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Background/aim Alterations in gut microbiota are associated with the pathogenesis of metabolic diseases, including metabolic-associated fatty liver disease (MAFLD). The aim of this study was to evaluate gut microbiota composition and functionality in patients with morbid obesity with different degrees of MAFLD, as assessed by biopsy. Subjects/methods 110 patients with morbid obesity were evaluated by biopsy obtained during bariatric surgery for MAFLD. Stool samples were collected prior to surgery for microbiota analysis. Results Gut microbiota from patients with steatosis and non-alcoholic steatohepatitis (NASH) were characterized by an enrichment in Enterobacteriaceae (an ethanol-producing bacteria), Acidaminococcus and Megasphaera and the depletion of Eggerthellaceae and Ruminococcaceae (SCFA-producing bacteria). MAFLD was also associated with enrichment of pathways related to proteinogenic amino acid degradation, succinate production, menaquinol-7 (K2-vitamin) biosynthesis, and saccharolytic and proteolytic fermentation. Basic histological hepatic alterations (steatosis, necroinflammatory activity, or fibrosis) were associated with specific changes in microbiota patterns. Overall, the core microbiome related to basic histological alterations in MAFLD showed an increase in Enterobacteriaceae and a decrease in Ruminococcaceae . Specifically, Escherichia coli was associated with steatosis and necroinflammatory activity, whilst Escherichia-shigella was associated with fibrosis and necroinflammatory activity. Conclusions We established a link between gut microbiota alterations and histological injury in liver diagnosis using biopsy. Harmful products such as ethanol or succinate may be involved in the pathogenesis and progression of MAFLD. Thus, these alterations in gut microbiota patterns and their possible metabolic pathways could add information to the classical predictors of MAFLD severity and suggest novel metabolic targets.

H. pylori infection and eradication cause perturbations of the gut microbiome. The gut microbiota has been identified as a potential contributor to metabolic diseases. We evaluate whether these alterations in intestinal microbiota composition produced by H. pylori infection and its posterior eradication with antibiotic treatment could be associated with glucose homeostasis in metabolically healthy subjects. Forty adult patients infected with H. pylori and 20 control subjects were recruited. The infected subjects were evaluated before and two months after eradication treatment (omeprazole, clarithromycin, amoxicillin). The microbiota composition in fecal samples was determined by 16S rRNA gene (V3-V4) sequencing using Illumina Miseq. Patients (pre- and post-H. pylori eradication) showed a decreased bacterial richness and diversity with respect to controls. There was an improvement in glucose homeostasis in subjects two months after H. pylori eradication treatment. Changes in the amount of Rikenellaceae, Butyricimonas, E. biforme, B. fragilis, and Megamonas were inversely associated with changes in the glucose level or related parameters (Hb1ac) in H. pylori eradication subjects. H. pylori infection and eradication with antibiotic treatment causes alteration of the human gut microbiome. The increase in SCFA-producing bacteria and glucose-removing bacteria, specifically members of Megamonas, Rikenellaceae and Butyricimonas, has been related with an improvement in glucose homeostasis after H. pylori eradication with antibiotic treatment.

Background: COVID-19 has taken on pandemic proportions with growing interest in prognostic factors. Overhydration is a risk factor for mortality in several medical conditions with its role in COVID-19, assessed with bioelectrical impedance (BI), gaining research interest. COVID-19 affects hydration status. The aim was to determine the hydration predictive role on 90 d survival COVID-19 and to compare BI assessments with traditional measures of hydration. Methods: We studied 127 consecutive COVID-19 patients. Hydration status was estimated using a 50 kHz phase-sensitive BI and estimated, compared with clinical scores and laboratory markers to predict mortality. Results: Non-surviving COVID-19 patients had significantly higher hydration 85.2% (76.9–89.3) vs. 73.7% (73.2–82.1) and extracellular water/total body water (ECW/TBW) 0.67 (0.59–0.75) vs. 0.54 (0.48–0.61) (p = 0.001, respectively), compared to surviving. Patients in the highest hydration tertile had increased mortality (p = 0.012), Intensive Care Unit (ICU) admission (p = 0.027), COVID-19 SEIMC score (p = 0.003), and inflammation biomarkers [CRP/prealbumin (p = 0.011)]. Multivariate analysis revealed that hydration status was associated with increased mortality. HR was 2.967 (95%CI, 1.459–6.032, p < 0.001) for hydration and 2.528 (95%CI, 1.664–3.843, p < 0.001) for ECW/TBW, which were significantly greater than traditional measures: CRP/prealbumin 3.057(95%CI, 0.906–10.308, p = 0.072) or BUN/creatinine 1.861 (95%CI, 1.375–2.520, p < 0.001). Hydration > 76.15% or ECW/TBW > 0.58 were the cut-off values predicting COVID-19 mortality with 81.3% and 93.8% sensitivity and 64 and 67.6% specificity, respectively. Hydration status offers a sensitive and specific prognostic test at admission, compared to established poor prognosis parameters. Conclusions and Relevance: Overhydration, indicated as high hydration (>76.15%) and ECW/TBW (>0.58), were significant predictors of COVID-19 mortality. These findings suggest that hydration evaluation with 50 kHz phase-sensitive BI measurements should be routinely included in the clinical assessment of COVID-19 patients at hospital admission, to identify increased mortality risk patients and assist medical care.

Background and objectives: the COVID-19 pandemic underscored the necessity of understanding the factors influencing susceptibility and disease severity, as well as a better recovery of functional status, especially in postcritical patients. evidence regarding the efficacy of vitamin D supplementation in reducing the severity of COVID-19 is still insufficient due to the lack of primary robust trial-based data and heterogeneous study designs. the principal aims of our study were to determine the impact of vitamin D deficiency or insufficiency on complications during intensive care unit (icu) stay, as well as its role in muscle mass and strength improvement as well as morphofunctional recovery during a multispecialty 6-month follow-up program based on adapted nutritional support and specific physical rehabilitation. as a secondary objective, we compared the association mentioned above between patients with sarcopenic obesity and non- sarcopenic obesity. methods: this prospective observational study included 94 outpatients postcritical COVID-19. two weeks after hospital discharge, patients were divided into sufficient (≥30 ng/mL), insufficient (20.01–29.99 ng/mL), or deficient (≤20 ng/mL) vitamin D levels. the differences in in-hospital complications and morphofunctional parameters including phase angle (PhA), body cell mass (BCM), handgrip strength (HGS), timed get-up-and-go (UAG), 6 min walk test (6MWT), and proinflammatory biochemical variables were analyzed. Incremental (Δ) changes in these parameters were also analyzed at the end of follow-up according to vitamin D levels and the presence vs. absence of sarcopenic obesity. A multivariate linear regression analysis was performed to detect possible confounding factors in the impact analysis of vitamin D changes on functional recovery in patients with obesity. Results: A total of 36.2% of patients exhibited vitamin D deficiency, 29.8% vitamin D insufficiency, and only 32.9% showed sufficient levels at hospital discharge. A total of 46.8% of patients had obesity, and 36.1% had sarcopenic obesity. Vitamin D deficiency was associated with longer hospital stays (p = 0.04), longer ICU stays (p = 0.04), more days of invasive mechanical ventilation (IMV) (p = 0.04), lower skeletal muscle mass/weight (SMM/w) (p = 0.04) and skeletal muscle index (SMI) (p = 0.047), higher fat mass percentage (FM%) (p = 0.04), C-reactive-protein (CRP) (p = 0.04), and glycated hemoglobin (HbA1c) (p = 0.03), and better performance in R-HGS (p = 0.04), UAG (p = 0.03), and 6MWT (p = 0.034) when compared with those with normal vitamin D levels. At six months, Δvitamin D significantly correlated with ΔHbA1c (p = 0.002) and CRP (p = 0.049). Patients with normal vitamin D values showed better recovery of ΔSMI (p = 0.046), ΔSMM/w (p = 0.04), ΔR-HGS (p = 0.04), and ΔUAG (p = 0.04) compared to those with abnormal vitamin D levels, and these improvements in ΔR-HGS and ΔUAG were greater in the subgroup of sarcopenic obesity compared than in nonsarcopenic obesity (p = 0.04 and p = 0.04, respectively). Multivariate regression analysis detected that these results were also attributable to a longer hospital stay and lower ΔCRP in the subgroup of patients with sarcopenic obesity. Conclusions: Vitamin D deficiency was associated with longer hospital stays, longer VMI requirement, worse muscle health, and a higher degree of systemic inflammation. Furthermore, normal vitamin D levels at the end of the follow-up were associated with better morphofunctional recovery in postcritical COVID-19, particularly in patients with sarcopenic obesity partly due to a higher degree of inflammation as a result of a longer hospital stay.

Background: Antibiotic therapy used to eradicate Helicobacter pylori has been associated with changes in plasma ghrelin and alterations in the gut microbiota. On the other hand, changes in ghrelin levels have been related to changes in gut microbiota composition. Our aim was to evaluate the relationship between changes in the gut microbiota and ghrelin levels in H. pylori infected patients who received antibiotic treatment for its eradication. Methods: A prospective case-control study that included forty H. pylori -positive patients who received eradication therapy (omeprazole, clarithromycin, and amoxicillin) and twenty healthy H. pylori antigen-negative participants. Patients were evaluated, including clinical, anthropometric and dietary variables, before and 2 months after treatment. Gut microbiota composition was analyzed through 16S rRNA amplicon sequencing (IlluminaMiSeq). Results: Changes in gut microbiota profiles and decrease in ghrelin levels were identified after H. pylori eradication treatment. Gut bacteria such as Bifidobacterium longum, Bacteroides, Prevotella, Parabacteroides distasonis , and RS045 have been linked to ghrelin levels fasting and/or post meals. Changes in the abundance of Lachnospiraceae , its genus Blautia , as well as Prevotella stercorea , and Megasphaera have been inversely associated with changes in ghrelin after eradication treatment. Conclusions: Eradication treatment for H. pylori produces changes in the composition of the intestinal microbiota and ghrelin levels. The imbalance between lactate producers such as Blautia , and lactate consumers such as Megasphaera, Lachnospiraceae , or Prevotella , could trigger changes related to ghrelin levels under the alteration of the eradication therapy used for H. pylori . In addition, acetate producing bacteria such as B. longum, Bacteroides , and P. distasonis could also play an important role in ghrelin regulation.

Changes in the intestinal microbial community and some metabolic disturbances, including obesity and type2 diabetes, are related. Glucagon-like peptide-1 (GLP-1) regulates glucose homeostasis. Microbiota have been linked to incretin secretion. Antibiotic use causes changes in microbial diversity and composition. Our aim was to evaluate the relationship between microbiota changes and GLP-1 secretion. A prospective case-control study with a Helicobacter pylori-positive patient model involving subjects under eradication therapy (omeprazole, clarithromycin, and amoxicillin). Forty patients with H. pylori infection and 20 matched participants, but negative for H. pylori antigen. Patients were evaluated before and two months after treatment. We analyzed anthropometric measurements, carbohydrate metabolism, lipid profile, and C-reactive protein. Gut microbiota composition was analyzed through 16S rRNA amplicon sequencing (IlluminaMiSeq). Eradication treatment for H. pylori decreased bacterial richness (Chao1, p = 0.041). Changes in gut microbiota profiles were observed at phylum, family, genus and species levels. GLP-1 secretion and variables of carbohydrate metabolism were improved. Correlations were seen between GLP-1 changes and variations within microbial community abundances, specifically Bifidobacterium adolescentis, the Lachnobacterium genus, and Coriobacteriaceae family. A conventional treatment to eradicate H. pylori could improve carbohydrate metabolism possibly in relation with an increase in GLP-1 secretion. GLP-1 secretion may be related to alterations in intestinal microbiota, specifically Lachnobacterium, B. adolescentis and Coriobacteriaceae.

Background: The gut microbiome plays an important role in the lipid metabolism. Antibiotic treatment causes changes in the intestinal microbiota. Our objective was to explore the relationship between changes in the intestinal microbiota and the level of plasma high density lipoprotein cholesterol (HDL) and low density lipoprotein cholesterol (LDL).Methods: Prospective case-control study with Helicobacter pylori -positive patients undergoing eradication therapy with omeprazole, clarithromycin, and amoxicillin. Stool and blood samples were obtained from 20 controls ( H. pylori negative) and 40 patients before and 2 months after antibiotic treatment. Gut microbiota was determined through 16S rRNA amplicon sequencing (Illumina MiSeq).Results: Eradication treatment for H. pylori increased the HDL levels, and caused changes in gut microbiota profiles. An unfavorable lipid profiles (high LDL and low HDL levels) was associated with a low microbial richness and an increase of the Bacteroidetes phylum. Prevotella copri, Lachonobacterium , and Delsufovibrio were positively associated with HDL while Rikenellaceae was negatively associated with HDL after completing antibiotic treatment.Conclusions: Helicobacter pylori eradication treatment could improve lipid metabolism in relation with an increase in the HDL. Changes in the abundance of specific bacteria, such as P. copri, Lachonobacterium, Delsufovibrio , and Rikenellaceae could be associated with change in the plasma HDL levels.

Recently, a number of studies have related the development of highly prevalent disorders such as type 2 diabetes and obesity to gut microbiota. Obesity itself have been associated with modifications in gut microbiota composition, and a tendency towards an overgrowth of microorganisms that obtain more efficient energy from diet. It's capacity to decompose the polysaccharides that can not be digested by the host, increase monosaccharide and short chain fatty acid (SCFA) production. However, the increase in fat mass is not only due to a more efficient harvest of energy, but also the microbiota participates in changes in endotoxemia, bowel permeability, insulin resistance, hormonal environment, expression of genes regulating lipogenesis, interaction with bile acids, as well as changes in the proportion of brown adipose tissue, and effects associated with the use of drugs such as metformin. Currently, use of prebiotics and probiotics and other innovative techniques like antibiotic therapy or gut microbiota transplant, has been proposed as suitable tools to control the development of metabolic diseases such as obesity or insulin resistance through the diet.

This is a retrospective study of data from clinical practice to observe the effect of a high-calorie, high-protein oral nutritional supplement (ONS) with β-hydroxy-β-methylbutyrate (HMB) on nutritional status, body weight, and muscle-related parameters in 283 adult patients with or at risk of malnutrition under standard of care, 63% being cancer patients. They were recommended to increase physical activity and energy and protein intake from regular diet plus two servings per day of a specialized ONS enriched with HMB or standard ONS for up to 6 months. Dietary records, adherence and tolerance to ONS, nutritional status, body composition, handgrip strength, and blood analysis at the beginning and the end of the intervention were recorded. This program improved nutritional status from 100% malnourished or at risk of malnutrition at baseline to 80% well-nourished at final visit. It also increased body weight by 3.6–3.8 kg, fat-free mass by 0.9 to 1.3 kg, and handgrip strength by 4.7 to 6.2 kg. In a subgroup of patients (n = 43), phase angle (PhA), and body cell mass (BCM) increased only in the patients receiving the ONS enriched with HMB (0.95 (0.13) vs. −0.36 (0.4), and 2.98 (0.5) vs. −0.6 (1.5) kg, mean difference (SE) from baseline for PhA and BCM, respectively), suggesting the potential efficacy of this supplement on muscle health.

Background: Cancer-related malnutrition is still unrecognized and undertreated in clinical practice. The morphofunctional assessment of disease-related malnutrition (DRM) is a new approach that focuses on evaluating changes in body composition and function. The aim of this study is to evaluate the prognostic value of classic and emerging assessment of malnutrition at 12-months survival in cancer patients. Methods. We conducted a prospective study on cancer outpatients. Bioelectrical impedance with phase angle (PhA), nutritional ultrasound by rectus femoris cross-sectional area (RFCSA), hand grip strength, and “Timed Up and Go Test” (TUG) were evaluated as predictors of mortality. Results. Fifty-seven patients were included. The non-survivors had lower PhA values than the survivors (4.7° vs. 5.4°; p < 0.001), and we had the same results with RFCSA 2.98 cm2/m2 vs. 4.27 cm2/m2 (p = 0.03). Cut-off points were identified using the ROC (receiver operating characteristic) curves for PhA (≤5.6° cancer patients, ≤5.9° men, ≤5.3° women), RFCSA (≤4.47 cm2/m2 cancer patients, ≤4.47° men, ≤2.73° women) and rectus femoris-Y-axis (RF-Y-axis; ≤1.3 cm cancer patients, ≤1.06 men, ≤1 women). In multivariate logistic regression analysis, we found that high PhA was significantly associated with a lower mortality hazard ratio (HR: 0.42 95% CI: 0.21–0.84, p = 0.014). Likewise, high RFCSA was associated with a decrease in mortality risk in the crude model (HR: 0.61 95% CI: 0.39–0.96, p = 0.031). This trend was also maintained in the adjusted models by the confounding variables. Conclusions. Low PhA and RFCSA values are significant independent predictors of mortality in cancer patients. These cut-off points are clinical data that can be used for nutritional assessment and the prediction of clinical outcomes.