Hepatoprotective Effect of Probiotic Lactobacillus rhamnosus GG Through the Modulation of Gut Permeability and Inflammasomes in a Model of Alcoholic Liver Disease in Zebrafish.

Objective: Alcoholic liver disease (ALD) is among the leading causes of death from liver disease. Among the factors involved in its pathogenesis are inflammation and increased intestinal permeability. The aim of this study was to assess the effect of Lactobacillus rhamnosus GG (LGG) on hepatic lipid accumulation, activation of inflammasomes, and gut permeability markers in experimental model of ALD with zebrafish.Methods: An experiment was conducted to assess the effective LGG dose capable of promoting intestinal colonization. Animals were divided into three groups (n = 64/group): ethanol group (E), ethanol + probiotic group (EP), and control group (C). Groups E and EP were exposed to 0.5% ethanol concentration for 28 days. At the end of this period, animals were euthanized, and livers were collected for Oil Red staining and assessment of the inflammasome system. Intestines were collected for evaluation of gut permeability markers.Results: The dose of 1.55 × 106 UFC LGG/fish/d promoted intestinal colonization. Group EP presented lower hepatic lipid accumulation, lower il-1ß expression, and higher cldn15a expression when compared to group E.Conclusions: Supplementation with LGG was protective for hepatic steatosis in ALD model. In addition, LGG influenced the modulation of the inflammatory response and markers of gut permeability, improving the gut barrier structure.

Avaliação do consumo de fósforo, potássio e alimentos processados e ultraprocessados em pacientes com doença renal crônica / Evaluation of the consumption of phosphorus, potassium and processed and ultra-processed foods by patients with chronic kidney disease

Introdução: Pacientes com doença renal crônica em hemodiálise necessitam orientações adequadas quanto a escolha de uma alimentação equilibrada, pois a qualidade da dieta pode influenciar diretamente no curso da doença. Objetivo: Caracterizar e avaliar o consumo de alimentos processados e ultraprocessados, fósforo e potássio em relação às recomendações para pacientes com doença renal crônica em hemodiálise. Métodos: Estudo transversal e quantitativo, realizado em uma Clínica de Nefrologia, no Vale do Taquari/RS, Brasil. A amostra foi por conveniência, composta por 47 pacientes. Foi utilizado registro alimentar de três dias não consecutivos, sendo avaliado o consumo de carboidrato, proteína, lipídios, fósforo e potássio para posteriormente serem comparados aos valores preconizados para pacientes com doença renal crônica renal. Para avaliar o consumo de alimentos processados e ultraprocessados, foi avaliada a frequência dos alimentos correspondentes encontrados no registro alimentar, utilizando como recomendação o Guia Alimentar para a População Brasileira. Resultados: Constatou-se um consumo inferior significativamente ao recomendado para carboidrato e lipídio (p ≤ 0,01), significativamente superior (p ≤ 0,01) em relação às proteínas. A ingestão de potássio estava abaixo da recomendação e do fósforo dentro das recomendações. Para os alimentos processados e ultraprocessados, o consumo médio foi de 17,70% das calorias totais ingeridas. Conclusão: O consumo de carboidrato, proteína, lipídios e potássio foi inadequado, quando comparado às recomendações preconizadas para os pacientes com doença renal crônica em hemodiálise. Quanto aos alimentos processados e ultraprocessados, o percentual encontrado é preocupante, visto que a qualidade desses alimentos pode trazer prejuízos ao estado nutricional e consequentemente ao tratamento dos pacientes avaliados.

Introduction: Patients with chronic kidney disease undergoing hemodialysis require adequate guidelines for the choice of a balanced diet, since diet quality may directly influence the course of the disease. Objective: Tocharacterize and evaluate the consumption of processed and ultra-processed foods, phosphorus and potassium in relation to recommendations for individuals with chronic kidney disease on hemodialysis. Methods: This is a cross-sectional and quantitative study performed at a Nephrology Clinic, in a city at Vale do Taquari/RS. The convenience sampling consisted of 47 patients. The food recall of three-day non-consecutive was used and the values obtained were compared with the values recommended for patients with chronic kidney disease for carbohydrate, protein, lipids, phosphorus and potassium. To evaluate the consumption of processed and ultra-processed foods, the frequency of the corresponding foods found in the food register, we used the recommendations from the Food Guide for the Brazilian Population. Results: It was found a consumption significantly lower than the recommended for carbohydrate and lipid (p ≤ 0.01), and significantly higher for protein (p ≤ 0.01). The potassium intake was below the recommendation and the phosphorus within the recommendations. For processed and ultra-processed foods, the average consumption was 17.70% of the total calories consumed. Conclusion: The consumption of carbohydrate, protein, lipids and potassium was inadequate according to recommendations for patients with chronic kidney disease on hemodialysis. In relation to be processed and ultra-processed foods, the percentage found is worrisome, since the quality of these foods can damage the nutritional status and consequently, the treatment of the evaluated patients.

Effect of probiotic supplementation in nonalcoholic steatohepatitis patients: PROBILIVER TRIAL protocol.

BACKGROUND: Recently factors in the relationship between gut microbiota, obesity, diabetes and the metabolic syndrome have been suggested in the development and progression of nonalcoholic steatohepatitis (NASH). In this sense, this work aims to evaluate the effects of probiotic supplementation on intestinal microbiota modulation, degree of hepatic steatosis and fibrosis, inflammation, gut permeability, and body composition. METHODS: This double-blind, randomized clinical trial will include adult outpatients with a diagnosis of NASH confirmed by biopsy with or without transient elastography. All patients will undergo a complete anamnesis to investigate their alcohol consumption, previous history, medications, nutritional assessment (dietary intake and body composition), sarcopenia, physical activity level and physical and functional capacity, cardiovascular risk, biochemical parameters for assessment of inflammatory status, lipid profile, hepatic function, gut permeability, and assessment of microbiota. These procedures will be performed at baseline and repeated after 24 weeks (at the end of the study). Through the process of randomization, patients will be allocated to receive treatment A or treatment B. Both patients and researchers involved will be blinded (double-blind study). The intervention consists of treatment with a probiotic mix (Lactobacillus acidophillus + Bifidobacterium lactis + Lactobacillus rhamnosus + Lactobacillus paracasei, 1 x 109 CFU for each) and the placebo which is identical in all its characteristics and packaging. Patients will be instructed to consume two sachets/day during 24 weeks and to report any symptoms or side effects related to the use of the sachets. Adherence control will be carried out through the patient's notes on a form provided, and also by checking the number of sachets used. DISCUSSION: The final results of study will be analyzed and disseminated in 2020. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03467282 . Registered on 15 March 2018.

Obesity, dynapenia and high cardiovascular risk co-exist in post-liver transplant setting: results of a cross-sectional study.

BACKGROUND: Cardiovascular disease is a major cause of death in post-liver transplantation (LT). The aim of this study was to evaluate LT patients as to the carotid intima-media thickness (CIMT) and its association with nutritional status, dietary intake, metabolic profile and cardiovascular risk factors. METHODS: In this cross-sectional study, adult patients with more than 12 months of post-transplant follow-up underwent clinical, laboratory, functional and nutritional evaluation by 3-day-diet-record, anthropometry and dynamometry. CIMT was evaluated by Doppler ultrasonography. RESULTS: Sixty-nine post-LT patients [males 61%, median of age 59 (51-64) years were included; median time post-liver transplantation 2.8 (1.4-6.3) years]. High prevalence of malnutrition was found (45% of arm muscle area < p15 and 71% of handgrip strength < p30). Excess weight was present in 72% of patients, body mass index ≥ 30 kg/m2 in 35% and metabolic syndrome in 51%. Abnormal CIMT was found in 54% of the sample. Patients with abnormal CIMT presented higher cardiovascular risk Score, LDL cholesterol, higher prevalence of high-sensitive C-reactive protein ≥ 1 mg/L and higher intake of saturated and trans fatty acids (P < 0.05 for all). CONCLUSIONS: Abnormal IMT was commonly found in LT patients presenting at the same time with overweight and dynapemia. These results were associated with higher LDL-cholesterol levels, high-sensitive C-reactive protein ≥ 1 mg/L and higher intake of saturated and trans fatty acids. Preventive measures, including dietary advice, are required for all post-liver transplantation patients to minimize cardiovascular risk.