Results From a Physical Activity Intervention Feasibility Study With Kidney Inpatients.

BACKGROUND: Individuals with end-stage kidney disease requiring dialysis are often physically inactive, resulting in reduced physical functioning, increased frailty, and reduced quality of life. Furthermore, extended hospital stays and frequent readmissions are common, exacerbating health care costs. Physical activity may improve physical functioning, disability, and frailty but is not part of standard care of patients requiring dialysis. Research is required to determine the feasibility of implementing physical function assessments and physical activity programs in kidney inpatients requiring dialysis. OBJECTIVE: To assess the feasibility and preliminary efficacy of an early-physical activity intervention (Move More study) in the care of kidney inpatients requiring dialysis. It was hypothesized that the intervention would be feasible with regards to administration and participation, meeting a priori feasibility criteria, and that kidney inpatients would benefit from participating. DESIGN: Pilot study. SETTING: Patient Unit 37, Foothills Medical Center, Calgary, AB, Canada. PATIENTS: Kidney in-patients receiving dialysis. MEASUREMENTS: Feasibility data were collected for recruitment, participation, assessment completion, physical activity completion, and adverse events. Participant and healthcare practitioner (HCP) satisfaction with the intervention was assessed using a questionnaire. Frailty and physical function were assessed by the kinesiologist at baseline and postintervention prior to hospital discharge. METHODS: The study was a single-arm pilot intervention examining feasibility and preliminary efficacy. Kidney inpatients requiring dialysis were recruited to an individualized in-hospital physical activity intervention for the duration of their hospital stay. The intervention was led by a kinesiologist and supported by the clinical care team, including physiotherapists and nurse clinicians. Individualized exercise programs were created for patients to perform daily during their stay. These programs focused on strength, mobility, balance, and general movement and were tailored to each patient's needs. RESULTS: Thirty-six percent of eligible patients (n = 23/64) consented to participate in the Move More study, of whom 78% (n = 18/23) completed the intervention. The a priori level for consent to participate in the intervention was set at 60%. In addition, the a priori level for completion of assessments pre and postintervention was 50%. Ninety-five percent (n = 22/23) of preintervention assessments were completed compared to 65% of postintervention assessments. All participants who completed the survey (100%, n = 14/14) and most of the staff (77%, n = 24/31) reported being satisfied or very satisfied with the program. There were no adverse events related to the intervention. On average, Move More patients demonstrated improvements in frailty status and specific subsets of quality of life. LIMITATIONS: Firstly, as a feasibility study, the research was not powered to address the effectiveness of the intervention and lacked a comparison group to definitively link observed changes to the intervention itself. The voluntary nature of recruitment may have been biased toward ESKD inpatients with above-average motivation and baseline function. Furthermore, the small sample size from a single site limits the generalizability of findings. An additional limitation was the fact that postassessments were missed on a large number of patients, due to them being discharged prior to research staff knowing and being able to complete the assessments. Finally, studying the length of stay across the institution, as opposed to just the individual ward, would provide insight into hospitalization impact for these patients. CONCLUSIONS: The administration of and participation in a physical activity intervention for kidney inpatients requiring dialysis was initially not feasible primarily due to low recruitment and adherence challenges. The study was modified by including a research team member on the unit to increase recruitment efforts and support exercise adherence. The intervention impact includes potentially benefits on frailty and quality of life.

CONTEXTE: Les personnes atteintes d'insuffisance rénale terminale (IRT) nécessitant une dialyze sont souvent inactives physiquement, ce qui entraîne une réduction du fonctionnement physique, une fragilité accrue et une diminution de la qualité de vie. De plus, les séjours prolongés à l'hôpital et les réadmissions fréquentes sont courants chez ces patients, ce qui accroît les coûts des soins de santé. L'activité physique peut améliorer le fonctionnement physique et réduire les incapacités et la fragilité, mais elle ne fait pas partie des soins courants prodigués aux patients nécessitant une dialyze. Des recherches sont nécessaires pour déterminer la faisabilité de la mise en œuvre d'évaluations du fonctionnement physique et de programs d'activité physique chez les patients hospitalisés atteints de néphropathie nécessitant une dialyze. OBJECTIFS: Évaluer la faisabilité et l'efficacité préliminaire d'une intervention précoce en matière d'activité physique (l'étude Move More) intégrée aux soins prodigués aux patients hospitalisés atteints d'insuffisance rénale et nécessitant une dialyze. L'hypothèse était que l'intervention serait réalisable en ce qui concerne l'administration et la participation, qu'elle répondrait aux critères de faisabilité a priori, et que les patients hospitalisés bénéficieraient d'une participation. TYPE D'ÉTUDE: Étude pilote. CADRE: L'unité de soins 37 du Foothills Medical Center de Calgary (Alberta) au Canada. SUJETS: Des patients hospitalisés recevant des traitements de dialyze. MESURES: Les données de faisabilité ont été recueillies pour le recrutement, la participation, l'achèvement de l'évaluation, l'achèvement du program d'activité physique et les événements indésirables. La satisfaction des participants et des professionnels de la santé à l'égard de l'intervention a été évaluée à l'aide d'un questionnaire. La fragilité et les fonctions physiques ont été évaluées avant et après l'intervention, et avant la sortie de l'hôpital. MÉTHODOLOGIE: L'étude était une intervention pilote à bras unique examinant la faisabilité et l'efficacité préliminaire. Les patients hospitalisés atteints d'insuffisance rénale et nécessitant une dialyze ont été recrutés pour une intervention individualisée d'activité physique pendant toute la durée de leur séjour à l'hôpital. L'intervention était dirigée par un kinésiologue et appuyée par l'équipe de soins cliniques qui comprenait notamment des physiothérapeutes et des infirmières cliniciennes. Des programs d'activité physique individualisés ont été créés afin que les patients puissent s'exercer quotidiennement pendant leur séjour. Ces programs étaient axés sur la force, la mobilité, l'équilibre et le mouvement général, et étaient adaptés aux besoins de chaque patient. RÉSULTATS: Trente-six pour cent des patients admissibles (n=23/64) ont consenti à participer à l'étude Move More; de ceux-ci, 78 % (n=18/23) ont complété l'intervention. Le niveau a priori de consentement à participer à l'intervention a été fixé à 60 % et celui de l'achèvement des évaluations avant et après l'intervention à 50 %. Quatre-vingt-quinze pour cent (n=22/23) des évaluations pré-intervention ont été effectuées, comparativement à 65 % pour les évaluations postintervention. Tous les participants qui ont répondu au sondage (100 %; n=14/14) et la majorité du personnel (77 %; n=24/31) interrogé ont déclaré être satisfaits ou très satisfaits du program. Aucun événement indésirable lié à l'intervention n'a été signalé. En moyenne, les patients de Move More ont montré des améliorations de leur état de fragilité et de sous-ensembles propres à la qualité de vie. LIMITES: Puisqu'il s'agit d'une étude de faisabilité, la recherche n'avait pas la puissance nécessaire pour évaluer l'efficacité de l'intervention et ne disposait pas de groupe de comparaison permettant d'établir un lien définitif entre les changements observés et l'intervention elle-même. La nature volontaire du recrutement pourrait avoir favorisé les patients hospitalisés atteints d'IRT ayant une motivation et une fonction de base supérieures à la moyenne. L'échantillon de petite taille, provenant d'un seul site, limite la généralisabilité des résultats. De plus, les évaluations postintervention ont été manquées pour un grand nombre de patients, ceux-ci ayant obtenu leur congé avant que le personnel de recherche ait été avisé ou en mesure de compléter les évaluations. Enfin, le fait de connaître la durée du séjour dans l'ensemble de l'établissement, et non seulement dans chaque service permettrait de mieux comprendre l'impact de l'hospitalization pour ces patients. CONCLUSION: L'exécution d'une intervention d'activité physique et la participation des patients hospitalisés nécessitant une dialyze à une telle intervention n'étaient pas réalisables initialement, principalement en raison de difficultés liées au recrutement et à l'observance. L'étude a été modifiée pour intégrer un membre de l'équipe de recherche dans l'unité de soins afin d'accroître les efforts de recrutement et de soutenir l'observance du program d'exercices. L'impact de l'intervention comprend des avantages potentiels sur la fragilité et la qualité de vie.

Physical activity, diet, and weight loss in patients recruited from primary care settings: An update on obesity management interventions.

BACKGROUND: Obesity and related comorbidities are the most common chronic conditions in North America where behavior modification including the adoption of physical activity (PA) and a healthful diet are primary treatment strategies. Patients are more likely to engage in behavior modification if encouraged by their physician; however, behavioral counseling in primary care rarely occurs due to lack of training and resources. A more effective method may be to refer patients from clinical settings to other health professionals. OBJECTIVE: This systematic review examines the effectiveness of behavior-based counseling for obesity management among participants referred from clinical settings. METHODS: PubMed, CINAHL, and EMBASE were used to identify randomized clinical trials (2014-2020) for weight loss with the following inclusion criteria: trial duration ≥12 months, included a control or usual care group, recruited adults with overweight or obesity from primary care and/or treated in the primary care setting, and the intervention included counseling on PA and diet. RESULTS: Seventeen studies, encompassing 21 different intervention groups with 6185 unique participants (56% female) met the inclusion criteria. All participants had overweight or obesity, with a body mass index between 28.2 and 41.0 kg/m2. In 11 (52%) of the intervention groups, significant weight loss in the intervention group was observed compared to usual care (mean weight loss: 4.9[2.1] kg vs. 1.0[0.9] kg). In 13 out of 18 interventions (72%) reporting weight loss at two time points, weight regain was observed by 12 months. Statistically significant weight loss was observed in one intervention (of two total) that was longer than 12 months. CONCLUSIONS: Sustained weight loss regardless of the behavior-based, intervention strategy remains a challenge for most adults. Given the established benefits of routine PA and a healthful diet, prioritizing the adoption of healthy behaviors regardless of weight loss may be a more effective strategy for ensuring long-term health benefit.

A Physical Activity Intervention Feasibility Study for Kidney Inpatients: A Basic Research Protocol.

BACKGROUND: Low physical activity levels and poor physical functioning are strongly associated with poor clinical outcomes and mortality in adult kidney failure patients, regardless of treatment modality. Compared with the general population, individuals with chronic kidney disease are physically inactive, have reduced physical abilities and difficulties performing routine daily tasks, lower health-related quality of life, and higher cardiovascular morbidity and mortality. In addition, frail kidney failure patients have higher hospitalization and mortality rates as compared with other kidney failure patients. Evidence suggests that assessment and recommendations for physical activity should be part of standard care for kidney failure patients. Structured exercise can improve physical function and quality of life in frail older adults and may be used specifically for management of frailty in kidney failure. However, research is needed to determine best practices for implementation of physical function measurements and physical activity promotion in standard kidney failure care. OBJECTIVE: The proposed Move More study will assess the feasibility of a physical activity intervention offered to the kidney failure inpatients in Calgary, Alberta. Specifically, this study is designed to examine the effects of an early physical activity/mobility intervention led by a kinesiologist, and supported by the clinical care team including physiotherapists (PT) and nurse clinicians. METHODS: The Move More study is a single-arm pilot intervention examining feasibility and optimal improvement in real-world conditions. Kidney failure inpatients at the Foothills Medical Centre will be recruited to participate. Patients will receive an individualized in-hospital physical activity/mobility intervention. Frailty and physical function will be assessed at baseline and postintervention prior to hospital discharge. The goal is to recruit 24 to 36 patients. CONCLUSIONS: Evidence needed to support the inclusion of mobility and physical activity as part of standard care will be gathered, with knowledge gained used to help direct future physical activity programming for kidney failure inpatients.

CONTEXTE: Un faible niveau d'activité physique et une santé physique hypothéquée sont fortement associés à de mauvais résultats cliniques et à la mortalité chez les adultes atteints d'insuffisance rénale terminale (IRT), quelle que soit la modalité de traitement. Comparativement à la population générale, les personnes atteintes d'IRT sont moins actives, ont des capacités physiques réduites, ont davantage de difficulté à accomplir leurs tâches quotidiennes, ont une plus faible qualité de vie liée à la santé, et présentent des taux plus élevés de morbidité et de mortalité associées aux maladies cardiovasculaires. Par ailleurs, les patients physiquement fragiles qui souffrent d'IRT présentent des taux d'hospitalisation et de mortalité plus élevés que les autres patients atteints d'IRT. Les données indiquent qu'une évaluation des fonctions physiques et des recommandations en matière d'activité physique devraient faire partie des soins courants prodigués aux patients souffrant d'IRT. Un programme d'exercice structuré est susceptible d'améliorer la santé physique et la qualité de vie des personnes âgées fragiles, et pourrait être utilisé précisément pour gérer la fragilité en contexte d'IRT. Des recherches sont cependant nécessaires pour cerner les meilleures pratiques à adopter pour mettre en œuvre des mesures évaluant la fonction physique et faire la promotion de l'activité physique dans le cadre des soins courants prodigués en contexte d'IRT. OBJECTIFS: L'étude Move More proposée évaluera la faisabilité d'une intervention favorisant l'activité physique qui sera offerte aux patients hospitalisés souffrant d'IRT à Calgary, en Alberta. Plus précisément, cette étude est conçue pour examiner les effets d'une intervention précoce en matière d'activité physique et de mobilité, dirigée par un kinésiologue et appuyée par une équipe de soins cliniques composée de physiothérapeutes (PT) et d'infirmières cliniciennes. MÉTHODOLOGIE: L'étude Move More est une intervention pilote à bras unique qui examinera la faisabilité et l'amélioration optimale en conditions réelles. Les patients avec IRT au centre médical Foothills seront recrutés pour participer à l'étude. Les patients bénéficieront d'un programme individualisé d'activité physique/mobilité à l'hôpital. La fragilité et les fonctions physiques seront évaluées avant et après l'intervention, avant la sortie de l'hôpital. L'objectif est de recruter entre 24 et 36 patients. CONCLUSIONS: Les preuves nécessaires pour appuyer l'inclusion d'une intervention visant la mobilité et l'activité physique aux soins courants seront rassemblées. Les connaissances acquises serviront à orienter de futurs programmes d'activité physique destinés aux patients hospitalisés souffrant d'IRT.

Sun-Protective Behaviors: An Educational Intervention With Hospital Staff Aimed at Skin Cancer Prevention in Children.

BACKGROUND: Melanoma incidence and mortality rates are predicted to steadily increase. Sun protection is important during early development because of the potential for overexposure to ultraviolet radiation while outdoors. OBJECTIVES: The purpose of this project was to design, implement, and evaluate an educational intervention provided to healthcare professionals (HCPs) with the intention of influencing the behaviors of child populations served. METHODS: The project evaluated HCPs' baseline knowledge about sun-protective behaviors, their level of knowledge regarding sun-protective behaviors postintervention, their intent to change behavior, and the feasibility of implementing behavior change within the organization. FINDINGS: Pre- to post-test knowledge significantly increased. All participants reported that they would encourage children's sunscreen usage, and 98% reported that they would support the behavior change; however, 35% indicated likeliness that they would personally use sunscreen or sun-protection methods.

Individual Response to Standardized Exercise: Total and Abdominal Adipose Tissue.

PURPOSE: (1) Determine the effect of exercise amount and intensity on the proportion of individuals for whom the adipose tissue (AT) response is above the minimal clinically important difference (MCID); and (2) Examine whether clinically meaningful anthropometric changes reflect individual AT responses above the MCID. METHODS: Men (n = 41) and women (n = 62) (52.7 ± 7.6 yr) were randomized to control (n = 20); low amount low intensity (n = 24); high amount low intensity (n = 30); and high amount high intensity (n = 29) treadmill exercise for 24 wk. The AT changes were measured by MRI. 90% confidence intervals for each individual's observed response were calculated as the observed score ±1.64 × TE (technical error of measurement). RESULTS: For visceral AT, HAHI and HALI had a greater proportion of individuals whose AT change and 90% confidence interval were beyond the MCID compared to controls (P < 0.006). For all other AT depots, all exercise groups had significantly more individuals whose changes were beyond the MCID compared with controls. Of those who achieved a waist circumference or body weight reduction ≥ the MCID, 76% to 93% achieved abdominal, abdominal subcutaneous, and visceral AT changes ≥ the MCID. CONCLUSIONS: Increasing exercise amount and/or intensity may increase the proportion of individuals who achieve clinically meaningful visceral AT reductions. Waist circumference or body weight changes beyond a clinically meaningful threshold are predictive of clinically meaningful abdominal adiposity changes.

Sustained exercise programs for hemodialysis patients: The characteristics of successful approaches in Portugal, Canada, Mexico, and Germany.

Despite having good intentions, hemodialysis (HD) clinics often fail to sustain exercise programs that they initiate. There are many reasons for this, including a lack of funding, inadequate training of the clinic staff, a lack of exercise professionals to manage the program or train the staff, and the many challenges inherent to exercising a patient population with multiple comorbid diseases. Despite these barriers, there are several outstanding examples of successful exercise programs in HD clinics throughout the world. The aim of this manuscript is to review the characteristics of four successfully sustained HD exercise programs in Portugal, Canada, Mexico, and Germany. We describe the unique approaches they have used to fund and manage their programs, the varied exercise prescriptions they incorporate, the unique challenges they face, and discuss the benefits they have seen. While the programs differ in many regards, a consistent theme is that they each have substantial and committed support from the entire clinic staff, including the nephrologists, administration, nurses, dietitians, and technicians. This suggests that exercise programs in HD clinics can be successfully implemented and sustained provided significant effort is made to foster a culture of physical activity throughout the clinic.

Individual Response to Standardized Exercise: Total and Abdominal Adipose Tissue.

PURPOSE: (1) Determine the effect of exercise amount and intensity on the proportion of adipose tissue (AT) responses likely, very likely, and unlikely above the minimal clinically important difference (MCID); and (2) Examine whether clinically meaningful anthropometric changes reflect individual AT responses above the MCID. METHODS: Men (n=41) and women (n=62) (52.7 ± 7.6 years) were randomized to control (N=20); low amount low intensity (LALI, N=24); high amount low intensity (HALI, N=30); and high amount high intensity (HAHI, N=29) exercise for 24 weeks. AT changes were measured by MRI. The probability that individual responses were > MCID after adjusting for technical error of measurement were calculated for each individual and categorized as: 'Unlikely' = < 25%, 'Possibly' = 25-74%, 'Likely' = 75-94%, 'Very Likely' = 95-100% chance. RESULTS: The HALI (total AT) and HAHI (total AT, visceral AT) groups had a greater proportion of individuals whose response was "very likely" ≥ MCID vs controls (p<0.006). Across the abdominal AT depots, for individuals who reduced WC or body weight ≥ 2 cm or 2 kg, respectively, 51-69% of responses were "likely" or "very likely" beyond the MCID. CONCLUSION: Increasing exercise amount and/or intensity may increase the proportion of individuals deemed 'very likely' to achieve clinically meaningful AT reductions. The use of anthropometric change to identify individual response for adiposity reduction remains a challenge.

Separate Effects of Exercise Amount and Intensity on Adipose Tissue and Skeletal Muscle Mass in Adults with Abdominal Obesity.

OBJECTIVE: To determine the effects of exercise amount (kilocalories per session) and intensity (percent of maximal oxygen consumption [% VO2 peak]) on adipose tissue (AT) and skeletal muscle (SM) in adults with abdominal obesity. METHODS: Participants (n = 103; 52.7 ± 7.6 years) were randomized to the following groups: control; low-amount, low-intensity exercise (180 kcal/session [women] and 300 kcal/session [men] at 50% VO2 peak); high-amount, low-intensity exercise (HALI; 360 kcal/session [women] and 600 kcal/session [men] at 50% VO2 peak); or high-amount, high-intensity exercise (HAHI; 360 kcal/session [women] and 600 kcal/session [men] at 75% VO2 peak) for 24 weeks. Activities of daily living were measured by accelerometry. Magnetic resonance imaging was used to measure tissue mass. RESULTS: Reduction in all AT depots was greater in the exercise groups compared with control (P < 0.002); however, there were no differences between exercise groups (P > 0.05). Visceral and abdominal subcutaneous AT reduction was uniform across the abdomen. Total SM mass did not change with exercise compared with control (P = 0.32). However, while lower-body SM mass was maintained (P = 0.32), upper-body SM mass in the high-amount, high-intensity and the high-amount, low-intensity groups was reduced compared with controls (P < 0.008). CONCLUSIONS: In adults with abdominal obesity, substantial reductions in total, abdominal subcutaneous, and visceral AT with a preservation of total SM mass were observed independent of exercise amount or intensity.

Depot-Specific Adipose Tissue Metabolite Profiles and Corresponding Changes Following Aerobic Exercise.

Objectives: Total, visceral, and abdominal subcutaneous adipose tissue (AT) depots have distinct associations with cardiometabolic health; however, the metabolite profiles that characterize each AT depot and its reduction following exercise are poorly understood. Our objectives were to (1) assess the independent associations between identified metabolites and total, visceral and abdominal subcutaneous AT; and (2) examine whether changes in metabolite concentrations and AT mass following aerobic exercise are associated. Methods: A secondary analysis was performed in 103 middle-aged abdominally obese men and women {[mean (SD)], 52.4 (8.0) years} randomized into one of four groups varying in exercise amount and intensity for 6 months duration: high amount high intensity, high amount low intensity, low amount low intensity, and control. One hundred and forty seven metabolites were profiled by liquid chromatography-tandem mass spectrometry. AT mass was measured by magnetic resonance imaging (MRI). Results: Individual metabolite associations with AT depots confirmed several established cross-sectional relationships between the obesity phenotype and metabolic pathways. Collapsed across exercise groups, reduction in visceral AT predicted increases in pyroglutamic acid (B = -0.41) and TCA cycle intermediates [succinic (B = -0.41) and fumaric acid (B = -0.20)], independent of change in total AT. Changes in UDP-GlcNAc (B = 0.43), pyroglutamic acid (B = -0.35), histidine (B = 0.20), citric acid/isocitric acid (B = -0.20), and creatine (B = 0.27) were significantly associated with changes in total AT (false discovery rate = 0.1). Conclusions: Our findings point to potential biomarkers of depot-specific AT reduction that may play a direct role in mediating cardiometabolic improvements.

Low-dose aspartame consumption differentially affects gut microbiota-host metabolic interactions in the diet-induced obese rat.

Aspartame consumption is implicated in the development of obesity and metabolic disease despite the intention of limiting caloric intake. The mechanisms responsible for this association remain unclear, but may involve circulating metabolites and the gut microbiota. Aims were to examine the impact of chronic low-dose aspartame consumption on anthropometric, metabolic and microbial parameters in a diet-induced obese model. Male Sprague-Dawley rats were randomized into a standard chow diet (CH, 12% kcal fat) or high fat (HF, 60% kcal fat) and further into ad libitum water control (W) or low-dose aspartame (A, 5-7 mg/kg/d in drinking water) treatments for 8 week (n = 10-12 animals/treatment). Animals on aspartame consumed fewer calories, gained less weight and had a more favorable body composition when challenged with HF compared to animals consuming water. Despite this, aspartame elevated fasting glucose levels and an insulin tolerance test showed aspartame to impair insulin-stimulated glucose disposal in both CH and HF, independently of body composition. Fecal analysis of gut bacterial composition showed aspartame to increase total bacteria, the abundance of Enterobacteriaceae and Clostridium leptum. An interaction between HF and aspartame was also observed for Roseburia ssp wherein HF-A was higher than HF-W (P<0.05). Within HF, aspartame attenuated the typical HF-induced increase in the Firmicutes:Bacteroidetes ratio. Serum metabolomics analysis revealed aspartame to be rapidly metabolized and to be associated with elevations in the short chain fatty acid propionate, a bacterial end product and highly gluconeogenic substrate, potentially explaining its negative affects on insulin tolerance. How aspartame influences gut microbial composition and the implications of these changes on the development of metabolic disease require further investigation.

Chronic coffee consumption in the diet-induced obese rat: impact on gut microbiota and serum metabolomics.

Epidemiological data confirms a strong negative association between regular coffee consumption and the prevalence of type 2 diabetes. Coffee is initially absorbed in the stomach and small intestine but is further fermented in the colon by gut microbiota. The bioavailability, production and biological activity of coffee polyphenols is modulated, in part, by gut microbiota. The purpose of this study was to determine if chronic coffee consumption could mitigate negative gut microbiota and metabolomic profile changes induced by a high-fat diet. Male Sprague-Dawley rats were randomized to chow (12% kcal fat) or high-fat (60% kcal fat) diet. Each group was further divided into water or caffeinated coffee for 10 weeks. Coffee consumption in high-fat-fed rats was associated with decreased body weight, adiposity, liver triglycerides and energy intake. Despite a more favorable body composition, rats displayed profound systemic insulin resistance, likely due to caffeine. Coffee consumption attenuated the increase in Firmicutes (F)-to-Bacteroidetes (B) ratio and Clostridium Cluster XI normally associated with high-fat feeding but also resulted in augmented levels of Enterobacteria. In the serum metabolome, coffee had a distinct impact, increasing levels of aromatic and circulating short-chain fatty acids while lowering levels of branched-chain amino acids. In summary, coffee consumption is able to alter gut microbiota in high-fat-fed rats although the role of these changes in reducing diabetes risk is unclear given the increased insulin resistance observed with coffee in this study.