The effect of dietary fiber on gut barrier function, gut microbiota, short‐chain fatty acids, inflammation and clinical outcomes in critically ill patients: A systematic review and meta‐analysis

Author(s):  
Ting Liu ◽  
Can Wang ◽  
Yu‐yu Wang ◽  
Li‐li Wang ◽  
Omorogieva Ojo ◽  
...  
Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Eleni Papoutsi ◽  
Vassilis G. Giannakoulis ◽  
Eleni Xourgia ◽  
Christina Routsi ◽  
Anastasia Kotanidou ◽  
...  

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Stefano Romano ◽  
George M. Savva ◽  
Janis R. Bedarf ◽  
Ian G. Charles ◽  
Falk Hildebrand ◽  
...  

AbstractThe gut microbiota is emerging as an important modulator of neurodegenerative diseases, and accumulating evidence has linked gut microbes to Parkinson’s disease (PD) symptomatology and pathophysiology. PD is often preceded by gastrointestinal symptoms and alterations of the enteric nervous system accompany the disease. Several studies have analyzed the gut microbiome in PD, but a consensus on the features of the PD-specific microbiota is missing. Here, we conduct a meta-analysis re-analyzing the ten currently available 16S microbiome datasets to investigate whether common alterations in the gut microbiota of PD patients exist across cohorts. We found significant alterations in the PD-associated microbiome, which are robust to study-specific technical heterogeneities, although differences in microbiome structure between PD and controls are small. Enrichment of the genera Lactobacillus, Akkermansia, and Bifidobacterium and depletion of bacteria belonging to the Lachnospiraceae family and the Faecalibacterium genus, both important short-chain fatty acids producers, emerged as the most consistent PD gut microbiome alterations. This dysbiosis might result in a pro-inflammatory status which could be linked to the recurrent gastrointestinal symptoms affecting PD patients.


2018 ◽  
Vol 107 (6) ◽  
pp. 965-983 ◽  
Author(s):  
Daniel So ◽  
Kevin Whelan ◽  
Megan Rossi ◽  
Mark Morrison ◽  
Gerald Holtmann ◽  
...  

2012 ◽  
Vol 95 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Julia M W Wong ◽  
Amin Esfahani ◽  
Natasha Singh ◽  
Christopher R Villa ◽  
Arash Mirrahimi ◽  
...  

Abstract Modulation of the gut microbiota is an area of growing interest, particularly for its link to improving and maintaining the systemic health of the host. It has been suggested to have potential to reduce risk factors associated with chronic diseases, such as elevated cholesterol levels in coronary heart disease (CHD). Diets of our evolutionary ancestors were largely based on plant foods, high in dietary fiber and fermentable substrate, and our gut microbiota has evolved against a background of such diets. Therapeutic diets that mimic plant-based diets from the early phases of human evolution may result in drug-like cholesterol reductions. In contrast, typical Western diets low in dietary fiber and fermentable substrate, and high in saturated and trans fatty acids, are likely contributors to the increased need for pharmacological agents for cholesterol reduction. The gut microbiota of those consuming a Western diet are likely underutilized and depleted of metabolic fuels, resulting in a less than optimal gut microbial profile. As a result, this diet is mismatched to our archaic gut microbiota and, therefore, to our genome, which has changed relatively little since humans first appeared. While the exact mechanism by which the gut microbiota may modulate cholesterol levels still remains uncertain, end products of bacterial fermentation, particularly the short chain fatty acids (i.e., propionate), have been suggested as potential candidates. While more research is required to clarify the potential link between gut microbiota and CHD risk reduction, consuming a therapeutic diet rich in plant foods, dietary fiber, and fermentable substrate would be a useful strategy for improving systemic health, possibly by altering the gut microbiota.


Proceedings ◽  
2020 ◽  
Vol 61 (1) ◽  
pp. 28
Author(s):  
Omorogieva Ojo ◽  
Qianqian Feng ◽  
Osarhumwese Osaretin Ojo ◽  
Xiaohua Wang

Background: Diabetes prevalence is on the increase globally and its impact on those with the condition in terms of acute and chronic complications can be profound. People with type 2 diabetes constitute the majority of those with the condition and the risk factors include obesity, lifestyle and gut microbiota dysbiosis. Poor dietary intake has been reported to influence the community of the gut microbiome. Therefore, a higher intake of dietary fibre may alter the environment in the gut and promote microbial growth and proliferation. Aim: This is a systematic review and meta-analysis which examined the effect of dietary fibre on gut microbiota in patients with type 2 diabetes. Method: This review was conducted in line with the PRISMA framework. Databases were searched for relevant articles which were screened based on inclusion and exclusion criteria. Results: Nine articles which met the inclusion criteria were selected for the systematic review and meta-analysis. High dietary fibre intake significantly improved (p < 0.05) the abundance of Bifidobacterium, total short-chain fatty acids (SCFAs) and HbA1c. Discussion: The promotion of SCFA producers in terms of greater diversity and abundance by dietary fibre may have resulted in improvement in glycated haemoglobin, partly due to increased GLP–1 production. Conclusion: High consumption of dietary fibre has a significant (p < 0.05) effect on Bifidobacterium, total SCFAs and HbA1c, but not (p > 0.05) on propionic, butyric and acetic acid, fasting blood glucose and the homeostatic model assessment of insulin resistance HOMAR–IR.


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