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.
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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.
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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

Introduction

Serum endomysial antibody (EMA) detection is still an important verification tool with high positive predictive value for coeliac disease (CeD) in patients positive with anti-transglutaminase antibody IgA (TGA) result or in seronegative cases with small intestinal villous atrophy. Moreover, EMA positivity is part of the non-invasive diagnostic criteria of CeD in children and adolescents with TGA+ results above 10 times of the upper limit of normal (>10xULN). EMA detections on the classical substrates, monkey oesophagus or human umbilical cord are less sensitive than TGA and both the preparation of the tissue slides and the reading are time-consuming and need expertise. Moreover, it is getting difficult to get commercial slides for the testing. Human umbilical cord vein-derived endothelial cells (HUVECs) produce in cell culture a regular extracellular matrix (ECM) resembling endomysial network with similar exposure of celiac-relevant transglutaminase epitopes as in tissue sections.

Aims & Methods

The aim of this study was to evaluate the diagnostic performance of EMA testing on HUVEC-ECM. Ninety new patients consecutively referred to our center between May –September 2023 in reason of positive coeliac antibody results in outside laboratories or by various rapid tests were prospectively tested for EMA-IgA on HUVEC-ECM prepared on 18-well plastic slides. Results were compared with those of our hospital’s TGA-IgA ELISA and EMA-IgA performed in 1:2.5 dilutions on a composite substrate containing monkey oesophagus, human umbilical cord and gut wall tissues.

Results

TGA-IgA, EMA-IgA on tissues and EMA-IgA on HUVEC-ECM were positive in 73, 62 and 67 samples with 94.4%, 92.9% and 95.7% accuracies for the final CeD diagnosis (non-invasive + biopsy-based), respectively. In 17 samples all three antibodies were negative; most of these patients had only TGA-IgG or DGP earlier.

Conclusion

The easily available novel HUVEC-ECM substrate provided high sensitivity and specifcity for EMA-IgA detection and also may improve the evaluation of coeliac autoimmunity when TGA is low positive or borderline.

Introduction

Since the global emergence of the COVID-19 pandemic in Spring 2020, numerous bariatric units worldwide have indefinitely postponed elective weight loss procedures, responding to the heightened risk profile associated with obesity during viral infections. Concomitantly, lockdown measures have led to significant lifestyle changes, notably reductions in physical activity and increases in food consumption, collectively contributing to weight gain in various populations. Intragastric balloons, recognized as effective means for initiating weight loss or serving as an interim solution before bariatric surgery, require upper endoscopy for insertion and removal. These procedures have faced significant disruptions due to the pandemic-driven reallocation of medical resources, including anesthesiologists and endoscopic services.

Aims & Methods

This study aims to evaluate the feasibility and safety of employing the Allurion Elipse® gastric balloon, an innovative device designed for administration without anesthesia or endoscopic guidance. This device could potentially reduce patient risk and conserve valuable hospital resources in times of medical crisis. A selected group of obese patients, as determined by our multidisciplinary bariatric team, were administered an encapsulated pill balloon, which, once ingested, expands with 550mL of fluid under the direct supervision of a gastroenterologist. Placement accuracy was confirmed through X-ray imaging. Alongside the physical intervention, patients received comprehensive support, including a customized diet plan, access to a digital health application connected to a weighing scale for remote monitoring, and regular virtual follow-ups. The primary measure of clinical efficacy was the percentage of total body weight loss (%TBWL).

Results

The study included seventeen consecutive patients (11 females, 6 males) with a mean age of 43.7 ± 9.9 years. These individuals had a mean weight of 104.21 ± 21.72 kilograms and a mean BMI of 36.11 ± 4.7 kg/m2. The balloon positioning procedures were efficiently completed in 20 to 30 minutes without technical complications. Most patients reported transient nausea and vomiting. However, these symptoms were manageable and did not lead to any severe adverse events. Only one patient required early balloon removal due to intolerance. After eight months of the procedure, with the balloon passing naturally four months prior, two patients reported a %TBWL of 19.8. The average %TBWL recorded at the four-month mark was 13%, and the weekly check-in compliance rate was 62%.

Conclusion

The COVID-19 pandemic has drastically impacted the availability and functionality of bariatric and endoscopic services, prompting the need for alternative methods that simplify and expedite the weight loss process. Although limited, the available data support the Allurion Program with the Elipse Balloon as a non-invasive, secure, and effective method to manage obesity. It facilitates rapid and sustainable weight loss, enables continuous remote support, and minimizes the impact on patients and the already strained health systems. This method represents a valuable alternative to traditional approaches, particularly during healthcare resource constraints.

References

Tønnesen CJ, et al. A novel intragastric balloon for treatment of obesity and type 2 diabetes. A two-center pilot trial. Scand J Gastroenterol. 2022
Mauro A., et al. A Comprehensive Review on Bariatric Endoscopy: Where We Are Now and Where We Are Going. Medicina (Kaunas). 2023
Navarra, G, et al. Bariatric surgery and the COVID-19 pandemic: SICOB recommendations on how to perform surgery during the outbreak and when to resume the activities in phase 2 of lockdown. Updates Surg. 2020
Vargas EJ, et al. Single Fluid-Filled Intragastric Balloon Safe and Effective for Inducing Weight Loss in a Real-World Population. Clin Gastroenterol Hepatol. 2018
Kumar N, et al. The Influence of the Orbera Intragastric Balloon Filling Volumes on Weight Loss, Tolerability, and Adverse Events: a Systematic Review and Meta-Analysis. Obes Surg. 2017