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A Specifically Tailored Multistrain Probiotic and Micronutrient Mixture Affects Nonalcoholic Fatty Liver Disease-Related Markers in Patients with Obesity after Mini Gastric Bypass Surgery.
Crommen, S, Rheinwalt, KP, Plamper, A, Simon, MC, Rösler, D, Fimmers, R, Egert, S, Metzner, C
The Journal of nutrition. 2022;(2):408-418
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Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is frequent among patients undergoing bariatric surgery. Beyond weight reduction, dietary supplements like micronutrients or probiotics that modify insulin resistance and lipotoxicity can be used to prevent or delay the progression of liver disease. OBJECTIVES We evaluated the effect of a dietary approach with a specifically tailored multistrain probiotic and micronutrient mixture compared with a basic care micronutrient supplement on serum alanine aminotransferase (ALAT) in obese patients after mini gastric bypass (MGB) surgery. METHODS This randomized, double-blind, controlled trial included 60 obese patients (age: 40 ± 10 y; BMI: 44 ± 3 kg/m²). Patients received a combination of specifically tailored multistrain probiotic powder and a specific micronutrient mixture (Pro+SM) or a control treatment consisting of a placebo and a basic care micronutrient mixture (Con+BM), with some micronutrients in lower doses than SM, for 12 wk after hospital discharge. Primary (serum ALAT) and secondary outcomes [serum aspartate aminotransferase (ASAT), fatty liver index, NAFLD fibrosis score, glucose metabolism, blood pressure (BP), heart rate] were assessed at week 0 and week 12. Data were analyzed using unpaired Student's t-tests or Mann-Whitney U tests to compare the changes due to each treatment to one another. RESULTS A total of 48 patients were included in the analyses. Changes in serum ALAT concentrations did not differ between groups. Compared with Con+BM, Pro+SM improved serum ASAT (difference: -8.0 U/L, 95% CI: -17.0, -4.0; P = 0.043), NAFLD fibrosis score (difference: -0.39; 95% CI: -0.78, 0; P = 0.048), serum triglycerides (difference: -22.8 mg/dL; 95% CI: -45.6, -0.1; P = 0.049) and the visceral adiposity index (difference: -0.70; 95% CI: -1.31, -0.08; P = 0.027). CONCLUSION Supplementation with a specifically tailored probiotic and micronutrient mixture improved NAFLD-related markers more than a basic micronutrient mixture in obese patients following MGB surgery. The trial was registered under clinicaltrials.gov as NCT03585413.
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Coping Strategies Influence Cardiometabolic Risk Factors in Chronic Psychological Stress: A Post Hoc Analysis of A Randomized Pilot Study.
Armborst, D, Bitterlich, N, Alteheld, B, Rösler, D, Metzner, C, Siener, R
Nutrients. 2021;14(1)
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Chronic psychological stress is increasingly recognized as a significant contributor to mental and physiological disorders in modern societies. The individual response to chronic stressors and resulting disorders depends on numerous factors. The aim of this study was to investigate the cardiometabolic risk profile in participants with ‘high’ and ‘very high’ chronic stress loads and the impact of positive and negative coping factors used. This study is a post hoc analysis of a randomised pilot study. For this analysis, baseline data were available for 62 chronic psychologically stressed participants, of whom 61 participants (43 women and 18 men) were included in the intention-to-treat (ITT) population. Results indicate that: - perceiving high chronic stress is significantly associated with the criteria of the metabolic syndrome. - on the contrary, a very high perceived chronic stress load seemed to be rather associated with mental health risk than with cardiometabolic risk. - inflammation and oxidative stress markers significantly correlated with cardiometabolic risk parameters. - stress load can be coped with in diverse ways and that the coping strategy is crucial for cardiometabolic risk. Authors conclude that long-term studies are necessary to examine further adaptations to chronic stress and to evaluate individual stress-management strategies.
Abstract
Chronic psychological stress can result in physiological and mental health risks via the activation of the hypothalamic-pituitary-adrenal (HPA) axis, sympathoadrenal activity and emotion-focused coping strategies. The impact of different stress loads on cardiometabolic risk is poorly understood. This post hoc analysis of a randomized pilot study was conducted on 61 participants (18-65 years of age) with perceived chronic stress. The Perceived Stress Questionnaire (PSQ30), Psychological Neurological Questionnaire (PNF), anthropometric, clinical and blood parameters were assessed. Subjects were assigned to 'high stress' (HS; PSQ30 score: 0.573 ± 0.057) and 'very high stress' (VHS; PSQ30 score: 0.771 ± 0.069) groups based on the PSQ30. Morning salivary cortisol and CRP were elevated in both groups. Visceral adiposity, elevated blood pressure and metabolic syndrome were significantly more frequent in the HS group vs. the VHS group. The fatty liver index (FLI) was higher (p = 0.045), while the PNF score was lower (p < 0.001) in the HS group. The HS group was comprised of more smokers (p = 0.016). Energy intake and physical activity levels were similar in both groups. Thus, high chronic stress was related to visceral adiposity, FLI, elevated blood pressure and metabolic syndrome in the HS group, while very high chronic stress was associated with psychological-neurological symptoms and a lower cardiometabolic risk in the VHS group, probably due to different coping strategies.
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Impact of a Specific Amino Acid Composition with Micronutrients on Well-Being in Subjects with Chronic Psychological Stress and Exhaustion Conditions: A Pilot Study.
Armborst, D, Metzner, C, Alteheld, B, Bitterlich, N, Rösler, D, Siener, R
Nutrients. 2018;(5)
Abstract
Chronic work-life stress leads to dysfunction of the hypothalamus⁻pituitary⁻adrenal axis, the autonomic nervous system, and the serotonergic system, with resultant impairment of overall well-being. Aim of the study was to improve perceived stress by a specific amino acid composition with micronutrients in the verum versus placebo group. A total of 59 participants (18⁻65 years) with self-reported perceived chronic stress and exhaustion conditions participated in this randomized, double-blind, placebo-controlled study. The Perceived Stress Questionnaire (PSQ30), amino acid profile, anthropometric, clinical, blood, urine parameters, and dietary intake were assessed. After 12 weeks, the verum group achieved significantly greater improvements in the total PSQ30 score compared with the placebo group. In the verum group, serum taurine concentration, folic acid concentration, urinary magnesium excretion, and the ratio of l-tryptophan to the sum of competing amino acids rose significantly. In the placebo group, serum concentrations of serotonin, protein, and magnesium decreased significantly, whereas the cardiometabolic risk parameters body weight, body mass index, waist circumference, and waist-to-height ratio increased significantly. Compared with placebo, the verum supplementation resulted in a higher improvement in perceived stress. Beneficial effects on the serotonergic system and preventive effects on magnesium homeostasis and some cardiometabolic risk factors were supposed. Additional effects might be caused by the optimized food intake.
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Dietary intervention with a specific micronutrient combination for the treatment of patients with cardiac arrhythmias: the impact on insulin resistance and left ventricular function.
Parsi, E, Bitterlich, N, Winkelmann, A, Rösler, D, Metzner, C
BMC cardiovascular disorders. 2018;(1):220
Abstract
BACKGROUND Cardiac arrhythmias (CA) are very common and may occur with or without heart disease. Causes of these disturbances can be components of the metabolic syndrome (MetS) or deficits of micronutrients especially magnesium, potassium, B vitamins and coenzyme Q10. Both causes may also influence each other. Insulin resistance (IR) is a risk factor for diastolic dysfunction. One exploratory outcome of the present pilot study was to assess the impact of a dietary intervention with specific micronutrients on the lowering of IR levels in patients with CA with the goal to improve the left ventricular (LV) function. METHODS This was a post hoc analysis of the randomized double blind, placebo-controlled pilot study in patients with CA (VPBs, SVPBs, SV tachycardia), which were recruited using data from patients who were 18-75 years of age in an Outpatient Practice of Cardiology. These arrhythmias were assessed by Holter ECG and LV function by standard echocardiography. Glucose metabolism was measured by fasting glucose, fasting insulin level and the Homeostasis Model Assessment of IR (HOMA-IR) at baseline and after 6 weeks of dietary supplementation. RESULTS A total of 54 randomized patients with CA received either a specific micronutrient combination or placebo. Dietary intervention led to a significant decrease in fasting insulin ≥58 pmol/l (p = 0.020), and HOMA-IR (p = 0.053) in the verum group after 6 weeks. At the same time, parameters of LV diastolic function were improved after intervention in the verum group: significant reduction of LV mass index (p = 0.003), and in tendency both a decrease of interventricular septal thickness (p = 0.053) as well as an increase of E/A ratio (p = 0.051). On the other hand, the premature beats (PBs) were unchanged under verum. CONCLUSIONS In this pilot study, dietary intervention with specific micronutrient combination as add-on to concomitant cardiovascular drug treatment seems to improve cardio metabolic health in patients with CA. Further studies are required. STUDY REGISTRATION The study was approved by the Freiburg Ethics Commission International and was retrospectively registered with the U.S. National Institutes of Health Clinical Trials gov ID NCT 02652338 on 16 December 2015.
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Has a mixture of amino acids and micronutrients influence on glucose metabolism and dietary fatty acid pattern in chronic psychosocially stressed persons? A pilot study.
Bitterlich, N, Chaborski, K, Parsi, E, Rösler, D, Metzner, C
International journal of food sciences and nutrition. 2016;(2):195-202
Abstract
Brain food, e.g. L-tryptophan, antioxidative substances, B vitamins and magnesium are thought to be beneficial for obesity, inflammation and insulin resistance. In the present pilot study we hypothesised that a specific amino acid mixture with micronutrients improves the cardiometabolic situation of chronically stressed persons. Cardiovascular and metabolic parameters were analysed as per protocol in 32 patients. Chronic stress disorders in the same patients were assessed by a psychological neurological questionnaire (PNF). After dietary intervention a reduction of the fasting serum insulin concentrations occurred in the treatment group. An association was found between PNF values, insulin concentrations at baseline and an insulin reduction after 12 weeks. The results support the use of our specific dietary supplement for improved stress management and a decrease in metabolic dysfunction.
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[Reduction of influenza-like infections by a phytoextract-vitamin-combination: a randomized, double-blind, placebo-controlled study].
Rösler, D, Fuchs, N, Markolin, G, Edler, B, Kuklinski, B, Kästenbauer, T
MMW Fortschritte der Medizin. 2012;:115-22
Abstract
BACKGROUND Recurrent infections are signs of a weakened immune system, and can be traced to a lack of vitamins and minerals. The objective of this study was to investigate the effect of a nutriological combination of vitamins, trace elements and phytochemicals on the incidence and duration of influenza-like infections. METHODS Healthy subjects at risk of increased infection exposure took part in a randomized, double-blind, placebo controlled study, each involving a supplementation period of 12 weeks. The occurrence and severity of influenza-like infections and resort to study medication was documented by diary entries. SF-36 questionnaires to measure the health-related quality of life were completed at the start and end of the study. At final examination compliance was examined with respect to returned study medication, diaries and a questionnaire administered to evaluate the effect, safety, and tolerability of the test substance. RESULTS Of 100 randomized participants, 80 (38 test treatment and 42 placebo) completed the study according to the protocol. In the test treatment group there were 60 influenza-like infections (1.6 infections/12 weeks), significantly fewer (p = 0.0003) compared with the placebo group with 113 episodes (2.7 infections/12 weeks). Further, the average number of days that the infection lasted was shorter in the test treatment group at 10.0 +/- 6.7 days, which was significantly shorter (p = 0.0003) than the placebo group at 28.5 +/- 13.6 days. The influenza-like symptom score and the mean duration of sick leave did not differ statistically between groups. Participants in the test treatment group assessed the global effectiveness of the test substance significantly better (p < 0.0001) than the participants of the placebo group. At the beginning of the study there was no difference between groups with respect to SF-36 results. However, at the completion of the study 6 of the 8 scales of SF-36 in the test treatment group were significantly better compared with the placebo group. CONCLUSION In summary, consumption of the complex nutriological test preparation was associated with a significant reduction in the incidence of influenza-like infections, as well as their duration, and it was associated with significantly improved vitality, social functioning, and psychological well-being.