Mulberry leaf benefits the intestinal epithelial barrier via direct anti-oxidation and indirect modulation of microbiota in pigs

BACKGROUND

Diarrhea and intestinal dysfunction commonly occur in young mammals, causing malnutrition and growth retardation in both human and livestock. As the traditional Chinese herb, mulberry leaf contains various bioactive compounds and showed several health benefits, such as regulating glucose and lipid metabolism, and modulating gut microbiota. Mulberry leaf exhibits the potential to modulate redox homeostasis and improve gut health, but the function and underlying mechanisms remains elucidative.

PURPOSE

To investigate the benefit of mulberry leaf on intestinal barrier in weanling pigs, illustrate the possible involvement of Keap1-Nrf2 mediated anti-oxidation and gut microbiota.

METHODS

Chemical compositions of mulberry leaf powder (MLP) and mulberry leaf extract (MLE) were determined. The effects of MLP on growth performance, intestinal barrier integrity, anti-oxidative capacity, immune function and gut microbiota were evaluated in weaned pigs. The regulation of redox homeostasis by MLE and the involvement of Keap1-Nrf2 signaling were further determined in H2O2 induced oxidative stress (OS) model in IPEC-J2 cells via determining reactive oxygen species (ROS) production by flow cytometry and related protein abundance by western blot analysis.

RESULTS

In weanling pigs, MLP reduced diarrhea incidence, and increased villus height, intestinal integrity and expression of tight junctions in intestinal mucosa. The improvement of intestinal barrier by MLP was associated with the enhancement in anti-oxidative capacity and the changes in gut microbiota and related short chain fatty acids production. Our study further revealed the direct regulation of MLE on tight junction expressions and ROS production to alleviate H2O2 induced OS in IPEC-J2 cells via the activating Keap1-Nrf2 signaling pathway.

CONCLUSIONS

Mulberry leaf in diet improved epithelial barrier via the direct anti-oxidation through the activation of Keap1-Nrf2 signaling pathway and the indirect modulation of gut microbiota in weaned pigs.

Low-carbohydrate diets in East Asians with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials

AIMS

Despite the reported success of low-carbohydrate diets in improving glycemic control in the Western countries, no studies have investigated the effects of such diets in Asians. We aimed to conduct a systematic review and meta-analysis of randomized controlled trials to examine the effects of low-carbohydrate diets on glycemic control in East Asian adults.

MATERIALS AND METHODS

We systematically searched the PubMed, Cochrane Library, and Embase databases from inception to June 28, 2023, to identify randomized controlled trials examining the efficacy of low-carbohydrate diets in patients with type 2 diabetes (PROSPERO number CRD 42023453007). The primary outcome was the difference in glycated hemoglobin levels between the low-carbohydrate diet and control groups. The secondary outcome was the difference in body mass index, fasting blood glucose level, blood pressure, and lipid profile.

RESULTS

Six randomized controlled trials met the eligibility criteria. The study duration ranged from 3 to 18 months, with five studies conducted within 6 months. The results showed that low-carbohydrate diets were more beneficial in lowering glycated hemoglobin levels and body mass index than control diets. The risk of bias for the six studies was minimal for two and moderate for four. The heterogeneity among the studies was low.

CONCLUSIONS

Low-carbohydrate diets improved glycated hemoglobin levels and body mass index in East Asians compared with control diets. Therefore, carbohydrate restriction may be effective for glycemic management in East Asians with type 2 diabetes for at least 6 months.

Dynamic change of gut microbiota in head and neck concurrent chemoradiotherapy patients and its potential value in the prediction of acute oral mucositis grade as well as quality of life

PURPOSE

Radiotherapy is the major therapy for head and neck squamous cell carcinoma (HNSCC). However, whether gut microbiota changes in HNSCC patients who received concurrent chemoradiotherapy remains unclear. This study aimed to investigate the dynamic change of gut microbiota composition, construct the first radiotherapy-related gut microbiota database in these patients and identify the potential value of the gut microbiota changing in the prediction of acute oral mucositis grade as well as patients' life quality.

METHODS

We enrolled 47 HNSCC patients who scheduled with concurrent chemoradiotherapy. The field was irradiated with a total dose of 66-70 Gy in 33-35 fractions. All the patients received 2-3 cycles of platinum-based chemotherapy. After feces specimens collected, bacterial genomic DNA was isolated using magnetic beads and then analyzed by the Illumina MiSeq Sequencing System based on the V3-V4 hypervariable regions of the 16S rRNA gene.

RESULTS

194 genera which belonged to 27 phyla were found in 141 samples. Increased abundance of microbiota in diversity and richness was observed in mid-radiotherapy group. Bacteroides, Blautia, Phascolarctobacterium were three main genera in all three groups and the mid-radiotherapy group had the highest relative abundance of Phascolarctobacterium. What is more, most significantly altered bacteria shared the same variation pattern which was increased in mid-radiotherapy while decreased to the almost same level of as pre-radiotherapy in post-radiotherapy group. Further analysis indicated that Bacteroidetes showing an upward trend while Proteobacteria declining in higher grade of acute mucositis. Moreover, relatively low abundant Proteobacteria was significantly correlated with high-grade acute oral mucositis. As for the quality of life, Lactobacillales and Actinomycetales were specifically found in better life quality group. However, Clostridia_UCG_014, Eubacteriaceae, UCG_010 and Moraxellaceae were unique abundantly present in worse life quality group.

CONCLUSION

Chemoradiotherapy can affect the composition of the gut microbiota in HNSCC patients during the mid-term of treatment. Yet self-stabilized ability maintained the gut microbiota homeostasis. Dynamic change of specific species could help predict acute oral mucositis grade and characterize different quality of life group in these patients.

Reflux, eosinophilic esophagitis, and celiac disease - the blurred lines

PURPOSE OF REVIEW

Gastroesophageal reflux disease (GERD) is a commonly recognized cause of dysphagia. Conversely, eosinophilic esophagitis (EoE) and celiac disease are rarer and often overlooked as dysphagia culprits. Overlap between these conditions complicates diagnosis and delays appropriate treatment. This review aims to clarify the distinctive dysphagia characteristics in each condition, explore potential overlaps, and offer guidance on differentiation.

RECENT FINDINGS

Recent studies have advanced our understanding of dysphagia mechanisms in GERD, EoE, and celiac disease, particularly in characterizing disordered motility and dysphagia's natural history. While upper endoscopy, biopsies, and manometry remain crucial in dysphagia assessment, novel diagnostic tools are emerging. New insights highlight the significance of cytokine-induced mucosal injury in all three conditions, revealing potential connections where mucosal damage in one disorder may contribute to the development of others.

SUMMARY

GERD, EoE, and celiac disease can coexist and present with similar symptoms. Distinguishing between them often entails upper endoscopy, esophageal biopsies, pH testing, and celiac serologies. EoE should be considered when GERD patients fail proton pump inhibitor therapy or when celiac patients have persistent esophageal symptoms despite a gluten-free diet. Consider celiac disease if dysphagia accompanies iron deficiency anemia, malabsorptive diarrhea, or osteoporosis. Recognizing the potential overlap between these conditions is crucial for guiding clinical evaluation and therapy.

Integration of observational and causal evidence for the association between adiposity and 17 gastrointestinal outcomes: An umbrella review and meta-analysis

We systematically reviewed observational and Mendelian randomization (MR) articles that evaluated the association between obesity and 17 gastrointestinal (GI) diseases to integrate causal and observational evidence. A total of 594 observational studies from 26 systematic reviews and meta-analyses and nine MR articles were included. For every 5 kg/m2 increase in body mass index (BMI), there was an increased risk of GI diseases ranging from 2% for rectal cancer (relative risk [RR]: 1.02, 95% confidence interval [CI]: 1.01 to 1.03) to 63% for gallbladder disease (RR: 1.63, 95% CI: 1.50 to 1.77). MR articles indicated that risks of developing GI diseases elevated with each 1 standard deviation increase in genetically predicted BMI, ranging from 11% for Crohn's disease to 189% for nonalcoholic fatty liver disease. Moreover, upper GI conditions were less susceptible, whereas hepatobiliary organs were more vulnerable to increased adiposity. Among the associations between obesity and the 17 GI conditions, causal relationships were inferred from only approximately half (10/17, 59%). This study reveals a substantial gap between observational and causal evidence, indicating that a combined approach is necessary to effectively inform public health policies and guide epidemiological research on obesity and GI diseases.

Malnutrition prevalence in hospitalized pediatric patients: A comparison of national and World Health Organization growth standards

BACKGROUND

The aim of the study was to investigate the frequency of malnutrition in hospitalized children and compare national growth standards with World Health Organization (WHO) standards.

METHODS

After obtaining height, weight, and mid-upper arm circumference values for 250 children aged 1 month to 5 years, nutrition status was assessed separately according to Neyzi and WHO standards. Weight-for-age z score (WAZ), weight-for-height z score (WHZ), height-for-age z score (HAZ), and mid-upper arm circumference z score (MUACz) were calculated based on age. Patients with WHZ < -2 were considered to have acute malnutrition, while those with HAZ < -2 were considered to have chronic malnutrition per WHO's definition.

RESULTS

According to the WHO and Neyzi standards, the z scores were as follows: WAZ (-0.53 ± 1.54/-0.61 ± 1.52), HAZ (-0.42 ± 1.61/-0.45 ± 1.38), WHZ (-0.33 ± 1.26/none), MUACz (-0.58 ± 1.31/none). The difference between WAZ scores for the two standards was highly significant (P = 0.0001), whereas the difference between HAZ scores didn't reach statistical significance (P = 0.052). In our study when evaluated according to WHO standards, the prevalence of acute and chronic malnutrition was 9.6% and 13.6%, respectively. The prevalence of chronic malnutrition in those aged <2 years was higher than in the 2-5 years age group (16.8% and 4.5%, respectively; P = 0.012).

CONCLUSION

There were highly significant differences in the assessment of malnutrition between the WHO and national Neyzi according to WAZ standards, contradicting the claim that WHO curves can be universally applicable. The high rates of acute and chronic malnutrition in our study indicate that malnutrition remains a significant nutrition problem in our country.

Is HLA-DQ typing useful in screening for celiac disease among Arabs with type 1 diabetes? A case-control study

OBJECTIVES

The data on the usefulness of DQ-typing in screening for celiac disease (CD) among type 1 diabetic (T1D) patients came from the West. We conducted this study among T1D patients to: (1) determine the frequency of DQ-genotypes, (2) assess the risk associated with human leukocyte antigen (HLA)-DQ genotypes, and (3) identify the cost-effective screening strategy.

METHODS

HLA-DQ genotyping was performed on 67 T1D patients with CD (cases) (mean age 15 years) and 224 T1D patients without CD (controls) (mean age 18.29 years) (2021-2023). The entry criterion for the control group was duration of T1D ≥5 years and negative annual celiac serology assay.

RESULTS

On comparison of the cases versus controls, T1D patients carrying homozygous DQ2.5 genotype (30% vs. 13.8%) or DR3-DQ2.5 haplotype (81.3% vs. 65.7%) showed significantly "higher risk" (odds ratio [OR] = 2.64, p = 0.002; OR = 2.3, p = 0.008, respectively) to develop CD. Only 4% do not harbor any of the CD-at risk genotypes (DQ2.5, DQ8, or DQ2.2) and none developed CD. Heterozygous DQ8 was associated with a significantly lower risk of developing CD with OR of 0.123 (1.5% in cases vs. 10.3% in controls, p = 0.022).

CONCLUSION

Only 4% of Saudi patients with T1D carry DQ-genotypes at no risk to develop CD, which supports the European guidelines that recommend celiac serology test as the most cost-effective screening method. We identified the risk gradient associated with DQ-genotypes to develop CD in our population which could help in counseling patients for the risk to develop CD and planning follow-up serology tests.

Exploring intimacy and family planning in Inflammatory Bowel Diseases: a qualitative study

BACKGROUND

Inflammatory bowel diseases (IBD), comprising ulcerative colitis and Crohn's disease, have a profound impact on people's lives. This study aims to investigate the perceived impact of IBD on sexual life and family planning to enhance understanding of the interplay between IBD, sexuality, intimacy and family planning to foster a better quality of life for those living with the condition.

MATERIALS AND METHODS

The study used the qualitative DIPEx method (Database of Personal Experiences of Health and Illness) developed by the Health Experiences Research Group at the University of Oxford, standardized for the Czech Republic. Semi-structured interviews with 36 participants (19 with Crohn's disease, 17 with ulcerative colitis) were conducted, employing open coding and thematic analysis. The maximum variation sampling was utilized, considering various factors, such as disease stage, medications, treatments, age, age at diagnosis and sociodemographic characteristics.

RESULTS

Five main topics emerged: sexual activity, body image and discomfort, partner relationships, family planning, and the role of gastroenterologists in family planning decisions. Participants' perceptions of sexuality varied, with some experiencing reduced sexual activity during acute phases of the disease. IBD had contrasting effects on partner relationships, and family planning was an important concern, with women valuing support and collaboration with their gastroenterologists in making pregnancy decisions. Information dissemination and open communication from professionals are highly needed.

CONCLUSIONS

This is the first study concerning the sexuality and family planning of people with IBD in the Czech Republic. It highlights the need for information and open communication from professionals.

Release of CM-12 from A2-type casein by the cleavage of Ser-Leu-Xaa at the C-terminus using Aspergillus oryzae alkaline protease

BACKGROUND

Aspergillus oryzae protease can release the opioid peptide β-casomorphin-10 (CM-10, YPFPGPIPNS, 60-69) from A2-type casein. However, not only is the yield of the active peptide low, but the key enzyme involved in processing has yet to be identified.

RESULTS

A significant amount of the opioid peptide 60YPFPGPIPNSLP71 (CM-12) was produced from the A2-type casein peptide 53AQTQSLVYPFPGPIPNSLPQNIPPLTQTPV82 when the active protease in A. oryzae protease extract was fractionated with DEAE-Sepharose. The fractionated enzyme produced CM-12 from bovine A2-type casein but not from bovine A1 casein. A major protein of 34 kDa was purified and identified as an alkaline protease (Alp). Motif prediction of the Alp cleavage site using Multiple EM for Motif Elicitation analysis revealed preferable cleavage at the C-terminal end of Ser-Leu-Xaa for the release of CM-12. A2-type casein hydrolysate by Alp exhibited similar levels of opioid activity to that of synthetic CM-12 in cAMP-Glo assays with μ-opioid receptor-expressing HEK293 cells. These results suggest that CM-12 is a major opioid peptide in the casein hydrolysate.

CONCLUSION

Our findings showed that Alp fractionated from A. oryzae protease extract produced the opioid peptide CM-12 from A2-type casein as a result of preferential cleavage at the C-terminal end of Ser-Leu-Xaa and the removal of coexisting enzymes. Moreover, docking predictions suggested a stable interaction between CM-12 and the 3D structure of Alp. Casein hydrolysate with Alp-containing CM-12 has the potential for use as a bioactive peptide material with opioid activity. © 2024 Society of Chemical Industry.

Advancements in the management of pediatric inflammatory bowel disease

INTRODUCTION

The management of pediatric inflammatory bowel disease (PIBD) has drastically changed in the last decade. The limited availability of new biologics or small molecule therapies, and concerns about durability in children has necessitated the development of other advances in management to optimize care.

AREAS COVERED

This review covers guidance for management targets and advances in optimizing biologic therapies, new medical therapies, adjuvant therapies, precision medicine and mental health concerns in PIBD. This review focused on recent advances and was not intended as a complete overview of the investigations and management of pediatric IBD.

EXPERT OPINION

Advancements include standardization of treatment goals via a treat-to-target strategy, optimizing anti-TNF biologics through combination therapy or proactive drug monitoring, earlier initiation of treatment for Crohn's disease, the emergence of new biologic/advanced therapies and a growing focus on adjuvant therapies targeting the microbiome. Future progress relies on the inclusion of children/adolescents in clinical trials to facilitate faster regulatory approval for pediatric therapies and the integration of precision medicine and mental health screening to improve patient care and outcomes.

Antimony resistant bacteria isolated from Budúcnosť adit (Pezinok-Kolársky vrch deposit) in western Slovakia

Potentially toxic elements (PTE), such as antimony (Sb), are dangerous putative contaminants for ground and surface waters around abandoned mines and ore deposits in Slovakia. Nearby mines antimony is commonly coprecipitated in ochre sediments precipitated from Fe-rich drainage waters and, therefore, these sites function as natural scavengers of this metalloid. Bacteria are well known to contribute to the process of redox state maintenance, biosorption and bioaccumulation of antimony and, consequently, to antimony precipitation or release from iron oxides complexes. Here we isolated 48 bacterial strains from circumneutral hydrous ferric oxides (HFO) rich iron ochres accumulated in the waters running from tailing pounds nearby Budúcnosť mine, Pezinok, Slovakia and polluted with high, but fluctuating, concentrations of antimony (130 μg/l Sb in water and 2317 mg/kg Sb in iron ochre in average). The isolated strains were V1-V9 16S rRNA sequenced and the resulting taxonomic affiliations of isolated strains were compared with taxonomy assignments obtained by V4 16S rRNA next generation sequencing approach, including two independent NGS analysis pipelines and different taxonomy classifiers ((IDTAXA (RDP, GTDB, SILVA, CONTAX), MEGAN (NCBI), RDP a SILVAngs). A Sb resistant subgroup of isolated strains (Pseudomonas A60B, Pseudomonas A59, Pseudomonas A28, Aeromonas A21, Aeromonas A13, Aeromonas A60A, Acinetobacter A14, Buttiauxella A58, Shewanella A20A a Yersinia A68), well growing at high Sb concentration (300 mg/l Sb), was tested for an ability of the strains to retain Sb from cultivation media. Based on ICP-MS measurements of the dried biomasses we concluded that all the strains can retain antimony from growth media to some extent, with strains Shewanella A20A, Buttiauxella A58, Yersinia A68 and Aeromonas A60A being the most effective.

Analysis of the Preventive Effect of Lonicera caerulea Pomace and Its Isolated Components on Colitis in Mice Based on Gut Microbiota and Serum Metabolomics

Inflammatory bowel disease (IBD), including relapsing-remitting ulcerative colitis and Crohn's disease, is a non-specific chronic intestinal inflammatory disease. Lonicera caerulea, which is rich in polyphenolic compounds, has been shown to exert antioxidative and anti-inflammatory effects. The research evaluates the dietary impacts of Lonicera caerulea pomace, its polyphenol-rich extract, and fiber-rich residue on colitis symptoms. Colitis was induced with 2.5% DSS (dextran sulfate sodium) aqueous solution after continuous feeding of customized Lonicera caerulea feed for 2.5 weeks. The results indicate that the intake of the polyphenol-rich extract has an effect in preventing colitis in mice, but the effect is less than that by the pomace itself, and the fiber residue alone does not prevent the condition when ingested. The pomace and polyphenol-rich extract have a positive regulatory effect on the gut microbiota of mice with colitis, and the intake of Lonicera caerulea pomace significantly restores 15 metabolites in mice with colitis, significantly improving five metabolic pathways, including steroid biosynthesis, with the regulation of metabolites and metabolic pathways being significantly correlated with the gut microbiota.

Selenium deficiency in inflammatory bowel disease: A comprehensive meta-analysis

Background

Micronutrient deficiencies, particularly selenium, are common in Inflammatory Bowel Diseases and may influence disease progression and severity. Various studies have investigated blood selenium levels in patients with inflammatory bowel disease, but these studies have shown considerable heterogeneity and are generally limited by small sample sizes. Therefore, this study aims to clarify the selenium status in patients with inflammatory bowel disease compared to controls and to explore the potential of selenium supplementation as a therapeutic option.

Method

A comprehensive search of online databases from January 1980 to December 2023 was conducted, focusing on studies related to selenium levels in patients with inflammatory bowel disease. The relationship between blood selenium concentrations in inflammatory bowel disease patients and controls was pooled using a random-effects model.

Results

From the 1853 references screened, 20 studies were selected based on the inclusion criteria, involving 1792 inflammatory bowel disease patients (including both Crohn's disease and ulcerative colitis cases) and 1648 controls. The meta-analysis demonstrated that inflammatory bowel disease patients have significantly lower selenium levels compared to the control group. This trend was consistent across subgroups differentiated by study characteristics such as design, geographical location, selenium detection methods, types of samples analyzed, and age categories of participants, with particularly notable deficiencies observed in patients with Crohn's disease. The robustness of these findings was supported by sensitivity analysis, and tests for publication bias indicated no significant skewing of results.

Conclusion

The analysis confirms that inflammatory bowel disease patients, especially those with Crohn's disease, have significantly lower levels of selenium compared to controls, suggesting that that selenium supplementation may serve as a valuable adjunct to the therapeutic regimen for managing inflammatory bowel disease, particularly in patients identified with selenium insufficiency.

Childhood obesity and risk of inflammatory bowel disease in adulthood: A Mendelian randomization study

It is well-known that childhood obesity is associated with various adult gastrointestinal diseases, inflammatory bowel disease (IBD) being no exception. However, previous epidemiological observational studies, while reporting a correlation between the 2, have left the question of a causal relationship inconclusive. This study aims to use a 2-sample Mendelian randomization (MR) analysis to assess the causal relationship between childhood obesity and IBD as well as its subtypes (ulcerative colitis [UC] and Crohn disease [CD]). Data on childhood obesity, IBD, and its subtypes (UC and CD) were sourced from IEU OpenGWAS (https://gwas.mrcieu.ac.uk/datasets/ieu-a-1096/) and IIBDGC (https://www.ibdgenetics.org/). The data were analyzed using the inverse variance weighted (IVW), MR-Egger, weighted median, simple mode, and weighted mode methods. The MR analysis indicates no causal relationship between childhood obesity and IBD or its subtypes (UC and CD). The consistency of the results across the IVW, MR-Egger, weighted median, simple mode, and weighted mode methods suggests the reliability of the findings. We found that childhood obesity is not causally related to IBD or its subtypes (UC and CD). This differs from prior studies. The observed discrepancies may be due to common biological or environmental confounding factors.

Diagnostic delay in inflammatory bowel disease: Current situation and problems

In this article, we comment on the article by Blüthner et al published recently. Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease, is a chronic relapsing and remitting condition primarily as a consequence of intestinal inflammation. It is important about adopting early and effective treatment to control clinical symptoms of IBD patients. Diagnostic delay can lead to adverse clinical outcomes and increase disease burden. Diagnostic delay is multifactorial. There are some factors related to diagnostic delay, such as patient factors and healthcare factors. We focus on the diagnostic tools for IBD, the outcomes and factors of diagnostic delay of IBD.

Selected Markers of Inflammation in the Saliva of Children Infected with Helicobacter pylori

Helicobacter pylori has been of interest to scientists and clinicians for many years, often causing diagnostic difficulties, especially in the youngest age group, in children. The presence of this bacterium in the population depends on the geographic region. However, it is assumed that even half of the world's population may be infected with H. pylori. Children infected with H. pylori-the study group (Hp(+)) and control group (Hp(-)), were chosen for further examination. The aim of the study was to analyze the concentrations of selected inflammatory markers in saliva (TNF-α, IL-8) and other markers (neutrophil defensin-1, sICAM-1, calprotectin, metalloproteinase-9, metalloproteinase-2, lactotransferrin, TLR-2) using ELISA technique. We confirmed the increased concentrations of IL-8, ND-1, and TLR-2 in the group of children infected with Helicobacter pylori. Moreover, there was also a positive, significant correlation between the concentration of ND-1 and MMP-2, sICAM-1, and calprotectin as well as MMP-9 and MMP-2 in the group of infected children. The study created new possibilities of insight into the pathogenetic mechanisms of developing inflammation in the mouth. This type of comprehensive research is also used to monitor the current disease process and create new opportunities for better in-depth diagnostics of children infected with H. pylori.

Vaccine Efficacy and Safety in Patients with Celiac Disease

Celiac disease (CD) is an autoimmune disorder caused by gluten intake in genetically predisposed individuals. This article provides an overview of the available data on the risks of infectious diseases and the mechanisms involved in CD, including a detailed analysis of vaccine efficacy, immunogenicity, and safety. The published articles were retrieved from the PubMed database using the terms "celiac disease", "efficacy", "hyposplenism", "immune response", "infections", "immunization", "immunogenicity", "safety", "vaccination", and "vaccine". CD can be associated with several autoimmune diseases, including selective immunoglobulin A deficiency (SIgAD), altered mucosal permeability, and hyposplenism. These conditions entail an increased risk of infections, which can be prevented by targeted vaccinations, although specific recommendations on immunization practices for subjects with CD have not been released. Regarding vaccinations, the immune response to the Hepatitis B virus (HBV) vaccine can be impaired in patients with CD; therefore, proposed strategies to elicit and maintain protective specific antibody titers are summarized. For patients with conditions that put them at risk of infections, vaccinations against Pneumococcus and other encapsulated bacteria should be recommended. Based on the available evidence, the Rotavirus vaccine offered to children could be useful in preventing CD in at-risk subjects. Overall, except for the HBV vaccine, vaccine efficacy in patients with CD is comparable to that in the general population, and no safety concerns have arisen.

Moderate-intensity continuous training and high-intensity interval training alleviate glycolipid metabolism through modulation of gut microbiota and their metabolite SCFAs in diabetic rats

Glucose and lipid metabolism disorders are typical of diabetic patients and are important factors leading to macrovascular and microvascular complications. The aim of this study was to understand the effects of different exercises on glycolipid metabolism in diabetic rats and the role of gut flora in metabolic maintenance. We measured glycolipid metabolic indices and short-chain fatty acids (SCFAs) content and sequenced and analyzed gut microbes after 8 weeks of moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) programs in type 2 diabetic rats(T2DM). We found that Enterococcaceae, Enterococcus, Subdoligranulum, Kurthia, Bacillales, and Planococcaceae may be key bacterial taxa related to T2DM and that both programs of exercise regulated the intestinal flora of rats with T2DM, improved their glycolipid metabolism, increased the abundance of SCFA-producing intestinal bacteria, and it was found that the PWY-5676 and P163-PWY pathways which are closely related to production of SCFAs were significantly upregulated in the exercise groups. Notably, MICT appeared to be more effective than HIIT in increasing the homogeneity of rat intestinal flora, enriching species, and increasing acetic acid and butyric acid content. These results suggest that exercise improves glycolipid metabolism in diabetic rats, which may be attributed to alterations in the structure of their intestinal flora.

The effect of probiotics on gestational diabetes mellitus: an umbrella meta-analysis

BACKGROUND

Prior studies indicated the positive effects of probiotics on glycemic regulation in patients with gestational diabetes mellitus (GDM). Nonetheless, the results remain inconclusive. To address this, we conducted an umbrella meta-analysis to evaluate the impact of probiotics on glycemic indicators in GDM.

METHODS

A comprehensive search was conducted on the PubMed and Scopus databases to identify all relevant meta-analyses of randomized clinical trials published until July 2024. The outcomes included serum hemoglobin A1C (HbA1c), fasting blood insulin (FBI), fasting blood sugar (FBS), homeostatic model assessment for insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), homeostatic model assessment of beta cell function (HOMA-B), C-peptide, and oral glucose tolerance test (OGTT). Standardized mean difference (SMD) was used to test the effects.

RESULTS

In total, 27 studies, comprising 33,378 participants, were included in the analysis. Probiotics resulted in a significant decrease in FBS (SMD: -0.39, 95% CI: -0.56 to -0.23), especially when administered for ≤ 7 weeks. Significant reductions were also observed in FBI (SMD: -1.99, 95% CI: -2.41 to -1.58), HOMA-IR (SMD: -0.61, 95% CI: -0.72 to -0.50), and HOMA-B (SMD: -24.58, 95% CI: -30.59 to -18.56). Moreover, supplementation with probiotics significantly improved QUICKI (SMD: 0.007, 95% CI: 0.004 to 0.01). There was significant evidence of heterogeneity and publication bias. No significant effects were observed on 1-h OGTT, 2-h OGTT, HbA1c, and C-peptide. No dose-specific effect was observed.

CONCLUSIONS

Supplementation with probiotics could improve glycemic control in women with GDM. The effects of probiotics on HOMA-IR, HOMA-B, and fasting insulin were clinically important, while, their effect on FBS was not clinically important.

Assessment of Serum Dynamic Thiol/Disulfide Homeostasis and Oxidative/Nitrosative Stress in Patients with Crohn's Disease

Background/Aims

Crohn's disease (CD) is a major subtype of chronic relapsing inflammatory gastrointestinal disorders. In this study, we assessed the possible contributions of serum oxidative/nitrosative stress and dynamic thiol/disulfide homeostasis to CD pathogenesis.

Materials and Methods

Patients with active CD (A-CD) at onset (n = 38), CD patients in the remission (R-CD) (n = 38), and healthy controls (n = 38) were prospectively included in this study. Serum oxidative/nitrosative parameters as well as total thiol and native thiol levels were analyzed.

Results

We observed significant augmentation in nitric oxide (NO) levels in both A-CD and R-CD patients compared to healthy controls. We detected marked reductions in the 3-nitrotyrosine levels in the patient groups. Glutathione, glutathione peroxidase, and myeloperoxidase levels were observed to be significantly lower in both the active and remission groups (P < .001). In the A-CD group, native thiol (P < .001) and total thiol (P < .01) levels were lower, and disulfide levels were higher than those of the control group (P < .01), while the native thiol/total thiol ratio was reduced and disulfide/total thiol (P < .001) and disulfide/native thiol (P < .001) ratios were elevated. Remarkably, no change in dynamic thiol/disulfide homeostasis was found in the R-CD group.

Conclusion

Our results showed increased serum NO levels and decreased antioxidant enzymes, particularly during the active phase of CD. Determination of thiol/disulfide homeostasis could help differentiate between the active and remission phases of the disease. Thiol/ disulfide parameters can be used as biomarkers for A-CD.

Prevalence, Risk Factors and Association with Clinical Outcomes of Malnutrition and Sarcopenia in Inflammatory Bowel Disease: A Prospective Study

INTRODUCTION

The prevalences of malnutrition and sarcopenia in patients with IBD are not precisely known, and nutritional assessment is not standardized. We assessed the prevalence and risk factors of these conditions in outpatients and their impact on clinical outcomes.

METHODS

This prospective longitudinal study considered patients who had IBD for at least one year, were attending a tertiary IBD center, and were followed for the subsequent year.

RESULTS

In a sample of 158 consecutive patients (96 with Crohn's disease and 62 with ulcerative colitis), the prevalence of malnutrition, according to GLIM criteria, was 13.3%. For identifying patients at risk of malnutrition, the Malnutrition Universal Screening Tool demonstrated better accuracy, (sensitivity 88.9 (65.3-98.6) and specificity 90.2 (83.8-93.4)) than the SaskIBD-NR questionnaire (sensitivity 69.3 (41.1-86.7) and specificity 60.9 (60.9-76.8)). The prevalence of sarcopenia was 34.2%. Considering clinical outcomes, sarcopenia at baseline was significantly associated with hospital admission within a year (p = 45.2% vs. 20.3%, 0.026).

CONCLUSIONS

Malnutrition and sarcopenia were present in about one-third of IBD patients. Awareness should be raised among physicians caring for IBD patients about the need to evaluate patients' nutritional statuses to help patients achieve a better quality of life.

Personalized nutrition in type 2 diabetes remission: application of digital twin technology for predictive glycemic control

Background

Type 2 Diabetes (T2D) is a complex condition marked by insulin resistance and beta-cell dysfunction. Traditional dietary interventions, such as low-calorie or low-carbohydrate diets, typically overlook individual variability in postprandial glycemic responses (PPGRs), which can lead to suboptimal management of the disease. Recent advancements suggest that personalized nutrition, tailored to individual metabolic profiles, may enhance the effectiveness of T2D management.

Objective

This study aims to present the development and application of a Digital Twin (DT) technology-a machine learning (ML)-powered platform designed to predict and modulate PPGRs in T2D patients. By integrating continuous glucose monitoring (CGM), dietary data, and other physiological inputs, the DT provides individualized dietary recommendations to improve insulin sensitivity, reduce hyperinsulinemia, and support the remission of T2D.

Methods

We developed a sophisticated DT platform that synthesizes real-time data from CGM, dietary logs, and other biometric inputs to create personalized metabolic models for T2D patients. The intervention is delivered via a mobile application, which dynamically adjusts dietary recommendations based on predicted PPGRs. This methodology is validated through a randomized controlled trial (RCT) assessing its impact on various metabolic markers, including HbA1c, metabolic-associated fatty liver disease (MAFLD), blood pressure, body weight, ASCVD risk, albuminuria, and diabetic retinopathy.

Results

Preliminary data from the ongoing RCT and real-world study demonstrate the DT's capacity to generate significant improvements in glycemic control and metabolic health. The DT-driven personalized nutrition plan has been associated with reductions in HbA1c, enhanced beta-cell function, and normalization of hyperinsulinemia, supporting sustained T2D remission. Additionally, the DT's predictions have contributed to improvements in MAFLD markers, blood pressure, and cardiovascular risk factors, highlighting its potential as a comprehensive management tool.

Conclusion

The DT technology represents a novel and scalable approach to personalized nutrition in T2D management. By addressing individual variability in PPGRs, this method offers a promising alternative to conventional dietary interventions, with the potential to improve long-term outcomes and reduce the global burden of T2D.

Acupuncture as an Adjunct to Lifestyle Interventions for Weight Loss in Simple Obesity: A Systematic Review and Meta-Analysis

Objective

This study aims to evaluate the efficacy of acupuncture as an adjunct to lifestyle interventions on weight loss in simple obesity.

Methods

Potentially eligible studies that assessed anthropometric outcomes as well as glucose and lipid metabolism following acupuncture combined with lifestyle interventions in simple obesity patients were searched from eight databases from inception to October 2023. All analyses were performed using the Review Manager software v5.4 and Stata software v17.0.

Results

Herein, 25 randomized controlled trials (RCTs) involving 2018 patients were included. Generally, acupuncture combined with lifestyle interventions outperformed lifestyle interventions alone in terms of body weight (MD = -4.73, 95% CI [-6.32, -3.13], p < 0.00001), body mass index (BMI) (MD = -2.11, 95% CI [-2.75, -1.48], p < 0.00001), waist circumference (WC) (MD = -4.96, 95% CI [-6.89, -3.03], p < 0.00001), body fat percentage (BF %) (MD = -2.61, 95% CI [-4,51, -0.71], p = 0.007), fasting plasma glucose (FPG) (SMD = -0.66, 95% CI [-1.02, -0.31], p = 0.0002), fasting serum insulin (FINS) (SMD = -1.12, 95% CI [-1.44, -0.81], p < 0.00001), homeostasis model assessment-insulin resistance (HOMA-IR) (MD = -1.22, 95% CI [-1.50, -0.94], p < 0.00001), total cholesterol (TC) (SMD = -1.14, 95% CI [-1.83, -0.45], p = 0.001), triglyceride (TG) (SMD = -1.31, 95% CI [-2.07, -0.56], p = 0.0006), and low-density lipoprotein cholesterol (LDL-C) (SMD = -1.81, 95% CI [-3.11, -0.51], p = 0.006). Subgroup analysis based on three subgroup variables (types of acupuncture and lifestyle interventions as well as treatment durations) could partially explain the heterogeneity of the results.

Conclusion

Acupuncture demonstrated an enhancing effect on the benefits of lifestyle interventions for weight loss in patients with simple obesity, including reducing body weight and improving glucose and lipid metabolism. This finding suggests its potential value as a complementary therapy alongside lifestyle interventions in a clinical setting. However, further validation with rigorously designed and high-quality RCTs is still needed in the future.

Added Value of Medical Subject Headings Terms in Search Strategies of Systematic Reviews: Comparative Study

BACKGROUND

The massive increase in the number of published scientific articles enhances knowledge but makes it more complicated to summarize results. The Medical Subject Headings (MeSH) thesaurus was created in the mid-20th century with the aim of systematizing article indexing and facilitating their retrieval. Despite the advent of search engines, few studies have questioned the relevance of the MeSH thesaurus, and none have done so systematically.

OBJECTIVE

The objective of this study was to estimate the added value of using MeSH terms in PubMed queries for systematic reviews (SRs).

METHODS

SRs published in 4 high-impact medical journals in general medicine over the past 10 years were selected. Only SRs for which a PubMed query was provided were included. Each query was transformed to obtain 3 versions: the original query (V1), the query with free-text terms only (V2), and the query with MeSH terms only (V3). These 3 queries were compared with each other based on their sensitivity and positive predictive values.

RESULTS

In total, 59 SRs were included. The suppression of MeSH terms had an impact on the number of relevant articles retrieved for 24 (41%) out of 59 SRs. The median (IQR) sensitivities of queries V1 and V2 were 77.8% (62.1%-95.2%) and 71.4% (42.6%-90%), respectively. V1 queries provided an average of 2.62 additional relevant papers per SR compared with V2 queries. However, an additional 820.29 papers had to be screened. The cost of screening an additional collected paper was therefore 313.09, which was slightly more than triple the mean reading cost associated with V2 queries (88.67).

CONCLUSIONS

Our results revealed that removing MeSH terms from a query decreases sensitivity while slightly increasing the positive predictive value. Queries containing both MeSH and free-text terms yielded more relevant articles but required screening many additional papers. Despite this additional workload, MeSH terms remain indispensable for SRs.

Longitudinal analysis of urinary I-FABP in extremely preterm infants that develop necrotizing enterocolitis

BACKGROUND

Intestinal fatty acid binding protein (I-FABP) is an intestinal epithelial protein detectable in infants with necrotizing enterocolitis (NEC). The longitudinal behavior of I-FABP following NEC or its association with gastrointestinal or neurodevelopmental outcomes is unknown.

METHODS

In this secondary analysis of the Preterm Erythropoietin Neuroprotection Trial, we compared infants with and without NEC. Urine I-FABP concentrations in matched infants (n = 70) were measured serially using ELISA and compared using paired analysis. In infants with NEC, the associations of I-FABP levels with short-term outcomes and neurodevelopmental outcomes at 22-26 months corrected age were determined using non-parametric analysis.

RESULTS

Infants with NEC were more likely to have cholestasis, death or severe neurodevelopmental impairment, cerebral palsy, and lower Bayley-III motor scores. Baseline urinary I-FABP levels were similar between groups. When compared to controls, infants with NEC had urinary I-FABP concentrations that were higher at diagnosis (median 11 vs 2.6 ng/ml, p = 0.006) and lower post-NEC (median 1 vs 5 ng/ml, p = 0.002). Diagnosis I-FABP levels were not associated with gastrointestinal or neurodevelopmental outcomes at 22-26 months corrected age.

CONCLUSIONS

In extremely preterm infants, urinary I-FABP was elevated at NEC diagnosis and lower post-NEC compared to matched controls. I-FABP levels were not associated with adverse gastrointestinal or neurodevelopmental outcomes.

IMPACT

Urinary intestinal fatty acid binding protein (I-FABP) levels are increased at diagnosis of NEC and fall to below baseline after NEC in extremely preterm infants. Urine I-FABP levels at NEC diagnosis are not associated with cholestasis, intestinal stricture or obstruction, need for additional intestinal surgery after NEC, or neurodevelopmental outcomes at 22-26 months corrected age. Urine I-FABP levels may be useful in the diagnosis of NEC. Diagnostic I-FABP levels do not predict short-term gastrointestinal or neurodevelopmental outcomes after NEC.

Cancer prevention at the microscopic level with the potent power of micronutrients

Cancer remains a leading cause of morbidity and mortality worldwide, necessitating ongoing exploration of effective prevention strategies. Micronutrients, vital for maintaining cellular health, offer promising avenues for cancer prevention. This review delineates the critical roles of micronutrients in cancer prevention, elucidating their mechanisms at the cellular level. Focusing on essential vitamins and minerals like Vitamins A, C, D, E, selenium, and zinc, we explore their profound effects on fundamental cellular processes such as DNA repair, oxidative stress regulation, cellular proliferation, and immune surveillance. These nutrients, characterized by their antioxidative, anti-inflammatory, and immune-enhancing properties, have shown potential in reducing the risk of cancer. The article synthesizes outcomes from a broad spectrum of clinical trials, epidemiological studies, and systematic reviews to evaluate the efficacy of micronutrients in thwarting cancer development. This critical analysis explores significant trials, addresses controversies in nutrient efficacy, and highlights the implications for clinical practice and public health policy. The review underscores the importance of integrating nutritional strategies into comprehensive cancer prevention frameworks and suggests directions for future research to optimize the preventive potentials of micronutrients.

Metabolomics reveals the metabolic disturbance caused by arsenic in the mouse model of inflammatory bowel disease

Arsenic exposure has long been a significant global health concern due to its association with various human diseases. The adverse health effects of arsenic can be influenced by multiple factors, resulting in considerable individual variability. Individuals with inflammatory bowel disease (IBD) are particularly vulnerable to the effects of toxin exposure, yet the specific impact of arsenic in the context of IBD remains unclear. In this study, we employed a non-targeted metabolomics approach to investigate how arsenic exposure affects metabolic homeostasis in an IBD model using Helicobacter trogontum-infected interleukin-10 deficient mice. Our results demonstrated that arsenic exposure disrupted the balance of various metabolites, including tryptophan, polyunsaturated fatty acids, purine and pyrimidine metabolites, and branched-chain amino acids, in mice with colitis but not in those without colitis. Notably, several crucial metabolites involved in anti-inflammatory responses, oxidative stress, and energy metabolism were significantly altered in mice with colitis. These results indicate that arsenic exposure in an IBD context can lead to extensive metabolic disturbances, potentially exacerbating disease severity and impacting overall health. This study underscores the necessity of evaluating arsenic toxicity in relation to IBD to better understand and mitigate associated health risks.

Fatty acid abnormalities in cystic fibrosis-the missing link for a cure?

The care for cystic fibrosis (CF) has dramatically changed with the development of modulators, correctors, and potentiators of the CFTR molecule, which lead to improved clinical status of most people with CF (pwCF). The modulators influence phospholipids and ceramides, but not linoleic acid (LA) deficiency, associated with more severe phenotypes of CF. The LA deficiency is associated with upregulation of its transfer to arachidonic acid (AA). The AA release from membranes is increased and associated with increase of pro-inflammatory prostanoids and the characteristic inflammation is present before birth and bacterial infections. Docosahexaenoic acid is often decreased, especially in associated liver disease Some endogenously synthesized fatty acids are increased. Cholesterol and ceramide metabolisms are disturbed. The lipid abnormalities are present at birth, and before feeding in transgenic pigs and ferrets. This review focus on the lipid abnormalities and their associations to clinical symptoms in CF, based on clinical studies and experimental research.

Protective effect of a newly probiotic Lactobacillus reuteri LY2-2 on DSS-induced colitis

PURPOSE

This study aimed to investigate the role of a newly isolated strain L.reuteri LY2-2 in colitis in mice and explored the underlying mechanisms. METHODS L.

REUTERI

LY2-2 was orally administered to mice with dextran sulfate sodium (DSS)-induced colitis. 5-Aminosalicylic acid (5-ASA) treatment was used as the drug control.

RESULTS

The results showed that the disease severity of colitis mice was significantly alleviated. The intestinal inflammation was restricted by synergistically reducing pro-inflammatory cytokines, inhibiting TLR4-NF-κB signaling, restoring the abnormal immune response, and enhancing intestinal barrier function. Of note, L.reuteri LY2-2 showed great potential in modulating macrophages polarization in colonic tissues. Moreover, the gut dysbiosis was improved. The potentially pro-inflammatory pathogenic bacteria such as Helicobacter and Romboutsia decreased and the probiotics including L.rhamnosus and L.plantarum increased. Interestingly, the above pathological indexes in the L.reuteri LY2-2 group were better than those in the 5-ASA group.

CONCLUSION

L.reuteri LY2-2 had a better protective effect on DSS-induced colitis via its anti-inflammatory and microbiota-balancing properties, which supports the potential value of this probiotic against colitis. These results contribute to product development of functional probiotics for colitis and provide valuable insights for their mechanisms of biological function to affect human health status.

The Risk of Venous Thromboembolism in Children With Inflammatory Bowel Disease

BACKGROUND

Recent studies of children with inflammatory bowel disease (IBD) demonstrate an increased venous thromboembolism (VTE) risk. However, estimates of risk are variable and case numbers are limited. The aim of this study was to provide national estimates of the risk of VTE in children with IBD.

METHODS

Hospital Episode Statistics was used to identify patients diagnosed with either IBD or VTE before reaching 18 years of age between 2001 and 2019. Populations and subgroups are described, and the risks of developing VTE in the general and IBD populations were calculated.

RESULTS

Children with VTE following a diagnosis of IBD or in the previous 6 months (n = 85) and with VTE without IBD (n = 4160) were studied. The absolute risk in children with IBD was 9.42 (95% confidence interval [CI], 7.4-11.4) per 10 000 patient-years, compared with 0.18 (95% CI, 18-0.19) in children without IBD. Between 6 months prior to and 1 year following IBD diagnosis was the highest absolute risk period for VTE (18.0; 95% CI, 13.7-22.4). The relative risk of VTE in children with IBD vs children without IBD was greatest in younger patient groups: the relative risk for the age band 0 to 8 years was 96.5 (95% CI, 51.8-179.9) and for 9 to 11 years was 153.1 (95% CI, 81.2-288.8) vs 14.3 (95% CI, 10.3-20.0) for 15 to 17 years. Cerebral venous sinus thrombosis represented 17.6% of pediatric VTE events in IBD patients compared with 4.2% in children without IBD (P = .001).

CONCLUSIONS

This study confirms the increased risk of VTE in children with IBD compared with children without IBD. The time of greatest VTE risk was around diagnosis. Cerebral venous sinus thrombosis was significantly more common in children with IBD than other children.

Breastfeeding Beyond Six Months: Evidence of Child Health Benefits

Breastfeeding is globally recognized as the optimal method of infant nutrition, offering health benefits for both the child and the mother, making it a public health priority. However, the potential advantages of breastfeeding extend well beyond initial months. Breast milk adapts to the evolving needs of the growing infant, and its immunological, microbiological, and biochemical properties have been associated with enhanced protection against infections and chronic diseases, improved growth and development, and lower rates of hospitalization and mortality. This review explores the evidence supporting the continuation of breastfeeding beyond six months. More meticulous studies employing consistent methodologies and addressing confounders are essential. This will enable a more accurate determination of the extent and mechanisms of the positive impact of prolonged breastfeeding and allow for the implementation of effective public health strategies.

Global, regional and country-specific burden of patella, tibia or fibula, or ankle fractures and its prediction to 2035: findings from global burden of disease study 2019

BACKGROUND

Bone fractures are a global public health issue and a major source of significant illness and financial hardship. However, to date, there is limited research on patella, tibia or fibula, or ankle fractures (FPTFA) disease burden.

METHODS

Using the framework of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we conducted temporal trends of disease burden, effects of sex and socio-demographic index (SDI) on age standardized prevalence rate (ASPR) and age-period-cohort model. Machine learning models were built to predict the ASPR of FPTFA in 2035.

RESULTS

In 1990 and 2019, the top three of all fractures with the highest ASPR was FPTFA. Globally, in 2019, there were 13529.45 million (95%UI: 11811.02, 15642.25), 9198.67 million (95%UI: 8518.9, 10009.91) and 77.54 million (95%UI: 34.09, 149.9) prevalent cases of fracture attributable to fall, transport injury and mechanical external force, respectively. The number of fracture prevalence and years lived with disability (YLDs), and ASPR were higher in males than in females. From 1990 to 2019, most of GBD regions showed a downward trend in average annual percent change (AAPC) of ASPR attributable to transport injuries, High-income Asia Pacific had the highest decline (AAPC= -1.81%, 95%CI: -1.89% to -1.74%). However, an upward trend in East Asia was observed (AAPC = 1.60%, 95%CI: 1.48-1.73%). With increasing SDI, the ASPR for FPTFA attributed to the fall and mechanical external force slowly increased and then turned downward, especially in high-income and high-SDI countries. The longitudinal age curve suggested that the attributed rate was increased for the three sites of lower limb fractures. The best predictive models for FPTFA caused by falls, transport injuries and mechanical external force were autoregressive integrated moving average model (ARIMA) (0,2,1), ARIMA (2,0,1) and ARIMA (0,2,2), with R2 of 0.96, 0.78 and 0.94, respectively. By 2035, ASPR for the fall-related FPTFA will continue to rise rapidly, whereas the ASPR of the transport injury-related FPTFA will gradually decrease.

CONCLUSION

FPTFA attributed to the falls is the dominant type and the burden and trends of the fall-related FPTFA are substantial. Fall prevention and access to treatment are crucial for reducing FPTFA burden.

Exploring nature's battlefield: organismic interactions in the discovery of bioactive natural products

Covering: up to March 2024.Microbial natural products have historically been a cornerstone for the discovery of therapeutic agents. Advanced (meta)genome sequencing technologies have revealed that microbes harbor far greater biosynthetic capabilities than previously anticipated. However, despite the application of CRISPR/Cas-based gene editing and high-throughput technologies to activate silent biosynthetic gene clusters, the rapid identification of new natural products has not led to a proportional increase in the discovery rate of lead compounds or drugs. A crucial issue in this gap may be insufficient knowledge about the inherent biological and physiological functions of microbial natural products. Addressing this gap necessitates recognizing that the generation of functional natural products is deeply rooted in the interactions between the producing microbes and other (micro)organisms within their ecological contexts, an understanding that is essential for harnessing their potential therapeutic benefits. In this review, we highlight the discovery of functional microbial natural products from diverse niches, including those associated with humans, nematodes, insects, fungi, protozoa, plants, and marine animals. Many of these findings result from an organismic-interaction-guided strategy using multi-omic approaches. The current importance of this topic lies in its potential to advance drug discovery in an era marked by increasing antimicrobial resistance.

Comprehensive analysis of psychological symptoms and quality of life in early patients with IBD: a multicenter study from China

OBJECTIVE

To investigate the prevalence and risk factors of psychological symptoms and quality of life (QoL) in early patients with inflammatory bowel disease (IBD).

METHODS

From September 2021 to May 2022, a unified questionnaire was developed to collect clinical data from early patients with IBD from 42 tertiary care hospitals. The influencing factors of psychological symptoms and poor QoL are screened by logistic regression analysis for constructing model in predicting poor QoL. The consistency index, receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration curve, and decision curve analysis (DCA) were used to evaluate the performance of the model.

RESULTS

A total of 939 early patients with IBD were surveyed, Among them, 20.3% exhibited anxiety, 21.7% had depression, 57.3% experienced sleep disturbance, and 41.9% reported poor QoL. The factors influencing psychological symptoms varied between ulcerative colitis (UC) and Crohn's disease (CD) patients. The QoL was primarily affected by disease activity, income level and depression. The AUC value of the model in the training group was 0.781 (95% CI: 0.748-0.814). The calibration diagram of the model closely matched the ideal curve. Compared to other prediction models, our model showed superior predictive capability, with NRI and IDI values of 0.324 (95%CI:0.196-0.4513) and 0.026 (95%CI:0.014-0.038), respectively. DCA indicated that the nomogram model could provide clinical benefits.

CONCLUSION

Early patients with IBD exhibit a high prevalence of psychological symptoms and poor QoL. The nomogram prediction model we constructed demonstrates high accuracy and performance in predicting QoL in early patients with IBD.

Normalization of Cystic Fibrosis Immune System Reverses Intestinal Neutrophilic Inflammation and Significantly Improves the Survival of Cystic Fibrosis Mice

BACKGROUND & AIMS

Cystic fibrosis (CF) is an autosomal recessive genetic disorder, affecting multiple organ systems. CF intestinal disease develops early, manifesting as intestinal bacterial overgrowth/dysbiosis, neutrophilic inflammation, and obstruction. As unresolvable infection and inflammation reflect host immune deficiency, we sought to determine if the CF-affected immune system plays any significant role in CF intestinal disease pathogenesis.

METHODS

CF and sibling wild-type (WT) mice underwent reciprocal bone marrow transplantation. After immune reconstitution, their mortality, intestinal transit, fecal inflammatory markers, and mucosal immune cell composition were assessed. Moreover, reciprocal neutrophil transfusion was conducted to determine if neutrophil function affects intestinal movement. Furthermore, expression of induced nitric oxide synthase (iNOS) and production of nitric oxide (NO) in CF and WT neutrophils were compared. Lastly, specific iNOS inhibitor 1400W was tested to prevent CF intestinal obstruction.

RESULTS

Immune restoration in CF mice reversed the intestinal neutrophilic inflammation, improved the intestinal dysmotility, and rescued the mice from mortality. Transfusion of WT neutrophils into CF mice ameliorated the retarded bowel movement. CF neutrophils expressed significantly more iNOS and produced significantly more NO. Pharmaceutical blocking of iNOS significantly improved intestinal transit and survival of CF mice.

CONCLUSIONS

CF immune defect plays a critical role in CF intestinal disease development. Activation of iNOS in inflammatory cells produces excessive NO, slows the bowel movement, and facilitates intestinal paralysis and obstruction in CF. Thus, normalization of the CF immune system may offer a novel therapy to treat CF intestinal disease.

Debate on the relationship between Helicobacter pylori infection and inflammatory bowel disease: a bibliometric analysis

Background

Inflammatory bowel diseases (IBD) are chronic inflammation conditions affecting the gastrointestinal tract. Studies point out an association between Helicobacter pylori (H. pylori) infection and IBD. This study aims to visually assess the research trends and hotspots in the field of H. pylori infection and IBD, review mainstream perspectives in this field, and provide a foundation for future research and treatment.

Methods

We searched the Web of Science Core Collection Database for literature related to H. pylori and IBD, using VOS viewer to generate visual charts.

Results

A total of 246 publications were included, with articles being the predominant type of document. A significant increase in the number of publications was observed after 2011. China contributed the most of researches. Keyword clusters revealed that the researches primarily focused on immune mechanism, gut microbiome, diagnosis and treatment of IBD. Time trend results indicated that current researches centered on gut microbiota and immune mechanisms.

Conclusion

H. pylori infection may have a protective effect on IBD. The exact mechanisms remain unclear and may involve immunomodulation and changes of gut microbiota. Further researches are necessary for better understanding this relationship and its implications for clinical practice. Further researches and clinical practice should pay attention to this topic.

Fibrosis-related Transcriptome Unveils a Distinctive Remodelling Matrix Pattern in Penetrating Ileal Crohn's Disease

BACKGROUND AND AIMS

Stricturing [B2] and penetrating [B3] ileal Crohn's disease have been reported to present similar levels of histopathological transmural fibrosis. This study aimed to compare the fibrosis-related transcriptomic profiles of penetrating and stricturing ileal Crohn's disease.

METHODS

Using Nanostring technology and comparative bioinformatics, we analysed the expression of 787 fibrosis-related genes in 36 ileal surgical specimens, 12 B2 and 24 B3, the latter including 12 cases with associated stricture[s] [B3s] and 12 without [B3o]. Quality control of extracted RNA was performed according to Nanostring parameters and principal component analysis for the distribution analysis. For the selection of the differentially expressed genes, a p-adjusted <0.05 and fold change ≤-1.5 or ≥1.5 were adopted. Quantitative polymerase chain reaction (qPCR) and immunohistochemistry analyses were used to validate selected differentially expressed genes.

RESULTS

We included 34 patients with B2 and B3 phenotypes, balanced for age at diagnosis, age at surgery, gender, Crohn's disease localisation, perianal disease, and therapy. Inflammation and fibrosis histopathological scoring were similar in all cases. B2 and B3 groups showed a very good clustering regarding 30 significantly differentially expressed genes, all being remarkably upregulated in B3. More than half of these genes were involved in Crohn's disease fibrogenesis, and eight differentially expressed genes were so in other organs. The most significantly active biological processes and pathways in penetrating disease were response to TGFβ and matrix organisation and degradation, as validated by immunohistochemistry.

CONCLUSIONS

Despite the histopathological similarities in fibrosis between stricturing and penetrating ileal Crohn's disease, their fibrosis-related transcriptomic profiles are distinct. Penetrating disease exhibits a distinctive transcriptomic landscape related to enhanced matrix remodelling.

The Epidemiology of Inflammatory Bowel Disease in Oceania: A Systematic Review and Meta-Analysis of Incidence and Prevalence

BACKGROUND

Past studies have shown high rates of inflammatory bowel disease (IBD) in Australia and New Zealand (NZ). We aimed to describe the epidemiology of IBD in Australia, NZ, and the surrounding region (collectively termed Oceania) by conducting a systematic review and meta-analysis.

METHODS

Electronic databases were searched from inception to April 2023 for studies reporting incidence or prevalence rates of IBD, Crohn's disease (CD), or ulcerative colitis (UC) in Oceania. All study designs were included. A meta-analysis calculated pooled estimates of incidence and prevalence, and a sensitivity analysis compared the pooled population-based studies with the non-population-based studies and the Australian and NZ studies separately.

RESULTS

Nineteen incidence and 11 prevalence studies were included; 2 studies were from the Pacific Islands, with the rest coming from Australia and NZ. Pooled estimates showed high incidence rates of 19.8 (95% confidence interval [CI], 15.8-23.7) for IBD, 8.3 (95% CI, 6.9-9.8) for CD, and 7.4 (95% CI, 5.7-9.1) for CD per 100 000 person-years. CD was more common than UC in most studies. The pooled estimates for the prevalence studies were 303.3 (95% CI, 128.1-478.4) for IBD, 149.8 (95% CI, 71.0-228.5) for CD, and 142.2 (95% CI, 63.1-221.4) for UC per 100 000 persons. Studies using population-based data collection methods showed higher pooled rates for both incidence and prevalence.

CONCLUSIONS

The incidence and prevalence of IBD in Oceania is high. The studies were heterogeneous and there were several geographic areas with no information, highlighting the need for more epidemiological studies of IBD.

The Disease Severity Index for Inflammatory Bowel Disease Is a Valid Instrument that Predicts Complicated Disease

BACKGROUND

The disease severity index (DSI) for inflammatory bowel disease (IBD) combines measures of disease phenotype, inflammatory activity, and patient-reported outcomes. We aimed to validate the DSI and assess its utility in predicting a complicated IBD course.

METHODS

A multicenter cohort of adults with IBD was recruited. Intraclass correlation coefficients (ICCs) and weighted Kappa assessed inter-rater reliability. Cronbach's alpha measured internal consistency of DSI items. Spearman's rank correlations compared the DSI with endoscopic indices, symptom indices, quality of life, and disability. A subgroup was followed for 24 months to assess for a complicated IBD course. Area under the receiver operating characteristics curve (AUROC) and multivariable logistic regression assessed the utility of the DSI in predicting disease progression.

RESULTS

Three hundred and sixty-nine participants were included (Crohn's disease [CD], n = 230; female, n = 194; mean age, 46 years [SD, 15]; median disease duration, 11 years [interquartile range, 5-21]), of which 171 (CD, n = 99; ulcerative colitis [UC], n = 72) were followed prospectively. The DSI showed inter-rater reliability for CD (ICC 0.93, n = 65) and UC (ICC 0.97, n = 33). The DSI items demonstrated inter-rater agreement (Kappa > 0.4) and internal consistency (CD, α > 0.59; UC, α > 0.75). The DSI was significantly associated with endoscopic activity (CDn=141, r = 0.65, P < .001; UCn=105, r = 0.80, P < .001), symptoms (CDn=159, r = 0.69, P < .001; UCn=132, r = 0.58, P < .001), quality of life (CDn=198, r = -0.59, P < .001; UCn=128, r = -0.68, P < .001), and disability (CDn=83, r = -0.67, P < .001; UCn=52, r = -0.74, P < .001). A DSI of 23 best predicted a complicated IBD course (AUROC = 0.82, P < .001) and was associated with this end point on multivariable analyses (aOR, 9.20; 95% confidence interval, 3.32-25.49).

CONCLUSIONS

The DSI reliably encapsulates factors contributing to disease severity and accurately prognosticates the longitudinal IBD course.

Influence of sex, age, ethnicity/race, and body mass index on the cerumen volatilome using two data analysis approaches: binary and semiquantitative

Human cerumen analysis is an innovative and non-invasive trend in diagnosing diseases. Recently, new cerumen volatile-based methods using binary (volatile presence/absence) and semiquantitative (volatile intensity) data approaches have shown great potential in detecting biomarkers for cancer, chronic and rare diseases, and xenobiotic exposures. However, to date, the impacts of demographic factors such as body mass index (BMI), sex, age, and ethnicity/race in cerumen data have not been widely described, which can hamper interpretation in biomarker discovery investigations. This study examined the effects of such factors in cerumen, defining the baseline volatile organic metabolites (VOMs) across different physiological groups. Cerumen samples from seventy volunteers were analyzed using headspace/gas chromatography-mass spectrometry (HS/GC-MS) and multivariate statistical analysis using binary and semiquantitative data approaches. In the binary data approach, several VOMs exhibited patterns of high occurrence in some specific demographic groups. However, no pattern of discrimination that could be attributed to demographic factors was observed. In the semiquantitative approach, the relative abundance of cerumen VOMs was more impacted by sex and BMI than age and ethnicity/race. In summary, we describe how cerumen VOM occurrence and abundance are affected by patient phenotype, which can pave the way for more personalized medicine in future cerumen volatile-based methods.

Dietary Patterns and Risk of Inflammatory Bowel Disease: A Systematic Review of Observational Studies

BACKGROUND

The incidence of inflammatory bowel disease (IBD) is increasing worldwide. Dietary patterns may be associated with odds of this disease. Although previous reviews have attempted to summarize the evidence in this field, the growing body of investigations prompted us to conduct an updated comprehensive systematic review.

METHODS

We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to evaluate the association between dietary patterns before disease onset and the risk of IBD. PubMed, SCOPUS, and Web of Science were searched using structured keywords up to November 20, 2023.

RESULTS

Twenty-four publications (13 case-control, 1 nested case-control, and 10 cohort studies) were included in this review. The sample size of these studies ranged from 181 to 482 887 subjects. The findings were inconsistent across the included studies, showing inverse, direct, or no association between different dietary patterns and the risk of IBD.

CONCLUSIONS

This review provides comprehensive data on the link between dietary patterns prior to IBD diagnosis and risk of this condition. The explicit finding of present review is the extent gap in our knowledge in this field. Therefore, large-scale, high-quality studies are warranted to improve our understanding of the relationship between dietary patterns and IBD risk.

Sexual dysfunctions in inflammatory bowel disease: role of Mediterranean diet and quality of life

BACKGROUND

Dietary factors and chronic gastrointestinal diseases are frequent determinants of sexual dysfunctions (SD). Whether inflammatory bowel diseases (IBD) are associated with SD is not well known as well as the role of diet and quality of life (QoL).

OBJECTIVES

To evaluate the prevalence of SD in a cohort of IBD patients and assess the role of clinical-demographic variables, adherence to Mediterranean diet (MD) and QoL.

MATERIALS AND METHODS

This is a cross-sectional observational study involving 301 patients (134 females and 167 males); 119 had Crohn's Disease and 182 had ulcerative colitis. SD were assessed through the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF). Adherence to MD was evaluated by the MD Score. QoL was investigated by the 12-item Short-Form Health Survey (SF-12) which yields summary scores of physical (PCS) and mental (MCS) health. Multiple logistic regression was used to identify predictors of SD.

RESULTS

Prevalence of SD in females was 61.9%, while 52.1% of males had erectile dysfunction. No differences in the prevalence of SD were found between CD and UC in both males and females. IBD activity, as defined by patient-reported outcomes, was significantly associated with SD in both sexes. In females, MD adherence score (OR 0.8, 95% CI 0.653-0.974, p = 0.027), PCS (OR = 0.936, CI 95% = 0.891-0.983, p = 0.008), and MCS (OR 0.9, 95% CI 0.906-0.985, p = 0.008) were protective against SD, whereas in males a higher PCS was associated with a lower probability of SD (OR 0.9, 95% CI 0.891-0.978, p = 0.004) DISCUSSION: IBD patients had a significant prevalence of SD which occurred more frequently in females than in males. Disease activity is associated with a higher likelihood of SD in both sexes, whereas dietary factors are differentially associated with SD in males and females. A better QoL is associated with a lower risk of SD.

CONCLUSION

SD is prevalent among men and women with IBD. Adherence to MD, PCS and MCS in females as well as PCS in males were protective against SD. The assessment of sexual function in IBD patients could be relevant in order to reach an early diagnosis and a timely treatment.

Effects of intergenerational transmission of small intestinal bacteria cultured from stunted Bangladeshi children with enteropathy

Environmental enteric dysfunction (EED), a small intestinal disorder found at a high prevalence in stunted children, is associated with gut mucosal barrier disruption and decreased absorptive capacity due to reduced intact small intestinal villi1-4. To test the hypothesis that intergenerational transmission of a perturbed small intestinal microbiota contributes to undernutrition by inducing EED5, we characterized two consortia of bacterial strains cultured from duodenal aspirates from stunted Bangladeshi children with EED - one of which induced local and systemic inflammation in gnotobiotic female mice. Offspring of dams that received this inflammatory consortium exhibited immunologic changes along their gut that phenocopied features of EED in children. Single nucleus plus bulk RNA-sequencing revealed alterations in inter-cellular signaling pathways related to intestinal epithelial cell renewal, barrier integrity and immune function while analyses of cerebral cortex disclosed alterations in glial- and endothelial-neuronal signaling pathways that regulate neural growth/axonal guidance, angiogenesis and inflammation. Analysis of ultrasonic vocalization calls in gnotobiotic P5-P9 pups indicated increased arousal and perturbed neurodevelopment in the offspring of dams harboring the inflammation-inducing consortium. Cohousing experiments and follow-up screening of candidate disease-promoting bacterial isolates identified a strain typically found in the oral microbiota (Campylobacter concisus) as a contributor to enteropathy. Given that fetal growth was also impaired in the dams with the consortium that induced enteropathy, this preclinical model allows the effects of the human small intestinal microbiota on both pre- and postnatal development to be ascertained, setting the stage for identification of small intestinal microbiota-targeted therapeutics for (intergenerational) undernutrition.

Review article: Evidence-based dietary management of inflammatory bowel disease

BACKGROUND

Dietary management of patients with inflammatory bowel disease (IBD) involves more than defining a therapeutic diet. The profusion of 'expert advice' is not necessarily built on evidence.

AIMS

To provide evidence-based guidance on all clinically relevant aspects of nutritional and dietary management of patients with IBD.

METHODS

A comprehensive review of the published literature was made.

RESULTS

Four pillars of management should be considered in all patients. First, nutritional status should be optimised, since myopenia and visceral obesity are associated with poorer outcomes, which can be improved with attention to their correction. Accurate point-of-care measurement of body composition is advocated to identify problems, guide interventions and monitor outcomes. Second, exclusive enteral nutrition and the Crohn's Disease Exclusion Diet with partial enteral nutrition in reducing intestinal inflammation in patients with Crohn's disease have sufficient evidence to be advocated. Multiple other dietary approaches, while promising, have insufficient evidence to be recommended. Third, dietary approaches are important in symptomatic control in many non-inflammatory scenarios. Finally, guidance on following a healthy diet is fundamental to the general health of patients. Multiple approaches are advocated, but the optimal strategy is unclear. The precarious nutritional status of patients with IBD together with the risks of nutritional inadequacy and maladaptive eating behaviours associated with restrictive diets dictate involvement of expert dietitians in assessment and personalised delivery of dietary interventions.

CONCLUSIONS

Four pillars of nutritional management require specific assessment and interventional strategies that should be chosen by evidence. Optimal delivery requires the skills of a specialised dietitian.

Preventing Recurrence of Crohn's Disease Post-Ileocaecal Surgery in Paediatric Patients: A Therapy Guide Based on Systematic Review of the Evidence

BACKGROUND AND AIMS

Ileocaecal resection (ICR) is frequent in paediatric patients with Crohn's disease (pCD). Despite rates of reoperation being low, the risk of clinical or endoscopic post-operative recurrence (POR) is high; effective medical strategies to prevent POR are thus needed. The aim of this systematic review (SR) was to identify and evaluate the published literature on post-operative medical prevention of POR in pCD to draft a possible therapy guide for pCD patients undergoing ICR.

METHODS

We performed an SR according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards and registered it in the PROSPERO database (ID: CRD42024533855). The population, intervention, control, outcome (PICO) model was focussed on post-surgical medical prevention of POR in pCD with clearly expressed definition of recurrence (endoscopically using a standardized scoring system (e.g. Rutgeerts score) or by laboratory markers, for example, faecal calprotectin (F-CPT), C-reactive protein (CRP) or by histological findings or by clinical activity indexes [e.g. weighted paediatric Crohn's disease activity index - (w)PCDAI]. From inception until 29 February 2024, the following databases were searched: PubMed/MEDLINE, Scopus/Embase, Web of Sciences, Evidence-Based Medicine Reviews (including Cochrane), Cochrane Central Registrar of controlled Trials (CENTRAL), ClinicalTrials.gov and EudraCT. Retrieved articles were evaluated for eligibility and finally selected publications for risk of bias using ROBINS-I tool.

RESULTS

Out of 811 publications identified by the search, only 5 fulfilled inclusion criteria of the SR. None of the studies fully answered our PICO question. The studies were overall of poor quality and the heterogeneity of the data did not allow us to perform meta-analysis, detailed statistical analysis or formal synthesis of data. Adverse events of post-operative medication were not described in any of the included studies. Existing guidelines of European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), North American Society for Paediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), European Crohn's and Colitis Organisation (ECCO) and American Gastroenterological Association (AGA) were reviewed and paediatric therapy guide for pCD undergoing ICR was drafted with respect to recent SRs and meta-analyses in adult population and including scarce paediatric data identified by our SR. As pCD patients undergoing ICR are a high-risk population, they should not be left untreated post-operatively. Anti-tumour necrosis factor (anti-TNF) drugs should be considered as first-line therapy in the majority of patients. Non-anti-TNF biologics should be considered in case of anti-TNF failure. Regular endoscopic monitoring starting at 6 months after the surgery and supported by regular F-CPT evaluation should be used to identify early endoscopic recurrence and to escalate the treatment.

CONCLUSION

Our SR revealed that there is wide variability in treatment strategies in children, and high-quality data are generally lacking. At the moment, paediatric prophylaxis of POR should be guided by available adult evidence with respect to the high-risk nature of pCD. Extensive research in pCD should be encouraged.

The impact of a whole foods dietary intervention on gastrointestinal symptoms, inflammation, and fecal microbiota in pediatric patients with cystic fibrosis: A pilot study

BACKGROUND

Gastrointestinal (GI) complications are a significant source of morbidity for people with cystic fibrosis (PwCF). Historically, dietary recommendations in CF have focused on calories, typically emphasizing a high fat diet. The changing landscape of CF highlights the need to update this nutritional strategy. There is little research into how the quality of calories consumed by PwCF influences nutritional outcomes, GI symptoms, or likely contributors: intestinal inflammation and GI microbiology. We assessed the feasibility of a whole foods-based diet (WFD) and avoidance of ultra-processed foods, measuring safety/tolerability, adherence, and GI symptoms, as well as fecal measures of inflammation and microbiota among children with CF (CwCF) with GI symptoms.

METHODS

Single center, 4-week dietary intervention involving CwCF aged 5-14 years who screened positive on GI symptom questionnaire. Assessments included weight, symptom questionnaires and adverse events (AEs). Stool was analyzed for microbiota (16S rRNA) and calprotectin.

RESULTS

108 children were pre-screened, 9 enrolled and 8 initiated and completed the study. There were no significant changes in weight and no AEs. PEDS-QL GI identified overall improvement in symptoms. Certain symptom domains (constipation, diarrhea, gas/bloating, stomach pain and hurt) demonstrated significant improvement on the WFD. Of two participants with abnormal fecal calprotectin at enrollment, both exhibited decreased values on WFD. There was no significant change in microbiota diversity.

CONCLUSION

A WFD diet was feasible and safe in CwCF. There was improvement in GI symptom scores based on both parent and child assessments. Larger studies are needed to further investigate effects on intestinal inflammation and microbiota.

Faecal intestinal permeability and intestinal inflammatory markers in older adults with age-related disorders: A systematic review and meta-analysis

This systematic review and meta-analysis appraised previous findings to uncover potential faecal intestinal permeability and intestinal inflammatory markers in older adults. A comprehensive literature search led to the identification of ten eligible studies with findings of potential faecal intestinal permeability (zonulin and alpha-1-antitrypsin) and intestinal inflammatory markers [calprotectin, lactoferrin and neutrophil gelatinase-associated lipocalin (NGAL)]. Most of the cases (n > 2) [Parkinson's disease (PD) and Alzheimer's disease (AD)] exhibited higher faecal alpha-1-antitrypsin, zonulin and calprotectin levels. The present meta-analysis confirmed significantly higher faecal alpha-1-antitrypsin in older persons with PD compared to non-PD [MD = 22.92 mg/dL; 95 % CI = 14.02-31.81, p < 0.00001; I2 = 0 % (p = 0.73)]. There was, however, no significant difference in faecal zonulin between PD and non-PD individuals [MD = 26.88 ng/mL; 95 % CI = -29.26-83.01, p = 0.35; I2 = 94 % (p < 0.0001)]. Meanwhile, faecal calprotectin was higher in older adults with GI symptoms, multiple system atrophy (MSA) or PD than the healthy controls [MD = 9.51 μg/g; 95 % CI = 0.07-18.95, p = 0.05; I2 = 84 % (p < 0.00001)]. Altogether, faecal calprotectin appears to be a potential intestinal inflammatory marker whereas previous findings on faecal alpha-1-antitrypsin as an intestinal permeability marker remain limited and require further validation.