Gut Microbial Carbohydrate Metabolism Hinders Weight Loss in Overweight Adults Undergoing Lifestyle Intervention With a Volumetric Diet.

The rising incidence of obesity requires the reevaluation of our current therapeutic strategies to optimize patient outcomes. The objective of this study was to determine whether compositional and functional characteristics of the gut microbiota in adults predict responses to a comprehensive lifestyle intervention program in overweight and obese adults. We recruited 26 participants from the Mayo Clinic Obesity Treatment Research Program between August 6, 2013, and September 12, 2013, to participate in a lifestyle intervention program for weight loss. Adults aged 18 to 65 years with a body mass index of 27 to 39.9 kg/m2 and able to provide informed consent were included in the study. Fecal stool samples were obtained at baseline and after 3 months. Loss of at least 5% of baseline weight after 3 months was defined as success. Clinical characteristics and gut microbial composition and function were compared between those who achieved at least 5% and those who achieved less than 5% weight loss. After 3 months, 9 of 26 participants lost at least 5% of their weight. The mean weight loss was 7.89 kg (95% CI, 6.46-9.32 kg) in the success group and 1.51 kg (95% CI, 0.52-2.49 kg) in the less than 5% weight loss group. An increased abundance of Phascolarctobacterium was associated with success. In contrast, an increased abundance of Dialister and of genes encoding gut microbial carbohydrate-active enzymes was associated with failure to lose 5% body weight. A gut microbiota with increased capability for carbohydrate metabolism appears to be associated with decreased weight loss in overweight and obese patients undergoing a lifestyle intervention program.

[Influence of gender on the clinical presentation and associated diseases in adults with celiac disease]. / Influencia del género en la presentación clínica y enfermedades asociadas en adultos con enfermedad celíaca (EC).

INTRODUCTION: Celiac disease is diagnosed predominantly in women. OBJECTIVES: We investigated the influence of gender on (i) age at diagnosis, (ii) clinical manifestations, and (iii) prevalence of associated disorders. METHODS: Clinical data were abstracted from the medical record of adults with biopsy-proven celiac disease. RESULTS: The cohort consisted of 385 patients (women, 71%). Women were diagnosed at a younger age (women, 46.1 years; men, 52.6 years; p = 0.001). The prevalence of the following symptoms was higher in women: nausea/vomiting (women, 31%; men, 16%; p = 0.001), constipation (women, 21%; men, 10%; p = 0.007), and malaise/fatigue (women, 43%; men, 33%; p = 0.06). Greasy stools were more prevalent in men (women, 11%; men, 22%; p = 0.006). Autoimmune diseases were observed in 127 (33%) patients with a female to male ratio of 1.6 (women, 37%; men, 23%; p = 0.006). Depression, osteoporosis, and fibromyalgia predominated in women. CONCLUSIONS: Our findings suggest clinically relevant gender-related differences in celiac disease. These gender differences should be taken into account when managing adult patients with celiac disease.

Gluten Introduction to Infant Feeding and Risk of Celiac Disease: Systematic Review and Meta-Analysis.

OBJECTIVE: To assess the evidence regarding the effect of time of gluten introduction and breastfeeding on the risk of developing celiac disease (CD). STUDY DESIGN: We included randomized controlled trials and observational studies evaluating the proper timing for introducing gluten to the infant diet, the appropriate quantity of gluten consumption at weaning, and the effect of breastfeeding on CD risk. Studies were located through the electronic databases Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), EMBASE (Ovid), and System for Information on Grey Literature in Europe (SIGLE). Two independent authors collected the data. RESULTS: A total of 1982 studies were identified, 15 of which were eligible for data extraction. A meta-analysis was performed on 2 randomized controlled trials, 10 cohort studies, and 1 case-control study. There was a 25% increase in CD risk with late (>6 months) vs recommended (4-6 months) gluten introduction (risk ratio [RR], 1.25; 95% CI, 1.08-1.45). There was no significant effect of breastfeeding vs no breastfeeding on CD risk (OR, 0.55; 95% CI, 0.28-1.10), with substantial heterogeneity (I(2) = 92%) among studies. CONCLUSION: There is currently no evidence to support that early introduction of gluten to the infant diet increases the risk of CD; however, late introduction of gluten may be associated with increased risk of CD. More studies are needed that control for potential confounders and that evaluate environmental factors in low-risk families.