Association between faecal pH and fat absorption in children with cystic fibrosis on a controlled diet and enzyme supplements dose

Faecal lipid profile as a new marker of fat maldigestion, malabsorption and microbiota

BACKGROUND

Fat malabsorption in children with cystic fibrosis (CF) leads to poor nutritional status and altered colonic microbiota. This study aimed at establishing the faecal lipid profile in children with CF, and exploring associations between the faecal lipidome and microbiota.

METHODS

Cross-sectional observational study with children with CF and an age-matched control group. Faecal lipidome was analysed by UHLC-HRMS and microbiota profiling by 16S rRNA amplicon sequencing.

RESULTS

Among 234 identified lipid species, five lipidome clusters (LC) were obtained with significant differences in triacylglycerols (TG), diacylglycerols (DG), monoacylglycerols (MG) and fatty-acids (FA): LC1 subjects with good digestion and absorption: low TG and low MG and FA; LC2 good digestion and poor absorption: low TG and high MG and FA; LC3 Mild digestion and poor absorption: intermediate TG and high MG and FA; LC4 poor digestion and absorption: high TG and high MG and FA; LC5 outliers. Bacteroidota and Verrucomicrobiota decreased over LC1-LC4, while Proteobacteria increased. Nutritional status indicators were significantly higher in LC1 and decreased over LC2-LC4.

CONCLUSION

Assessing faecal lipidome may be relevant to determine how dietary lipids are digested and absorbed. This new evidence might be a method to support targeted nutritional interventions towards reverting fat maldigestion or malabsorption.

IMPACT

Lipidomic analysis enabled the identification of the lipid species related to maldigestion (triglycerides) or malabsorption (monoglycerides and fatty acids). Children with cystic fibrosis can be grouped depending on the faecal lipidome profile related to dietary fat maldigestion or malabsorption. The lipidome profile in faeces is related to the composition of microbiota and nutritional status indicators.

ESPEN-ESPGHAN-ECFS guideline on nutrition care for cystic fibrosis

BACKGROUND

Nutritional status is paramount in Cystic Fibrosis (CF) and is directly correlated with morbidity and mortality. The first ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with CF were published in 2016. An update to these guidelines is presented.

METHODS

The study was developed by an international multidisciplinary working group in accordance with officially accepted standards. Literature since 2016 was reviewed, PICO questions were discussed and the GRADE system was utilized. Statements were discussed and submitted for on-line voting by the Working Group and by all ESPEN members.

RESULTS

The Working Group updated the nutritional guidelines including assessment and management at all ages. Supplementation of vitamins and pancreatic enzymes remains largely the same. There are expanded chapters on pregnancy, CF-related liver disease, and CF-related diabetes, bone disease, nutritional and mineral supplements, and probiotics. There are new chapters on nutrition with highly effective modulator therapies and nutrition after organ transplantation.

Diagnosis and Management of Gastrointestinal Manifestations in Children with Cystic Fibrosis

Cystic fibrosis (CF) is primarily known for its pulmonary consequences, which are extensively explored in the existing literature. However, it is noteworthy that individuals with CF commonly display gastrointestinal (G-I) manifestations due to the substantial presence of the cystic fibrosis transmembrane conductance regulator (CFTR) protein in the intestinal tract. Recognized as pivotal nonpulmonary aspects of CF, G-I manifestations exhibit a diverse spectrum. Identifying and effectively managing these manifestations are crucial for sustaining health and influencing the overall quality of life for CF patients. This review aims to synthesize existing knowledge, providing a comprehensive overview of the G-I manifestations associated with CF. Each specific G-I manifestation, along with the diagnostic methodologies and therapeutic approaches, is delineated, encompassing the impact of innovative treatments targeting the fundamental effects of CF on the G-I tract. The findings underscore the imperative for prompt diagnosis and meticulous management of G-I manifestations, necessitating a multidisciplinary team approach for optimal care and enhancement of the quality of life for affected individuals. In conclusion, the authors emphasize the urgency for further clinical studies to establish a more robust evidence base for managing G-I symptoms within the context of this chronic disease. Such endeavors are deemed essential for advancing understanding and refining the clinical care of CF patients with G-I manifestations.

Effects of overfeeding on the digestive efficiency, voluntary physical activity levels, and fecal characteristics and microbiota of adult cats

The incidence of feline obesity continues to rise despite it being a preventable disease. There are many risks and health perturbations associated with obesity, with several of those impacting a pet's quality of life, wellness, and longevity. Feline obesity is commonly studied, but most research has been focused on weight loss rather than weight gain. To our knowledge, feline studies have not examined the implications of overfeeding and weight gain on gastrointestinal transit time (GTT) nor the association it has with the fecal microbiota. Therefore, the objective of this study was to determine the effects of overfeeding and weight gain on apparent total tract digestibility (ATTD), GTT, blood hormones, serum metabolites, hematology, fecal microbiota populations, and voluntary physical activity of cats. Eleven lean adult spayed female cats [body weight (BW) = 4.11 ± 0.43 kg; body condition score = 5.41 ± 0.3; age = 5.22 ± 0.03 y] were used in a longitudinal weight gain study. After a 2-wk baseline phase, cats were allowed to overeat for 18 wk. A commercially available complete and balanced diet was fed during the baseline phase to identify the intake needed to maintain BW. Cats were then fed the same diet ad libitum to induce weight gain. Fecal samples, blood samples, and voluntary physical activity data were collected at baseline (week 0) and 6, 12, and 18 wk after weight gain. Fecal samples were collected for microbiota analysis, determination of ATTD, and GTT measurement while blood samples were collected for serum chemistry, hematology, and insulin and leptin measurements. Microbiota data were evaluated using QIIME2. All other measures were evaluated statistically using the mixed models procedure of SAS using repeated measures analysis, with time effects being the focus. A P < 0.05 was considered significant. The ATTD of dry matter (P = 0.0061), organic matter (P = 0.0130), crude protein (P < 0.0001), fat (P = 0.0002), and gross energy (P = 0.0002), and GTT (P = 0.0418) decreased with overfeeding and weight gain. Fecal bacterial alpha diversity measures were unchanged, but fecal bacterial beta diversity was impacted (P < 0.05) with overfeeding and weight gain. The relative abundances of 16 bacterial genera, including Bifidobacterium, Collinsella, Erysipelatoclostridium were affected (P < 0.05) by overfeeding and weight gain. In conclusion, overfeeding and subsequent weight gain reduced ATTD, reduced GTT, and caused changes to the fecal microbial community of adult cats.

The fatty acid imbalance of cystic fibrosis exists at birth independent of feeding in pig and ferret models

Persons with cystic fibrosis (CF) exhibit a unique alteration of fatty acid composition, marked especially among polyunsaturates by relative deficiency of linoleic acid and excess of Mead acid. Relative deficiency of docosahexaenoic acid is variably found. However, the initial development of these abnormalities is not understood. We examined fatty acid composition in young CF ferrets and pigs, finding abnormalities from the day of birth onward including relative deficiency of linoleic acid in both species. Fatty acid composition abnormalities were present in both liver and serum phospholipids of newborn CF piglets even prior to feeding, including reduced linoleic acid and increased Mead acid. Serum fatty acid composition evolved over the first weeks of life in both non-CF and CF ferrets, though differences between CF and non-CF persisted. Although red blood cell phospholipid fatty acid composition was normal in newborn animals, it became perturbed in juvenile CF ferrets including relative deficiencies of linoleic and docosahexaenoic acids and excess of Mead acid. In summary, fatty acid composition abnormalities in CF pigs and ferrets exist from a young age including at birth independent of feeding and overlap extensively with the abnormalities found in humans with CF. That the abnormalities exist prior to feeding implies that dietary measures alone will not address the mechanisms of imbalance.