'Gut health' and the microbiome in the popular press: a content analysis

From hype to hope: Considerations in conducting robust microbiome science

Microbiome science has been one of the most exciting and rapidly evolving research fields in the past two decades. Breakthroughs in technologies including DNA sequencing have meant that the trillions of microbes (particularly bacteria) inhabiting human biological niches (particularly the gut) can be profiled and analysed in exquisite detail. This microbiome profiling has profound impacts across many fields of research, especially biomedical science, with implications for how we understand and ultimately treat a wide range of human disorders. However, like many great scientific frontiers in human history, the pioneering nature of microbiome research comes with a multitude of challenges and potential pitfalls. These include the reproducibility and robustness of microbiome science, especially in its applications to human health outcomes. In this article, we address the enormous promise of microbiome science and its many challenges, proposing constructive solutions to enhance the reproducibility and robustness of research in this nascent field. The optimisation of microbiome science spans research design, implementation and analysis, and we discuss specific aspects such as the importance of ecological principals and functionality, challenges with microbiome-modulating therapies and the consideration of confounding, alternative options for microbiome sequencing, and the potential of machine learning and computational science to advance the field. The power of microbiome science promises to revolutionise our understanding of many diseases and provide new approaches to prevention, early diagnosis, and treatment.

Microbiotoxicity: antibiotic usage and its unintended harm to the microbiome

PURPOSE OF REVIEW

Antibiotic use is associated with development of antimicrobial resistance and dysregulation of the microbiome (the overall host microbial community). These changes have in turn been associated with downstream adverse health outcomes. This review analyses recent important publications in a rapidly evolving field, contextualizing the available evidence to assist clinicians weighing the potential risks of antibiotics on a patient's microbiome.

RECENT FINDING

Although the majority of microbiome research is observational, we highlight recent interventional studies probing the associations between antibiotic use, microbiome disruption, and ill-health. These studies include germ-free mouse models, antibiotic challenge in healthy human volunteers, and a phase III study of the world's first approved microbiome-based medicine.

SUMMARY

The growing body of relevant clinical and experimental evidence for antibiotic-mediated microbiome perturbation is concerning, although further causal evidence is required. Within the limits of this evidence, we propose the novel term 'microbiotoxicity' to describe the unintended harms of antibiotics on a patient's microbiome. We suggest a framework for prescribers to weigh microbiotoxic effects against the intended benefits of antibiotic use.

Anorexia nervosa and microbiota: systematic review and critical appraisal

PURPOSE

Recent studies have reported a gut microbiota imbalance or dysbiosis associated with anorexia nervosa (AN), which has prompted an appraisal of its aetiological role, and the reformulation of AN as a metabo-psychiatric disorder. Thus, the aim of this paper was to critically review the current scientific findings regarding the role of microbiota in anorexia nervosa.

METHODS

A systematic study of peer-reviewed literature published in four databases between 2009 and 2022 was conducted according to PRISMA guidelines. Both human and animal studies were included.

RESULTS

A total of 18 studies were included. In animal models, both the preclinical and clinical findings were inconsistent regarding microbiota composition, faecal metabolite concentrations, and the effects of human faecal microbiota transplants.

CONCLUSION

The methodological limitations, lack of standardisation, and conceptual ambiguity hinder the analysis of microbiota as a key explanatory factor for AN.

LEVEL OF EVIDENCE

Level I, systematic review.

Gut health, the microbiome and dietary choices: An exploration of consumer perspectives

AIMS

To explore consumer perceptions regarding dietary behaviours related to the gut microbiome, to assist in effective translation of research to practice.

METHODS

Online focus groups were conducted (adults with no formal medical or nutrition training). Semi-structured open-ended questioning explored perspectives related to gut health and dietary behaviours. A qualitative descriptive analysis approach was undertaken in duplicate.

RESULTS

Fourteen focus groups were conducted (n = 38, 15 males, 23 females). Four overarching themes regarding consumer perceptions were identified. These were (a) gut health equates with wellbeing, (b) there are divergent perceptions of how diet influences gut health, (c) interest in scientific evidence does not necessarily influence dietary behaviour and (d) gastrointestinal symptoms influence dietary behaviour.

CONCLUSIONS

Consumers are interested in gut health and understand that diet may be important. Given that current literature regarding diet and gut health does not differ from dietary guidelines, consumer interest may provide a timely slant to promote longstanding guidelines. Consumer education to limit scepticism around government messaging, including utilisation of social media by nutrition professionals, may be key to improving adherence to guidelines.

Online information in Spanish on probiotics, yoghurt, kefir, kombucha, fibre and prebiotics: an analysis of the quality of information and the certainty of the evidence supporting health claims

OBJECTIVE

To examine the certainty of the evidence supporting health claims about probiotics, yoghurt, kefir, kombucha, fibre and prebiotics, and to assess the quality of online information in Spanish.

DESIGN

Content analysis.

METHODS

We compiled a data set of 114 web pages by searching six popular search phrases in Spanish relating to probiotics, yoghurt, kefir, kombucha, fibre and prebiotics on Google.es and coded them for typology and health claims. We examined the certainty of the evidence for health claims from systematic reviews. Information quality was assessed according to 10 criteria, where a web page: mentions scientific publications and reports their conclusions; quantifies relative and absolute effects; acknowledges some limitations; discusses certainty of evidence; reports the potential harms, alternatives and costs; and does not argue based on personal experiences.

RESULTS

Gastrointestinal health (86.0%), general health (57.9%), cardiovascular health (53.5%) and immune system health (50.9%) were the most widely mentioned topics. Half of claims (52.6%, 70/133) were supported by evidence from systematic reviews. Probiotics had the highest number of claims supported by evidence and kombucha the lowest. The highest certainty was found for antibiotic-associated diarrhoea, necrotising enterocolitis and otitis (moderate) in probiotics and yoghurt, infectious diarrhoea and hepatic encephalopathy (moderate) in prebiotics, and cardiovascular health (high to moderate) and colorectal cancer (moderate) in fibre. On a scale of 0-10, the median information quality score for all web pages was 3. Only 18.4% reported study conclusions, 7.9% quantified the effects, 28.9% acknowledged some limitations in the research and 42.1% reported potential harms.

CONCLUSIONS

Most online health claims for dietary interventions intended for improving health through the gut microbiome are supported by low or very low certainty of evidence. Online information does not align with the evidence and is incomplete or unbalanced.

Attitudes and awareness of Australian women regarding peripartum antibiotic use: A multicentre survey

BACKGROUND

Peripartum antibiotics are commonly administered. Little is known of the attitudes of pregnant women toward peripartum antibiotics.

AIM

We aimed to assess the awareness of and attitudes toward peripartum antibiotic use in Australian women.

MATERIALS AND METHODS

We surveyed post-partum women at three hospitals over six months. Women reported if they received antibiotics 48 h either side of delivery and responded to statements assessing attitudes to peripartum antibiotic use. Administered antibiotics were recorded. We reported the proportion receiving antibiotics and the proportion aware of receiving them. Participants responded on five-point Likert scales and selected side effects of concern.

RESULTS

Participants responding were 248 of 299 (83%, Royal Brisbane and Women's Hospital), 56 of 106 (53%, Caboolture Hospital) and 17 (Redcliffe Hospital, denominator not recorded). Of 183 (57%) receiving antibiotics, 134 (73%) received them pre-delivery only, 18 (10%) post-delivery only and 31 (17%) pre- and post-delivery. Pre-delivery, the most common indication was pre-incisional prophylaxis for caesarean delivery (93 of 160 responses, 58%). Seventy-nine (51%, 156 responses) of those receiving pre-delivery antibiotics were aware. Of 49 women receiving post-delivery antibiotics, 36 (73%) were aware. Most agreed they were worried that pre-delivery antibiotics would affect their baby (198, 62%) and 160 (50%) were concerned about effects on their own microbiome. Most (204, 65%) agreed they would rather not take antibiotics while breastfeeding.

CONCLUSION

Many women were unaware of receiving pre-delivery antibiotics. Most had concerns about side effects. Improved communication regarding peripartum antibiotic use would improve patient-centred care.

Metaomics in Clinical Laboratory: Potential Driving Force for Innovative Disease Diagnosis

Currently, more and more studies suggested that reductionism was lack of holistic and integrative view of biological processes, leading to limited understanding of complex systems like microbiota and the associated diseases. In fact, microbes are rarely present in individuals but normally live in complex multispecies communities. With the recent development of a variety of metaomics techniques, microbes could be dissected dynamically in both temporal and spatial scales. Therefore, in-depth understanding of human microbiome from different aspects such as genomes, transcriptomes, proteomes, and metabolomes could provide novel insights into their functional roles, which also holds the potential in making them diagnostic biomarkers in many human diseases, though there is still a huge gap to fill for the purpose. In this mini-review, we went through the frontlines of the metaomics techniques and explored their potential applications in clinical diagnoses of human diseases, e.g., infectious diseases, through which we concluded that novel diagnostic methods based on human microbiomes shall be achieved in the near future, while the limitations of these techniques such as standard procedures and computational challenges for rapid and accurate analysis of metaomics data in clinical settings were also examined.