Evaluation of gut microbiota predictive potential associated with phenotypic characteristics to identify multifactorial diseases.

Gut microbiota has been implicated in various clinical conditions, yet the substantial heterogeneity in gut microbiota research results necessitates a more sophisticated approach than merely identifying statistically different microbial taxa between healthy and unhealthy individuals. Our study seeks to not only select microbial taxa but also explore their synergy with phenotypic host variables to develop novel predictive models for specific clinical conditions. DESIGN: We assessed 50 healthy and 152 unhealthy individuals for phenotypic variables (PV) and gut microbiota (GM) composition by 16S rRNA gene sequencing. The entire modeling process was conducted in the R environment using the Random Forest algorithm. Model performance was assessed through ROC curve construction. RESULTS: We evaluated 52 bacterial taxa and pre-selected PV (p < 0.05) for their contribution to the final models. Across all diseases, the models achieved their best performance when GM and PV data were integrated. Notably, the integrated predictive models demonstrated exceptional performance for rheumatoid arthritis (AUC = 88.03%), type 2 diabetes (AUC = 96.96%), systemic lupus erythematosus (AUC = 98.4%), and type 1 diabetes (AUC = 86.19%). CONCLUSION: Our findings underscore that the selection of bacterial taxa based solely on differences in relative abundance between groups is insufficient to serve as clinical markers. Machine learning techniques are essential for mitigating the considerable variability observed within gut microbiota. In our study, the use of microbial taxa alone exhibited limited predictive power for health outcomes, while the integration of phenotypic variables into predictive models substantially enhanced their predictive capabilities.

What is Already Known on this Subject? While the gut microbiota has been implicated as potential signatures or biomarkers for various clinical conditions, the establishment of causality in humans remains largely elusive.The role of the gut microbiota in maintaining the host organism's proper physiological function is well-established, yet data regarding the composition of the gut microbiota in disease states often suffer from poor reproducibility.What Are the New Findings? Our study demonstrates that relying solely on differences in the relative abundance of bacterial taxa between groups falls short as a means of identifying clinical markers.We advocate the use of robust statistical tools, such as bootstrapping, to mitigate the substantial variability observed in gut microbiota studies, thereby enhancing the reproducibility of research findings.Our findings underscore the limited predictive power of microbial taxa in isolation for health outcomes.The integration of phenotypic variables into predictive models with gut microbiota significantly augments the ability to predict health outcomes.How This Study Might Advance Research Despite the growing enthusiasm for using gut microbiota as biomarkers for various clinical conditions, the lack of standardization throughout the research process impedes progress in this field.Our study emphasizes the necessity of rigorously testing predictions of clinical conditions based on gut microbiota using bootstrapping techniques, promoting greater reproducibility in research findings.

Is There an Advantage in Enriching Parenteral Lipid Emulsions Containing Fatty Acids From Fish Oil With Medium-Chain Triglycerides? A Study on Body Pool Concentrations of ω-3 Fatty Acids in Lewis Rats.

BACKGROUND: The addition of medium-chain triglycerides (MCTs) into parenteral lipid emulsions rich in fatty acids from fish oil (FOLEs) has been shown to improve their clearance and extrahepatic uptake. We assessed whether this effect could favor the leukocyte uptake of ω-3 polyunsaturated fatty acids (PUFAs) for immunomodulatory purposes METHODS: Following 5-day adaptation in metabolic cages, 42 male Lewis rats fed with AIN-93M chow were killed (baseline control group [BC]) or submitted to central venous catheterization and distributed into (1) surgical control group without parenteral infusion (chow group), (2) test emulsion (MCT/LCT/FO) group with the parenteral infusion of a FOLE containing 40% MCT, and (3) control emulsion group (LCT/FO) with the parenteral infusion of an FOLE without MCT. The 2 FOLEs had similar ω-3 PUFA contents and ω-6/ω-3 PUFA ratios and were infused during 48 and 72 hours. Concentrations of ω-3 and ω-6 PUFAs in plasma, liver, and blood mononuclear and polymorphonuclear leukocytes were assessed by gas chromatography RESULTS: In both FOLE groups, leukocyte concentrations of ω-3 PUFAs peaked after 48 hours' infusion (vs BC). At this time point, plasma concentrations of ω-3 PUFAs were higher in MCT/LCT/FO group than in LCT/FO group and the opposite was found in the liver (P<.05), but no differences in PUFA concentrations were observed between these groups in leukocytes (P>.05) CONCLUSION: The ω-3 PUFAs provided by FOLEs rich in MCT were less incorporated by liver and remained more available for extrahepatic cell delivery, but this did not result in a clear benefit in increasing their incorporation by peripheral leukocytes.

Type 2 Diabetes Metabolic Improvement After Roux-en-Y Gastric Bypass May Include a Compensatory Mechanism That Balances Fatty Acid ß and ω Oxidation.

BACKGROUND: More than half of patients who undergo Roux-en-Y gastric bypass (RYGB) can experience type 2 diabetes (T2D) remission, but the systemic and gastrointestinal (GI) metabolic mechanisms of this improvement are still elusive. METHODS: Paired samples collected before and 3 months after RYGB from 28 women with obesity and T2D were analyzed by metabolomics with gas chromatography coupled to mass spectrometry. Samples include plasma (n = 56) and biopsies of gastric pouch (n = 18), gastric remnant (n = 10), duodenum (n = 16), jejunum (n = 18), and ileum (n = 18), collected by double-balloon enteroscopy. RESULTS: After RYGB, improvements in body composition and weight-related and glucose homeostasis parameters were observed. Plasma-enriched metabolic pathways included arginine and proline metabolism, urea and tricarboxylic acid (TCA) cycles, gluconeogenesis, malate-aspartate shuttle, and carnitine synthesis. In GI tissue, we observed alterations of ammonia recycling and carnitine synthesis in gastric pouch, phenylacetate metabolism and trehalose degradation in duodenum and jejunum, ketone bodies in jejunum, and lactose degradation in ileum. Intermediates molecules of the TCA cycle were enriched, particularly in plasma, jejunum, and ileum. Fluctuations of dicarboxylic acids (DCAs) were relevant in several metabolomic tests, and metabolite alterations included aminomalonate and fumaric, malic, oxalic, and succinic acids. The product/substrate relationship between these molecules and its pathways may reflect a compensatory mechanism to balance metabolism. CONCLUSIONS: RYGB was associated with systemic and GI metabolic reprogramming. DCA alterations link ω and ß fatty acid oxidation to homeostatic mechanisms, including TCA cycle improvement.

Quality control of enteral nutrition therapy in cancer patients at nutritional risk / Control de calidad en terapia nutricional enteral en el paciente oncológico con riesgo nutricional

Introduction: Quality indicators in nutritional therapy (QINTs) allow for the practical assessment of quality in the management of enteral nutrition therapy (ENT) among hospitalized patients. Objective: To control ENT quality in cancer patients at nutritional risk. Methods: A prospective, observational study was performed with cancer patients over 19 years of age who had undergone exclusive ENT for at least 72 h. Nutritional Risk Screening was used to assess nutritional risk; in the presence of nutritional risk, the Subjective Global Assessment (SGA) was used. Six QINTs were applied. Results: Our study included 211 patients (mean age: 59 ± 10 years, 67.3% men). Most common cancer diagnoses were head and neck (68.2%) and gastrointestinal (18%). Nutritional risk was identified in 93.3% (n = 197) of patients; SGA identified malnutrition in 84.2% of patients (n = 166). ENT was used for 9.7 ± 7 days, presenting a daily deficit of -243.1 ± 141 ml of dietary volume, -363.3 ± 214.1 kcal, and -14.2 ± 8.41 g of protein. Three of the six QINTs were in accordance with the proposed goal: frequency of SGA application, calculations of nutritional needs, and frequency of diarrhea. Three of the six QINTs were in disagreement with the proposed goal: ENT infused volume exceeding 70% of prescribed volume, frequency of digestive fasting exceeding 24 h, and frequency of constipation. Prescriptions for anticholinergic drugs (p = 0.023) and diuretics (p = 0.007) were associated with diarrhea. Conclusion: Nutritional risk and malnutrition are frequent among ENT cancer patients. Quality control in ENT was moderately impaired by episodes of fasting and intestinal motility disorders (AU)

Objetivos: controlar la calidad de la TNE en pacientes con cáncer en riesgo nutricional. Metodología: estudio prospectivo, observacional, con pacientes oncológicos > 19 años y sobre TNE exclusiva > 72 h. Para la evaluación del riesgo nutricional fue utilizada la Nutritional Risk Screening y en presencia de riesgo nutricional fue aplicada la Subjective Global Assessment (SGA). Fueron aplicados 6 ICTN. Resultados: nuestro estudio incluyó 211 pacientes (edad promedio de 59 ± 10 años; 67,3% de sexo masculino). Los diagnósticos oncológicos más predominantes fueron: cáncer de cabeza y cuello (68,2%) y gastrointestinal (18%). El riesgo nutricional estaba presente en el 93,3% (n = 197) de los pacientes; la SGA identificó desnutrición en 84,2% (n = 166). La TNE fue aplicada por 9,7 ± 7 días y presentó un déficit diario de -243,1 ± 141 ml de volumen de dieta administrada, -363,3 ± 214,1 kcal y -14,2 ± 8,41 g de proteínas. Tres de los seis ICTN aplicados estuvieron de acuerdo con la meta: frecuencia de aplicación de la SGA; cálculo de las necesidades nutricionales y frecuencia de diarrea. En desacuerdo con la meta: volumen de la TNE administrada > 70% de lo prescrito; frecuencia de ayuno digestivo > 24 h y frecuencia de estreñimiento. La prescripción de medicamentos anticolinérgicos (p = 0,023) y diuréticos (p = 0,007) se asoció con la aparición de diarrea. Conclusión: el riesgo nutricional y la desnutrición son frecuentes entre pacientes con cáncer que reciben TNE. El control de calidad en la TNE se afectó de una forma negativa por los episodios de ayuno y disturbios en el tránsito intestinal (AU)

NUTRITIONAL SUPPORT FOR FULMINANT HEPATITIS.

INTRODUCTION: fulminant hepatitis (FH) is associated with exacerbated hypercatabolism, hypoglycemia and hyperammonemia that are accompanied by the release of proinflammatory cytokines and catabolic hormones into the systemic circulation worsening patient's clinical condition. Nutritional support is a crucial element for the recovery of these patients. OBJECTIVES: the aim of this review is to update Nutritional Support for Fulminant Hepatitis. METHODS: the review was performed using electronic search on Medline-PubMed using Mesh-terms. RESULTS AND DISCUSSION: there are not many data available on nutritional support to fulminant hepatitis or acute liver failure. Strategies for initial nutritional intervention are focused on the control of the previously described FH metabolic derangements, and should be individualized according to the severity of patient's clinical condition. Energy and protein can be provided in amounts of 25­40 kcal/kg/day and 0.8-1.2 g/kg/day, respectively. Enteral nutrition therapy is indicated for patients with advancing encephalopathy or for those who cannot be properly fed orally. Euglycemia must be achieved and protein intake can be based on BCAA formulae. Lipids can be administered as energy supplementation with caution. Adequate nutrition therapy can potentially reduce morbidity and mortality of FH patients.

Introducción: la hepatitis fulminante se asocia a un exacerbado hipercatabolismo, la hipoglicemia y la hiperamonemia están acompañadas por la liberación de citocinas proinflamatorias y hormonas catabólicas en la circulación sistémica, empeorando la condición clínica del paciente. El apoyo nutricional es un elemento crucial para la recuperación de estos pacientes. Objetivos: el objetivo de esta revisión es actualizar el apoyo nutricional para la hepatitis fulminante. Métodos: la revisión se llevó a cabo mediante la búsqueda electrónica en Medline-PubMed, utilizando malla de términos. Resultados y discusión: no hay muchos datos disponibles sobre el apoyo nutricional para lahepatitis fulminante o fallo hepático agudo. Las estrategias de intervención nutricional inicial se centran en el control de los trastornos metabólicos de la hepatitis fulminante descritos anteriormente, que deben ser individualizadas de acuerdo a la gravedad de la situación clínica del paciente. Energía y proteína se pueden proporcionar en cantidades de 25­40 kcal / kg / día y 0,8-1,2 g / kg / día, respectivamente. La terapia nutricional enteral está indicada en pacientes con encefalopatía avanzada o para aquellos que no pueden ser adecuadamente alimentados por vía oral. Se debe obtener una euglicemia y la ingesta de proteínas puede estar basada en fórmulas de BCAA. Los lípidos se pueden administrar como suplemento energético con precaución. Una terapia nutricional adecuada puede potencialmente reducir la morbilidad y la mortalidad de los pacientes con hepatitis fulminante.

Design of quality indicators for oral nutritional therapy / Diseño de indicadores de calidad para terapia nutricional oral

Objective: quality indicators in nutritional therapy (NT) have been proposed as useful tools to improve clinical NT. This study was conducted to develop feasible quality indicators in oral nutritional therapy (QIONTs) to aid quality control. Methods: a Clinical Nutrition Task Force composed of Brazilian NT experts from the International Life Science Institute (ILSI) developed QIONTs. In an internet-based psychometric survey, 40 independent Brazilian NT practitioners assessed four attributes (simplicity, utility, objectivity, and low cost) of each QIONT using a five-point Likert scale. Results: independent NT experts consistently classified all 12 QIONTs developed by the ILSI team as good (mean Cronbach’s alpha = 0.84). In ranked order, the QIONTs enable assessment of the frequency of nutritional screening, oral nutritional supplementation (ONS) prescription to malnourished patients receiving an oral diet, ONS prescription to patients receiving an oral diet but at risk of malnutrition, nutritional assessment, adhesion to ONS regime, hospitalized patients with insufficient oral dietary intake and ONS prescription, ICU patients with insufficient oral dietary intake and ONS prescription, oral intake assessment in ICU patients, oral intake assessment in ward patients, oral supplement volume intolerance due to inappropriate offering time, ONS flavor intolerance, and ONS volume intolerance. Conclusion: twelve potentially feasible new QIONTs were developed and approved for clinical practice by experts (AU)

Objetivo: los indicadores de calidad en la terapia nutricional han sido propuestos como herramientas útiles para mejorar la terapia nutricional (TN). Este estudio pretende diseñar indicadores de calidad de terapia nutricional oral (ICTNO) factibles en el control de calidad de TN oral. Métodos: el diseño de ICTNO fue realizado por una comisión de nutrición clínica compuesta por brasileños expertos en TN del International Life Science Institute (ILSI). Más tarde, la aprobación de estos ICTNO fue valorada con análisis psicométricos recogiendo las opiniones de otros brasileños dedicados independientemente a la TN (n = 40) vía SurveyMonkey (encuesta por internet). Esta consistió en cuatro atributos valorando cada ICTNO (simplicidad, utilidad, objetividad y bajo precio) seguida de una escala Likert con cinco puntos. Resultados: los expertos en TN de ILSI proporcionaron el diseño de 12 QIONT, que fueron todos consistentemente (Alfa de Cronbach = 0,84) clasificados como válidos por expertos independientes en NT. Por orden de relevancia, los nuevos ICTNO valoraron: la frecuencia de screening nutricional, la prescripción de suplementos de nutrición oral para pacientes desnutridos que ya reciben dieta oral, la prescripción de suplementos de nutrición oral para pacientes con bajo riesgo nutricional que ya reciben dieta oral, el consejo nutricional, la adhesión al suplemento nutricional oral, los pacientes hospitalizados con dieta oral insuficiente y prescripción de suplementos nutricionales orales, los pacientes de UCI con dieta oral insuficiente y prescripción de suplementos nutricionales orales, el consejo de nutrición oral en pacientes de UCI, el consejo de nutrición oral en pacientes en planta, la intolerancia al volumen de suplemento oral debido a dosificación inadecuada, la intolerancia al sabor del suplemento oral y la intolerancia al volumen de suplemento oral. Conclusión: según la opinión experta, 12 potenciales y factibles nuevos ICTNO fueron diseñados y aprobados para la práctica clínica (AU)

Efficiency of the 24-hour food recall instrument for assessing nutrient intake before and after Roux-en-Y gastric bypass / Eficacia del instrumento de recordatorio de comidas de 24 horas para la evaluación de la ingesta de nutrientes antes y después de bypass gástrico en Y de Roux

Background: Nutritional and food intake assessments before and after bariatric surgery may be important to correct eating habits and nutritional deficiencies. Aim: To assess the efficiency of the 24-hour food recall (24hR) form as a fast method for assessing nutrient intake before and after a Roux-en-Y gastric bypass (RYGB). Methods: This study analyzed data from 10 obese patients with type 2 diabetes mellitus (T2DM). Food intake (calories, macronutrients, and micronutrients) before and 3 months after RYGB were assessed with the 24hR as well as the seven-day food record (7dR) as the gold standard reference. Virtual Nutri Plus® software was used to quantify nutrients. Results: The 7dR data revealed deficits in the estimated intake of total fiber and 14 out of 22 micronutrients pre- and postoperatively, combined; the 24hR failed to detect intake deficits in only two of these micronutrients (vitamins A and B3). Other postoperative deficits included carbohydrates, vitamin B1, copper, and iron, on which the 24hR was sensitive to only the iron deficit. In our pre- versus post-operative comparison analyses, the 7dR revealed decreases in total calories, carbohydrates, total and all subclasses of fat and fiber, and 12 micronutrients; in the analogous comparison analyses, the 24hR failed to detect decreases in the ingestion of monounsaturated and saturated fats and in six of these micronutrients. Conclusions: In obese T2DM patients, the 24hR performed reasonably well for probing nutrient intake before and after RYGB, but is not recommended for tracking changes over time, including pre- versus postoperative deficits (AU)

Introducción: Las evaluaciones nutricionales y de ingesta de comida antes y después de cirugía bariátrica puede ser importante para corregir hábitos de alimentación y deficiencias nutricionales. Objetivo: Evaluar la eficacia del formulario de recordatorio de alimento de 24 horas (24hR) como método rápido de evaluación de ingesta de nutrientes antes y después de bypass gástrico en Y de Roux (RYGB). Métodos: Este estudio analizó datos de 10 pacientes obesos con diabetes mellitus de tipo 2 (T2DM). Se evaluó la ingesta de alimentos (calorías, macronutrientes y micronutrientes) antes y 3 meses después de RYGB con el 24hR además del registro de alimentos de siete días (7dR) como patrón de referencia estándar. Se utilizó el software Virtual Nutri Plus® para cuantificar los nutrientes. Resultados: Los datos del 7dR revelaron deficiencias en la ingesta estimada de fibra total y 14 de 22 micronutrientes pre- y postoperación, combinados; el 24hR no pudo detectar deficiencias de ingesta en solo dos de estos micronutrientes (vitaminas A y B3). Otras deficiencias postoperatorias incluyeron carbohidratos, vitamina B1, cobre y hierro, sobre las que el 24hR detectó solo la deficiencia de hierro. En nuestros análisis comparativos pre- y post-operación, el 7dR reveló descensos en calorías totales, carbohidratos, grasas totales y todas las subclasses de grasa y fibra, y 12 micronutrientes; en los análisis comparativos análogos, el 24hR no logró detectar descensos en la ingesta de grasas monoinsaturadas y saturadas y en seis de estos micronutrientes. Conclusiones: En pacientes obesos con T2DM, el 24hR funcionó razonablemente bien demostrando la ingesta de nutrientes antes y después de RYGB, pero no se recomienda para registrar cambios a lo largo del tiempo, incluyendo deficiencias pre- y postoperación (AU)

ILSI Task Force on enteral nutrition; estimated composition and costs of blenderized diets / Grupo de estudios ILSI sobre nutrición enteral; composición y costos estimados de dietas artesanales

Blenderized tube diets (BTD) are used in some parts of Brazil and few studies have analyzed their features in comparison with industrialized preparations. Among 14 randomly collected BTD recipes 9 were poorly described or failed to standardize foodstuffs and portions and, consequently, nutrient and energy composition was difficult to define. Only five BTD allowed theoretical estimation of their nutritional properties. Macronutrient content was highly variable, often conflicting with accepted daily recommendations. According to the literature there are further disadvantages with BTD use including diet high risk of contamination, physical and chemical instability, and high osmolarity and viscosity. Nominal cost of BTD was comparatively low in relation to industrialized formulas; however we did not compute labor and indirect expenses, probably rendering final value more expensive than with the industrialized alternative. It is likely that within such circumstances, hospital and home care malnutrition will not be adequately dealt with and related complications may occur. It is concluded that the continued use of blenderized tube feeding diets requires careful assessment, prioritizing correction of potencial nutritional deficits by means of safe, balanced, chemically complete and effective nutritional prescriptions (AU)

Dietas enterales artesanales (DEA) son utilizadas en algunas partes de Brasil y pocos estudios analizaron sus características en comparación con las preparaciones industrializadas. De un total de 14 DEA colectadas 9 estaban mal definidas o no establecían claramente los géneros alimenticios y porciones empleados, consecuentemente fue difícil calcular su composición en nutrientes y energia. Solo cinco DEA permitieron una estimativa teórica de sus propiedades nutricionales. El contenido de los macronutrientes era muy variable, y con frecuencia divergente de las recomendaciones diarias aceptas. De acuerdo con la literatura hay otros inconvenientes en el uso de DEA, o sea elevado riesgo de contaminación, inestabilidad físico-química, y alta osmolaridad y viscosidad de las DEA. El costo nominal de las dietas fue comparativamente bajo en relación a las formulaciones industrializadas, pero los gastos laborales y otros costos indirectos no fueron computados por nosotros, probablemente conduciendo a un valor total final superior al de la alternativa industrializada. Es esperado que en tales circunstancias la desnutrición no quedara bien tratada y complicaciones relacionadas podrán aparecer. La conclusión es que el empleo continuado de dietas artesanales requiere una evaluación criteriosa, con prioridad para la corrección de los déficits nutricionales utilizando prescripciones seguras, balanceadas quimicamente, completas y efectivas (AU)

Ingestion of glutamine and maltodextrin two hours preoperatively improves insulin sensitivity after surgery: a randomized, double blind, controlled trial.

OBJECTIVE: To investigate whether the abbreviation of preoperative fasting with a drink containing glutamine and dextrinomaltose improves organic response to surgical trauma. METHODS: Thirty-six female patients adult (18-62 years) candidates for elective laparoscopic cholecystectomy were randomly divided into three groups: conventional fasting (fasting group), and two groups receiving two different diets, eight hours (400ml) and two hours before induction of anesthesia (200ml): carbohydrate (CHO) group (12.5% dextrinomaltose) and the glutamine (GLN) group (12.5% dextrinomaltose and 40 and 10g of glutamine, respectively). Blood samples were collected pre and postoperatively. RESULTS: Twenty-eight patients completed the study. No pulmonary complication occurred. Gastric residual volume was similar between groups (p = 0.95). Postoperatively, all patients from the fasting group had abnormal glucose (> 110mg/dl), this abnormality being of 50% when compared to the CHO group (p = 0.14), and of 22.2% when compared to the GLN group (p = 0.01). All patients who had the fasting period shortened (CHO + GLN) had normal postoperative insulin, contrasting with 66.7% in the fasted group (p = 0.02). The abnormal sensitivity to insulin postoperatively rose from 32.1% to 46.4% of cases (p = 0.24), and it occurred in only 11.1% of patients in GLN group when compared to 55.5% in the fasting group (p = 0.02). CONCLUSION: the abbreviation of preoperative fasting for two hours with dextrinomaltose and glutamine improves insulin sensitivity in patients undergoing elective laparoscopic cholecystectomy.