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

Introduction

Nowadays the use of a gluten-free diet (GFD) is erroneously considered a healthy life choice worldwide, despite evidence supports its beneficial effect only in the treatment of celiac disease and, possibly, gluten sensitivity. GFD can modify microbiota composition, decreasing specifically bacterial species involved in polysaccharides metabolism and short chain fatty acids (SCFAs) production. In fact, a GFD usually show a lower carbohydrate composition with an increase of dietary fats, and a fiber intake significantly below the recommended range. In this study, we investigated whether the amount of daily intake complex carbohydrates during GFD was associated with the reduction of microbial richness and species’ relative abundance.

Aims & Methods

We enrolled 36 healthy subjects and randomly assigned to a self-made GFD (SGFD) regimen (n=23, yrs=35±14) or to a GFD under nutritional supervision (NGFD) that ensured 60% of daily dietary carbohydrates intake (n=13; 29±12 yrs). A total of 144 fecal samples were collected at day 0, and 3, 7, 30 days during GFD, sequenced via shotgun metagenomic and profiled via bioBAkery 3. Data were analyzed on MetaPhlAn 4.0 and HUMAnN 3.0 for taxonomic and functional profiling. Alpha-diversity (Shannon index, SI) and relative abundances were computed. Only species detectable in least 5 subjects were considered (600 species). Statistical analysis was performed using a linear mixed model and Friedman’s ANOVA. P-values were combined and corrected for multiple hypothesis testing (q-value).

Results

Alpha-diversity did not significantly change during 30 days of GFD in both groups.
However, 14 and 10 species significantly changed in their relative abundance in the SGFD and NGFD groups,respectively. We observed a decrease of Bifidobacterium longum (SGB17248) and Candidatus Cibionibacter quicibialis (SGB15286) (q<0.05) with no intergroup differences. SGFD showed a decrease of butyrate producing species, i.e. Dorea longicatena and Anaerobutyricum hallii.

Conclusion

During GFD, microbial alpha-diversity preservation is independent from the daily carbohydrate intake.However, we identified consistent modifications in microbial relative abundances that partially differ in the two groups. The NGFD group showed a significant decrease in five Bifidobacterium species’ bacteria. Bifidobacteria are functionally linked to complex carbohydrate metabolism and associated with immunomodulatory properties. Despite we cannot point out specific role for gluten or carbohydrate intake in the microbiota’s richness variation, healthy subjects should not be encouraged to follow a GFD for its negative effects on gut health.

References

Melini, Valentina; Melini, Francesca (2019). Gluten-Free Diet: Gaps and Needs for a Healthier Diet. Nutrients, 11(1), 170–. doi:10.3390/nu11010170
Jones AL. The Gluten-Free Diet: Fad or Necessity? Diabetes Spectr. 2017 May;30(2):118-123. doi: 10.2337/ds16-0022. PMID: 28588378; PMCID: PMC5439366.
Gessaroli M, Frazzoni L, Sikandar U, Bronzetti G, Pession A, Zagari RM, Fuccio L, Forchielli ML. Nutrient intakes in adult and pediatric coeliac disease patients on gluten-free diet: a systematic review and meta-analysis. Eur J Clin Nutr. 2023 Aug;77(8):784-793. doi: 10.1038/s41430-023-01280-0. Epub 2023 Mar 1. PMID: 36859658.
Hansen, L.B.S., Roager, H.M., Søndertoft, N.B. et al. A low-gluten diet induces changes in the intestinal microbiome of healthy Danish adults. Nat Commun 9, 4630 (2018). https://doi.org/10.1038/s41467-018-07019-x

Introduction

Obesity and metabolic dysfunction-associated steatotic liver disease (MASLD) have been linked to gut dysbiosis.

Aims & Methods

This study aimed to investigate the relationship between gut microbiota composition, hepatic fat content and stiffness, and body mass index (BMI) status. This cross-sectional study enrolled adolescents aged 12 to 18. Transient elastography with controlled attenuation parameter (CAP) was employed to diagnose hepatic fibrosis and steatosis. Fecal samples were analyzed by 16S rRNA sequencing. Relative abundance, as well as alpha- and beta-diversity of the microbiota, were compared across participants with different nutrition statuses and the presence of hepatic steatosis and fibrosis.

Results

A total of 76 participants (51 males) were recruited for this study, including 43 with normal weight, 19 overweight, and 14 obese. The clinical characteristics of the participants are presented in Table 1. Hepatic steatosis was present in 8 out of 14 obese participants (57.2%) and 2 out of 19 overweight (10.5%) participants. Hepatic fibrosis was detected in 4 out of 14 obese participants (28.6%) but none in the normal weight or overweight groups. There were no significant differences in alpha- or beta-diversity between the normal weight, overweight, and obese groups. The Firmicutes to Bacteroidetes (F/B) ratio was 1.2 across all three groups. Several genera, including Eubacterium_halli_group and Ruminococcus_gauvreauii_group were present in higher abundances in the gut microbiome of the obese group compared to the normal-weight group, with p values of 0.025 and 0.036, respectively. In contrast, Bifidobacterium was more abundant in the normal-weight participants (p=0.012). Obese individuals with hepatic fibrosis exhibited a significantly higher F/B ratio compared to those without hepatic fibrosis (p=0.04). There were significant differences in the relative abundance of specific genera between the fibrosis and non-fibrosis groups: Phascolarctobacterium (p=0.020), Dorea (p=0.040), and Ruminococcus_gauvreauii_group (p=0.045) were present in higher abundances in the fibrosis group, whereas Senegalimassilia was more abundant in the non-fibrosis group (p=0.037).

Conclusion

Hepatic steatosis and fibrosis are common among obese adolescents. The gut microbiota abundance in obese individuals with hepatic fibrosis differ from those without it. Further studies are crucial to explore the role of gut microbiota modification in the progression of hepatic steatosis and fibrosis.