News Round-up
Survey to Identify Clinical Knowledge and Educational Needs of Healthcare Professionals on the Topic of Dysphagia and Malnutrition
The European Society for Swallowing Disorders (ESSD) is an international non-profit association aiming to improve the quality of care for those affected by swallowing disorders. The Society brings together healthcare professionals and researchers from multiple disciplines to promote excellence in care, education, and research into swallowing and swallowing disorders.
The ESSD would be delighted if you could take part in their online survey that aims to identify the most urgent educational needs among healthcare professionals on the topic of dysphagia and malnutrition and shape future care. The survey, which includes demographic questions and questions on the topic of nutritional care and dysphagia should take no more than 10 minutes to complete.
To take part, visit: https://essd.org/dysphagia-and-malnutrition-survey-participate-now.
Resistant Starch Could Slow Down Progression of Non-Alcoholic Fatty Liver Disease
Adding resistant starch in the diet could slow down the progression of non-alcoholic fatty liver disease (NAFLD) by altering gut microbiota composition, a new study by an international team of researchers shows. The results were published in Cell Metabolism.
The study was led by the University of Jena in Germany. Researchers from Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, the University of Hong Kong and the Leibniz Institute for Natural Product Research and Infection Biology also took part in the study.
Previous studies suggest that fatty liver disease that is not caused by excessive alcohol consumption is closely linked to the gut microbiome, and foods that modulate gut microbiota could be an effective non-pharmacological intervention to deal with NAFLD. Against this background, the researchers conducted a randomised clinical trial with 200 patients affected by the disease. Half of them supplemented their diet with 40 grams of resistant starch daily for four months, and the other half used a placebo product. Among the participants following a resistant starch diet, the accumulation of fat in the diseased liver was reduced. Furthermore, an increase was observed in certain types of bacteria in the gut of the participants, and these bacteria positively influenced fat reduction and transport in the liver. In addition, reduced NAFLD and inflammation biomarkers indicated an alleviation of liver damage.
The researchers found that the number of beneficial bacteria increases when resistant starch is metabolised by microorganisms in the colon. At the same time, the number of harmful bacteria decreases. This leads to a more balanced gut microbiome which can have a positive impact on health
The team examined serum and faecal samples from the participants and found that the level of Bacteroides stercoris, in particular, increases significantly the more severe NAFLD is. However, Bacteroides stercoris occurred in smaller amounts in test persons after eating 40 grams of resistant starch per day. The researchers conclude that to alleviate fatty liver, it might be advisable to consume a fist-sized amount of foods containing resistant starch at every meal.
As the disease is most often linked to overweight and obesity, the first line of treatment is usually weight loss through a combination of a healthy diet and exercise. In order to establish specific recommendations for the use of resistant starch in the treatment, further and longer-term studies are needed.
Research: Yueqiong Ni, et al. (2023). Resistant starch decreases intrahepatic triglycerides in patients with NAFLD via gut microbiome alterations. Cell Metab.; 35: 1530-1547.
Study Finds Connection Between Gut Microbiome and Bone Density
There is growing evidence that a relative abundance of certain gut microbes may be related to skeletal health, according to a new study published in Frontiers in Endocrinology. If confirmed by additional research, the findings could provide the opportunity to alter gut microbiomes to achieve better bone health, as scientists learn more about ‘osteomicrobiology’, a new term recently used to characterise this relationship.
Due to the lack of large-scale human studies of the gut microbiome and skeletal health, researchers led by Paul C. Okoro, Data Scientist II at Hebrew SeniorLife and Hinda and Arthur Marcus Institute for Aging Research, and principal investigator Douglas P. Kiel, M.D., M.P.H., Senior Scientist at the Marcus Institute, conducted an observational study based on the Framingham Third Generation Study of men and women, and the Osteoporotic fractures in Men (MrOS) study of older men to determine whether they could find a potentially modifiable factor contributing to skeletal health. The study used high-resolution imaging of the arm and leg.
Entitled ‘A Two-Cohort Study on the Association between the Gut Microbiota and Bone Density, Microarchitecture, and Strength’, the study found that bacteria called Akkermansia, which has been associated with obesity, and Clostridiales bacterium DTU089, had negative associations with bone health for older adults. DTU089, a bacterium from the class, Clostridia, has been described to be more abundant in people with lower physical activity, and lower protein intake, and could be significant because prior studies have found protein intake and physical activity have a definite connection to skeletal health.
“We found patterns in which greater abundance of microbiota were associated with worse measures of bone density and microarchitecture. In fact, some bacteria were associated with differences in the bone cross sectional area, suggesting the possibility that certain microbes could influence how the bone changes size with ageing,” said Dr Kiel. “It is premature to know if the bacterial organisms themselves may have effects on skeletal health. With additional studies we might be able to gain insights regarding associations between specific bacterial species in the intestine and skeletal integrity. We also hope to identify specific functional pathways influenced by the bacteria that could influence the skeleton. For example, some bacteria can lead to low levels of inflammation that may affect bone health. Ultimately, if findings like this are confirmed, we may be able to target the gut microbiome to influence skeletal health.”
Paper: Okoro PC, et al. (2023). A Two-Cohort Study on the Association between the Gut Microbiota and Bone Density, Microarchitecture, and Strength Front. Endocrinol.; https://doi.org/10.3389/fendo.2023.1237727.
Consuming Added Sugars May Increase Risk of Kidney Stones
A study in Frontiers in Nutrition has shown, for the first time, that an elevated consumption of added sugars may be associated with kidney stone formation. Lead author, Dr Shan Yin, a researcher at the Affiliated Hospital of North Sichuan Medical College, Nanchong, China, said: “It suggests that limiting added sugar intake may help to prevent the formation of kidney stones.”
Yin et al. analysed epidemiological data on 28,303 adult women and men, collected between 2007 to 2018 within the US National Health and Nutrition Examination Survey (NHANES). Participants self-reported if they had a history of kidney stones. Each participant’s daily intake of added sugars was estimated from their recall of their most recent consumption of food and drinks, given twice: once in a face-to-face interview, and once in a telephone interview between three and 10 days later.
Each participant also received a healthy eating index score (HEI-2015), which summarises their diet in terms of the adequacy of beneficial diet components such as fruits, vegetables, and whole grains, and moderation of potentially harmful foods, for example refined grains, sodium, and saturated fats.
The researchers adjusted the odds of developing kidney stones per year during the trial for a range of explanatory factors. These included gender, age, race or ethnicity, relative income, BMI, HEI-2015 score, smoking status, and whether the participants had a history of diabetes.
At the start of the study, participants with a higher intake of added sugar tended to have a higher current prevalence of kidney stones, a lower HEI score, and a lower education level. The overall mean intake of added sugars was 272.1 calories per day, which corresponds to 13.2% of the total daily energy intake.
The researchers showed that after adjusting for these factors, the percentage of energy intake from added sugars was positively and consistently correlated with kidney stones. For example, participants whose intake of added sugars was among the 25% highest in the population had 39% greater odds of developing kidney stones over the course of the study.
Similarly, participants who derived more than 25% of their total energy from added sugars had an 88% greater odds than those who derived less than 5% of their total energy from added sugars.
The results also indicated that participants from ‘Other’ ethnicities – for example Native American or Asian people – had higher odds of developing kidney stones when exposed to greater-than-average amounts of added sugars than Mexican American, other Hispanic, non-Hispanic White, and non-Hispanic Black people. People with a greater Poverty-Income Ratio (PIR; ie, the ratio between their income and the federal poverty level) had greater odds of developing kidney stones when exposed to more added sugars than people at or slightly above poverty level.
The mechanisms of the relation between consuming more added sugars and a greater risk of developing kidney stones is not yet known. Because this was an uncontrolled observational trial, it can’t yet be ruled out that unknown confounding factors might drive this association.
“Further studies are needed to explore the association between added sugar and various diseases or pathological conditions in detail,” cautioned Yin. “For example, what types of kidney stones are most associated with added sugar intake? How much should we reduce our consumption of added sugars to lower the risk of kidney stone formation? Nevertheless, our findings already offer valuable insights for decision-makers.”
Research: Yin S, et al. (2023). Association between added sugars and kidney stones in U.S. adults: data from National Health and Nutrition Examination Survey 2007–2018. Front Nutr.; doi: 10.3389/fnut.2023.1226082.
Certain Gut Conditions May be Early Warning Signs of Parkinson’s Disease
Certain gut problems, such as constipation, difficulty swallowing, and irritable bowel syndrome (IBS), may be early warning signs of Parkinson’s disease, suggests research published online in the journal Gut.
Gastrointestinal symptoms are thought to precede the development of cerebrovascular disease, such as stroke or a brain aneurysm, or Alzheimer’s disease, and it has been suggested (Braak’s hypothesis) that gut conditions may precede the development of Parkinson’s disease too.
To test this hypothesis, the researchers used data from a US nationwide medical record network (TriNetX) to compare 24, 624 people who had been diagnosed with Parkinson’s disease of unknown cause with those who had been diagnosed with other neurological conditions – Alzheimer’s disease (19,046) or cerebrovascular disease (23,942) – or with none of these (24,624; comparison group).
Those with Parkinson’s disease were matched with people in the other groups for age, sex, race and ethnicity, and length of diagnosis to compare the frequency of gut conditions included in their electronic health record for an average of 6 years before their Parkinson’s disease diagnosis.
The researchers then tested the same hypothesis, but in a different way, by dividing all the adults in the network who had been diagnosed with any of 18 gut conditions into separate groups—one for each condition of interest.
People in these groups were matched with people without the particular gut condition and monitored via their medical records for 5 years to see how many of them developed Parkinson’s disease or other neurological disorders.
Both analyses indicated that 4 gut conditions were associated with a higher risk of a Parkinson’s disease diagnosis.
Specifically, gastroparesis (delayed stomach emptying), dysphagia (difficulty swallowing), and constipation were all associated with a more than doubling in risk of Parkinson’s disease in the 5 years preceding the diagnosis, while IBS without diarrhoea was associated with a 17% higher risk.
Appendix removal, however, seemed to be protective, prompting questions about its potential role in the disease processes leading to Parkinson’s disease, say the researchers.
Neither inflammatory bowel disease nor vagotomy were associated with a heightened risk.
Some other gut issues, including functional dyspepsia; IBS with diarrhoea; and diarrhoea plus faecal incontinence, were also more prevalent among people who developed Parkinson’s disease. But these conditions were also more prevalent before the onset of Alzheimer’s disease or cerebrovascular disease.
This is an observational study, and as such, can’t establish cause. The researchers also highlight several limitations to their findings, including that the monitoring period was relatively short and that the diagnostic information captured in electronic health records might have been incomplete.
Nevertheless, they conclude: “This study is the first to establish substantial observational evidence that the clinical diagnosis of not only constipation, but also dysphagia, gastroparesis and irritable bowel syndrome without diarrhoea might specifically predict the development of Parkinson’s disease.”
They add: “These findings warrant alertness for [gastrointestinal] syndromes in patients at higher risk for Parkinson’s disease and highlight the need for further investigation of [gastrointestinal] precedents in Alzheimer’s disease and cerebrovascular disease.”
Research: Konings B, et al. (2023). Gastrointestinal syndromes preceding a diagnosis of Parkinson’s disease: testing Braak’s hypothesis using a nationwide database for comparison with Alzheimer’s disease and cerebrovascular diseases. Gut.; doi: 10.1136/gutjnl-2023-329685.