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Exploring choices of early nutritional support for patients with sepsis based on changes in intestinal microecology.
Yang, XJ, Wang, XH, Yang, MY, Ren, HY, Chen, H, Zhang, XY, Liu, QF, Yang, G, Yang, Y, Yang, XJ
World journal of gastroenterology. 2023;29(13):2034-2049
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Sepsis is a condition brought about by infection and results in organ dysfunction and gut microbiota imbalance. Nutrition plays a large part in recovery from sepsis, however it is unclear as to the optimal diet for gut microbial balance in individuals with sepsis. This randomised control trial of 30 individuals with sepsis aimed to determine the optimal delivery of nutrition for gut microbial health either through a gastric tube (TEN), through the jugular vein (TPN), or a mixture of the two modes (SPN). The results showed differences in gut microbiota composition between the different modes of nutrition. Enterococcus increased in TEN, Campylobacter decreased in TPN, and Dialister decreased in SPN groups. Fermentation products produced by gut microbiota also changed depending on the mode of nutrition, with the TEN group showing improvements amongst the most fermentation products. Individuals in the TEN group also showed improved immune system function alongside those in the SPN group. It was concluded that based upon improvements to the immune system and gut microbiota, TEN is the most suitable mode for nutrition in individuals with sepsis. This study could be used by healthcare professionals to understand that nutrition methods for individuals with sepsis aren’t equally effective and recovery may be faster if individuals receive nutrition through a gastric tube.
Abstract
BACKGROUND Sepsis exacerbates intestinal microecological disorders leading to poor prognosis. Proper modalities of nutritional support can improve nutrition, immunity, and intestinal microecology. AIM: To identify the optimal modality of early nutritional support for patients with sepsis from the perspective of intestinal microecology. METHODS Thirty patients with sepsis admitted to the intensive care unit of the General Hospital of Ningxia Medical University, China, between 2019 and 2021 with indications for nutritional support, were randomly assigned to one of three different modalities of nutritional support for a total of 5 d: Total enteral nutrition (TEN group), total parenteral nutrition (TPN group), and supplemental parenteral nutrition (SPN group). Blood and stool specimens were collected before and after nutritional support, and changes in gut microbiota, short-chain fatty acids (SCFAs), and immune and nutritional indicators were detected and compared among the three groups. RESULTS In comparison with before nutritional support, the three groups after nutritional support presented: (1) Differences in the gut bacteria (Enterococcus increased in the TEN group, Campylobacter decreased in the TPN group, and Dialister decreased in the SPN group; all P < 0.05); (2) different trends in SCFAs (the TEN group showed improvement except for Caproic acid, the TPN group showed improvement only for acetic and propionic acid, and the SPN group showed a decreasing trend); (3) significant improvement of the nutritional and immunological indicators in the TEN and SPN groups, while only immunoglobulin G improved in the TPN group (all P < 0.05); and (4) a significant correlation was found between the gut bacteria, SCFAs, and nutritional and immunological indicators (all P < 0.05). CONCLUSION TEN is recommended as the preferred mode of early nutritional support in sepsis based on clinical nutritional and immunological indicators, as well as changes in intestinal microecology.
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Effects of exercise intensity on gut microbiome composition and function in people with type 2 diabetes.
Torquati, L, Gajanand, T, Cox, ER, Willis, CRG, Zaugg, J, Keating, SE, Coombes, JS
European journal of sport science. 2023;23(4):530-541
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While it is well known that gut microbiome composition is both inherited and mostly modulated by diet, emerging evidence suggests regular exercise is associated with higher microbial diversity and health promoting taxa. The aim of this study was to examine whether different intensities of exercise exert differential effects on gut microbiome composition and function in low-active people with type 2 diabetes (T2D). This study was a sub-study of the Exercise for Type 2Diabetes (E4D) Study. Fourteen participants volunteered for this sub-study and were randomised into one of the two exercise groups. Results showed that: - in low active people with T2D, moderate intensity, longer duration exercise resulted in increased Bifidobacterium and Escherichia genera, A. municiphila, and butyrate-producing taxa from orders Lachnospirales and Clostridium Cluster IV. - higher intensity exercise also increased butyrate producers, but from different orders (Eryspelothrichales and Oscillospirales), and less investigated species (M.smithii, Negativibacilli spp). - there were no changes in gut microbiome metabolites (short-chain fatty acids). Authors concluded that over an 8-week training intervention, exercise intensity had differing effects on the abundance of specific gut microbiome taxa and function in low active people with T2D.
Abstract
Exercise is positively associated with higher microbial diversity, but there is limited information on exercise intensity's effect on gut microbiome composition and function in clinical populations. This study examines whether different intensities of exercise exert differential effects on gut microbiome composition and function in low active people with type 2 diabetes. This is a sub-study of the Exercise for Type 2 Diabetes Study, a single centre, prospective, randomised controlled trial. Participants (n = 12) completed 8-weeks of combined aerobic and resistance moderate intensity continuous training (C-MICT) or combined aerobic and resistance high-intensity interval training (C-HIIT). Faecal samples were collected before and after intervention to measure gut microbiome composition and metabolic pathways (metagenome shotgun sequencing) and short-chain fatty acids. Post-exercise α-diversity was different between groups as was the relative abundance of specific taxa was (p < .05). Post-exercise relative abundance of Bifidobacterium, A. municiphila, and butyrate-producers Lachnospira eligens, Enterococcus spp., and Clostridium Cluster IV were higher at lower exercise intensity. Other butyrate-producers (from Eryspelothrichales and Oscillospirales), and methane producer Methanobrevibacter smithii were higher at higher exercise intensity. Pyruvate metabolism (ko00620),COG "Cell wall membrane envelope biogenesis" and "Unknown function" pathways were significantly different between groups and higher in C-MICT post-exercise. Differential abundance analysis on KO showed higher expression of Two-component system in C-HIIT. Transcription factors and "unknown metabolism" related pathways decreased in both groups. There were no significant between group changes in faecal short chain fatty acids. Exercise intensity had a distinct effect on gut microbiome abundance and metabolic function, without impacting short-chain fatty acid output.HighlightsEvidence of exercise effect on gut microbiome outcomes is limited to healthy and athletic populationsIn low active people with type 2 diabetes, different exercise intensities increased specific health promoting and butyrate producers species, and showed differentially abundant gut microbiome metabolic pathways.Further investigation is warranted, and if this supports the present findings, then specific exercise intensities may be promoted to target specific species and optimise gut health.
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The Effect of Kefir Supplementation on Improving Human Endurance Exercise Performance and Antifatigue.
Lee, MC, Jhang, WL, Lee, CC, Kan, NW, Hsu, YJ, Ho, CS, Chang, CH, Cheng, YC, Lin, JS, Huang, CC
Metabolites. 2021;11(3)
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Compared to sedentary people, athletes exhibit a much more abundant and diverse composition of gut bacteria. Hence the relationship between gut microbes and energy usage and exercise performance has attracted much attention in recent years. Probiotics and prebiotic-related products have demonstrated the potential to enhance metabolic pathways and influence energy levels, energy consumption and exercise performance. And previous studies demonstrated positive effects on exercise endurance associated with the consumption of kefir, a fermented dairy product containing Lactobacilli species as part of the microbial symbiosis. This study investigated whether kefir can promote changes in the gut microbiota, improve exercise endurance performance, and influences fatigue during and after exercise. The study enrolled sixteen, untrained 20–30-year-old for a double-blind crossover design study, supplementing with SYNKEFIR™ for 28 days whilst observing changes in metabolic markers, body composition, exercise endurance and faecal gut bacteria. In summary, supplementation with SYNKEFIR™ significantly improved exercise performance and reduced the production of lactic acid after exercise. In addition, kefir supplementation seemed to reduce fatigue and accelerated the recovery from fatigue after exercise, with a marked reduction in lactic acid production after exercise. Though kefir supplementation had no significant effect on other post-exercise fatigue biochemical indicators nor did it induce notable changes in gut bacteria composition. As SYNKEFIR™ is a starter culture isolated from traditional kefir it could be expected that other traditional kefir products would have similar effects. Kefir as a food product is suited to a wide range of people, and it could be considered part of a healthy diet plan for untrained individuals wishing to support their exercise performance.
Abstract
Kefir is an acidic, carbonated, and fermented dairy product produced by fermenting milk with kefir grains. The Lactobacillus species constitutes an important part of kefir grains. In a previous animal study, kefir effectively improved exercise performance and had anti-fatigue effects. The purpose of this research was to explore the benefits of applying kefir to improve exercise performance, reduce fatigue, and improve physiological adaptability in humans. The test used a double-blind crossover design and supplementation for 28 days. Sixteen 20-30 year-old subjects were divided into two groups in a balanced order according to each individual's initial maximal oxygen uptake and were assigned to receive a placebo (equal flavor, equal calories, 20 g/day) or SYNKEFIR™ (20 g/day) every morning. After the intervention, there were 28 days of wash-out, during which time the subjects did not receive further interventions. After supplementation with SYNKEFIR™, the exercise time to exhaustion was significantly greater than that before ingestion (p = 0.0001) and higher than that in the Placebo group by 1.29-fold (p = 0.0004). In addition, compared with the Placebo group, the SYNKEFIR™ administration group had significantly lower lactate levels in the exercise and recovery (p < 0.05). However, no significant difference was observed in the changes in the gut microbiota. Although no significant changes in body composition were found, SYNKEFIR™ did not cause adverse reactions or harm to the participants' bodies. In summary, 28 days of supplementation with SYNKEFIR™ significantly improved exercise performance, reduced the production of lactic acid after exercise, and accelerated recovery while also not causing any adverse reactions.
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Intensive, prolonged exercise seemingly causes gut dysbiosis in female endurance runners.
Morishima, S, Aoi, W, Kawamura, A, Kawase, T, Takagi, T, Naito, Y, Tsukahara, T, Inoue, R
Journal of clinical biochemistry and nutrition. 2021;68(3):253-258
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Athletes are more predisposed to experience gastrointestinal disorders after practices and competition, which is known as exercise-induced gastrointestinal syndrome. The aim of this study was to understand the effect of highly intensive endurance exercise on the gut microbiota for the possible development of future treatments of exercise-induced gastrointestinal disorders. The study compared the gut environment (gut microbiota and its metabolites) between female elite endurance runners and non-athletic, but healthy women of similar age living within close geographic locations. Results indicate that female elite endurance runners had gut microbiotas and metabolites profiles that differed from those observed in age-matching female controls. Furthermore, the female elite endurance runners had higher levels of the gut bacteria, Faecalibacterium. Authors conclude that further studies are needed to evaluate the relationship between the microbiota and the production of bacterial metabolites in the gut of athletes.
Abstract
Intensive, prolonged exercise is known to induce gastrointestinal disorders such as diarrhea, with gut dysbiosis suggested as being one of the causatives. In the present study, we wanted to investigate the relationship between intensive exercise and the gut microbiota status. To that end, the microbiota, the moisture content and the bacterial metabolites (e.g., organic acids) of female endurance runners (n = 15) and those of non-athletic but healthy, age-matching female controls (n = 14) were compared. The analysis of the gut microbiota analysis showed that, unlike control subjects, female endurance runners had distinct microbiotas, with some bacteria found in higher abundances likely being involved in gut inflammation. The concentration of succinate, a gut bacterial metabolite regarded as undesirable when accumulated in the lumen, was significantly (p<0.05) higher in the female endurance runners. Faecalibacterium, that was significantly (p<0.05) abundant in female endurance runners, can produce succinate in certain environments and hence may contribute to succinate accumulation, at least partly. The present work suggested that the gut microbiotas of female endurance runners are seemingly dysbiotic when compared with those of control subjects. Further investigation of the mechanism by which intensive, prolonged exercise affects the gut microbiota is recommended.
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Protective effect of probiotics in patients with non-alcoholic fatty liver disease.
Cai, GS, Su, H, Zhang, J
Medicine. 2020;99(32):e21464
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Non-alcoholic fatty liver disease (NAFLD) is common in people with obesity and is characterised by high amounts of fat stored in the liver. Diet and exercise are the standard treatments, however recent studies have indicated that the gut microbiota may have an important role. This randomised control trial of 140 patients with NAFLD, aimed to assess the effect of probiotics when added to standard therapy for 3 months. The results showed that although gut microbiota, some aspects of liver function, blood lipids and blood sugars were all improved in individuals on standard therapy, there were additional improvements in those on standard therapy plus probiotics. It was concluded that although standard therapy alone is adequate to improve NAFLD, probiotics plus standard therapy was superior to standard therapy alone and effective in treatment of NAFLD. This study could be used by health professionals to justify the addition of probiotics to standard therapy to further improve NAFLD outcomes.
Abstract
To investigate the effects of probiotics on liver function, glucose and lipids metabolism, and hepatic fatty deposition in patients with non-alcoholic fatty liver disease (NAFLD).Totally 140 NAFLD cases diagnosed in our hospital from March 2017 to March 2019 were randomly divided into the observation group and control group, 70 cases in each. The control group received the diet and exercise therapy, while the observation group received oral probiotics based on the control group, and the intervention in 2 groups lasted for 3 months. The indexes of liver function, glucose and lipids metabolism, NAFLD activity score (NAS), and conditions of fecal flora in 2 groups were compared before and after the treatment.Before the treatment, there were no significant differences on alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamine transferase (GGT), total bilirubin (TBIL), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), insulin resistance index (HOMA-IR), NAFLD activity score (NAS), and conditions of fecal flora in 2 groups (P > .05). After the treatment, ALT, AST, GGT, TC, TG, HOMA-IR, NAS, and conditions of fecal flora in the observation group were better than those in the control group, and the observation group was better after treatment than before. All these above differences were statistically significant (P < .05).Probiotics can improve some liver functions, glucose and lipids metabolism, hepatic fatty deposition in patients with NAFLD, which will enhance the therapeutic effects of NAFLD.
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The microbiome of professional athletes differs from that of more sedentary subjects in composition and particularly at the functional metabolic level.
Barton, W, Penney, NC, Cronin, O, Garcia-Perez, I, Molloy, MG, Holmes, E, Shanahan, F, Cotter, PD, O'Sullivan, O
Gut. 2018;67(4):625-633
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The human gut microbiome is known to actively influence metabolism, immunity and development. It has been shown that increased physical activity and healthy diet is associated with positive changes in faecal microbial diversity and composition compared with sedentary individuals. The aim of this study was to assess the metabolic activity of the microbiota between extremely active and sedentary individuals. Metabolic and genetic factors of the gut microbiome were analysed in 40 professional rugby players and 46 sedentary controls. This study found significant differences in faecal microbiota between athletes and sedentary controls at the functional metabolic level, providing deeper insight into the link between sustained physical activity and metabolic health. Based on these results, the authors conclude exercise may be an effective way to manipulate the gut microbiome and suggest further controlled trials be done to better understand the relationship between diet, exercise and the gut microbiome.
Abstract
OBJECTIVE It is evident that the gut microbiota and factors that influence its composition and activity effect human metabolic, immunological and developmental processes. We previously reported that extreme physical activity with associated dietary adaptations, such as that pursued by professional athletes, is associated with changes in faecal microbial diversity and composition relative to that of individuals with a more sedentary lifestyle. Here we address the impact of these factors on the functionality/metabolic activity of the microbiota which reveals even greater separation between exercise and a more sedentary state. DESIGN Metabolic phenotyping and functional metagenomic analysis of the gut microbiome of professional international rugby union players (n=40) and controls (n=46) was carried out and results were correlated with lifestyle parameters and clinical measurements (eg, dietary habit and serum creatine kinase, respectively). RESULTS Athletes had relative increases in pathways (eg, amino acid and antibiotic biosynthesis and carbohydrate metabolism) and faecal metabolites (eg, microbial produced short-chain fatty acids (SCFAs) acetate, propionate and butyrate) associated with enhanced muscle turnover (fitness) and overall health when compared with control groups. CONCLUSIONS Differences in faecal microbiota between athletes and sedentary controls show even greater separation at the metagenomic and metabolomic than at compositional levels and provide added insight into the diet-exercise-gut microbiota paradigm.