News Round-up
Do you work in neurodisability? Your Opinions Needed
Can you help support a research project – GPATH Support – conducted by a team of researchers at Hertfordshire University funded by the National Health Institute for Research, Health Services and Delivery Research Programme?
The project aims to identify support models for children with neurodisability and complex feeding needs and their families when making a decision about tube feeding and ongoing support issues.
The link below takes you to a survey – the survey can be completed by families/healthcare professionals. It should take 10-15 minutes to complete. It asks you to value two different models of support and provide some information about you and the family. The survey is anonymous. That is, the data you provide will not identify you.
For further information, please visit: https://herts.eu.qualtrics.com/jfe/form/SV_508kWeNETwc7IMJ
Whole Grain can Contribute to Health by Changing Intestinal Serotonin Production
Adults consuming whole grain rye have lower plasma serotonin levels than people eating low-fibre wheat bread, according to a recent study by the University of Eastern Finland and the International Agency for Research on Cancer (IARC).
In the study, the consumption of cereal fibre from rye or wheat was also found to reduce serotonin levels in the colon of mice. In light of the results, the health benefits of whole grain cereals may be linked, at least in part, to the alteration of serotonin production in the intestines, where the majority of the body’s serotonin is produced. The results of were published in The American Journal of Clinical Nutrition.
The consumption of whole grain cereals has been associated with a lower risk of type 2 diabetes, cardiovascular disease and some cancers, but the underlying mechanisms are still poorly understood. There may be effects on bioactive compounds contained in whole grains, phytochemicals and fibres from which different metabolites are produced by intestinal bacteria.
The new study explored how the consumption of wholegrain rye modulates concentrations of different metabolites in the bloodstream. The study employed untargeted metabolite profiling, also known as metabolomics, which can simultaneously detect numerous metabolites, including those previously unknown.
For the first four weeks of the study, the participants ate 6-10 slices a day of low-fibre wheat bread, and then another four weeks the same amount of wholegrain rye bread or wheat bread supplemented with rye fibre. Otherwise, they didn’t change their diet. At the end of both periods, they gave blood samples, which were analysed by a combination of liquid chromatography and mass spectrometry. Their plasma metabolite profiles between the different diet periods were then compared.
The consumption of wholegrain rye led to, among other things, significantly lower serotonin concentrations when compared to consumption of low-fibre wheat bread. The researchers also tested in mice whether the addition of cereal fibre to the diet changes serotonin production in the intestine. The diet of the mice was supplemented for nine weeks with rye bran, wheat bran or cellulose flour. The mice receiving rye or wheat bran had significantly lower serotonin in their colon.
Serotonin is best known as a neurotransmitter in the brain. However, serotonin produced by the intestines remains separated from the brain, serving various peripheral functions including modulation of gut’s motility. Increased blood serotonin has also been associated with high blood glucose levels.
"Whole grain, on the other hand, is known to reduce the risk of diabetes, and on the basis of these new results, the effect could at least partly be due to a decrease in serotonin levels," says Academy Research Fellow Kati Hanhineva from the University of Eastern Finland.
The researchers are also interested in the association of serotonin with colorectal cancer.
“Some recent studies have found cancer patients to have higher plasma serotonin levels than healthy controls,” Scientist Pekka Keski-Rahkonen from IARC adds.
The consumption of wholegrain rye bread was also associated with lower plasma concentrations of taurine, glycerophosphocholine and two endogenous glycerophospholipids. In addition, the researchers identified 15 rye phytochemicals whose levels in the bloodstream increased with the consumption of rye fibre.
Research article: Decreased plasma serotonin and other metabolite changes in healthy adults after consumption of wholegrain Rye: an untargeted metabolomics study. Keski-Rahkonen P, et al (2019). The American Journal of Clinical: https://doi.org/10.1093/ajcn/nqy394.
First Randomised Controlled Trial of FMT for Obesity Shows Potential Progress
Study explores role of changing microbiome as step towards possible new weight-loss therapy.
Using capsules filled with faecal matter from a lean donor, researchers successfully changed some of the composition of the gut microbiota of patients with obesity, a possible step toward a new treatment for weight loss. In the first randomised controlled trial of faecal microbiota transplantation (FMT) in metabolically healthy people with obesity, researchers presenting at Digestive Disease Week® (DDW) 2019 said they were encouraged they could induce changes among the trillions of microorganisms and their genetic material within the intestinal tract.
"In our clinic, we see patients who really don't have any other medical problems, but just cannot lose weight. It is a very important patient population that we really wanted to give focus to and try to help understand," said Jessica Allegretti, MD, lead author of the study and director of the Fecal Microbiota Transplant Program at Brigham and Women's Hospital in Boston.
The pilot study included 22 patients with obesity but did not have any other health issues commonly associated with obesity, such as diabetes or liver disease. During the 12-week study, half the patients took capsules containing faecal matter from a lean donor and the rest took identical-looking placebo capsules. Researchers then looked for changes in a gut hormone, glucagon-like peptide 1 (GLP1), which is linked to the satiety reflex, the feeling that you've eaten enough, and is associated with weight gain and loss. Potential weight loss was a secondary focus of the study.
While initial trial results did not show differences in the GLP1 hormone or weight loss, researchers said they were very pleased to detect other changes in the microbiota of FMT recipients, including a decrease in a specific bile acid and alterations in stool samples that showed increased similarity to those of the lean donor.
"Our study adds an encouraging first step in trying to understand the role the gut microbiome is playing in metabolically healthy people with obesity," Dr Allegretti said. "This will hopefully lend itself to more targeted therapies in the future."
Researchers said they plan to seek more sensitive measures of GLP1 and, with additional research, look at varied dosages of faecal material and other mechanisms to better understand the role of the microbiome in obesity. Animal models have previously shown that obese mice can be made lean and lean mice made obese by changing their gut microbiota. Previous human trials of FMT transplant have shown improvement in insulin resistance in the liver in patients with metabolic syndrome.
"The bile acid data is certainly intriguing and suggests that maybe there are one or more different pathways at play," Dr Allegretti added. "Obesity is a very complex disorder, and a multifactorial process is probably at the heart of its development."
DDW Presentation Details: Dr Allegretti presented data from the study, ‘Fecal microbiota transplantation for the treatment of obesity: a randomized, placebo-controlled pilot Trial,’ abstract 620, on 20th May 2019 - www.ddw.org
Individual Nutrition Shows Benefits in Hospital Patients
Individualised nutrition not only causes hospital patients to consume more protein and calories, but also improves clinical treatment outcomes. This has been demonstrated in a study by researchers from the University of Basel and Aarau Cantonal Hospital in the journal The Lancet.
People who struggle to eat and drink properly following an illness are at risk of consuming too little protein and energy. This phenomenon affects over a third of inpatients in the medical wards of hospitals.
Malnutrition not only reduces the hospitalised patients’ quality of life; it also has an adverse impact on disease progression, increasing the risk of complications and the mortality rate.
Where there is a risk of nutritional deficit, guidelines recommend individualised nutrition during the patient’s stay in hospital in order to guarantee their supply of protein and calories. Possible measures range from a nutritional plan to tube feeding and intravenous feeding.
First controlled study
Until now, the lack of meaningful studies meant that it was unclear whether individual nutrition management actually had a positive impact on patients, especially as nutritional support can also have unwanted side effects.
Now, in a clinical trial involving more than 2,000 patients at eight Swiss hospitals, researchers have examined the benefits of such nutritional support in a randomised controlled study for the first time.
For the trial, medical patients at risk of malnutrition were divided at random into two groups. One group received the usual dishes from the hospital kitchen during their hospitalisation. For the patients in the second group, dietitians compiled an individual nutritional plan.
Individual nutrition shows benefits
After 30 days, it was clear that individualised nutrition not only achieved a better supply of energy and protein, but also led to a general improvement in treatment outcomes. The comparison showed that fewer serious complications occurred and the mortality rate fell. Statistically, it was possible to prevent a serious complication in one in 25 people treated and one death for every 37 people treated.
“Our results show that malnutrition is a modifiable risk factor and that the therapy has a positive influence on disease progression,” says study leader Professor Philipp Schütz, who is an SNSF professor at the University of Basel and head of internal and emergency medicine at the Aarau Cantonal Hospital in Switzerland.
“This study has major implications for the treatment of hospital patients with multiple morbidities and should help to reinforce the importance of nutritional therapy in high-risk patients.”
The ‘Effect of early nutritional support on frailty, functional outcomes and recovery of malnourished medical inpatients trial’ (EFFORT) was supported by the Swiss National Science Foundation and the research fund of the Aarau Cantonal Hospital. Philipp Schuetz, et al. (2019). Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial. The Lancet; DOI: 10.1016/S0140-6736(18)32776-4