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Proietti E, Rapallo F, Molinari E, Mucci V, Marinelli L, Borgarelli C, Burlando B, Pisciotta L, Demori I. Online Questionnaire with Fibromyalgia Patients Shows Negative Correlations between Disease Severity and Adherence to Mediterranean Diet. Nutrients 2024; 16:1078. [PMID: 38613111 PMCID: PMC11013287 DOI: 10.3390/nu16071078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
Fibromyalgia (FM) is a multidimensional disorder in which intense chronic pain is accompanied by a variety of psychophysical symptoms that impose a burden on the patients' quality of life. Despite the efforts and the recent advancement in research, FM pathogenesis and effective treatment remain unknown. Recently, the possible role of dietary patterns and/or components has been gaining attention. The current study aimed to investigate a potential correlation between adherence to the Mediterranean diet (MedDiet) and FM severity in a sample of Italian FM patients. An online survey was designed, composed of customized questions and validated questionnaires with the aim of investigating the intensity and type of pain, the presence of other psychophysical symptoms, the overall impact of FM, general food and lifestyle habits, and adherence to the MedDiet. The collected responses were analyzed for descriptive statistics, linear regression, and propensity score analyses. The results show that, despite considerable use of pharmaceuticals and supplements, FM participants suffered from a high-severity grade disease. However, those with good adherence to the MedDiet experienced a lower pain intensity and overall FM impact. A propensity score analysis indicates a positive influence of the MedDiet against FM severity, thus unveiling the need for well-designed intervention studies to evaluate the therapeutic potential of different dietary patterns.
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Affiliation(s)
- Elisa Proietti
- Department of Internal Medicine (DIMI), University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy; (E.P.); (C.B.); (L.P.)
| | - Fabio Rapallo
- Department of Economics (DIEC), University of Genova, Via Vivaldi, 5, 16126 Genova, Italy;
| | - Elena Molinari
- Clincal Psychology Center, Division of Neurology, E.O. Ospedali Galliera, Via Mura delle Cappuccine 14, 16128 Genova, Italy;
| | - Viviana Mucci
- School of Science, Western Sydney University, Penrith, NSW 2750, Australia;
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Largo P. Daneo 3, 16132 Genova, Italy;
- IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Division of Clinical Neurophysiology, Largo R. Benzi 10, 16132 Genova, Italy
| | - Consuelo Borgarelli
- Department of Internal Medicine (DIMI), University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy; (E.P.); (C.B.); (L.P.)
| | - Bruno Burlando
- Department of Pharmacy (DIFAR), University of Genova, Viale Benedetto XV 3, 16132 Genova, Italy;
| | - Livia Pisciotta
- Department of Internal Medicine (DIMI), University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy; (E.P.); (C.B.); (L.P.)
- IRCCS Ospedale Policlinico San Martino, Department of Internal Medicine, Operative Unit of Dietetics and Clinical Nutrition, Largo R. Benzi 10, 16132 Genova, Italy
| | - Ilaria Demori
- Department of Pharmacy (DIFAR), University of Genova, Viale Benedetto XV 3, 16132 Genova, Italy;
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Ma Y, Yang D, Huang J, Liu K, Liu H, Wu H, Bao C. Probiotics for inflammatory bowel disease: Is there sufficient evidence? Open Life Sci 2024; 19:20220821. [PMID: 38585636 PMCID: PMC10998680 DOI: 10.1515/biol-2022-0821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/26/2023] [Accepted: 12/11/2023] [Indexed: 04/09/2024] Open
Abstract
Inflammatory bowel disease (IBD) refers to chronic inflammatory disorders of the gut. Ulcerative colitis (UC) and Crohn's disease (CD) are two subtypes of IBD. Evidence suggests that the intestinal microbiota plays a role in the pathogenesis of IBD, so probiotics have garnered a lot of interest as a potential treatment or prevention for IBD. However, clinical evidence of the efficacy of probiotics is still debatable. We performed a literature review. An advanced search considered clinical studies on probiotic for IBD from inception to 2023 in PubMed, Embase, Cochrane Library, and Web of Science. In the treatment of UC with probiotics, only Escherichia coli Nissle 1917 for maintenance treatment of UC in remission, and Bifidobacterium and VSL#3 for induction of remission in patients with mild to moderately active UC have shown strong evidence. Currently, there are no definitive conclusions regarding the effectiveness of probiotics in CD. The mechanism of probiotic treatment for IBD may be related to reducing oxidative stress, repairing the intestinal barrier, regulating intestinal flora balance, and modulating intestinal immune response. Differences in the benefits of probiotics between CD and UC may be attributable to the different lesion extent and immune-mediated pathophysiology. More robust randomized clinical trials are required to validate the efficacy and safety of diverse probiotic strains in IBD.
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Affiliation(s)
- Yueying Ma
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai200437, China
- Shanghai University of Traditional Chinese Medicine, Shanghai201203, China
| | - Dandan Yang
- Hong Kong Baptist University, Hong Kong999077, China
| | - Jin Huang
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai200437, China
- Shanghai University of Traditional Chinese Medicine, Shanghai201203, China
| | - Kunli Liu
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai200437, China
- Shanghai University of Traditional Chinese Medicine, Shanghai201203, China
| | - Huirong Liu
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai200437, China
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai200030, China
| | - Huangan Wu
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai200437, China
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai200030, China
| | - Chunhui Bao
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai200437, China
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai200030, China
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Belloni S, Caruso R, Giacon C, Baroni I, Conte G, Magon A, Arrigoni C. Microbiome-Modifiers for Cancer-Related Fatigue Management: A Systematic Review. Semin Oncol Nurs 2024; 40:151619. [PMID: 38503656 DOI: 10.1016/j.soncn.2024.151619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES This study systematically investigates the evidence regarding the use of probiotics in managing cancer-related fatigue (CRF). STUDY DESIGN We conducted a systematic review of randomized controlled trials. DATA SOURCES The systematic search encompassed six databases: PubMed, CINHAL, Cochrane Database of Systematic Reviews, Web of Science, Scopus, and EMBASE, covering the period from inception to December 2023. The assessment of risk of bias employed the Cochrane risk of bias tool (RoB 2). A narrative synthesis and an exploratory meta-analysis were conducted to summarize the evidence. RESULTS Among 460 records, three studies met the eligibility criteria and were included in the review. These studies involved a total of 284 participants with colorectal and breast cancer. One study demonstrated a marginal improvement in CRF postchemotherapy in colorectal cancer patients using probiotics. Another study, also using probiotics, reported a significant reduction in CRF among colorectal cancer patients undergoing chemotherapy. Additionally, a study employing synbiotics showed a substantial decrease in CRF severity in breast cancer patients receiving chemotherapy. CONCLUSION The study presents initial but varied evidence suggesting the potential of probiotics and synbiotics as adjunctive therapies in managing CRF alongside anticancer treatments. IMPLICATIONS FOR NURSING PRACTICE In nursing practice, large-scale clinical trials are urgently needed to evaluate the effectiveness of probiotics in treating cancer-related fatigue during cancer therapy. Insights from this review could guide nurses in selecting appropriate probiotic strains and integrating microbiome modifiers into comprehensive care plans, potentially enhancing the quality of life for cancer patients.
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Affiliation(s)
- Silvia Belloni
- Gastroenterology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Chiara Giacon
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Irene Baroni
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Gianluca Conte
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
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Chávez García SN, Rodríguez-Herrera R, Nery Flores S, Silva-Belmares SY, Esparza-González SC, Ascacio-Valdés JA, Flores-Gallegos AC. Sprouts as probiotic carriers: A new trend to improve consumer nutrition. FOOD CHEMISTRY. MOLECULAR SCIENCES 2023; 7:100185. [PMID: 38155686 PMCID: PMC10753383 DOI: 10.1016/j.fochms.2023.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/15/2023] [Accepted: 11/04/2023] [Indexed: 12/30/2023]
Abstract
Over the past few decades, efforts to eradicate hunger in the world have led to the generation of sustainable development goals to reduce poverty and inequality. It is estimated that the current coronavirus pandemic could add between 83 and 132 million to the total number of undernourished people in the world by 2021. Food insecurity is a contributing factor to the increase in malnutrition, overweight and obesity due to the quality of diets to which people have access. It is therefore necessary to develop functional foods that meet the needs of the population, such as the incorporation of sprouts in their formulation to enhance nutritional quality. Germination of grains and seeds can be used as a low-cost bioprocessing technique that provides higher nutritional value and better bioavailability of nutrients. Consequently, the manuscript describes relevant information about the germination process in different seeds, the changes caused in their nutritional value and the use of techniques within the imbibition phase to modify the metabolic profiles within the sprouts such as inoculation with lactic acid bacteria and yeasts, to generate a functional symbiotic food.
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Affiliation(s)
| | | | | | | | - Sandra Cecilia Esparza-González
- School of Odontology, Universidad Autónoma de Coahuila, Boulevard Venustiano Carranza and José Cárdenas S/N, Republica Oriente, C.P. 25280 Saltillo, Coahuila, Mexico
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Purdel C, Ungurianu A, Adam-Dima I, Margină D. Exploring the potential impact of probiotic use on drug metabolism and efficacy. Biomed Pharmacother 2023; 161:114468. [PMID: 36868015 DOI: 10.1016/j.biopha.2023.114468] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/05/2023] Open
Abstract
Probiotics are frequently consumed as functional food and widely used as dietary supplements, but are also recommended in treating or preventing various gastrointestinal diseases. Therefore, their co-administration with other drugs is sometimes unavoidable or even compulsory. Recent technological developments in the pharmaceutical industry permitted the development of novel drug-delivery systems for probiotics, allowing their addition to the therapy of severely ill patients. Literature data regarding the changes that probiotics could impose on the efficacy or safety of chronic medication is scarce. In this context, the present paper aims to review probiotics currently recommended by the international medical community, to evaluate the relationship between gut microbiota and various pathologies with high impact worldwide and, most importantly, to assess the literature reports concerning the ability of probiotics to influence the pharmacokinetics/pharmacodynamics of some widely used drugs, especially for those with narrow therapeutic indexes. A better understanding of the potential influence of probiotics on drug metabolism, efficacy and safety could contribute to improving therapy management, facilitating individualized therapy and updating treatment guidelines.
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Affiliation(s)
- Carmen Purdel
- "Carol Davila" University of Medicine and Pharmacy, Faculty of Pharmacy, Department of Toxicology, Traian Vuia 6, Bucharest 020956, Romania
| | - Anca Ungurianu
- "Carol Davila" University of Medicine and Pharmacy, Faculty of Pharmacy, Department of Biochemistry, Traian Vuia 6, Bucharest 020956, Romania.
| | - Ines Adam-Dima
- "Carol Davila" University of Medicine and Pharmacy, Faculty of Pharmacy, Department of Toxicology, Traian Vuia 6, Bucharest 020956, Romania
| | - Denisa Margină
- "Carol Davila" University of Medicine and Pharmacy, Faculty of Pharmacy, Department of Biochemistry, Traian Vuia 6, Bucharest 020956, Romania
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Pulvirenti G, Sortino V, Manti S, Parisi GF, Papale M, Giallongo A, Leonardi S. Pathogenesis, diagnosis, dietary management, and prevention of gastrointestinal disorders in the paediatric population. Ital J Pediatr 2022; 48:172. [PMID: 36089576 PMCID: PMC9465927 DOI: 10.1186/s13052-022-01366-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/04/2022] [Indexed: 11/13/2022] Open
Abstract
Nutrition has a central role in child growth with long-term effects, and nutrition management in gastrointestinal disorders has great importance for child health and disease outcomes. Breast milk is the first choice for infant nutrition. When it is not available, special milk formulas are adopted in specific conditions, as a medical treatment. Moving from the strong guidelines, recommendations and the new possibilities of special diet treatment, this review will analyse the current diet treatment in different gastrointestinal disorders, including food allergy, cystic fibrosis, inflammatory bowel diseases, short-bowel syndrome, gastroesophageal reflux, and eosinophilic esophagitis. The review also aimed at understanding the role of diet and its effects on these diseases. The growth monitoring can prevent malnutrition and improve disease outcomes, particularly in children, and an appropriate dietary management targeted to specific disorders is the best therapeutic choice alone or in combination with pharmacological therapy.
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Probiotics in the Management of Mental and Gastrointestinal Post-COVID Symptomes. J Clin Med 2022; 11:jcm11175155. [PMID: 36079082 PMCID: PMC9457065 DOI: 10.3390/jcm11175155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/17/2022] [Accepted: 08/29/2022] [Indexed: 01/30/2023] Open
Abstract
Patients with “post-COVID” syndrome manifest with a variety of signs and symptoms that continue/develop after acute COVID-19. Among the most common are gastrointestinal (GI) and mental symptoms. The reason for symptom occurrence lies in the SARS-CoV-2 capability of binding to exact receptors, among other angiotensin converting enzyme 2 (ACE2) receptors in gastrointestinal lining and neuropilin-1 (NRP-1) in the nervous system, which leads to loss of gastrointestinal and blood-brain barriers integrity and function. The data are mounting that SARS-CoV-2 can trigger systemic inflammation and lead to disruption of gut-brain axis (GBA) and the development of disorders of gut brain interaction (DGBIs). Functional dyspepsia (FD) and irritable bowel syndrome (IBS) are the most common DGBIs syndromes. On the other hand, emotional disorders have also been demonstrated as DGBIs. Currently, there are no official recommendations or recommended procedures for the use of probiotics in patients with COVID-19. However, it can be assumed that many doctors, pharmacists, and patients will want to use a probiotic in the treatment of this disease. In such cases, strains with documented activity should be used. There is a constant need to plan and conduct new trials on the role of probiotics and verify their clinical efficacy for counteracting the negative consequences of COVID-19 pandemic. Quality control is another important but often neglected aspect in trials utilizing probiotics in various clinical entities. It determines the safety and efficacy of probiotics, which is of utmost importance in patients with post-acute COVID-19 syndrome.
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Mei F, Wu M, Zhao L, Hu K, Gao Q, Chen F, Kwong JS, Wang Y, Shen XP, Ma B. Probiotics for the prevention of Hirschsprung-associated enterocolitis. Cochrane Database Syst Rev 2022; 4:CD013714. [PMID: 35470864 PMCID: PMC9039968 DOI: 10.1002/14651858.cd013714.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hirschsprung-associated enterocolitis (HAEC) is a leading cause of serious morbidity and potential mortality in children with Hirschsprung's disease (HD). People with HAEC suffer from intestinal inflammation, and present with diarrhoea, explosive stools, and abdominal distension. Probiotics are live microorganisms with beneficial health effects, which can optimise gastrointestinal function and gut flora. However, the efficacy and safety of probiotic supplementation in the prevention of HAEC remains unclear. OBJECTIVES To assess the effects of probiotic supplements used either alone or in combination with pharmacological interventions on the prevention of Hirschsprung-associated enterocolitis. SEARCH METHODS We searched CENTRAL, PubMed, Embase, the China BioMedical Literature database (CBM), the World Health Organization International Clinical Trials Registry, ClinicalTrials.gov, the Chinese Clinical Trials Registry, Australian New Zealand Clinical Trials Registry, and Clinical Trials Registry-India, from database inception to 27 February 2022. We also searched the reference lists of relevant articles and reviews for any additional trails. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing probiotics and placebo, or any other non-probiotic intervention, for the prevention of HAEC were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias of the included studies; disagreements were resolved by discussion with a third review author. We assessed the certainty of evidence using the GRADE approach. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes. MAIN RESULTS We included two RCTs, with a total of 122 participants. We judged the overall risk of bias as high. We downgraded the evidence due to risk of bias (random sequence generation, allocation concealment, and blinding) and small sample size. The evidence is very uncertain about the effect of probiotics on the occurrence of HAEC (OR 0.58, 95% CI 0.10 to 3.43; I² = 74%; 2 studies, 120 participants; very low-certainty evidence). We found one included study that did not measure serious adverse events and one included study that reported no serious adverse events related to probiotics. Probiotics may result in little to no difference between probiotics and placebo in relation to the severity of children with HAEC at Grade I (OR 0.66, 95% CI 0.14 to 3.16; I² = 25%; 2 studies, 120 participants; low-certainty evidence). The effects of probiotics on the severity of HAEC at Grade II are very uncertain (OR 1.14, 95% CI 0.01 to 136.58; I² = 86%; 2 studies, 120 participants; very low-certainty evidence). Similarly, the evidence suggests that probiotics results in little to no difference in relation to the severity of HAEC at Grade III (OR 0.43, 95% CI 0.05 to 3.45; I² = 0%; 2 studies, 120 participants; low-certainty evidence). No overall mortality or withdrawals due to adverse events were reported. Probiotics may result in little to no difference in the recurrence of episodes of HAEC compared to placebo (OR 0.85, 95% CI 0.24 to 3.00; 1 study, 60 participants; low-certainty evidence). AUTHORS' CONCLUSIONS There is currently not enough evidence to assess the efficacy or safety of probiotics for the prevention of Hirschsprung-associated enterocolitis when compared with placebo. The presence of low- to very-low certainty evidence suggests that further well-designed and sufficiently powered RCTs are needed to clarify the true efficacy of probiotics.
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Affiliation(s)
- Fan Mei
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Mei Wu
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Li Zhao
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Kaiyan Hu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Qianqian Gao
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Fei Chen
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Joey Sw Kwong
- Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Yanan Wang
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Ping Shen
- Department of Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Bin Ma
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
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Zhang Y, Wei X, Sun Q, Qian W, Liu X, Li J, Long Y, Wan X. Different Types and Functional Effects of Probiotics on Human Health through Regulating Glucose Homeostasis. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2021; 69:14781-14791. [PMID: 34855398 DOI: 10.1021/acs.jafc.1c04291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
With the increasing improvement of people's living standards, hyperglycemia has become one of the most frequent diseases in the world. The current drug therapy may have some negative effects and even cause some complications. As one of the most popular functional ingredients, probiotic bacteria have been proven to play important roles in balancing the glucose homeostasis level in animal and human clinic trials. In this perspective, we sorted three types of probiotics, discussed probiotic safety evaluation, and listed the known probiotic functional foods that assist to control glucose homeostasis. Then, the further summarization of the mechanisms on how probiotic bacteria could regulate glucose homeostasis and the developing trend of probiotic functional foods were discussed.
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Affiliation(s)
- Yong Zhang
- Zhongzhi International Institute of Agricultural Biosciences, Shunde Graduate School, Research Center of Biology and Agriculture, University of Science and Technology Beijing (USTB), Beijing 100024, People's Republic of China
- Beijing Beike Institute of Precision Medicine and Health Technology, Beijing 100192, People's Republic of China
- Beijing Engineering Laboratory of Main Crop Bio-Tech Breeding, Beijing International Science and Technology Cooperation Base of Bio-Tech Breeding, Beijing Solidwill Sci-Tech Company, Limited, Beijing 100192, People's Republic of China
| | - Xun Wei
- Zhongzhi International Institute of Agricultural Biosciences, Shunde Graduate School, Research Center of Biology and Agriculture, University of Science and Technology Beijing (USTB), Beijing 100024, People's Republic of China
- Beijing Beike Institute of Precision Medicine and Health Technology, Beijing 100192, People's Republic of China
- Beijing Engineering Laboratory of Main Crop Bio-Tech Breeding, Beijing International Science and Technology Cooperation Base of Bio-Tech Breeding, Beijing Solidwill Sci-Tech Company, Limited, Beijing 100192, People's Republic of China
| | - Qian Sun
- Zhongzhi International Institute of Agricultural Biosciences, Shunde Graduate School, Research Center of Biology and Agriculture, University of Science and Technology Beijing (USTB), Beijing 100024, People's Republic of China
| | - Weiyi Qian
- Zhongzhi International Institute of Agricultural Biosciences, Shunde Graduate School, Research Center of Biology and Agriculture, University of Science and Technology Beijing (USTB), Beijing 100024, People's Republic of China
- Beijing Beike Institute of Precision Medicine and Health Technology, Beijing 100192, People's Republic of China
| | - Xinjie Liu
- Zhongzhi International Institute of Agricultural Biosciences, Shunde Graduate School, Research Center of Biology and Agriculture, University of Science and Technology Beijing (USTB), Beijing 100024, People's Republic of China
- Beijing Beike Institute of Precision Medicine and Health Technology, Beijing 100192, People's Republic of China
- Beijing Engineering Laboratory of Main Crop Bio-Tech Breeding, Beijing International Science and Technology Cooperation Base of Bio-Tech Breeding, Beijing Solidwill Sci-Tech Company, Limited, Beijing 100192, People's Republic of China
| | - Jinping Li
- Beijing Beike Institute of Precision Medicine and Health Technology, Beijing 100192, People's Republic of China
- Beijing Engineering Laboratory of Main Crop Bio-Tech Breeding, Beijing International Science and Technology Cooperation Base of Bio-Tech Breeding, Beijing Solidwill Sci-Tech Company, Limited, Beijing 100192, People's Republic of China
| | - Yan Long
- Zhongzhi International Institute of Agricultural Biosciences, Shunde Graduate School, Research Center of Biology and Agriculture, University of Science and Technology Beijing (USTB), Beijing 100024, People's Republic of China
- Beijing Beike Institute of Precision Medicine and Health Technology, Beijing 100192, People's Republic of China
- Beijing Engineering Laboratory of Main Crop Bio-Tech Breeding, Beijing International Science and Technology Cooperation Base of Bio-Tech Breeding, Beijing Solidwill Sci-Tech Company, Limited, Beijing 100192, People's Republic of China
| | - Xiangyuan Wan
- Zhongzhi International Institute of Agricultural Biosciences, Shunde Graduate School, Research Center of Biology and Agriculture, University of Science and Technology Beijing (USTB), Beijing 100024, People's Republic of China
- Beijing Beike Institute of Precision Medicine and Health Technology, Beijing 100192, People's Republic of China
- Beijing Engineering Laboratory of Main Crop Bio-Tech Breeding, Beijing International Science and Technology Cooperation Base of Bio-Tech Breeding, Beijing Solidwill Sci-Tech Company, Limited, Beijing 100192, People's Republic of China
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Sizentsov A, Salnikova E, Sizentsov Y, Peshkov S, Barysheva E, Naumenko O, Romanenko N. Technology for evaluating the ability of probiotic strains to accumulate copper ions in vitro and in vivo using Bacillus bacteria. Vet World 2021; 14:1752-1759. [PMID: 34475694 PMCID: PMC8404112 DOI: 10.14202/vetworld.2021.1752-1759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 05/19/2021] [Indexed: 12/04/2022] Open
Abstract
Background and Aim: Microorganisms of the genus Bacillus comprising probiotics could have an antitoxic effect that is manifested in the active excretion of toxic substances from the body, as well as heavy metals. This study was conducted to assess the effects of copper ions on probiotic strains based on the members of the genus Bacillus in vitro and in vivo. Materials and Methods: The following probiotic preparations were selected for this experiment: “Sporobacterin,” “Bactisubtil,” and “Vetom-2.” Sporobacterin liquid, manufactured by Bakoren LLC, is based on Bacillus subtilis 534. Bactisubtil, manufactured by Marion Merrell Dow, Inc., is based on Bacillus cereus 5832. The first part of the experiment (in vitro) was conducted to assess the influence of copper ions on the growth and bioaccumulating ability of probiotic strains. The second part of the experiment (in vivo) was conducted to assess the influence of copper ions on the body of laboratory animals and to determine the ability of probiotic strains to remove copper ions from the body of laboratory animals. Statistical analysis was performed using Statistical Package for the Social Sciences, calculating the average value (M), standard deviation (s), and standard deviation error (m). p<0.05 was used to denote statistical significance. Results: In the previous studies, we found the presence of pronounced sorption characteristics of representatives of both the intestinal microbiome and probiotic strains based on them. In this study, we have studied the prospects of using physiological and adaptive mechanisms of resistance of transient probiotic strains in the system of correction of the elemental status of the animal body due to excessive intake of copper ions into the body. The advantage of their use is due to not only sorption but also the high levels of elimination of complexes accumulated on the surface. Analyzing the data, we can state the following. The excessive content of copper ions inhibits the activity of all microorganisms, and the presence of CuSO4 in the nutrient medium reduces the exponential growth phase by 6 h for B. licheniformis. The analysis of data on the bioaccumulating property of the probiotic strains under study shows that B. cereus (part of Bactisubtil) had the most pronounced sorbing effect with the level of accumulation of 23.96%. Conclusion: We found that probiotic preparations do not affect biochemical indices of blood and biotissues (the muscle and bone tissue, and the cutaneous covering). As a result of determining the ability of Bacillus bacteria comprising the probiotics under this study to accumulate heavy metals by measuring their concentration in the tissues of laboratory animals, the preparations contribute to reducing the toxic effects of copper ions on the body. The cutaneous covering has the greatest accumulation property relative to copper ions. The most effective probiotic under this study in copper ion poisoning was Bactisubtil, and the least effective was Vetom-2.
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Affiliation(s)
- Aleksey Sizentsov
- Department of Biochemistry and Microbiology, Orenburg State University, 13, Pobedy Prospect, Orenburg, 460018, Russia
| | - Elena Salnikova
- Department of Biochemistry and Microbiology, Orenburg State University, 13, Pobedy Prospect, Orenburg, 460018, Russia
| | - Yaroslav Sizentsov
- Department of Biochemistry and Microbiology, Orenburg State University, 13, Pobedy Prospect, Orenburg, 460018, Russia
| | - Sergey Peshkov
- Department of Biochemistry and Microbiology, Orenburg State University, 13, Pobedy Prospect, Orenburg, 460018, Russia
| | - Elena Barysheva
- Department of Biochemistry and Microbiology, Orenburg State University, 13, Pobedy Prospect, Orenburg, 460018, Russia
| | - Olga Naumenko
- Department of Biochemistry and Microbiology, Orenburg State University, 13, Pobedy Prospect, Orenburg, 460018, Russia
| | - Natalia Romanenko
- Department of Biochemistry and Microbiology, Orenburg State University, 13, Pobedy Prospect, Orenburg, 460018, Russia
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11
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Stevenson C, Blaauw R, Fredericks E, Visser J, Roux S. Probiotic effect and dietary correlations on faecal microbiota profiles in irritable bowel syndrome. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2021. [DOI: 10.1080/16070658.2019.1697038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Cheryl Stevenson
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Renée Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ernst Fredericks
- Department of Biochemistry and Microbiology, Nelson Mandela University, Port Elizabeth, South Africa
| | - Janicke Visser
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Saartjie Roux
- Department of Biochemistry and Microbiology, Nelson Mandela University, Port Elizabeth, South Africa
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12
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Lagatuz M, Vyas RJ, Predovic M, Lim S, Jacobs N, Martinho M, Valizadegan H, Kao D, Oza N, Theriot CA, Zanello SB, Taibbi G, Vizzeri G, Dupont M, Grant MB, Lindner DJ, Reinecker HC, Pinhas A, Chui TY, Rosen RB, Moldovan N, Vickerman MB, Radhakrishnan K, Parsons-Wingerter P. Vascular Patterning as Integrative Readout of Complex Molecular and Physiological Signaling by VESsel GENeration Analysis. J Vasc Res 2021; 58:207-230. [PMID: 33839725 PMCID: PMC9903340 DOI: 10.1159/000514211] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/23/2020] [Indexed: 11/19/2022] Open
Abstract
The molecular signaling cascades that regulate angiogenesis and microvascular remodeling are fundamental to normal development, healthy physiology, and pathologies such as inflammation and cancer. Yet quantifying such complex, fractally branching vascular patterns remains difficult. We review application of NASA's globally available, freely downloadable VESsel GENeration (VESGEN) Analysis software to numerous examples of 2D vascular trees, networks, and tree-network composites. Upon input of a binary vascular image, automated output includes informative vascular maps and quantification of parameters such as tortuosity, fractal dimension, vessel diameter, area, length, number, and branch point. Previous research has demonstrated that cytokines and therapeutics such as vascular endothelial growth factor, basic fibroblast growth factor (fibroblast growth factor-2), transforming growth factor-beta-1, and steroid triamcinolone acetonide specify unique "fingerprint" or "biomarker" vascular patterns that integrate dominant signaling with physiological response. In vivo experimental examples described here include vascular response to keratinocyte growth factor, a novel vessel tortuosity factor; angiogenic inhibition in humanized tumor xenografts by the anti-angiogenesis drug leronlimab; intestinal vascular inflammation with probiotic protection by Saccharomyces boulardii, and a workflow programming of vascular architecture for 3D bioprinting of regenerative tissues from 2D images. Microvascular remodeling in the human retina is described for astronaut risks in microgravity, vessel tortuosity in diabetic retinopathy, and venous occlusive disease.
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Affiliation(s)
- Mark Lagatuz
- Redline Performance Solutions, Ames Research Center, National Aeronautics and Space Administration, Moffett Field CA, USA
| | - Ruchi J. Vyas
- Mori Associates, Space Biology Division, Ames Research Center, National Aeronautics and Space Administration, Moffett Field CA, USA
| | - Marina Predovic
- Blue Marble Space Institute of Science, Space Biology Division, Ames Research Center, National Aeronautics and Space Administration, Moffett Field CA, USA
| | - Shiyin Lim
- Blue Marble Space Institute of Science, Space Biology Division, Ames Research Center, National Aeronautics and Space Administration, Moffett Field CA, USA
| | - Nicole Jacobs
- Blue Marble Space Institute of Science, Space Biology Division, Ames Research Center, National Aeronautics and Space Administration, Moffett Field CA, USA
| | - Miguel Martinho
- Universities Space Research Association, Intelligent Systems Division, Exploration Technology Directorate, Ames Research Center, National Aeronautics and Space Administration, Moffett Field CA, USA
| | - Hamed Valizadegan
- Universities Space Research Association, Intelligent Systems Division, Exploration Technology Directorate, Ames Research Center, National Aeronautics and Space Administration, Moffett Field CA, USA
| | - David Kao
- Advanced Supercomputing & Intelligent Systems Divisions, Exploration Technology Directorate, Ames Research Center, National Aeronautics and Space Administration, Moffett Field CA, USA
| | - Nikunj Oza
- Advanced Supercomputing & Intelligent Systems Divisions, Exploration Technology Directorate, Ames Research Center, National Aeronautics and Space Administration, Moffett Field CA, USA
| | - Corey A. Theriot
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
- KBRWyle, Johnson Space Center, National Aeronautics and Space Administration, Houston, TX, USA
| | - Susana B. Zanello
- KBRWyle, Johnson Space Center, National Aeronautics and Space Administration, Houston, TX, USA
| | - Giovanni Taibbi
- Department of Ophthalmology and Visual Sciences, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Gianmarco Vizzeri
- Department of Ophthalmology and Visual Sciences, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Mariana Dupont
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama, Birmingham AL, USA
| | - Maria B. Grant
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama, Birmingham AL, USA
| | - Daniel J. Lindner
- Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland OH, USA
| | - Hans-Christian Reinecker
- Departments of Medicine and Immunology, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alexander Pinhas
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Toco Y. Chui
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Richard B. Rosen
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicanor Moldovan
- Department of Ophthalmology, Indiana University School of Medicine and Indiana University Purdue University at Indianapolis IN, USA
- Richard L. Roudebush VA Medical Center, Veteran’s Administration, Indianapolis IN, USA
| | - Mary B. Vickerman
- Data Systems Branch, John Glenn Research Center, National Aeronautics and Space Administration, Cleveland, OH, USA (retired)
| | - Krishnan Radhakrishnan
- Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, Rockville, MD, USA
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Patricia Parsons-Wingerter
- Space Biology Division, Space Technology Mission Directorate, Ames Research Center, National Aeronautics and Space Administration, Moffett Field, CA, USA
- Low Gravity Exploration Technology, Research and Engineering Directorate, John Glenn Research Center, National Aeronautics and Space Administration, Cleveland, OH, USA
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13
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Pan Y, Yang L, Dai B, Lin B, Lin S, Lin E. Effects of Probiotics on Malnutrition and Health-Related Quality of Life in Patients Undergoing Peritoneal Dialysis: A Randomized Controlled Trial. J Ren Nutr 2021; 31:199-205. [DOI: 10.1053/j.jrn.2020.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/03/2020] [Accepted: 04/22/2020] [Indexed: 12/27/2022] Open
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14
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Tomczak H, Wrońska M, Pecyna P, Hampelska K. The issue of the correct use of probiotics
in the absence of recommendations. POSTEP HIG MED DOSW 2021. [DOI: 10.5604/01.3001.0014.7701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Antibiotics are important for saving both human health and life. Antibiotics destroy all bacteria
within their spectrum, because they do not distinguish between good and bad bacteria.
Even if an antibiotic therapy lasts only a few days, it may cause diarrhoea and mycosis.
Antibiotics destroy most bacterial species in the intestines. These changes may affect one’s
whole life. Today it is a challenge for medicine to be able to manipulate the microbiome so
as to restore normal relations between microorganisms. At present, when antibiotics are
abused, probiotics are very often applied. However, as there are no recommendations,
a lot of mistakes can be made when using them. Both drugs and dietary supplements can be
classified as probiotics. Medicinal probiotics are subject to very strict registration requirements
and their use is associated with a specific disease or ailment. Probiotic microorganisms
must be classified according to their genus, species and strain. These preparations
may contain one or more probiotic strains depending on its application. At present there
are no established schemes or rules concerning the dosage of probiotic preparations. This
issue arouses numerous controversies. It is assumed that the probiotic should be applied
at a dose which proved to have a beneficial effect in tests conducted on humans. Patients
usually make decisions on the choice and dosage of preparations themselves. Individualised
probiotic therapy is the key to success. There is no universal preparation – a specific probiotic
should be used in a particular clinical case.
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Affiliation(s)
- Hanna Tomczak
- Central Microbiology Laboratory, H. Święcicki Clinical Hospital at the Medical University in Poznań, Poznań, Poland
| | - Marta Wrońska
- Central Microbiology Laboratory, H. Święcicki Clinical Hospital at the Medical University in Poznań, Poznań, Poland
| | - Paulina Pecyna
- Department of Genetics and Pharmaceutical Microbiology, Poznań University of Medical Sciences, Poznań, Poland
| | - Katarzyna Hampelska
- Central Microbiology Laboratory, H. Święcicki Clinical Hospital at the Medical University in Poznań, Poznań, Poland
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15
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Lee YY, Leow AHR, Chai PF, Raja Ali RA, Lee WS, Goh KL. Use of probiotics in clinical practice with special reference to diarrheal diseases: A position statement of the Malaysian Society of Gastroenterology and Hepatology. JGH OPEN 2021; 5:11-19. [PMID: 33490608 PMCID: PMC7812487 DOI: 10.1002/jgh3.12469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 12/17/2022]
Abstract
Probiotics comprise a large group of microorganisms, which have different properties and thus confer different benefits. The use of probiotics has shown promising results in the management of diarrheal diseases. While the availability of probiotic products has flourished in the marketplace, there is limited guidance on the selection of probiotics for clinical use. This position paper is aimed at informing clinicians about the proper selection criteria of probiotics based on current evidence on strain-specific efficacy and safety for the management of diarrheal diseases. Members of the working group discussed issues on probiotic use in clinical practice, which were then drafted into statements. Literature to support or refute the statements were gathered through a search of medical literature from 2011 to 2020. Recommendations were formulated based on the drafted statements and evidence gathered, revised as necessary, and finalized upon agreement of all members. Twelve statements and recommendations were developed covering the areas of quality control in the manufacturing of probiotics, criteria for selection of probiotics, and established evidence for use of probiotics in diarrheal diseases in adults and children. Recommendations for the use of specific probiotic strains in clinical practice were categorized as proven and probable efficacy based on strength of evidence. Robust evidence is available to support the use of probiotics for diarrheal diseases in clinical practice. Based on the results obtained, we strongly advocate the careful evaluation of products, including manufacturing practices, strain-specific evidence, and contraindications for at-risk populations when choosing probiotics for use in clinical practice.
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Affiliation(s)
- Yeong-Yeh Lee
- Department of Medicine, School of Medical Sciences Universiti Sains Malaysia Kota Bharu Malaysia.,Gut Research Group, Faculty of Medicine Universiti Kebangsaan Malaysia Kuala Lumpur Malaysia
| | - Alex H-R Leow
- Gastroenterology Unit, Department of Medicine, Faculty of Medicine Universiti Kebangsaan Malaysia Jalan Universiti Kuala Lumpur Malaysia.,University of Malaya Medical Centre Jalan Universiti Kuala Lumpur Malaysia
| | - Pei-Fan Chai
- University of Malaya Medical Centre Jalan Universiti Kuala Lumpur Malaysia
| | - Raja Affendi Raja Ali
- Gut Research Group, Faculty of Medicine Universiti Kebangsaan Malaysia Kuala Lumpur Malaysia.,Endoscopy Centre Pantai Hospital Kuala Lumpur Malaysia
| | - Way-Seah Lee
- Department of Paediatrics, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Khean-Lee Goh
- Department of Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
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16
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Collinson S, Deans A, Padua-Zamora A, Gregorio GV, Li C, Dans LF, Allen SJ. Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev 2020; 12:CD003048. [PMID: 33295643 PMCID: PMC8166250 DOI: 10.1002/14651858.cd003048.pub4] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Probiotics may be effective in reducing the duration of acute infectious diarrhoea. OBJECTIVES To assess the effects of probiotics in proven or presumed acute infectious diarrhoea. SEARCH METHODS We searched the trials register of the Cochrane Infectious Diseases Group, MEDLINE, and Embase from inception to 17 December 2019, as well as the Cochrane Controlled Trials Register (Issue 12, 2019), in the Cochrane Library, and reference lists from studies and reviews. We included additional studies identified during external review. SELECTION CRITERIA Randomized controlled trials comparing a specified probiotic agent with a placebo or no probiotic in people with acute diarrhoea that is proven or presumed to be caused by an infectious agent. DATA COLLECTION AND ANALYSIS Two review authors independently applied inclusion criteria, assessed risk of bias, and extracted data. Primary outcomes were measures of diarrhoea duration (diarrhoea lasting ≥ 48 hours; duration of diarrhoea). Secondary outcomes were number of people hospitalized in community studies, duration of hospitalization in inpatient studies, diarrhoea lasting ≥ 14 days, and adverse events. MAIN RESULTS We included 82 studies with a total of 12,127 participants. These studies included 11,526 children (age < 18 years) and 412 adults (three studies recruited 189 adults and children but did not specify numbers in each age group). No cluster-randomized trials were included. Studies varied in the definitions used for "acute diarrhoea" and "end of the diarrhoeal illness" and in the probiotic(s) tested. A total of 53 trials were undertaken in countries where both child and adult mortality was low or very low, and 26 where either child or adult mortality was high. Risk of bias was high or unclear in many studies, and there was marked statistical heterogeneity when findings for the primary outcomes were pooled in meta-analysis. Effect size was similar in the sensitivity analysis and marked heterogeneity persisted. Publication bias was demonstrated from funnel plots for the main outcomes. In our main analysis of the primary outcomes in studies at low risk for all indices of risk of bias, no difference was detected between probiotic and control groups for the risk of diarrhoea lasting ≥ 48 hours (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.91 to 1.09; 2 trials, 1770 participants; moderate-certainty evidence); or for duration of diarrhoea (mean difference (MD) 8.64 hours shorter, 95% CI 29.4 hours shorter to 12.1 hours longer; 6 trials, 3058 participants; very low-certainty evidence). Effect size was similar and marked heterogeneity persisted in pre-specified subgroup analyses of the primary outcomes that included all studies. These included analyses limited to the probiotics Lactobacillus rhamnosus GG and Saccharomyces boulardii. In six trials (433 participants) of Lactobacillus reuteri, there was consistency amongst findings (I² = 0%), but risk of bias was present in all included studies. Heterogeneity also was not explained by types of participants (age, nutritional/socioeconomic status captured by mortality stratum, region of the world where studies were undertaken), diarrhoea in children caused by rotavirus, exposure to antibiotics, and the few studies of children who were also treated with zinc. In addition, there were no clear differences in effect size for the primary outcomes in post hoc analyses according to decade of publication of studies and whether or not trials had been registered. For other outcomes, the duration of hospitalization in inpatient studies on average was shorter in probiotic groups than in control groups but there was marked heterogeneity between studies (I² = 96%; MD -18.03 hours, 95% CI -27.28 to -8.78, random-effects model: 24 trials, 4056 participants). No differences were detected between probiotic and control groups in the number of people with diarrhoea lasting ≥ 14 days (RR 0.49, 95% CI 0.16 to 1.53; 9 studies, 2928 participants) or in risk of hospitalization in community studies (RR 1.26, 95% CI 0.84 to 1.89; 6 studies, 2283 participants). No serious adverse events were attributed to probiotics. AUTHORS' CONCLUSIONS Probiotics probably make little or no difference to the number of people who have diarrhoea lasting 48 hours or longer, and we are uncertain whether probiotics reduce the duration of diarrhoea. This analysis is based on large trials with low risk of bias.
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Affiliation(s)
- Shelui Collinson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Andrew Deans
- Urgent Care, Team Medical, Paraparaumu, New Zealand
| | - April Padua-Zamora
- Department of Pediatrics, University of the Philippines Manila College of Medicine-Philippine General Hospital, Manila, Philippines
| | - Germana V Gregorio
- Department of Pediatrics, University of the Philippines Manila College of Medicine-Philippine General Hospital, Manila, Philippines
| | - Chao Li
- Tropical Clinical Trials Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Leonila F Dans
- Department of Pediatrics, University of the Philippines Manila College of Medicine-Philippine General Hospital, Manila, Philippines
| | - Stephen J Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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17
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Zommiti M, Feuilloley MGJ, Connil N. Update of Probiotics in Human World: A Nonstop Source of Benefactions till the End of Time. Microorganisms 2020; 8:E1907. [PMID: 33266303 PMCID: PMC7760123 DOI: 10.3390/microorganisms8121907] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023] Open
Abstract
Lactic acid bacteria (LAB) are known for their biotechnological potential. Moreover, LAB are distinguished by amazing criteria: Adjusting the intestinal environment, inhibiting pathogenic microbes in the gastrointestinal tract, ability to reduce pathogen adhesion activity, improving the balance of the microbiota inside the intestine, capabilities of regulating intestinal mucosal immunity, and maintaining intestinal barrier function. The escalating number of research and studies about beneficial microorganisms and their impact on promoting health has attracted a big interest in the last decades. Since antiquity, various based fermented products of different kinds have been utilized as potential probiotic products. Nevertheless, the current upsurge in consumers' interest in bioalternatives has opened new horizons for the probiotic field in terms of research and development. The present review aims at shedding light on the world of probiotics, a continuous story of astonishing success in various fields, in particular, the biomedical sector and pharmaceutical industry, as well as to display the importance of probiotics and their therapeutic potential in purpose to compete for sturdy pathogens and to struggle against diseases and acute infections. Shadows and future trends of probiotics use are also discussed.
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Affiliation(s)
- Mohamed Zommiti
- Unité de Protéomique Fonctionnelle et Potentiel Nutraceutique de la Biodiversité de Tunisie, Institut Supérieur des Sciences Biologiques Appliquées de Tunis, Université Tunis El-Manar, Tunis 1006, Tunisia
| | - Marc G. J. Feuilloley
- Laboratoire de Microbiologie Signaux et Microenvironnement (LMSM) EA 4312, Université de Rouen Normandie, Normandie Université, F-27000 Evreux, France; (M.G.J.F.); (N.C.)
| | - Nathalie Connil
- Laboratoire de Microbiologie Signaux et Microenvironnement (LMSM) EA 4312, Université de Rouen Normandie, Normandie Université, F-27000 Evreux, France; (M.G.J.F.); (N.C.)
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18
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Singh A, Koenen B, Kirby DF. Bariatric Surgery and Its Complications in Inflammatory Bowel Disease Patients. Inflamm Bowel Dis 2020; 26:1155-1165. [PMID: 31626698 DOI: 10.1093/ibd/izz246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Indexed: 12/14/2022]
Abstract
Recent data have suggested that bariatric procedures, especially laparoscopic sleeve gastrectomy (SG), are safe and effective weight loss measures in patients with inflammatory bowel disease (IBD). But most of the studies have looked at short-term outcomes, and there is a general lack of awareness of underlying disease processes and baseline comorbidities in IBD patients undergoing bariatric procedures. Postbariatric issues in IBD patients including diarrhea from dumping syndrome, choleretic diarrhea, a high prevalence of small intestinal bacterial overgrowth, gastroesophageal reflux disease, Barrett's esophagus, stomal ulcerations, stenosis, and renal and gallstones can complicate the natural history of IBD. This could lead to unnecessary hospitalizations, change of medical therapy, and poor surgical and quality of life outcomes. In this review, we will discuss major complications after common bariatric procedures (SG, Roux-en-Y gastric bypass, and gastric banding) and suggest possible management strategies.
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Affiliation(s)
- Amandeep Singh
- Department of Gastroenterology, Hepatology & Nutrition, Center for Human Nutrition, Center for Gut Rehabilitation and Intestinal Transplantation, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian Koenen
- Department of Gastroenterology, Hepatology & Nutrition, Center for Human Nutrition, Center for Gut Rehabilitation and Intestinal Transplantation, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donald F Kirby
- Department of Gastroenterology, Hepatology & Nutrition, Center for Human Nutrition, Center for Gut Rehabilitation and Intestinal Transplantation, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
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19
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Yan F, Polk DB. Probiotics and Probiotic-Derived Functional Factors-Mechanistic Insights Into Applications for Intestinal Homeostasis. Front Immunol 2020; 11:1428. [PMID: 32719681 PMCID: PMC7348054 DOI: 10.3389/fimmu.2020.01428] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/03/2020] [Indexed: 12/20/2022] Open
Abstract
Advances in our understanding of the contribution of the gut microbiota to human health and the correlation of dysbiosis with diseases, including chronic intestinal conditions such as inflammatory bowel disease (IBD), have driven mechanistic investigations of probiotics in intestinal homeostasis and potential clinical applications. Probiotics have been shown to promote intestinal health by maintaining and restoring epithelial function, ensuring mucosal immune homeostasis, and inhibiting pathogenic bacteria. Recent findings reveal an approach for defining previously unrecognized probiotic-derived soluble factors as potential mechanisms of probiotic action. This review focuses on the impact of probiotics and probiotic-derived functional factors, including probiotic products and metabolites by probiotics, on the cellular responses and signaling pathways involved in maintaining intestinal homeostasis. Although there is limited information regarding the translation of probiotic treatment outcomes from in vitro and animal studies to clinical applications, potential approaches for increasing the clinical efficacy of probiotics for IBD, such as those based on probiotic-derived factors, are highlighted in this review. In this era of precision medicine and targeted therapies, more basic, preclinical, and clinical evidence is needed to clarify the efficacy of probiotics in maintaining intestinal health and preventing and treating disease.
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Affiliation(s)
- Fang Yan
- Division of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - D Brent Polk
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States.,Department of Biochemistry and Molecular Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States.,Division of Gastroenterology, Hepatology & Nutrition, Children's Hospital Los Angeles, Los Angeles, CA, United States
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20
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Agans RT, Giles GE, Goodson MS, Karl JP, Leyh S, Mumy KL, Racicot K, Soares JW. Evaluation of Probiotics for Warfighter Health and Performance. Front Nutr 2020; 7:70. [PMID: 32582752 PMCID: PMC7296105 DOI: 10.3389/fnut.2020.00070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022] Open
Abstract
The probiotic industry continues to grow in both usage and the diversity of products available. Scientific evidence supports clinical use of some probiotic strains for certain gastrointestinal indications. Although much less is known about the impact of probiotics in healthy populations, there is increasing consumer and scientific interest in using probiotics to promote physical and psychological health and performance. Military men and women are a unique healthy population that must maintain physical and psychological health in order to ensure mission success. In this narrative review, we examine the evidence regarding probiotics and candidate probiotics for physical and/or cognitive benefits in healthy adults within the context of potential applications for military personnel. The reviewed evidence suggests potential for certain strains to induce biophysiological changes that may offer physical and/or cognitive health and performance benefits in military populations. However, many knowledge gaps exist, effects on health and performance are generally not widespread among the strains examined, and beneficial findings are generally limited to single studies with small sample sizes. Multiple studies with the same strains and using similar endpoints are needed before definitive recommendations for use can be made. We conclude that, at present, there is not compelling scientific evidence to support the use of any particular probiotic(s) to promote physical or psychological performance in healthy military personnel. However, plausibility for physical and psychological health and performance benefits remains, and additional research is warranted. In particular, research in military cohorts would aid in assessing the value of probiotics for supporting physical and psychological health and performance under the unique demands required of these populations.
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Affiliation(s)
- Richard T Agans
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States.,Naval Medical Research Unit Dayton, Environmental Health Effects Laboratory, Dayton, OH, United States
| | - Grace E Giles
- Soldier Performance Optimization Directorate, U.S. Army Combat Capabilities Development Command - Soldier Center, Natick, MA, United States
| | - Michael S Goodson
- Air Force Research Laboratory, 711th Human Performance Wing, Wright Patterson Air Force Base, Dayton, OH, United States
| | - J Philip Karl
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Samantha Leyh
- Air Force Research Laboratory, 711th Human Performance Wing, Wright Patterson Air Force Base, Dayton, OH, United States.,Oak Ridge Institute for Science and Education, Wright Patterson Air Force Base, Oak Ridge, TN, United States
| | - Karen L Mumy
- Naval Medical Research Unit Dayton, Environmental Health Effects Laboratory, Dayton, OH, United States
| | - Kenneth Racicot
- Soldier Performance Optimization Directorate, U.S. Army Combat Capabilities Development Command - Soldier Center, Natick, MA, United States
| | - Jason W Soares
- Soldier Performance Optimization Directorate, U.S. Army Combat Capabilities Development Command - Soldier Center, Natick, MA, United States
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21
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Cheng FS, Pan D, Chang B, Jiang M, Sang LX. Probiotic mixture VSL#3: An overview of basic and clinical studies in chronic diseases. World J Clin Cases 2020; 8:1361-1384. [PMID: 32368530 PMCID: PMC7190945 DOI: 10.12998/wjcc.v8.i8.1361] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/27/2020] [Accepted: 04/08/2020] [Indexed: 02/05/2023] Open
Abstract
Probiotics are known as “live microorganisms” and have been proven to have a health effect on hosts at the proper dose. Recently, a kind of probiotic mixture including eight live bacterial strains, VSL#3, has attracted considerable attention for its combined effect. VSL#3 is the only probiotic considered as a kind of medical food; it mainly participates in the regulation of the intestinal barrier function, including improving tight junction protein function, balancing intestinal microbial composition, regulating immune-related cytokine expression and so on. The objective of this review is to discuss the treatment action and mechanism for the administration of VSL#3 in chronic diseases of animals and humans (including children). We found that VSL#3 has a therapeutic or preventive effect in various systemic diseases per a large number of studies, including digestive systemic diseases (gastrointestinal diseases and hepatic diseases), obesity and diabetes, allergic diseases, nervous systemic diseases, atherosclerosis, bone diseases, and female reproductive systemic diseases.
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Affiliation(s)
- Fang-Shu Cheng
- Department of Dermatology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
- Class 85 of 101k, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Dan Pan
- Department of Geriatrics, the First Affiliated Hospital, China Medical University, Shenyang 110001, Liaoning Province, China
| | - Bing Chang
- Department of Gastroenterology, the First Affiliated Hospital, China Medical University, Shenyang 110001, Liaoning Province, China
| | - Min Jiang
- Department of Gastroenterology, the First Affiliated Hospital, China Medical University, Shenyang 110001, Liaoning Province, China
| | - Li-Xuan Sang
- Department of Geriatrics, the First Affiliated Hospital, China Medical University, Shenyang 110001, Liaoning Province, China
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European General Practitioners perceptions on probiotics: Results of a multinational survey. PHARMANUTRITION 2020. [DOI: 10.1016/j.phanu.2020.100178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Feehan A, Garcia-Diaz J. Bacterial, Gut Microbiome-Modifying Therapies to Defend against Multidrug Resistant Organisms. Microorganisms 2020; 8:microorganisms8020166. [PMID: 31991615 PMCID: PMC7074682 DOI: 10.3390/microorganisms8020166] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 02/07/2023] Open
Abstract
Antibiotics have revolutionized human and animal healthcare, but their utility is reduced as bacteria evolve resistance mechanisms over time. Thankfully, there are novel antibiotics in the pipeline to overcome resistance, which are mentioned elsewhere in this special issue, but eventually bacteria are expected to evolve resistance to most new compounds as well. Multidrug resistant organisms (MDROs) that cause infections increase morbidity, mortality, and readmissions as compared with susceptible organisms. Consequently, many research and development pipelines are focused on non-antibiotic strategies, including fecal microbiota transplantation (FMT), probiotics and prebiotics, and a range of therapies in between. Studies reviewed here focus on efforts to directly treat or prevent MDRO infections or colonization. The studies were collected through clinicaltrials.gov, PubMed, and the International Conference on the Harmonisation Good Clinical Practice website (ichgcp.net). While the gold standard of clinical research is randomized controlled trials (RCTs), several pilot studies are included because the field is so young. Although a vast preclinical body of research has led to studies in humans, animal and in vitro studies are not within the scope of this review. This narrative review discusses microbiome-modifying therapies targeting MDROs in the gut and includes current results, ongoing clinical trials, companies with therapies in the pipeline specifically for MDROs, and commentary on clinical implementation and challenges.
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Affiliation(s)
- Amy Feehan
- Infectious Disease Department, Ochsner Clinic Foundation, New Orleans, LA 70121, USA;
| | - Julia Garcia-Diaz
- Infectious Disease Department, Ochsner Clinic Foundation, New Orleans, LA 70121, USA;
- The University of Queensland Faculty of Medicine, Ochsner Clinical School, New Orleans, LA 70121, USA
- Correspondence: ; Tel.: +1-504-842-4005
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Bischoff SC, Escher J, Hébuterne X, Kłęk S, Krznaric Z, Schneider S, Shamir R, Stardelova K, Wierdsma N, Wiskin AE, Forbes A. ESPEN practical guideline: Clinical Nutrition in inflammatory bowel disease. Clin Nutr 2020; 39:632-653. [PMID: 32029281 DOI: 10.1016/j.clnu.2019.11.002] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/01/2019] [Indexed: 02/06/2023]
Abstract
The present guideline is the first of a new series of "practical guidelines" based on more detailed scientific guidelines produced by ESPEN during the last few years. The guidelines have been shortened and now include flow charts that connect the individual recommendations to logical care pathways and allow rapid navigation through the guideline. The purpose of the present practical guideline is to provide an easy-to-use tool to guide nutritional support and primary nutritional therapy in inflammatory bowel disease (IBD). The guideline is aimed at professionals working in clinical practice, either in hospitals or in outpatient medicine, and treating patients with IBD. In 40 recommendations, general aspects of care in patients with IBD, and specific aspects during active disease and in remission are addressed. All recommendations are equipped with evidence grades, consensus rates, short commentaries and links to cited literature.
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Affiliation(s)
- Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany.
| | - Johanna Escher
- Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Xavier Hébuterne
- Gastroentérologie et Nutrition Clinique, CHU de Nice, Université Côte d'Azur, Nice, France
| | - Stanisław Kłęk
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Krakow, Poland
| | - Zeljko Krznaric
- Clinical Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia
| | - Stéphane Schneider
- Gastroentérologie et Nutrition Clinique, CHU de Nice, Université Côte d'Azur, Nice, France
| | - Raanan Shamir
- Tel-Aviv University, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Kalina Stardelova
- University Clinic for Gasrtroenterohepatology, Clinal Centre "Mother Therese", Skopje, Macedonia
| | | | - Anthony E Wiskin
- Pediatric Gastroenterology & Nutrition Unit, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Alastair Forbes
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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Recent Advances in Prevention and Therapies for Clinical or Experimental Necrotizing Enterocolitis. Dig Dis Sci 2019; 64:3078-3085. [PMID: 30989465 DOI: 10.1007/s10620-019-05618-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/08/2019] [Indexed: 01/09/2023]
Abstract
Necrotizing enterocolitis (NEC) is one of the most severe diseases of preterm neonates and has a high mortality rate. With the development of inspection techniques and new biomarkers, the diagnostic accuracy of NEC is constantly improving. The most recognized potential risk factors include prematurity, formula-feeding, infection, and microbial dysbiosis. With further understanding of the pathogenesis, more effective prevention and therapies will be applied to clinical or experimental NEC. At present, such new potential prevention and therapies for NEC are mainly focused on the Toll-like receptor 4 inflammatory signaling pathway, the repair of intestinal barrier function, probiotics, antioxidative stress, breast-feeding, and immunomodulatory agents. Many new studies have changed our understanding of the pathogenesis of NEC and improve our approaches for preventing and treating of NEC each year. This review provides an overview of the recent researches focused on clinical or experimental NEC and highlights the advances made within the past 5 years toward the development of new potential preventive approaches and therapies for this disease.
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Abstract
PURPOSE OF REVIEW There is growing evidence encouraging the use of probiotics in many conditions in children. However, given the wide number of probiotics available and contradictory data in the literature, the health-care provider is often faced with uncertainness about whether or not to use probiotics and which one(s) to choose. We here review current hypotheses regarding the efficacy and safety of probiotics and evaluate the available data on the use of probiotics in most common diseases in children. Considering that probiotics have strain-specific effects, we will focus on individual probiotic strains rather than on probiotics in general. RECENT FINDINGS Strain-specific efficacy was clearly demonstrated with Lactobacillus rhamnosus GG and Saccharomyces boulardii I-745 in the treatment of acute infectious diarrhea, Lactobacillus reuteri DSM 17938 in infantile colics, Lactobacillus rhamnosus GG, and VSL#3 in irritable bowel syndrome. In addition, encouraging results are seen for use of probiotics in necrotizing enterocolitis, food allergy, and nonalcoholic fatty liver disease. However, the data available for constipation are to be considered somewhat equivocal. SUMMARY The clinical relevance of these findings indicates that healthcare providers need to take strain-specificity and disease specificity of probiotics into consideration when recommending probiotic for their patients.
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Gut Microbiome: Profound Implications for Diet and Disease. Nutrients 2019; 11:nu11071613. [PMID: 31315227 PMCID: PMC6682904 DOI: 10.3390/nu11071613] [Citation(s) in RCA: 547] [Impact Index Per Article: 109.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/05/2019] [Accepted: 07/11/2019] [Indexed: 02/07/2023] Open
Abstract
The gut microbiome plays an important role in human health and influences the development of chronic diseases ranging from metabolic disease to gastrointestinal disorders and colorectal cancer. Of increasing prevalence in Western societies, these conditions carry a high burden of care. Dietary patterns and environmental factors have a profound effect on shaping gut microbiota in real time. Diverse populations of intestinal bacteria mediate their beneficial effects through the fermentation of dietary fiber to produce short-chain fatty acids, endogenous signals with important roles in lipid homeostasis and reducing inflammation. Recent progress shows that an individual’s starting microbial profile is a key determinant in predicting their response to intervention with live probiotics. The gut microbiota is complex and challenging to characterize. Enterotypes have been proposed using metrics such as alpha species diversity, the ratio of Firmicutes to Bacteroidetes phyla, and the relative abundance of beneficial genera (e.g., Bifidobacterium, Akkermansia) versus facultative anaerobes (E. coli), pro-inflammatory Ruminococcus, or nonbacterial microbes. Microbiota composition and relative populations of bacterial species are linked to physiologic health along different axes. We review the role of diet quality, carbohydrate intake, fermentable FODMAPs, and prebiotic fiber in maintaining healthy gut flora. The implications are discussed for various conditions including obesity, diabetes, irritable bowel syndrome, inflammatory bowel disease, depression, and cardiovascular disease.
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van den Nieuwboer M, Claassen E. Dealing with the remaining controversies of probiotic safety. Benef Microbes 2019; 10:605-616. [PMID: 31131618 DOI: 10.3920/bm2018.0159] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
A clear safety profile of probiotics in clinical practice is essential in decision-making for all stakeholders and regulators. Probiotics have been investigated in different target populations, conditions and age groups. This also includes the use of probiotics in critically ill patients. Despite promising results reported with the use of probiotics and synbiotics, there is still a lively discussion regarding the proper and safe use of probiotics among physicians, researchers and regulators. This doubt and debate was sparked by the high incidence in mortality reported in a study with critically ill patients. Whereas no causal relationship has been established since, safety of probiotic has been questioned. In response, an overwhelming body of evidence suggesting that probiotics are safe has been compiled. Moreover, data indicates that probiotics reduce the number of adverse events compared to the control. However, due to a lack of standardised safety reporting in clinical studies, a strong evidence base on probiotic safety remains to be established. Here, we will discuss: (1) the rationale for using probiotics in the critically ill; (2) what happened during the Dutch Pancreatitis trial; (3) what are the known safety risks of probiotics based on the available data; and finally (4) how standardisation in safety reporting can drive probiotic innovation. Building a strong safety profile for probiotic strains will solidify its use in individuals that can benefit the most from microbial modulation.
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Affiliation(s)
- M van den Nieuwboer
- Athena Institute, VU Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, the Netherlands
| | - E Claassen
- Athena Institute, VU Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, the Netherlands
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Scognamiglio M, Costa D, Sorriento A, Napoli C. Current Drugs and Nutraceuticals for the Treatment of Patients with Dyslipidemias. Curr Pharm Des 2019; 25:85-95. [DOI: 10.2174/1381612825666190130101108] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/20/2019] [Indexed: 02/05/2023]
Abstract
Coronary heart disease (CHD) remains the leading cause of disability and death in industrialized Countries.
Among many conditions, which contribute to the etiology and progression of CHD, the presence of high
low density lipoprotein-cholesterol (LDL-C) levels represents the major risk factor. Therefore, the reduction of
LDL-C levels plays a key role in the management of patients with high or very high cardiovascular risk. Although
statins represent the gold standard therapy for the reduction of cholesterol levels, these drugs do not allow to
achieve target levels of LDL-C in all patients. Indeed, a significant number of patients resulted intolerants, especially
when the dosage increased. The availability of new lipid-lowering drugs, such as ezetimibe and PCSK9
inhibitors, may represent an important alternative or complement to the conventional lipid-lowering therapies.
However, long-term studies are still needed to define both efficacy and safety of use of these latter new drugs.
Some nutraceuticals may become an adequate and effective support in the management of some patients. To date,
several nutraceuticals with different mechanism of actions that provide a good tolerability are available as lipidlowering
agents. In particular, the most investigated are red yeast rice, phytosterols, berberine, beta-glucans and
soy. The aim of this review was to report recent data on the efficacy and safety of principle hypocholesterolemic
drugs available and to evaluate the possible role of some nutraceuticals as support therapy in the management of
patients with dyslipidemias.
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Affiliation(s)
- Michele Scognamiglio
- U.O.C. Division of Clinical Immunology, Immunohematology, Transfusion Medicine and Transplant Immunology, Clinical Department of Internal Medicine and Specialistics, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, University of Campania , Italy
| | - Dario Costa
- U.O.C. Division of Clinical Immunology, Immunohematology, Transfusion Medicine and Transplant Immunology, Clinical Department of Internal Medicine and Specialistics, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, University of Campania , Italy
| | - Antonio Sorriento
- U.O.C. Division of Clinical Immunology, Immunohematology, Transfusion Medicine and Transplant Immunology, Clinical Department of Internal Medicine and Specialistics, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, University of Campania , Italy
| | - Claudio Napoli
- U.O.C. Division of Clinical Immunology, Immunohematology, Transfusion Medicine and Transplant Immunology, Clinical Department of Internal Medicine and Specialistics, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, University of Campania , Italy
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The effect of probiotic and synbiotic supplementation on biomarkers of inflammation and oxidative stress in diabetic patients: A systematic review and meta-analysis of randomized controlled trials. Pharmacol Res 2019; 142:303-313. [DOI: 10.1016/j.phrs.2019.02.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 02/06/2023]
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Sniffen JC, McFarland LV, Evans CT, Goldstein EJC. Choosing an appropriate probiotic product for your patient: An evidence-based practical guide. PLoS One 2018; 13:e0209205. [PMID: 30586435 PMCID: PMC6306248 DOI: 10.1371/journal.pone.0209205] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/30/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Clinicians and patients face a daunting task when choosing the most appropriate probiotic for their specific needs. Available preparations encompass a diverse and continuously expanding product base, with most available products lacking evidence-based trials that support their use. Even when evidence exists, not all probiotic products are equally effective for all disease prevention or treatment indications. At this point in time, drug regulatory agencies offer limited assistance with regard to guidance and oversight in most countries, including the U.S. METHODS We reviewed the current medical literature and sources on the internet to survey the types of available probiotic products and to determine which probiotics had evidence-based efficacy data. Standard medical databases from inception to June 2018 were searched and discussions with experts in the field were conducted. We graded the strength of the evidence for probiotics having multiple, randomized controlled trials and developed a guide for the practical selection of current probiotic products for specific uses. RESULTS We found the efficacy of probiotic products is both strain-specific and disease-specific. Important factors involved in choosing the appropriate probiotic include matching the strain(s) with the targeted disease or condition, type of formulation, dose used and the source (manufacturing quality control and shelf-life). While we found many probiotic products lacked confirmatory trials, we found sufficient evidence for 22 different types of probiotics from 249 trials to be included. For example, several types of probiotics had strong evidence for the prevention of antibiotic-associated diarrhea [Saccharomyces boulardii I-745, a three-strain mixture (Lactobacillus acidophilus CL1285, L. casei Lbc80r, L. rhamnosus CLR2) and L. casei DN114001]. Strong evidence was also found for four types of probiotics for the prevention of a variety of other diseases/conditions (enteral-feed associated diarrhea, travellers' diarrhea, necrotizing enterocolits and side-effects associated with H. pylori treatments. The evidence was most robust for the treatment of pediatric acute diarrhea based on 59 trials (7 types of probiotics have strong efficacy), while an eight-strain multi-strain mixture showed strong efficacy for inflammatory bowel disease and two types of probiotics had strong efficacy for irritable bowel disease. Of the 22 types of probiotics reviewed, 15 (68%) had strong-moderate evidence for efficacy for at least one type of disease. CONCLUSION The choice of an appropriate probiotic is multi-factored, based on the mode and type of disease indication and the specific efficacy of probiotic strain(s), as well as product quality and formulation. TRIAL REGISTRATION This review was registered with PROSPERO: CRD42018103979.
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Affiliation(s)
- Jason C. Sniffen
- Department of Internal Medicine, Infectious Disease Section, Florida Hospital Orlando, Orlando, FL, United States of America
| | - Lynne V. McFarland
- Department of Medicinal Chemistry, School of Pharmacy, University of Washington Medical Center, Seattle, Washington United States of America
| | - Charlesnika T. Evans
- Department of Preventive Medicine and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Veterans Affairs (VA), Center of Innovation of Complex Chronic Healthcare (CINCCH), Edward Hines, Jr. VA Hospital, Hines, IL, United States of America
| | - Ellie J. C. Goldstein
- RM Alden Research Laboratory and David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
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Supplementation of p40, a Lactobacillus rhamnosus GG-derived protein, in early life promotes epidermal growth factor receptor-dependent intestinal development and long-term health outcomes. Mucosal Immunol 2018; 11:1316-1328. [PMID: 29875401 PMCID: PMC6162144 DOI: 10.1038/s41385-018-0034-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 04/01/2018] [Accepted: 04/15/2018] [Indexed: 02/04/2023]
Abstract
The beneficial effects of the gut microbiota on growth in early life are well known. However, knowledge about the mechanisms underlying regulating intestinal development by the microbiota is limited. p40, a Lactobacillus rhamnosus GG-derived protein, transactivates epidermal growth factor receptor (EGFR) in intestinal epithelial cells for protecting the intestinal epithelium against injury and inflammation. Here, we developed p40-containing pectin/zein hydrogels for targeted delivery of p40 to the small intestine and the colon. Treatment with p40-containing hydrogels from postnatal day 2 to 21 significantly enhanced bodyweight gain prior to weaning and functional maturation of the intestine, including intestinal epithelial cell proliferation, differentiation, and tight junction formation, and IgA production in early life in wild-type mice. These p40-induced effects were abolished in mice with specific deletion of EGFR in intestinal epithelial cells, suggesting that transactivation of EGFR in intestinal epithelial cells may mediate p40-regulated intestinal development. Furthermore, neonatal p40 treatment reduced the susceptibility to intestinal injury and colitis and promoted protective immune responses, including IgA production and differentiation of regulatory T cells, in adult mice. These findings reveal novel roles of neonatal supplementation of probiotic-derived factors in promoting EGFR-mediated maturation of intestinal functions and innate immunity, which likely promote long-term beneficial outcomes.
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Affiliation(s)
- M. E. Sanders
- International Scientific Association for Probiotics and Prebiotics; Centennial CO USA
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Abstract
PURPOSE OF REVIEW The emergence of next-generation 16S rRNA sequencing techniques has facilitated a more detailed study of the body's microbiota and led to renewed interest in the association between microbial exposure and asthma inception. In this review, we evaluate the evidence that the respiratory tract and intestinal microbiota contribute to asthma pathogenesis and progression. RECENT FINDINGS Human studies have revealed associations between the presence of potentially pathogenic bacteria in the respiratory tract in early life and subsequent risk of allergic sensitization and asthma. Similarly, alterations in the intestinal microbiota of neonates have also been shown to precede the development of asthma. Emerging evidence suggests that the lung microbiota is dysregulated in asthma with specific changes in bacterial diversity and community composition according to severity and phenotype. Studies using germ-free mice have been invaluable in moving our understanding from correlation to causation by demonstrating a mechanistic link between the neonatal microbiota and the development of allergic airway inflammation. SUMMARY An expanding body of literature supports the hypothesis that early life microbial exposures and bacterial communities within the lung and/or intestine play an important role in shaping early immunological development. Perturbations in the microbiota may promote immune defects associated with the development of asthma and allergic sensitization.
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Abstract
The three main oral diseases of humans, that is, caries, periodontal diseases, and oral candidiasis, are associated with microbiome shifts initiated by changes in the oral environment and/or decreased effectiveness of mucosal immune surveillance. In this review, we discuss the role that microbial-based therapies may have in the control of these conditions. Most investigations on the use of microorganisms for management of oral disease have been conducted with probiotic strains with some positive but very discrete clinical outcomes. Other strategies such as whole oral microbiome transplantation or modification of community function by enrichment with health-promoting indigenous oral strains may offer more promise, but research in this field is still in its infancy. Any microbial-based therapeutics for oral conditions, however, are likely to be only one component within a holistic preventive strategy that should also aim at modification of the environmental influences responsible for the initiation and perpetuation of microbiome shifts associated with oral dysbiosis.
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Abstract
With the advent of the scientific realization that the microbiota of the gastrointestinal tract was more than the cells that exist in the body, the full importance of prebiotics and probiotics has come forth. The importance has been stressed and is available in the new textbook entitled, "The Microbiota in Gastrointestinal Pathophysiology: Implication for Human Health, Prebiotics, Probiotics and Dysbiosis." There is enough evidence now published in the literature so that the scientific world now believes that prebiotics and probiotics are important in gastrointestinal disease.
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Affiliation(s)
- Martin H Floch
- Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street, 1089 LMP, New Haven, CT 06850, USA.
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Heeney DD, Gareau MG, Marco ML. Intestinal Lactobacillus in health and disease, a driver or just along for the ride? Curr Opin Biotechnol 2018; 49:140-147. [PMID: 28866243 PMCID: PMC5808898 DOI: 10.1016/j.copbio.2017.08.004] [Citation(s) in RCA: 223] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 07/20/2017] [Accepted: 08/14/2017] [Indexed: 02/07/2023]
Abstract
Metagenomics and related methods have led to significant advances in our understanding of the human microbiome. Members of the genus Lactobacillus, although best understood for essential roles in food fermentations and applications as probiotics, have also come to the fore in a number of untargeted gut microbiome studies in humans and animals. Even though Lactobacillus is only a minor member of the human colonic microbiota, the proportions of those bacteria are frequently either positively or negatively correlated with human disease and chronic conditions. Recent findings on Lactobacillus species in human and animal microbiome research, together with the increased knowledge on probiotic and other ingested lactobacilli, have resulted in new perspectives on the importance of this genus to human health.
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Affiliation(s)
- Dustin D Heeney
- Department of Food Science & Technology, University of California, Davis, USA
| | - Mélanie G Gareau
- Department of Anatomy, Physiology & Cell Biology, School of Veterinary Medicine, University of California, Davis, USA
| | - Maria L Marco
- Department of Food Science & Technology, University of California, Davis, USA.
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Yeh TL, Shih PC, Liu SJ, Lin CH, Liu JM, Lei WT, Lin CY. The influence of prebiotic or probiotic supplementation on antibody titers after influenza vaccination: a systematic review and meta-analysis of randomized controlled trials. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:217-230. [PMID: 29416317 PMCID: PMC5790137 DOI: 10.2147/dddt.s155110] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Influenza infection is a common disease with a huge disease burden. Influenza vaccination has been widely used, but concerns regarding vaccine efficacy exist, especially in the elderly. Probiotics are live microorganisms with immunomodulatory effects and may enhance the immune responses to influenza vaccination. Methods We conducted a systematic review and meta-analysis to determine the influence of prebiotics/probiotics/synbiotics supplementation on vaccine responses to influenza vaccination. Studies were systematically identified from electronic databases up to July 2017. Information regarding study population, influenza vaccination, components of supplements, and immune responses were extracted and analyzed. Twelve studies, investigating a total of 688 participants, were included in this review. Results Patients with prebiotics/probiotics supplements were found to have higher influenza hemagglutination inhibition antibody titers after vaccination (for A/H1N1, 42.89 vs 35.76, mean difference =7.14, 95% CI =2.73, 11.55, P=0.002; for A/H3N2, 105.4 vs 88.25, mean difference =17.19, 95% CI =3.39, 30.99, P=0.01; for B strain, 34.87 vs 30.73, mean difference =4.17, 95% CI =0.37, 7.96, P=0.03). Conclusion Supplementation with prebiotics or probiotics may enhance the influenza hemagglutination inhibition antibody titers in all A/H1N1, A/H3N2, and B strains (20%, 19.5%, and 13.6% increases, respectively). Concomitant prebiotics or probiotics supplementation with influenza vaccination may hold great promise for improving vaccine efficacy. However, high heterogeneity was observed and further studies are warranted.
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Affiliation(s)
- Tzu-Lin Yeh
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu
| | - Pei-Ching Shih
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu
| | - Shu-Jung Liu
- Department of Medical Library, MacKay Memorial Hospital, Tamsui Branch, New Taipei City
| | - Chao-Hsu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu
| | - Jui-Ming Liu
- Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan.,Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Te Lei
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu
| | - Chien-Yu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu
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Jiang Q, Kainulainen V, Stamatova I, Korpela R, Meurman JH. Lactobacillus rhamnosus GG in Experimental Oral Biofilms Exposed to Different Carbohydrate Sources. Caries Res 2018; 52:220-229. [PMID: 29353279 DOI: 10.1159/000479380] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/04/2017] [Indexed: 12/31/2022] Open
Abstract
Probiotic administration may favour caries prevention, as recent research has shown. This in vitro study aimed to investigate the growth of Lactobacillus rhamnosus GG (LGG) in experimental biofilms exposed to various carbohydrates, and also to assess its cariogenic potential. Multispecies experimental oral biofilms with or without LGG were grown with a sole-carbohydrate source (fructose/glucose/lactose/sorbitol/sucrose). The viable cells of LGG and structure of the biofilms were examined after 64.5 h of incubation, and pH values of spent media were measured at 16.5, 40.5, and 64.5 h. Fermentation profiles of LGG in biofilm media were assessed with study carbohydrate as the sole energy source. Our results showed that LGG reached higher viable cell numbers with glucose and sucrose in 64.5-h multispecies experimental oral biofilms compared to other carbohydrates. When LGG was incorporated in biofilms, no distinct pH changes at any time points were observed under any of the carbohydrates used; the pH values of spent media at each time point were lower when lactose was used, compared to other carbohydrates. The fermentation profiles of LGG in biofilm media were similar to its growth in MRS (no obvious growth with lactose or sucrose). In conclusion, LGG in our in vitro multispecies experimental oral biofilms was capable of surviving and growing well in each carbohydrate source. LGG might not have harmful effects on dental hard tissues. Another finding from our study was that the lowest pH values were observed in the presence of lactose, and the thickest biofilms were in sucrose.
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Affiliation(s)
- Qingru Jiang
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Ghoshal UC, Gwee KA, Holtmann G, Li Y, Park SJ, Simadibrata M, Sugano K, Wu K, Quigley EMM, Cohen H. The role of the microbiome and the use of probiotics in gastrointestinal disorders in adults in the Asia-Pacific region - background and recommendations of a regional consensus meeting. J Gastroenterol Hepatol 2018; 33:57-69. [PMID: 28589613 DOI: 10.1111/jgh.13840] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/28/2017] [Accepted: 05/30/2017] [Indexed: 12/11/2022]
Abstract
The Asia-Pacific region is diverse, with regard to ethnicity, culture, and economic development incorporating some of the world's least and most developed nations. Gastrointestinal diseases are common in the Asia-Pacific region, and their prevalence, presentation, and management vary considerably within the region. There is growing evidence for an important role for the human gut microbiota in gastrointestinal health. As a consequence, geographic variations in the composition of the gut microbiota may contribute to variations in both the prevalence and response to therapy of specific diseases. Probiotics have been proposed as a valuable option in the prevention and treatment of a number of gastrointestinal illnesses, but the quality of available evidence to support their efficacy is variable. A meeting of international experts in adult and pediatric gastroenterology was held at the Sorbonne University, Paris, France, on April 11 and 12, 2016, to discuss current evidence supporting the use of probiotics in gastrointestinal disorders in the Asia-Pacific region. This article provides an overview of the discussions held at this meeting and recommends the formation of an Asia-Pacific Consortium on Gut Microbiota similar to those established in Europe and North America.
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Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Kok-Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gerald Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital Brisbane, University of Queensland, Brisbane, Queensland, Australia
| | - Yanmei Li
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China
| | - Soo Jung Park
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Marcellus Simadibrata
- Faculty of Medicine, University of Indonesia and Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,RSUPN Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Kentaro Sugano
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kaichun Wu
- Fourth Military Medical University, Xi'an, China
| | - Eamonn M M Quigley
- Division of Gastroenterology and Hepatology, Lynda K and David M Underwood Center for Digestive Disorders, Houston Methodist Hospital, Houston, Texas, USA
| | - Henry Cohen
- Clínica de Gastroenterología, Facultad de Medicina, Montevideo, Uruguay
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Cameron D, Hock QS, Kadim M, Mohan N, Ryoo E, Sandhu B, Yamashiro Y, Jie C, Hoekstra H, Guarino A. Probiotics for gastrointestinal disorders: Proposed recommendations for children of the Asia-Pacific region. World J Gastroenterol 2017; 23:7952-7964. [PMID: 29259371 PMCID: PMC5725290 DOI: 10.3748/wjg.v23.i45.7952] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 09/29/2017] [Accepted: 11/01/2017] [Indexed: 02/06/2023] Open
Abstract
Recommendations for probiotics are available in several regions. This paper proposes recommendations for probiotics in pediatric gastrointestinal diseases in the Asia-Pacific region. Epidemiology and clinical patterns of intestinal diseases in Asia-Pacific countries were discussed. Evidence-based recommendations and randomized controlled trials in the region were revised. Cultural aspects, health management issues and economic factors were also considered. Final recommendations were approved by applying the Likert scale and rated using the GRADE system. Saccharomyces boulardii CNCM I-745 (Sb) and Lactobacillus rhamnosus GG (LGG) were strongly recommended as adjunct treatment to oral rehydration therapy for gastroenteritis. Lactobacillus reuteri could also be considered. Probiotics may be considered for prevention of (with the indicated strains): antibiotic-associated diarrhea (LGG or Sb); Clostridium difficile-induced diarrhea (Sb); nosocomial diarrhea (LGG); infantile colic (L reuteri) and as adjunct treatment of Helicobacter pylori (Sb and others). Specific probiotics with a history of safe use in preterm and term infants may be considered in infants for prevention of necrotizing enterocolitis. There is insufficient evidence for recommendations in other conditions. Despite a diversity of epidemiological, socioeconomical and health system conditions, similar recommendations apply well to Asia pacific countries. These need to be validated with local randomized-controlled trials.
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Affiliation(s)
- Donald Cameron
- Department of Gastroenterology and Clinical Nutrition, Royal Children’s Hospital, Melbourne 3052, Australia
| | - Quak Seng Hock
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Musal Kadim
- Child Health Department, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta 12220, Indonesia
| | - Neelam Mohan
- Department of Pediatric Gastroenterology, Hepatology And Liver Transplantation, Medanta The Medicity 122001, Gurugram Haryana, India
| | - Eell Ryoo
- Department of Pediatrics, Gachon University, Gil Gachon Children’s Hosptial, Incheon 21565, South Korea
| | - Bhupinder Sandhu
- Department of Paediatric Gastroenterology, Royal Hospital for Children, Bristol BS2 8BJ, United Kingdom
| | - Yuichiro Yamashiro
- Probiotics Research Laboratory, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
| | - Chen Jie
- The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 610041, Zhejiang Province, China
| | - Hans Hoekstra
- Department of Pediatrics, Hieronymus Bosch Hospital, ’s-Hertogenbosch 5223GZ, The Netherlands
| | - Alfredo Guarino
- Unit of Pediatrics Infectious Diseases and Clinical Nutrition of the Department of Translational Medical Science-Section of Pediatrics, University of Naples Federico II, Naples 80131, Italy
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Abstract
Fibromyalgia (FM) has historically been associated with several diseases in gastroenterology and hepatology. The most substantiated evidence pertains to irritable bowel syndrome (IBS). The pathogeneses of FM and IBS remain unclear, but it is likely related to dysregulation within the brain-gut axis, resulting in a hyperalgesic state. IBS and FM share other similarities, including a female predominance, fatigue, insomnia, and susceptibility to psychiatric state. These common manifestations and pathogeneses serve as a foundation for overlapping, multidisciplinary treatment modalities.
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Affiliation(s)
- Richard A Schatz
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, 114 Doughty Street, STB Suite 249, Charleston, SC 29425, USA.
| | - Baharak Moshiree
- Division of Gastroenterology, Carolinas HealthCare System, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
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Shaffer M, Armstrong AJS, Phelan VV, Reisdorph N, Lozupone CA. Microbiome and metabolome data integration provides insight into health and disease. Transl Res 2017; 189:51-64. [PMID: 28764956 PMCID: PMC5659916 DOI: 10.1016/j.trsl.2017.07.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/28/2017] [Accepted: 07/08/2017] [Indexed: 02/07/2023]
Abstract
For much of our history, the most basic information about the microbial world has evaded characterization. Next-generation sequencing has led to a rapid increase in understanding of the structure and function of host-associated microbial communities in diverse diseases ranging from obesity to autism. Through experimental systems such as gnotobiotic mice only colonized with known microbes, a causal relationship between microbial communities and disease phenotypes has been supported. Now, microbiome research must move beyond correlations and general demonstration of causality to develop mechanistic understandings of microbial influence, including through their metabolic activities. Similar to the microbiome field, advances in technologies for cataloguing small molecules have broadened our understanding of the metabolites that populate our bodies. Integration of microbial and metabolomics data paired with experimental validation has promise for identifying microbial influence on host physiology through production, modification, or degradation of bioactive metabolites. Realization of microbial metabolic activities that affect health is hampered by gaps in our understanding of (1) biological properties of microbes and metabolites, (2) which microbial enzymes/pathways produce which metabolites, and (3) the effects of metabolites on hosts. Capitalizing on known mechanistic relationships and filling gaps in our understanding has the potential to enable translational microbiome research across disease contexts.
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Affiliation(s)
- Michael Shaffer
- Department of Medicine, University of Colorado Denver, Aurora, Colo; Computational Bioscience Program, University of Colorado Denver, Aurora, Colo
| | - Abigail J S Armstrong
- Department of Medicine, University of Colorado Denver, Aurora, Colo; Department of Immunology and Microbiology, University of Colorado Denver, Aurora, Colo
| | - Vanessa V Phelan
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Denver, Aurora, Colo
| | - Nichole Reisdorph
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Denver, Aurora, Colo
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Valdovinos M, Montijo E, Abreu A, Heller S, González-Garay A, Bacarreza D, Bielsa-Fernández M, Bojórquez-Ramos M, Bosques-Padilla F, Burguete-García A, Carmona-Sánchez R, Consuelo-Sánchez A, Coss-Adame E, Chávez-Barrera J, de Ariño M, Flores-Calderón J, Gómez-Escudero O, González-Huezo M, Icaza-Chávez M, Larrosa-Haro A, Morales-Arámbula M, Murata C, Ramírez-Mayans J, Remes-Troche J, Rizo-Robles T, Peláez-Luna M, Toro-Monjaraz E, Torre A, Urquidi-Rivera M, Vázquez R, Yamamoto-Furusho J, Guarner F. The Mexican consensus on probiotics in gastroenterology. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2017. [DOI: 10.1016/j.rgmxen.2017.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Liu MY, Yang ZY, Dai WK, Huang JQ, Li YH, Zhang J, Qiu CZ, Wei C, Zhou Q, Sun X, Feng X, Li DF, Wang HP, Zheng YJ. Protective effect of Bifidobacterium infantis CGMCC313-2 on ovalbumin-induced airway asthma and β-lactoglobulin-induced intestinal food allergy mouse models. World J Gastroenterol 2017; 23:2149-2158. [PMID: 28405142 PMCID: PMC5374126 DOI: 10.3748/wjg.v23.i12.2149] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/17/2017] [Accepted: 02/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To determine whether oral administration of Bifidobacterium infantis CGMCC313-2 (B. infantis CGMCC313-2) inhibits allergen-induced airway inflammation and food allergies in a mouse model.
METHODS Ovalbumin (OVA)-induced allergic asthma and β-lactoglobulin-induced food allergy mouse models were used in this study. Following oral administration of B. infantis CGMCC313-2 during or after allergen sensitization, histopathologic changes in the lung and intestine were evaluated by hematoxylin and eosin (HE) staining. In the allergic asthma mouse model, we evaluated the proportion of lung-infiltrating inflammatory cells. OVA-specific IgE and IgG1 levels in serum and cytokine levels in bronchoalveolar lavage fluid (BALF) were also assessed. In the food allergy mouse model, the levels of total IgE and cytokines in serum were measured.
RESULTS Oral administration of B. infantis CGMCC313-2 during or after allergen sensitization suppressed allergic inflammation in lung and intestinal tissues, while the proportion of infiltrating inflammatory cells was significantly decreased in the BALF of allergic asthma mice. Moreover, B. infantis CGMCC313-2 decreased the serum levels of total IgE in food allergy mice, and reductions in IgE and IgG1 were also observed in OVA-induced allergic asthma mice. The expression of interleukin-4 (IL-4) and IL-13 in both serum and BALF was suppressed following the administration of B. infantis CGMCC313-2, while an effect on serum IL-10 levels was not observed.
CONCLUSION B. infantis CGMCC313-2 inhibits the secretion of allergen-induced IgE, IL-4 and IL-13, and attenuates allergic inflammation.
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Ringel Y. The Gut Microbiome in Irritable Bowel Syndrome and Other Functional Bowel Disorders. Gastroenterol Clin North Am 2017; 46:91-101. [PMID: 28164856 DOI: 10.1016/j.gtc.2016.09.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Emerging data from epidemiologic, microbiome, and physiology research in patients with functional bowel disorders (FBDs) provide evidence for a linkage between alterations in the intestinal microbiota and FBDs. However, currently most of the data is based on association studies, and the causality role of the microbiota in these disorders is not established. Growing evidence for compositional changes and the increasing recognition of the association between the intestinal microbiota and gut-brain functions that are relevant to the pathophysiology and/or clinical symptoms of FBDs have led to increased interest in manipulating the intestinal microbiota for the treatment of these disorders.
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Affiliation(s)
- Yehuda Ringel
- Department of Gastroenterology, Beilinson Hospital, Petach Tikva 49100, Israel; School of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC 27599, USA.
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Sebastián Domingo JJ. Review of the role of probiotics in gastrointestinal diseases in adults. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 40:417-429. [PMID: 28185664 DOI: 10.1016/j.gastrohep.2016.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 11/25/2016] [Accepted: 12/02/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Probiotics may act as biological agents that modify the intestinal microbiota and certain cytokine profiles, which can lead to an improvement in certain gastrointestinal diseases. OBJECTIVES To conduct a review of the evidence of the role of probiotics in certain gastrointestinal diseases in adults. SEARCH METHODS Review conducted using appropriate descriptors, filters and limits in the PubMed database (MEDLINE). SELECTION CRITERIA The MeSH terms used were Probiotics [in the title] AND Gastrointestinal Diseases, with the following limits or filters: Types of study: Systematic Reviews, Meta-Analysis, Guideline, Practice Guideline, Consensus Development Conference (and Consensus Development Conference NIH), Randomized Controlled Trial, Controlled Clinical Trial and Clinical Trial; age: adults (19 or older); language: English and Spanish; in humans, and with at least one abstract. DATA COLLECTION AND ANALYSIS Full texts of all the Systematic Reviews and meta-analyses directly related to the review's objective were obtained, as well as the Randomised Controlled Trials of the studies that were considered relevant and of sufficient quality for this review. MAIN RESULTS Certain probiotics, different for each process, have proven to be effective and beneficial in cases of acute infectious diarrhoea, antibiotic-associated diarrhoea, Clostridium difficile-associated diarrhoea, pouchitis and Helicobacter pylori infection eradication. AUTHORS' CONCLUSIONS Although some probiotics have not demonstrated any benefit, there are certain gastrointestinal diseases in which the use of probiotics, true biological agents, can be recommended.
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48
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Valdovinos MA, Montijo E, Abreu AT, Heller S, González-Garay A, Bacarreza D, Bielsa-Fernández M, Bojórquez-Ramos MC, Bosques-Padilla F, Burguete-García AI, Carmona-Sánchez R, Consuelo-Sánchez A, Coss-Adame E, Chávez-Barrera JA, de Ariño M, Flores-Calderón J, Gómez-Escudero O, González-Huezo MS, Icaza-Chávez ME, Larrosa-Haro A, Morales-Arámbula M, Murata C, Ramírez-Mayans JA, Remes-Troche JM, Rizo-Robles T, Peláez-Luna M, Toro-Monjaraz EM, Torre A, Urquidi-Rivera ME, Vázquez R, Yamamoto-Furusho JK, Guarner F. The Mexican consensus on probiotics in gastroenterology. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2017; 82:156-178. [PMID: 28104319 DOI: 10.1016/j.rgmx.2016.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/17/2016] [Accepted: 08/26/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Probiotics are frequently prescribed in clinical practice. Their efficacy in treating gastrointestinal disorders is supported by a significant number of clinical trials. However, the correct prescription of these agents is hampered due to a lack of knowledge of the scientific evidence and to the different presentations and microbial compositions of the probiotics that are currently available. AIM To provide the clinician with a consensus review of probiotics and recommendations for their use in gastroenterology. MATERIALS AND METHODS Controlled clinical trials, meta-analyses, and systematic reviews published up to 2015 were selected, using the MESH terms: probiotics, gastrointestinal diseases, humans, adults, AND children. The Delphi method was employed. Eighteen gastroenterologists treating adult patients and 14 pediatric gastroenterologists formulated statements that were voted on until agreement>70% was reached. The level of evidence based on the GRADE system was evaluated for each statement. RESULTS AND CONCLUSIONS Eleven statements on the general concepts of probiotics and 27 statements on the use of probiotics in gastrointestinal diseases in both adults and children were formulated. The consensus group recommends the use of probiotics under the following clinical conditions: the prevention of diarrhea associated with antibiotics, the treatment of acute infectious diarrhea, the prevention of Clostridium difficile infection and necrotizing enterocolitis, the reduction of adverse events from Helicobacter pylori eradication therapy, relief from irritable bowel syndrome symptoms, the treatment of functional constipation in the adult, and the induction and maintenance of remission in patients with ulcerative colitis and pouchitis, and the treatment of covert and overt hepatic encephalopathy.
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Affiliation(s)
- M A Valdovinos
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
| | - E Montijo
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
| | - A T Abreu
- Servicio de Gastroendoscopia, Hospital Regional n.(o) 2 con Unidad de Medicina de Atención Ambulatoria, IMSS, Ciudad de México, México
| | - S Heller
- Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México, México
| | - A González-Garay
- Metodología de la Investigación, Instituto Nacional de Pediatría, Ciudad de México, México
| | - D Bacarreza
- Hospital Infantil de las Californias, Tijuana, BC, México
| | - M Bielsa-Fernández
- Unidad de Pacientes en Estudio, Universidad Autónoma de Guadalajara, Zapopan, Jalisco, México
| | - M C Bojórquez-Ramos
- UMAE Hospital de Pediatría, Centro Médico Nacional de Occidente, IMSS, , Guadalajara, Jalisco, México
| | - F Bosques-Padilla
- Departamento de Medicina Interna, División de Gastroenterología, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, N.L., México
| | - A I Burguete-García
- Departamento de Epidemiología Genética e Infecciones, CISEI, INSP, Cuernavaca, Mor., México
| | | | - A Consuelo-Sánchez
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - E Coss-Adame
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - J A Chávez-Barrera
- Departamento de Gastroenterología Pediátrica, UMAE Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, IMSS, Ciudad de México, México
| | - M de Ariño
- Servicio de Gastroenterología, Hospital Español, Ciudad de México, México
| | - J Flores-Calderón
- Departamento de Gastroenterología y Endoscopia, UMAE Hospital de Pediatría Dr. Silvestre Frenk Freund, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - O Gómez-Escudero
- Clínica de Gastroenterología, Endoscopia Digestiva y Motilidad Gastrointestinal, Hospital Ángeles Puebla, Puebla, México
| | - M S González-Huezo
- Departamento de Gastroenterología, Centro Médico Issemym, Metepec, Estado de México, México
| | | | - A Larrosa-Haro
- Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | | | - C Murata
- Metodología de la Investigación, Instituto Nacional de Pediatría, Ciudad de México, México
| | - J A Ramírez-Mayans
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
| | - J M Remes-Troche
- Laboratorio de Motilidad y Fisiología Digestiva, Instituto de Investigaciones Médico Biológicas, Universidad Veracruzana (UV), Veracruz, México
| | - T Rizo-Robles
- Servicio de Gastroenterología, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, IMSS, Ciudad de México, México
| | - M Peláez-Luna
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - E M Toro-Monjaraz
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
| | - A Torre
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - M E Urquidi-Rivera
- Servicio de Gastroenterología Pediátrica y Endoscopia, Hospital Regional ISSSTE, Monterrey, N.L., México
| | - R Vázquez
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - J K Yamamoto-Furusho
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - F Guarner
- Servicio de Aparato Digestivo, Hospital Vall d'Hebrón, Barcelona, España
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Zubarioglu U, Uslu S, Bulbul A. New Frontiers of Necrotizing Enterocolitis: From Pathophysiology to Treatment. Health (London) 2017. [DOI: 10.4236/health.2017.91008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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50
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Forbes A, Escher J, Hébuterne X, Kłęk S, Krznaric Z, Schneider S, Shamir R, Stardelova K, Wierdsma N, Wiskin AE, Bischoff SC. ESPEN guideline: Clinical nutrition in inflammatory bowel disease. Clin Nutr 2016; 36:321-347. [PMID: 28131521 DOI: 10.1016/j.clnu.2016.12.027] [Citation(s) in RCA: 395] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/28/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The ESPEN guideline presents a multidisciplinary focus on clinical nutrition in inflammatory bowel disease (IBD). METHODOLOGY The guideline is based on extensive systematic review of the literature, but relies on expert opinion when objective data were lacking or inconclusive. The conclusions and 64 recommendations have been subject to full peer review and a Delphi process in which uniformly positive responses (agree or strongly agree) were required. RESULTS IBD is increasingly common and potential dietary factors in its aetiology are briefly reviewed. Malnutrition is highly prevalent in IBD - especially in Crohn's disease. Increased energy and protein requirements are observed in some patients. The management of malnutrition in IBD is considered within the general context of support for malnourished patients. Treatment of iron deficiency (parenterally if necessary) is strongly recommended. Routine provision of a special diet in IBD is not however supported. Parenteral nutrition is indicated only when enteral nutrition has failed or is impossible. The recommended perioperative management of patients with IBD undergoing surgery accords with general ESPEN guidance for patients having abdominal surgery. Probiotics may be helpful in UC but not Crohn's disease. Primary therapy using nutrition to treat IBD is not supported in ulcerative colitis, but is moderately well supported in Crohn's disease, especially in children where the adverse consequences of steroid therapy are proportionally greater. However, exclusion diets are generally not recommended and there is little evidence to support any particular formula feed when nutritional regimens are constructed. CONCLUSIONS Available objective data to guide nutritional support and primary nutritional therapy in IBD are presented as 64 recommendations, of which 9 are very strong recommendations (grade A), 22 are strong recommendations (grade B) and 12 are based only on sparse evidence (grade 0); 21 recommendations are good practice points (GPP).
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Affiliation(s)
- Alastair Forbes
- Norwich Medical School, University of East Anglia, Bob Champion Building, James Watson Road, Norwich, NR4 7UQ, United Kingdom.
| | - Johanna Escher
- Erasmus Medical Center - Sophia Children's Hospital, Office Sp-3460, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
| | - Xavier Hébuterne
- Gastroentérologie et Nutrition Clinique, CHU de Nice, Université Côte d'Azur, Nice, France.
| | - Stanisław Kłęk
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, 15 Tyniecka Street, 32-050, Skawina, Krakau, Poland.
| | - Zeljko Krznaric
- Clinical Hospital Centre Zagreb, University of Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia.
| | - Stéphane Schneider
- Gastroentérologie et Nutrition Clinique, CHU de Nice, Université Côte d'Azur, Nice, France.
| | - Raanan Shamir
- Tel-Aviv University, Schneider Children's Medical Center of Israel, 14 Kaplan St., Petach-Tikva, 49202, Israel.
| | - Kalina Stardelova
- University Clinic for Gastroenterohepatology, Clinical Centre "Mother Therese", Mother Therese Str No 18, Skopje, Republic of Macedonia.
| | - Nicolette Wierdsma
- VU University Medical Center, Department of Nutrition and Dietetics, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Anthony E Wiskin
- Paediatric Gastroenterology & Nutrition Unit, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ, United Kingdom.
| | - Stephan C Bischoff
- Institut für Ernährungsmedizin (180) Universität Hohenheim, Fruwirthstr. 12, 70593 Stuttgart, Germany.
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