Introduction

There is a close relationship between the rise in obesity and the increase in consumption of sugar-sweetened beverages. According to a report by the World Health Organization (WHO), about 18% of children and adolescents worldwide are affected by overweight or obesity. Sweet beverage consumption is particularly high in this age group. The WHO recommends reducing sugar intake to prevent and treat obesity. Reduction of sugar intake can be achieved through partial substitution with alternative sweeteners. Erythritol is a naturally occurring non-caloric bulk sweetener. Unlike sugar, erythritol does not affect plasma glucose and insulin concentrations yet stimulates the release of gastrointestinal satiation hormones.

Aims & Methods

This study aimed to evaluate the impact of daily erythritol versus sucrose intake over 5 weeks on parameters of glycemic control, food intake and gastrointestinal symptoms in healthy adolescents.
In this randomized, double-blind, parallel trial, 30 healthy, lean adolescents (15 per group: mean ± SD; age: 16.9 ± 1.5 years; BMI: 20.9 ± 1.8 kg/m²) were included. For a duration of 5 weeks, they received a daily total of 36 g of erythritol (divided into two portions of 18 g in 150 mL tap water; ERY), or 25 g of sucrose (divided into two portions of 12.5 g in 150 mL tap water; SUC). During the week before and the last week of intervention, food intake was assessed by food records. Before and after the intervention period, an oral glucose tolerance test was carried out and blood samples were collected at fixed time points to measure plasma glucose and insulin. Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and Homeostatic Model Assessment of Insulin Sensitivity (HOMA-%S)) were calculated. The Gastrointestinal Symptom Rating Scale (GSRS) was applied to assess gastrointestinal symptoms at 3 timepoints (before, during week 3, and after the intervention).

Results

In the erythritol-group, parameters of glycemic control were not significantly different in response to the intervention. In the sucrose-group Cmax for blood glucose was not significantly different but Cmax for blood insulin (PRE_SUC: 91.67 ± 33.71 mIU/L vs. POST_SUC: 127.38 ± 68.24 mIU/L; p = 0.030) and HOMA-IR (PRE_SUC: 1.79 ± 0.74 vs. POST_SUC: 2.51 ± 0.74; p < 0.001) were significantly increased, while HOMA-%S (PRE_SUC: 70.5 ± 47.3 vs. POST_SUC: 43.2 ± 12.5; p = 0.016) was significantly reduced after the intervention period. In the erythritol-group, total sugar intake (PRE_ERY: 90.3 ± 34.0 g vs. POST_ERY: 71.0 ± 36.0 g; p = 0.034) and total carbohydrate intake (PRE_ERY: 256.8 ± 54.8 g vs. POST_ERY: 211.1 ± 71.0 g; p = 0.038) were significantly reduced after the intervention period, while total caloric intake (PRE_ERY: 2113.7 ± 495.4 kcal vs. POST_ERY: 1855.1 ± 495.7 kcal; p = 0.068) showed a trend of reduction. In the sucrose-group, total sugar intake (PRE_SUC: 75.4 ± 31.2 g vs. POST_SUC: 92.4 ± 24.7 g; p = 0.073) showed a trend of increase after the intervention period, while total carbohydrate and total caloric intakes were not significantly different. The total score of GSRS was not significantly different between the groups but increased significantly over time in both groups (p = 0.045).

Conclusion

Daily erythritol intake in healthy, lean adolescents over 5 weeks did not affect parameters of glycemic control but led to a significant reduction of total carbohydrate and total sugar intake. In contrast, the sucrose intervention resulted in a significant increase in maximum insulin concentration and HOMA-IR, along with a significant decrease in HOMA-%S.

Introduction

Diet is an essential regulator of brain function, evidenced by longstanding associations between nutrient intake and neuronal function, synaptic plasticity, and neurotransmitter release. Recent studies have suggested that diet may impact mental health and cognition and even convey susceptibility to neurogenerative disease. However, there is little related neuroimaging evidence to date.

Aims & Methods

Our aim was to delineate the association between diet, brain structure and function. We studied 518 healthy participants from the Cambridge Centre for Aging and Neuroscience (CAM-Can) repository (261 male and 257 female, mean age 53 ± .79 years). Participants were clustered via their self-reported dietary intakes using K-means clustering. Resting-state functional, white matter tractography, and grey matter volumetry networks conditional to dietary cluster were analysed using network-based statistics, controlling for participant age and sex as nuisance covariates. Relevant clinical data comprising BMI and Hospital Anxiety and Depression Score (HADS) were compared between diet clusters using Welch’s t-test.

Results

Four distinct dietary intake patterns were identified: balanced, meat-predominant, vegetarian, and raw vegetable-predominant diets. Specific dietary types – balanced, meat-predominant and vegetarian – were associated with increased functional, grey matter or white matter connectivity between regions comprising the bilateral insula, frontomedial cortex (FMC) and bilateral anterior cingulate cortex (ACC) (p<0.04). A balanced diet was associated with significantly increased functional, structural, and white matter connectivity between frontal brain regions, including the orbitofrontal cortex (OFC), superior frontal gyri (SFG), and FMC (p=0.04) when compared to other diet clusters. A balanced diet was associated with a significantly reduced depression score (HADS-D) (p=0.03), compared to a meat-predominant one. The meat-predominant diet cluster was correlated with increased structural connectivity at the bilateral ACC (p=0.03) and significantly increased BMI (p=0.01), when compared to vegetarian diets.

Conclusion

In the largest study of its kind, we reveal the structural and functional connectomic brain associations of diet. Notably, the set of brain regions implicated have broader established roles across interoception, emotion, memory, reward and addiction. Our findings imply a possible physiological correlate for diet-induced changes in behaviour, weight, mood, and cognition previously observed in the literature, and pave the way for future research.

References

1.Zhang R, Zhang B, Shen C, Sahakian BJ, Li Z, Zhang W, et al. Associations of dietary patterns with brain health from behavioral, neuroimaging, biochemical and genetic analyses. Nat Ment Health. 2024 Apr 1;1–18.
2.Gaynor AM, Varangis E, Song S, Gazes Y, Noofoory D, Babukutty RS, et al. Diet moderates the effect of resting state functional connectivity on cognitive function. Sci Rep. 2022 Sep 27;12(1):16080.
3.Jensen DEA, Leoni V, Klein-Flügge MC, Ebmeier KP, Suri S. Associations of dietary markers with brain volume and connectivity: A systematic review of MRI studies. Ageing Res Rev. 2021 Sep 1;70:101360.
4.Rolls ET, Feng R, Cheng W, Feng J. Orbitofrontal cortex connectivity is associated with food reward and body weight in humans. Soc Cogn Affect Neurosci. 2023 Jan 1;18(1):nsab083.
5.Tan HE, Sisti AC, Jin H, Vignovich M, Villavicencio M, Tsang KS, et al. The gut–brain axis mediates sugar preference. Nature. 2020 Apr;580(7804):511–6.
6.Rolls ET. Functions of the anterior insula in taste, autonomic, and related functions. Brain Cogn. 2016 Dec 1;110:4–19.
7.Frank S, Kullmann S, Veit R. Food related processes in the insular cortex. Front Hum Neurosci. 2013 Aug 23;7:499.

Disclosure

No conflicts of interest.

Introduction

The only effective treatment for celiac disease (CD) is lifelong compliance with a gluten-free diet. Lactobacilli and Bifidobacterium spp. may play a role in the breakdown of gluten. Ithas been demonstrated that Lactobacilli can detoxify gliadin peptides after partial digestion by human proteases. These findings could suggest the use of probiotics as complementary therapy for CD.

Aims & Methods

We designed a study to determine the potential effect of a combination of Lactobacillus (acidophilus HA-122, casei HA-108) and Bifidobacterium bifidum HA-132 on perception of symptoms and on the inflammatory-immunological markers in patients with active CD.
25 adult patients were randomized to receive bid of a probiotic combination of Lactobacilus and Biffidobacter for six weeks (13 pts) va a placebo group (12 pts) while being on gluten-free diet. Laboratory studies included routine blood tests, CD specific antibodies, determination of IL-1b, IL-6 and TNF-alpha. CD serology and duodenal histology were performed at baseline, at the end of treatment and at 30 days after therapy. Histological damage in intestinal biopsy samples was graded according to the Marsh modified classification. At baseline and follow-up visit, patients completed the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire. Histological damage in intestinal biopsy samples was graded according to the Marsh modified classification.

Results

25 pacients, 13 in the probiotic associated arm, 12 in the placebo arm, with median age of 40, BMI 21.2, 18 with symptomatic CD (equal distribuited) and 7 with sublinical CD (4 in the probiotic arm, 9 in the placebo arm). Baseline serology: IGA tTG 1986.6 (group A) vs 1507.1 (placebo group). Baseline hystology (Marsh classification)- Marsh 3a 1 pacient in probiotic group, 2 in the placebo arm. 5 pts Mars 3b3 in group A and 2 in the placebo arm and 17 pts Marsh 3c (9 pts probiotic, 8 pts placebo). IELs density (mean range) was 44.5 in the first group vs 42.5
After treatment: clinical aleviation of indigestion and diareea (p=0.002), constipation (p=0. 0396), gastro-esophageal reflux (p=0.0493) and abdominal pain (p=0.0378)-superior in the probiotic associated treatment.
Serologic parameters: IgA tTG 0,96 in the probiotic arm vs 1,16 in the placebo (p=0.048), IgA EMA 1,05 vs 0,97 (p=0.028), IgG DGP 0,91 vs 1,12 (p=0.21).
Improvement of the inflamatory status: decrease of IL-1b, IL 6 and TNF-a was superior in the probiotic associated group (p=0.071, p=0.083, p=0.078).
Regarding the histologic response: IELs 0,83 vs 1.07 in the placebo arm (p=0.049).

Conclusion

Tests and the lymphocyte infiltrates in the mucosal biopsy specimen in uur study suggests that prebiotic/probiotic treatment may improve symptoms and serology in celiac disease.

Disclosure

I don t have any conflict of interest to declare

Clinical Case Summary

A 39-year-old woman with no previous significant medical history presented with a week-long history of diarrhea and black stools in the last 48 hours. Laboratory tests revealed mild anemia (Hb 11 mean corpuscular volume 78), and normal levels of inflammatory markers. Esophagogastroduodenoscopy (EGD) was performed, showing in the second portion of the duodenum atrophic mucosa with villous blunting, scalloped folds, and multiple superficial subcentimetric ulcers covered with fibrin, as shown in figures 1, 2, 3. Duodenal biopsies demonstrated marked villous atrophy, intraepithelial lymphocytosis, and absence of plasma cells. Given the villous atrophy, a differential diagnosis with celiac disease was considered, and anti-tissue transglutaminase IgA antibodies and anti-endomysial were requested, which came back negative. Further investigation revealed low levels of IgG and IgA, and after excluding secondary causes, diagnosis of common variable immunodeficiency and celiac disease-like enteropathy were established. Replacement treatment was initiated with intravenous immunoglobulins, resulting in clinical and endoscopic improvement of the patient.

References

Malamut G, Verkarre V, Suarez F, et al. The enteropathy associated with common variable immunodeficiency: the delineated frontiers with celiac disease. Am J Gastroentero 2010
Malesza IJ, Malesza M, Krela-Kaźmierczak I, et al. Primary Humoral Immune Deficiencies: Overlooked Mimickers of Chronic Immune-Mediated Gastrointestinal Diseases in Adults. Int J Mol Sci 2020
Hashash JG, Squire J, Francis FF, Binion DG, Cross RK, Farraye FA. An Expert Opinion/Approach: Clinical Presentations, Diagnostic Considerations, and Therapeutic Options for Gastrointestinal Manifestations of Common Variable Immune Deficiency. Am J Gastroenterol 2022
Andersen IM, Jørgensen SF. Gut inflammation in CVID: causes and consequences. Expert Rev Clin Immunol 2022

Introduction

Transition of adolescents with inflammatory bowel disease (IBD) to adult care is a challenge for patients, families, and healthcare providers. Considering that ~ 25% of IBD patients are diagnosed before the age of 16 years, and that these patients are at higher risk for poorer clinical disease outcomes. interest in the transition of care has been increasing considerably in the last decade. To assess the main clinical and epidemiological features of a single centre pedriatic population of IBD patients at diagnosis and at the time of transition to the adult center

Aims & Methods

From June 2014 to June 2023 we performed a multicenter, observational, cross-sectional study that included pediatric patients with IBD enrolled in the only pediatric IBD reference center in Sardinia. Data were obtained from the patients’ medical records and from a questionnaire administered at the inclusion visit.

Results

Sixty-five IBD patients were enrolled (UC 40, CD 25, M 32, F 33). Median age at diagnosis was 13 years (IQR 2-18). After a median disease duration of 8 years (IQR: 1-25), no UC patients experienced proximal estension of proctitis or left-sided colitis, and no CD patients experienced new localizations of disease. Fifteen patients developed extraintestinal manifestations. No significant difference was found in median diagnostic delay (DD) between UC [4 months (IQR: 1-84)] and CD patients [4,5 months (IQR: 1-48)]. At the transition visit, overall, twenty-nine patients (44,6%) were exposed to one biologic agent (vs 3% at baseline; p<0.02); 0 patients (0%) were exposed to two biologic agents. 4,6% of patients (3/ 65) underwent surgery

Conclusion

Our results provide important insights into the clinical and epidemiological features of paediatric IBD population, and while waiting for a nation Italian registry, present eligible data on the IBD population in Sardinia