67
0.00

2.44
58.54
29.27
9.76
0.00

4.88
60.98
24.39
7.32
2.44

BMI, body mass index

Values are means  SD
* Paired-samples t test comparing each group before versus after; P < 0.05.

intestinal architecture with dietary FOS treatment: Increases in

intestinal crypt number, depth, and bifurcations and in the
production of short-chain fatty acids, and a decrease in luminal
pH [8,9]. Particularly, these three types of effects can be the main
reasons for better mineral absorption, which increases their
bioavailability [1012].
Nutritional deciencies of micronutrients, mainly iron and
zinc, are common in preschool-aged children [13]. Lack of certain
micronutrients, especially zinc and iron, can lead to clinically
signicant immunodeciency and infections in children. Thus, in
this group the addition of prebiotic food can increase mineral
bioavailability and strengthen the immune system.
Fructan consumption can increase immune system efciency
[14]. In animals, yacon our ingestion stimulates the local
immune response by increasing the levels of secretory immunoglobulin A (sIgA), interleukin IL-10, and IL-4. Its immunomodulatory effect may be indirect, by inuencing the growth of
bidobacteria and lactobacilli, or through a direct interaction
with the immune system [4]. However, to our knowledge, there
are few studies about the effects of FOS on the immune response
in humans [14].
In this context, the aim of this study is to evaluate the effects
of yacon on the iron and zinc nutritional state and immune
response in preschool children.
Methods
Participants
One hundred seventeen preschool children ages 2 to 5 y from two full-time
public nurseries were recruited for this study. The children were submitted to an
initial blood sampling after the consent of their parents or guardians. The
exclusion criteria were hemoglobin <11 mg/dL and the use of ferrous sulfate,
vitamins, or mineral supplements. Children from one nursery were placed in the
control group (n 58), whereas the other group received yacon our (n 59) for
18 wk. The children were evaluated for anthropometric and biochemical parameters and local and systemic immune response (Fig. 1). General characteristics of the children are presented in Table 1. The study was approved by the Ethics
Committee on Human Subject of the Federal University of Vicosa, MG, Brazil,
protocol number 028/2012, and by the local education secretary.

(0.5%) for 10 min as adapted from an earlier method [15]. After this procedure, it
was dried (24 h at 60 C) in an airow dryer (Polidryer). The our was stored in
plastic bags, 2 to 5 kg each, at a temperature of 10 C. The FOS content was
determined as indicated previously [16]. The levels of protein, carbohydrates,
lipids, ber, ash, and humidity were evaluated using AOAC method [17].
Dietary intervention
The children in the yacon group received yacon for 18 wk in amounts to
provide 0.14 g FOS/kg body weight daily [18], which was calculated according to
the mean body weight of each school class and the yacon our FOS level. To
enhance the yacon acceptability, it was offered in preparations such as candy (fed
after lunch and prepared with yacon, water, and milk powder), cake, and cookies
(fed at breakfast time). The preparations were offered daily (Monday through
Friday). The offered preparations and the leftovers were weighed daily to evaluate the acceptability. Parents and teachers were asked about the possible
presence of adverse effects throughout the intervention period.
The caloric content of the preparations was calculated based on the chemical
composition of the yacon our and other ingredients, using the Avanutri program, version 1.0 for Windows.
Dietary assessment
For dietary assessment, the food consumption average of 3 nonconsecutive
d was evaluated by direct food weighing method and 24-h recall. The foods
ingested at the nurseries were weighed on 2 non-consecutive weekdays [19].
Food portions were weighed on a digital portable scale of 2-kg capacity and 1-g
precision. The number of repeats and the leftovers were recorded. Meals fed at
home were evaluated by 24-h recall based on information provided by the
childrens guardians on the same weekday of the direct food weight in the
nurseries and on a weekend day. Food composition was analyzed by using Avanutri. The adequacy of macronutrients was evaluated based on the acceptable
macronutrient distribution range (AMDR), and micronutrients based on the
estimated average requirement (EAR) or adequate intake [20,21].
Anthropometric assessment
The weight and height of the children were determined according to a previous method [22] before and after dietary intervention. For weight measurements, an electronic digital portable scale (150 kg capacity and 50 g precision)
was used. A stadiometer was used for height measurement. These parameters
were used to calculate the body mass index for age (BMI/A), which was compared
with the reference z score and classied according to the World Health Organization recommendations [23].
Hematologic evaluation

Obtaining the yacon our

Two hundred kg of yacon was purchased weekly from a rural producer of
, Esprito Santo, Brazil. After selecting, washing, sanitizing,
Santa Maria do Jetiba
and peeling, the tubercle was processed and immersed in a citric acid solution

Samples of blood were collected by venous puncture. The blood was analyzed
for red blood cells (RBCs), hematocrit (Htc), hemoglobin (Hb) concentration,
mean cell volume (MCV), mean cell hemoglobin (MCH), and mean cell hemoglobin concentration (MCHC). Serum was taken for ferritin and iron

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M. G. Vaz-Tostes et al. / Nutrition 30 (2014) 666672

Fig. 1. Experimental design.

determinations. RBCs were counted manually using a Neubauer chamber [24].

Hb and serum iron (sFe) were measured using colorimetric Bioclin kits. Serum
ferritin (sF) was determined by immunoturbidimetry, and glucose was evaluated
by a commercial colorimetric assay. Zinc was measured in plasma and erythrocytes by atomic absorption spectrophotometry [25,26]. The biochemical parameters were evaluated before and after the dietary intervention.

groups before the study. Most children in both groups had an

adequate nutritional status, although a relatively high prevalence of children at risk for overweight or children already
overweight was found (Table 1).

Fecal samples

Intervention with yacon

Parents were asked to take fecal samples from their children before and after
the intervention period. Parents collected the samples in feces containers, stored
them immediately in their home freezer, and took the samples to the nursery on
the day after collection. During the collection period, the investigators visited the
nursery regularly to collect fecal samples. Fecal samples were transported to the
laboratory in an icebox and stored at 80 C.

The yacon our demonstrated high amounts of FOS (35.06%),

carbohydrate, and ber (Table 2). The preparations had low
caloric values (candy: 30 kcal; cake: 80 kcal; cookie: 90 kcal) and
contained 6, 7, or 9 g our yacon, according to the childs body
weight.
The total average consumption of FOS was 0.09  0.04 g/kg
body weight. In all, 55% of children had an average daily intake
between 0.10 and 0.15 g/kg, 33% had an average daily intake
between 0.05 and 0.09 g/kg, and 12% had an average daily intake
of 0.01 to 0.04 g/kg. The children demonstrated no adverse effects at this level of FOS intake. The preparations were well
accepted by the children (candy: 81.06%; cake: 78.53%; cookie:
73.75%).

Systemic and local immune biomarkers

Flow-cytometric multiplex arrays were used to evaluate proinammatory
cytokines (IL-6 and TNF-a) and anti-inammatory cytokines (IL-10 and IL-4) in
serum samples with Luminex technology using the kit CAT # HCYTOMAG-60 K04 (Millipore), and the concentrations were determined in a MagPix Analyzer
with the software xPonent/Analist, version 4.2.
To evaluate intestinal immune response, sIgA was quantied. For the determination of sIgA, 10% (w/v) fecal homogenates were prepared according to
standard procedures. Fecal samples were defrosted on ice. Suspensions were
made by adding 1 g feces to 9 mL of phosphate-buffered saline and homogenizing
for 10 min using a vortex. The mucosal immunity was evaluated based on the
fecal sIgA concentration, which was measured using an Immunochron enzymelinked immunosorbent assay (ELISA).
Data analysis
The parameters before and after the intervention were evaluated using the
paired t test or Wilcoxon test (a 5%), according to the normality of the sample
distribution as evaluated by the Kolmogorov-Smirnov test. The data were
~o Paulo, SP,
analyzed using SPSS, version 19.0 (IBM SPSS Statistics Base, DMSS, Sa
Brasil).

Results
Population characteristics
The preschool children displayed similar age, sex, anthropometric measurements and nutritional characteristics in both

Nutrient intake
A high percentage of the children ages 4 to 5 y presented
inadequate dietary zinc intake. This result was observed in both
the yacon group (40.6%) and control group (34.7%). The observed

Table 2
Composition of yacon our
Composition (%)

Yacon our

Protein
Humidity
Lipids
Ash
Total carbohydrates
Fiber
Fructooligosaccharides

4.52
5.92
0.33
2.94
86.29
10.68
35.06

M. G. Vaz-Tostes et al. / Nutrition 30 (2014) 666672

669

Table 3
Daily dietary intake of energy and nutrients of preschool children during the intervention
Nutrients

Yacon
n 41

Control
n 31

Median intake
Carbohydrates (g)
23 y
45 y
Proteins (g)
23 y
45 y
Lipids (g)
23 y
45 y
Fibers (g)
23 y
45 y
Iron (mg)
23 y
45 y
Zinc (mg)
23 y
45 y

% Inad

Median intake

% Inad

181.87 (101.55256.52)
172.48 (82.76225.87)

2.4
4.9

157.36 (85.68353.34)
167.28 (149.43219.76)

3.2
0

43.24 (23.4562.09)
38.64 (23.87104.85)

2.4
0

41.58 (32.6595.15)
46.32 (34.0169.75)

3.2
0

35.55 (19.4450.72)
32.84 (20.0346.25)

36.6
17.1

32.39 (17.4582.54)
35.52 (25.3335.52)

51.6
12.9

11.38 (6.7019.43)
12.89 (5.3823.32)

88.8
100

11.77 (5.6821.87)
12.37 (8.6917.03)

90.47
100

6.78 (4.979.81)
7.31 (4.5711.80)

0.52
2.50

7.5 (3.9315.37)
7.16 (4.9411.3)

2.65
1.6

4.77 (3.996.00)
3.93 (2.995.96)

0.00
40.6

5.44 (4.517.6)
5.30 (4.766.91)

0.04
34.7

% Inad, percentage of inadequacy in the group

Values are median (minimummaximum)

ber intake was inadequate in both groups and stage of life,

ranging from an 88.8% to a 100% inadequacy rate (Table 3).
Anthropometric parameters
The children demonstrated weight gain and increased height
after the intervention in both groups. Comparing BMI before and
after intervention, there was a decrease in the yacon group but
no difference in the control group. Before and after the study, a
high percentage of children were classied as eutrophic, but
there was a high prevalence of risk for overweight and actual
overweight at both times (Table 1).
Blood parameters of iron and zinc
There was no difference in RBC, serum iron, ferritin, hematocrit, or MCV between before and after the intervention in the
yacon group. However, Hb, MCH, and MCHC decreased at the end
of the study in that group. No change in these parameters was
seen in the control group. Plasma zinc was not affected by the
intervention. Erythrocyte zinc decreased after the intervention in
both groups (Table 4).

Systemic and local immune biomarkers

We found increased serum IL-4 but no alterations in IL-10, IL6, or TNF-a in the yacon group after the intervention. In the
control group, there was a reduction of TNF-a at the end of the
study (before: 24.16  2.27 pg/mL; after: 13.13  1.03 pg/mL)
(Fig. 2). After the intervention, there was an increase in fecal sIgA
in the yacon group (before: 1125.64  403.99 mg/mL; after:
2406.49  686.40 mg/mL), but not in controls (before:
3379.74  616.09 mg/mL; after: 2357.87  500.45 mg/mL) (Fig. 3).
Discussion
Microbiota is an essential constituent of gut defense. The
composition of intestinal microbiota does not change signicantly after infancy. However, various dietary and environmental
factors, infections, and antibiotics cause changes in the microbiota throughout the childhood. One of the most important
modulators of the gut microbiome is diet [27]. Compared with
probiotics, prebiotics may have a different or more pronounced
inuence on the infants intestinal metabolism, because they are
substrate for fermentation [28]. Then, the insertion of prebiotics

Table 4
Blood parameters of preschool children in yacon and control groups before and after intervention
Blood parameters

Yacon

Control

Before
Htc (%)
sFe (mg/dL)
sF (mg/L)
RBC (P/mm3)
Hb (g/dL)
MCV (fL)
MCH (pg)
MCHC (g/dL)
plZn (mg/dL)
eriZn (mg/gHb)

36.65
60.85
32.91
4.22
13.32
88.26
31.92
36.57
103.48
35.68

After
 4.16
 30.43
 24.65
 0.57
 1.64
 13.67
 4.12
 4.57
 18.24
 10.10

35.17
66.44
26.74
4.29
11.13
85.55
26.81
31.86
113.61
29.74

 2.36
 24.26
 28.96
 0.93
 1.63
 18.46
 5.68
 5.52
 27.13
 9.11

P-value

Before

0.078
0.474
0.322
0.699
<0.05
0.495
<0.05
<0.05
0.107
<0.05

35.32 
89.00 
35.98 
4.46 
13.55 
80.28 
30.85 
38.41 
145.60 
47.58 

P-value*

After
3.00
69.04
26.98
0.59
2.54
10.72
6.81
6.64
37.47
12.86

35.00 
60.91 
28.10 
4.26 
12.99 
84.91 
31.29 
37.12 
136.14 
38.85 

2.61
32.44
33.73
0.84
1.86
16.98
6.46
4.91
52.67
7.66

0.636
0.061
0.399
0.343
0.380
0.263
0.825
0.475
0.393
<0.05

eriZn, erythrocyte zinc; Hb, hemoglobin; Htc, hematocrit; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin concentration; MCV, mean
corpuscular volume; plZn, plasma zinc; RBCs, red blood cells; sF, ferritin; sFe, serum iron. Values are means  SD
* Paired-samples t test comparing each group before versus after; P < 0.05.

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M. G. Vaz-Tostes et al. / Nutrition 30 (2014) 666672

Fig. 2. IL, interleukin; TNF, tumor necrosis factor n 25 (test group); n 25 (control group). *Paired-samples t test comparing each group before versus after; P < 0.05.

in food school programs to preschool children, can stimulate the

growth and activity of benecial microorganisms in intestine
environment with an important role in the intestinal mucosal
defense system and moreover, could be benet to increase the
bioavailability of minerals, preventing common mineral deciencies in this stage of life [6,7,29,30].
Yacon, an abundant source of FOS, is considered a prebiotic.
We found high FOS content in the yacon our offered to preschool children (35.06%) compared with others studies [15,18].
FOS is fermented selectively by bidobacteria and lactobacilli,
which are probiotic bacteria [2]. Therefore, the addition of yacon
root to childrens diets presents a potential opportunity to
stimulate the growth of health-promoting bacteria and exert
benecial effects on the gut immune system.
Bidobacteria naturally inhabit the human gastrointestinal
tract and can exert several benecial effects to the host [31].
Elements of the gut microbiota are thought to be required for the
proper development of the hosts immune system. There is evidence that the gut microbiota exerts a key role in inducing IgA
production, as well as maintaining the homeostasis of several Tcell populations, including regulatory T cells and T-helper
cells [32].

Fig. 3. sIgA, secretory immunoglobulin A n 18 (test group); n 19 (control

group). *Paired-samples t test comparing each group before versus after; P < 0.05.

The sIgA and innate mucosal defenses are the rst line of
defense against microbial antigens in the intestinal mucosa. The
sIgA inhibits the colonization of pathogenic bacteria in the gut
and the mucosal penetration of pathogens [33,34]. IL-4 is an
immunomodulatory cytokine secreted by activated T lymphocytes, basophils, and mast cells. It plays an important role in
modulating the balance between pro- and anti-inammatory
responses [35]. The increase in circulating proinammatory
cytokines triggers immune cells to release anti-inammatory
cytokines to down-regulate the immune response, through
complex feedback mechanisms, to maintain homeostasis [36,37].
Our results are in line with studies that found that FOS
increased fecal sIgA concentration and serum IL-4, showing the
importance of adding FOS to childrens diets. A study performed
in preschool children reported an increase of salivary sIgA after
probiotic supplementation [33]. One study [38] reported that
oligofructose and inulin stimulate natural killer cell activity and
increase the phagocytic capacity of macrophages in mice. It has
been demonstrated [4] that FOS modulated the intestinal immune response in animals that consumed yacon our, by
increasing IgA, IL-10, and IL-4 on the intestinal lamina propria.
There was an increase in IL-4 producing cells in the intestine,
mainly mast cells. In this case, the role of mast cells at the mucosa level is related to adaptive response or antigen clearance
more than in the mediation of allergic process whose response is
restricted to allergen structure.
Considering the increase in the IL-4 production in the children receiving yacon our, a higher IL-10 levels would be expected because both cytokines have an anti-inammatory role,
although this was not observed. The possible reason for this
result is the evaluation of systemic instead of local IL-10 levels. In
the intestine, IL-10 is produced by regulatory T cells, T-effector
cells, macrophages, dendritic cells, and epithelial cells [39]. It has
been experimentally demonstrated that the intake of FOS increases the IL-10 and interferon (IFN)-g production for cells in
the Peyers patches, which suggests that prebiotic activates
different subpopulations of T lymphocytes and/or dendritic cells
of the intestinal tract [14]. Furthermore, this work was developed
with a preschool population, then to ensure safety of dietary the
intervention, our group adopted the smallest daily dose of FOS
(0.14 g/kg) that has no reported intestinal discomfort in humans

M. G. Vaz-Tostes et al. / Nutrition 30 (2014) 666672

Acknowledgments
The study was supported by grants from Fundac~
ao de Amparo
 Pesquisa do Esprito Santo (FAPES) and Coordenaca
~o de Apera
feicoamento de Pessoal de Nvel Superior (CAPES).

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[18]; however it may not have been sufcient to promote the

expected systemic IL-10 production.
Iron and zinc are important nutrients for the immune system.
They have a high prevalence of deciency in children [13]. Human
studies have evaluated the positive effects of FOS on the bioavailability of minerals, especially calcium [5,6]. Animal studies show an
increase in iron absorption with yacon administration [8,9]. FOS
consumption decreases the cecum pH and increases production of
short-chain fatty acids, promoting intestinal changes and increases
in the number and bifurcation of crypts, which might favor iron
absorption due to an intestinal surface increase.
We found no positive effect of yacon on iron nutritional status.
Because the sample was composed of non-anemic children, the
absorption ability probably was reduced, which can contribute to
these results. It has been reported that there is an inverse correlation between serum iron concentration and iron absorption. The
mechanism of iron absorption in the large intestine has not yet
been claried. However, sufcient iron is absorbed in the large
intestine of rats recovering from iron-deciency anemia [40].
Additionally, there is an increased demand for Hb to support
growth in children. In preschool children, a study that offered fermented milk fortied with iron and a probiotic found a decrease in
Hb at the end of the intervention [41]. The authors related the results to the faster growth ratio in the probiotic group; the same
result was obtained in the present study in Hb levels.
The decrease in erythrocyte zinc observed in both groups in
this work may reect a deciency in the intake of this mineral
in the long term. The evaluation of erythrocyte zinc does not
reect recent changes in the level of zinc, so it is the most
appropriate indicator to evaluate the nutritional status of this
mineral [42]. Between the ages of 4 and 5 y, there is an increased
nutritional need for zinc. However, we found an inadequate
intake of zinc, an important factor that contributes to nutritional
deciency, in children in this age group.
To our knowledge, no other study has used yacon as a source
of FOS for children, and there is still no consensus about the
amount needed to improve mineral bioavailability without
adverse effects to the individual. Preschool children have high
mineral needs due to rapid growth, so the addition of only prebiotics to the diet, in the administered dose, without additional
dietary sources of iron and zinc was not sufcient to improve
their nutritional status.
The present study found that, although yacon did not improve
the nutritional status of iron and zinc in preschool children, it
promoted immunologic effects, with higher production of sgA
and IL-4. The clinical consequences of the immunomodulation
mediated by prebiotic supplementation are less fever, fewer
gastrointestinal and respiratory infections, and less atopic
dermatitis at an early age [28,43,44]. However, it should be
emphasized that although the well-proven effect of prebiotics
has been described in infants, more clinical studies are necessary
in older children [45].
Yacon is a promising source of prebiotic FOS to be included in
childrens diets with potential health benets, considering the
effects in the local and systemic immune response. Further
studies should be carried out to evaluate the mechanisms associated with the intestinal environment.

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