Gut Microbiome-How Does Two-Month Consumption of Fiber-Enriched Rolls Change Microbiome in Patients Suffering from MASLD?

BACKGROUND

The occurrence of metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global problem which commonly affects patients with co-existing diseases/conditions, such as type 2 diabetes and dyslipidemia. The effective treatment of MASLD is still limited; however, diet plays a significant role in its management. There are multiple beneficial properties of dietary fiber, including its ability to modify the gut microbiome. Therefore, the aim of this study was to determine the effect of the consumption of fiber-enriched rolls on the gut microbiome and microbial metabolites in patients suffering from MASLD.

METHODS

The participants were recruited according to the inclusion criteria and were required to consume fiber-enriched rolls containing either 6 g or 12 g of fiber. There were three assessment timepoints, when the anthropometric and laboratory parameters were measured, and 16s on nanopore sequencing of the fecal microbiome was conducted.

RESULTS

Firmicutes and Bacteroidetes were the most abundant phyla in the patients living with MASLD. It was demonstrated that the amount of short-chain fatty acids (SCFAs) changed after the consumption of fiber-enriched rolls; however, this was strongly associated with both the timepoint and the type of SCFAs-acetate and butyrate. Additionally, the high-fiber diet was related to the increase in phyla diversity (p = 0.006571).

CONCLUSIONS

Overall, the introduction of an appropriate amount of fiber to the diet seems to be promising for patients suffering from MASLD due to its ability to create an improvement in gut microbiome-related aspects.

Patient‑centered care and "people-first language" as tools to prevent stigmatization of patients with obesity

Obesity is a global health problem with serious consequences, such as diabetes, dyslipidemia, cardiovascular disease, infertility, and certain cancers. Excess body weight, mainly due to its manifestation in an individual's appearance, also affects the psychological condition. Therefore, health care providers need to make an effort to diagnose and comprehensively treat obesity. The obesity treatment should be systemic and carried out by a multidisciplinary therapeutic team consisting of a doctor, nurse, dietitian, psychologist or physiotherapist, and surgeon. The first-line therapy of obesity includes lifestyle modification and increased physical activity. Pharmacological treatment is recommended in all adult patients with a body mass index (BMI) exceeding 30 kg/m2 or those with a BMI greater than or equal to 27 kg/m2 with at least 1 obesity‑related comorbidity. Bariatric surgery should be considered in adults with a BMI of 40 kg/m2 or greater, or those with a BMI greater than or equal to 35 kg/m2 with at least 1 obesity‑related disease. The holistic model of obesity treatment also includes psychological therapy. The European Association for the Study of Obesity recommends psychological assistance for all individuals with previous treatment failure. Adverse or harmful actions toward people with obesity, ascribing negative traits and behaviors to them, and their marginalization in the public space are referred to as stigmatization of obesity. This phenomenon is associated with reduced compassion and willingness to help, and a feeling of dislike or even anger toward this group of patients. The consequences of stigmatization are worse mental health, poorer physical health, avoidance of health care, and the maintenance or increase of excess body weight. Therefore, talking about obesity using the principles of "people-first language," as well as implementing a patient‑centered care model are important.

The Influence of Obesity on Nutrition and Physical Activity during COVID-19 Pandemic: A Case-Control Study

Obesity is one of the important risk factors for a severe course of COVID-19. Maintaining a healthy body weight through diet and physical activity is a reasonable approach to preventing a SARS-CoV-2 infection or in alleviating its course. The goal of the study was to determine the influence of obesity on nutrition and physical activity during the COVID-19 pandemic. A total of 964 respondents, including 227 individuals with a body mass index (BMI) ≥30 kg/m2 were evaluated in this study. In the case of 482 respondents, including 105 individuals (21.8%) with BMI ≥ 30 kg/m2, the data were collected during the pandemic period from 1 June to 31 August 2020. The remaining 482 individuals were the “pre-pandemic” group, selected via propensity score matching (PSM) out of the 723 National Health Program study participants whose data was collected in 2017−2019. The evaluated dietary health factors were quantitatively similar in patients with BMI of either <30 kg/m2 or ≥30 kg/m2 and showed no significant changes during the pandemic. The diets of those who suffered from obesity prior to the pandemic showed the evaluated unhealthy nutritional factors to be less pronounced in comparison with those of individuals with BMI < 30 kg/m2. During the pandemic, the BMI ≥ 30 kg/m2 group showed a significant increase in the overall calorie intake (by 319 kcal; p = 0.001) and an increased consumption of total carbohydrates 299.3 ± 83.8 vs. 252.0 ± 101.5; p = 0.000), sucrose (51.7 ± 30.0 vs. 71.6 ± 49.9; p = 0.000), plant protein (26.3 ± 12.1 vs. 29.3 ± 8.3; p = 0.040), total fat (73.1 ± 42.6 vs. 84.9 ± 29.6; p = 0.011) and saturated fatty acids (29.5 ± 16.4 vs. 34.3 ± 13.9; p = 0.014) in comparison with the pre-pandemic period. The energy and nutritional value of the diets of BMI < 30 kg/m2 individuals did not change between the pre-pandemic and pandemic period. Before the pandemic, the level of leisure physical activity of the BMI ≥ 30 kg/m2 group was significantly lower than of those with BMI < 30 kg/m2. Such differences were not observed in the levels of physical activity at work or school. The pandemic did not alter the amount of physical activity either during leisure time or at work/school in individuals with BMI ≥ 30 kg/m2. However, respondents without obesity exercised significantly less during the pandemic than before. In conclusion, the pandemic altered the diets and levels of physical activity in the Polish population, with dietary changes observed in individuals with BMI ≥ 30 kg/m2 and changes in physical activity observed in those with BMI < 30 kg/m2.

Management of obesity in the times of climate change and COVID-19: an interdisciplinary expert consensus report

Obesity is a chronic disease that is associated with increased metabolic and cardiovascular risk, excessive morbidity and mortality worldwide. The authors of the present consensus, clinicians representing medical specialties related to the treatment of obesity and its complications, reviewed a number of European and American guidelines mostly published in 2019-2021, and summarized the principles of obesity management to provide a practical guidance considering the impact that increased adiposity poses to health. The primary goal of obesity treatment from clinical perspective is to prevent or slow down the progression of diseases associated with obesity, reduce metabolic and cardiovascular risk and improve the quality of life by achieving adequate and stable weight reduction. However, obesity should not only be considered as a disease requiring treatment in an individual patient, but also as a civilization disease requiring preventive measures at the population level. Despite the evident benefits, obesity management within the health care system - whether through pharmacotherapy or bariatric surgery - is only a symptomatic treatment, with all its limitations, and will not ultimately solve the problem of obesity. The important message is that available treatment options fail to correct the true drivers of the obesity pandemic. To this end, new solutions and efforts to prevent obesity in the populations are needed.

Diagnosis and treatment of thyroid disorders in obese patients - what do we know?

Obesity-related changes in the composition of the body interfere with the proper functioning of the thyrotropic axis, leading to its disturbances and changes in the structure of the thyroid gland. Distinguishing what is related to obesity and what constitutes pathological changes is crucial for the proper treatment of patients. In this paper authors present a case of a patient with a diet-induced obesity, whose only abnormalities in thyroid assessment included an elevated level of thyroid stimulating hormone (TSH) and hypoechoic thyroid gland on ultrasound. Based on this clinical situation, we reviewed literature in order to establish rules regarding management of thyroid disorders in obese individuals. The most common obesity-related thyroid abnormality is an isolated increase of TSH, without clinical symptoms of hypothyroidism, defined as hyperthyrotropinaemia. In obese adults, autoimmune thyroid disease is found equally often as in the normal-weight population. Thyroid enlargement, increased risk of nodules, and decreased echogenicity, not related to autoimmunity, is frequent among obese individuals. Weight loss leads to the normalisation of TSH levels and thyroid echogenicity. Excessive weight can influence both the TSH level and ultrasound image of the thyroid gland; however, these findings can be reversed by weight reduction. Therefore, in asymptomatic obese patients elevated TSH should not be treated with thyroid hormone replacement.

Gastric Ulcer Hemorrhage - a Potential Life-Threatening Complication of Intragastric Balloon Treatment of Obesity

BACKGROUND

Some morbidly obese patients do not qualify for bariatric surgery due to general health contraindications. Intragastric balloon treatment might be a therapeutic option in the above-mentioned cases. It can prime super-obese patients with end-stage disease for bariatric surgery. As a neoadjuvant therapy before surgery, it leads to a downstage of the disease by preliminary weight reduction, to an improvement in general health and, in summary, to a reduction of the perioperative risk. It is generally considered to be a safe method. However, due to the wide range of possible complications and unusual symptoms after intragastric balloon treatment, an interdisciplinary, instead of only a surgical or endoscopic, treatment and follow-up might be recommended in these patients.

CASE REPORT

We here describe a potential life-threatening complication in the form of gastric bleeding as a consequence of intragastric balloon treatment and simultaneous aspirin taking and Helicobacter pylori infection.

CONCLUSION

There have been reports of some complications of intragastric balloon treatment. However, to the best of our knowledge there were no reports concerning life-threatening hemorrhage from gastric ulcer.

Hypoxia and Coriolis Illusion in Pilots During Simulated Flight

INTRODUCTION

Pilots' vision and flight performance may be impeded by spatial disorientation and high altitude hypoxia. The Coriolis illusion affects both orientation and vision. However, the combined effect of simultaneous Coriolis illusion and hypoxia on saccadic eye movement has not been evaluated.

METHOD

A simulated flight was performed by 14 experienced pilots under 3 conditions: once under normal oxygen partial pressure and twice under reduced oxygen partial pressures, reflecting conditions at 5000 m and 6000 m (16,404 and 19,685 ft), respectively. Eye movements were evaluated with a saccadometer.

RESULTS

At normal oxygen pressure, Coriolis illusion resulted in 55% and 31% increases in mean saccade amplitude and duration, respectively, but a 32% increase in mean saccade frequency was only noted for saccades smaller than the angular distance between cockpit instruments, suggesting an increase in the number of correction saccades. At lower oxygen pressures a pronounced increase in the standard deviation of all measures was noticed; however, the pattern of changes remained unchanged.

DISCUSSION

Simple measures of saccadic movement are not affected by short-term hypoxia, most likely due to compensatory mechanisms.

[Type 2 diabetes prevention. Experts' Group position paper endorsed by the Polish Cardiac Society Working Group on Cardiovascular Pharmacotherapy]

Type 2 diabetes is responsible for approximately 90% of all diabetes worldwide and it is a global public health problem. This is a chronic, progressive, metabolic disease characterised by hyperglycaemia, which leads to microangiopathic and macroangiopathic complications. Subjects with type 2 diabetes have increased mortality and a reduced life expectancy compared with those without diabetes. Strong evidence supports the fact that identification of type 2 diabetes risk factors and early intervention influencing the modifiable ones can reduce incidence rate of diabetes and prevalence of its complications. There are many advantages of such interventions for patients (prolonged life expectancy, improvement of life quality) and for the whole society (reduction of the costs). Therefore the guidelines for the prevention of type 2 diabetes are needed. Experts of the Polish Cardiac Society Working Group on Cardiovascular Pharmacotherapy reviewed recently published clinical studies regarding the prevention of type 2 diabetes and prepared their recommendations. The guidelines are designed to assist clinicians and other healthcare workers to make evidence based management decisions. The strategies are grouped broadly into interventions that aim to change lifestyle through physical activity and diet, interventions based on drug administration (pharmacotherapy) and surgical interventions.

Evaluation of overweight and obesity in Helicopter Emergency Medical Service (HEMS) worker

INTRODUCTION

Obesity now affects people from all walks of life, including those who work in the field of medical aid provision on a daily basis. So far, there has been no research assessing the nutrition status of Helicopter Emergency Medical Service (HEMS) crews.

OBJECTIVES

To evaluate the degree to which overweight and obesity prevail among Helicopter Emergency Medical Service Air Ambulances (HEMS LPR) crew members, and determine the overall excess body fat and fatty tissue distribution in the subjects.

MATERIAL AND METHODS

In order to evaluate the prevalence of overweight and obesity in HEMS crew members, the following anthropometric measurements were used: height, body mass, waist and hip circumferences. Assessment of their nutritional status was made by using some generally used indicators, i.e. calculating the subjects' BMI, WHR and WHtR.

RESULTS

Pilots were older than the paramedics in a statistically significant way. On the basis of using the BMI indicator, it was shown that only 36% of HEMS crew members had normal body weight. Analysis of the percentage of body fat determined that 61.5% of the paramedics and 39.4% of the pilots had normal weight. 26.2% paramedics and 28.8% pilots were diagnosed as overweight. Obesity characterised 12.3% of paramedics and 31.8% of pilots. The above were statistically significant differences (p= 0.0117). Waist circumference exceeded 102 cm in 25.9% of the subjects and WHR>1 characterised 20.6% of those examined.

CONCLUSIONS

Analysis of the results obtained revealed that an alarmingly high percentage of crew members suffer from excessive body mass and fat, particularly in the group of pilots. Immediate action should be taken in order to reduce the body mass and introduce preventive measures among the subjects.

Hepatic angiogenesis and fibrosis are common features in morbidly obese patients

Background

A mass of visceral adipose tissue is one of the most important determinants of progressive liver injury in nonalcoholic fatty liver disease (NAFLD). In accordance, nonalcoholic steatohepatitis (NASH) and fibrosis are believed to occur more commonly in morbidly obese patients compared with nonobese NAFLD patients.

Aim of the study

Comparative analysis of NAFLD histopathologic features and angiogenesis activity in morbidly obese and nonobese subjects.

Materials and methods

Biopsy samples from 40 severely obese (BMI ≥40 kg m⁻²) and 30 nonobese (BMI ≤30 kg m⁻²) NAFLD patients were examined. Kleiner’s classification was used to diagnose NASH by grading steatosis, cytoplasmatic ballooning of hepatocytes, and lobular inflammation. The severity of fibrosis was evaluated according to the liver fibrosis staging system. Qualitative and quantitative immunohistochemical analyses of VEGF A, Flk-1, and CD34 were performed to study angiogenesis and the terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) method was used to study hepatocyte apoptosis.

Results

Severely obese patients did not differ from nonobese patients with respect to age and sex distribution. NASH was diagnosed in nine (22.5%) severely obese patients and in seven (23.3%) nonobese patients. Fibrosis was more common in morbidly obese patients (82.5 vs. 43.5%, χ^² = 11.71, p = 0.003) and was not associated with NASH. Moreover, the severity of fibrosis was greater in obese patients, as advanced fibrosis (bridging fibrosis and cirrhosis) occurred in six (15%) severely obese patients and in two (6.7%) nonobese patients. In morbidly obese individuals, angiogenesis was independent of NASH and was activated at the stage of simple steatosis. In severe obesity, there was a positive relationship between the stage of fibrosis and angiogenic activity.

Conclusion

In severely obese patients, fibrosis is probably promoted by mechanisms independent of NASH. In these patients, angiogenesis is activated early in the natural history of NAFLD and correlates with the severity of fibrosis.

Postoperative analgesia in a morbidly obese patient with chronic renal failure

BACKGROUND

The number of surgical interventions performed in obese patients has recently been increasing. Anaesthesia in a morbidly obese patient may be difficult, due to many pathophysiologic changes and co-morbidities, together with altered pharmacokinetics and pharmacodynamics of anaesthestic agents. We present a case of multimodal preventive analgesia in a bariatric patient with chronic renal failure.

CASE REPORT

A 36-year-old, morbidly obese man (BMI 47.8 kg m-2) was scheduled for a laparoscopic adjustable gastric banding (LAGB). The anaesthetic risk was increased because of hypertension, chronic renal failure, steatohepatitis and obstructive sleep apnoea syndrome. 30 minutes before anaesthesia, the patient received 2 g iv paracetamol. After induction, he was given 8 mg dexamethasone and 100 mg tramadol. All port-sites were infiltrated with 0.5% bupivacaine and adrenaline, both before skin incision, and before wound closure. Since NSAIDs and opioids were contraindicated because of the patient's co-morbidities, postoperative analgesia consisted of tramadol and paracetamol, given alternately, every 3 hours. The patient was discharged home 28 hours after surgery.

DISCUSSION AND CONCLUSION

According to the Polish Postoperative Pain Management Recommendations 2008, the pain after LAGB is multifactorial and rated as category 2. The pre-emptive analgesia and postoperative regimen presented in this case can be recommended in similar cases.

Liver visfatin expression in morbidly obese patients with nonalcoholic fatty liver disease undergoing bariatric surgery

BACKGROUND

Visfatin has been identified as a new adipokine with proinflammatory and immunomodulating properties. It seems to interfere with immune and fibrogenic process in nonalcoholic fatty liver disease (NAFLD). The aim was to assess visfatin expression in the liver tissue and its association with biochemical parameters and morphological features in NAFLD patients.

MATERIAL AND METHODS

The study included 40 severely obese patients with NAFLD who underwent intraoperative wedge liver biopsy during a bariatric operation. Immunohistochemical assay was carried out with the use of a visfatin mice monoclonal antibody.

RESULTS

Visfatin expression in the liver was observed in all patients. The expression was significantly higher in patients with fibrosis (p = 0.036) and was positively correlated with the fibrosis stage (r = 0.52, p = 0.03). There was no difference between patient with nonalcoholic steatohepatitis (NASH) and simple steatosis (p = 0.54). Inflammatory activity and NAS (NAFLD Activity Score) score were not associated with visfatin expression. There was a tendency of more evident visfatin liver expression in morbidly obese patients with diabetes mellitus.

CONCLUSION

Our study showed a positive association between visfatin and the fibrosis stage in NAFLD. This observation suggests a potential role of this adipokine in the pathogenesis and progression of NAFLD. Visfatin expression does not seem to be associated with liver steatosis and inflammation.