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Stachowska E, Gudan A, Mańkowska-Wierzbicka D, Liebe R, Krawczyk M. Dysbiosis and nutrition in steatotic liver disease: addressing the unrecognized small intestinal bacterial overgrowth (SIBO) challenge. Intern Emerg Med 2024:10.1007/s11739-024-03533-7. [PMID: 38499938 DOI: 10.1007/s11739-024-03533-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/09/2024] [Indexed: 03/20/2024]
Abstract
Steatotic liver disease (SLD) is characterized by hepatic fat accumulation, potentially causing major consequences such as liver decompensation. Currently, we lack medications for the treatment of SLD. Therapeutic recommendations for patients include a hypocaloric diet, weight loss, and physical activity. In particular, the Mediterranean diet is frequently recommended. However, this diet might exacerbate intestinal problems in a subset of patients with coexisting small intestinal bacterial overgrowth (SIBO). Previous studies have reported that SIBO is more predominant in patients with fatty liver than in healthy individuals. Both our research and the findings of others have highlighted a challenge related to nutritional therapy in patients with fatty liver who also suffer from SIBO inasmuch as SIBO induces several phenomena (like bloating or abdominal pain) that can adversely affect patients' quality of life and might be exacerbated by the Mediterranean diet. This may lower their adherence to the intervention. As a solution, we suggest introducing additional diagnostics (e.g., breath test) in patients with SLD who complain of SIBO-like symptoms. The next step is to modify their diets temporarily starting with several weeks of "elimination and sanitation." This would involve restricting products rich in fermentable sugars and polyols, while simultaneously treating the bacterial overgrowth. In summary, while the hypocaloric Mediterranean diet is beneficial for patients with fatty liver, those with coexisting SIBO may experience exacerbated symptoms. It is vital to consider additional diagnostics and dietary modifications for this subset of patients to address both liver and intestinal health concurrently.
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Affiliation(s)
- Ewa Stachowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, Broniewskiego 24, 71-460, Szczecin, Poland.
| | - Anna Gudan
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, Broniewskiego 24, 71-460, Szczecin, Poland
| | - Dorota Mańkowska-Wierzbicka
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Roman Liebe
- Clinic of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University, Magdeburg, Germany
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
- Laboratory of Metabolic Liver Diseases, Center for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
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Mańkowska-Wierzbicka D, Zuraszek J, Wierzbicka A, Gabryel M, Mahadea D, Baturo A, Zakerska-Banaszak O, Slomski R, Skrzypczak-Zielinska M, Dobrowolska A. Alterations in Gut Microbiota Composition in Patients with COVID-19: A Pilot Study of Whole Hypervariable 16S rRNA Gene Sequencing. Biomedicines 2023; 11:biomedicines11020367. [PMID: 36830905 PMCID: PMC9953267 DOI: 10.3390/biomedicines11020367] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/13/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
It is crucial to consider the importance of the microbiome and the gut-lung axis in the context of SARS-CoV-2 infection. This pilot study examined the fecal microbial composition of patients with COVID-19 following a 3-month recovery. Using for the first time metagenomic analysis based on all hypervariable regions (V1-V9) of the 16S rRNA gene, we have identified 561 microbial species; however, 17 were specific only for the COVID-19 group (n = 8). The patients' cohorts revealed significantly greater alpha diversity of the gut microbiota compared to healthy controls (n = 14). This finding has been demonstrated by operational taxonomic units (OTUs) richness (p < 0.001) and Chao1 index (p < 0.01). The abundance of the phylum Verrucomicrobia was 30 times higher in COVID-19 patients compared to healthy subjects. Accordingly, this disproportion was also noted at other taxonomic levels: in the class Verrucomicrobiae, the family Verrucomicrobiaceae, and the genus Akkermansia. Elevated pathobionts such as Escherichia coli, Bilophila wadsworthia, and Parabacteroides distasonis were found in COVID-19 patients. Considering the gut microbiota's ability to disturb the immune response, our findings suggest the importance of the enteric microbiota in the course of SARS-CoV-2 infection. This pilot study shows that the composition of the microbial community may not be fully restored in individuals with SARS-CoV-2 following a 3-month recovery.
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Affiliation(s)
- Dorota Mańkowska-Wierzbicka
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznan, Poland
- Correspondence: (D.M.-W.); (M.S.-Z.)
| | - Joanna Zuraszek
- Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland
| | - Adrianna Wierzbicka
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznan, Poland
| | - Marcin Gabryel
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznan, Poland
| | - Dagmara Mahadea
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznan, Poland
| | - Alina Baturo
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznan, Poland
| | | | - Ryszard Slomski
- Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland
| | - Marzena Skrzypczak-Zielinska
- Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland
- Correspondence: (D.M.-W.); (M.S.-Z.)
| | - Agnieszka Dobrowolska
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznan, Poland
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Sawicka-Gutaj N, Zybek-Kocik A, Kloska M, Ziółkowska P, Czarnywojtek A, Sowiński J, Mańkowska-Wierzbicka D, Ruchała M. Effect of restoration of euthyroidism on visfatin concentrations and body composition in women. Endocr Connect 2021; 10:462-470. [PMID: 33764900 PMCID: PMC8111308 DOI: 10.1530/ec-21-0059] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/24/2021] [Indexed: 12/18/2022]
Abstract
Dysregulation of thyroid function has known impact on body metabolism, however, data regarding metabolic outcome after restoration of thyroid function is limited. Therefore, the aim of the study was to investigate the effect of restoration of euthyroidism on serum visfatin, and its associations with insulin resistance and body composition. This is an observational study with consecutive enrollment. Forty-nine hyperthyroid (median age of 34 years) and 44 hypothyroid women (median age of 46 years) completed the study. Laboratory parameters and body composition analysis were assessed before and after the therapy. In the hyperthyroid group, visfatin concentrations increased (P < 0.0001), while glucose concentrations decreased (P < 0.0001). Total body mass and fat mass in the trunk and limbs significantly increased during the treatment. In the hypothyroid group, significant weight loss resulted from decrease of fat and muscle masses in trunk and limbs. Visfatin serum concentrations positively correlated with total fat mass (r = 0.19, P = 0.01) and insulin concentrations (r = 0.17, P = 0.018). In conclusion, restoration of thyroid function is not associated with beneficial changes in body composition, especially among hyperthyroid females.
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Affiliation(s)
- Nadia Sawicka-Gutaj
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
- Correspondence should be addressed to N Sawicka-Gutaj:
| | - Ariadna Zybek-Kocik
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Michał Kloska
- Lehigh Valley Health Network, Department of Medicine, Lehigh Valley Hospital – Cedar Crest, Allentown, USA
| | - Paulina Ziółkowska
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Agata Czarnywojtek
- Department of Pharmacology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jerzy Sowiński
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Dorota Mańkowska-Wierzbicka
- Department of Gastroenterology, Internal Medicine, Metabolic Diseases and Dietetics, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Wierzbicka A, Mańkowska-Wierzbicka D, Cieślewicz S, Stelmach-Mardas M, Mardas M. Interventions Preventing Vaginitis, Vaginal Atrophy after Brachytherapy or Radiotherapy Due to Malignant Tumors of the Female Reproductive Organs-A Systematic Review. Int J Environ Res Public Health 2021; 18:3932. [PMID: 33918070 PMCID: PMC8070443 DOI: 10.3390/ijerph18083932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Radiotherapy, as a method of treatment of cervical and uterine cancers, may induce severe late-onset vaginal side effects. Unfortunately, little evidence on the management of adverse effects has been presented. This study aimed to evaluate the available interventions which reduce symptoms of vaginitis and vaginal atrophy by improving dyspareunia, mucosal inflammation, vaginal pH and vaginal dryness in women who have undergone brachytherapy or radiotherapy due to uterine or cervical malignancies. MATERIALS AND METHODS A comprehensive literature search was performed following PRISMA guidelines. The systematic search was conducted using electronic databases, namely Scopus, Web of Science and PubMed, between October and November 2020 to identify randomized controlled trials (RCT) and, prospective randomized studies (PRS). RESULTS The analyzed population consists of 376 patients with uterine or cervical cancer, treated with hyaluronic acid, vitamin A, vitamin E, alpha-tocopherol acetate and dienestrol. Intervention with HA along with vitamin A and vitamin E revealed advantage in endpoints such as reduced dyspareunia, vaginal mucosal inflammation, vaginal dryness, bleeding, fibrosis and cellular atypia. Administration of alpha-tocopherol acetate reduced vaginal mucosal inflammation and improved vaginal acanthosis, whereas dienestrol resulted in reduced dyspareunia, vaginal caliber and bleeding. CONCLUSIONS Vaginal suppositories were found to be clinically effective at the management of late-onset vulvovaginal side effects after radiotherapy.
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Affiliation(s)
- Adrianna Wierzbicka
- Department of Obesity Treatment, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Science, Szamarzewskiego 84 St, 60-569 Poznan, Poland
| | - Dorota Mańkowska-Wierzbicka
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Heliodor Święcicki Hospital, Przybyszewskiego 49, 60-355 Poznań, Poland
| | - Stanisław Cieślewicz
- Department of Oncology, Poznan University of Medical Science, Szamarzewskiego 82/84 St, 60-569 Poznan, Poland
| | - Marta Stelmach-Mardas
- Department of Obesity Treatment, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Science, Szamarzewskiego 84 St, 60-569 Poznan, Poland
| | - Marcin Mardas
- Department of Oncology, Poznan University of Medical Science, Szamarzewskiego 82/84 St, 60-569 Poznan, Poland
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Wierzbicka A, Mańkowska-Wierzbicka D, Mardas M, Stelmach-Mardas M. Role of Probiotics in Modulating Human Gut Microbiota Populations and Activities in Patients with Colorectal Cancer-A Systematic Review of Clinical Trials. Nutrients 2021; 13:nu13041160. [PMID: 33915854 PMCID: PMC8066620 DOI: 10.3390/nu13041160] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Growing attention has been given to the role of nutrition and alterations of microbial diversity of the gut microbiota in colorectal cancer (CRC) pathogenesis. It has been suggested that probiotics and synbiotics modulate enteric microbiota and therefore may be used as an intervention to reduce the risk of CRC. The aim of this study was to evaluate the influence of probiotics/synbiotics administration on gut microbiota in patients with CRC. METHODS PubMed, Scopus, and Web of Science were searched between December 2020 and January 2021. Randomized controlled trials (RCTs) recruiting adults with CRC, who have taken probiotics/synbiotics for at least 6 days were included. Changes in gut microbiota and selected biochemical and inflammatory parameters (i.e., hsCRP, IL-2, hemoglobin) were retrieved. RESULTS The search resulted in 198 original research articles and a final 6 were selected as being eligible, including 457 subjects. The median age of patients was 65.4 years old and they were characterized by the median BMI value: 23.8 kg/m2. The literature search revealed that probiotic/synbiotic administration improved enteric microbiota by increasing the abundance of beneficial bacteria such as Lactobacillus, Eubacterium, Peptostreptococcus, Bacillus and Bifidobacterium, and decreased the abundance of potentially harmful bacteria such as Fusobacterium, Porhyromonas, Pseudomonas and Enterococcus. Additionally, probiotic/synbiotic intervention improved release of antimicrobials, intestinal permeability, tight junction function in CRC patients. CONCLUSIONS The use of probiotics/synbiotics positively modulates enteric microbiota, improves postoperative outcomes, gut barrier function and reduces inflammatory parameters in patients suffering from CRC.
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Affiliation(s)
- Adrianna Wierzbicka
- Department of Obesity Treatment, Metabolic Disorders and Clinical Dietetics Poznań University of Medical Sciences, Szamarzewskiego 84, 60-569 Poznań, Poland;
| | - Dorota Mańkowska-Wierzbicka
- Department of Gastroenterology, Metabolic Diseases, Internal Medicine and Dietetics, Poznan University of Medical Sciences, 84, 60-569 Poznań, Poland;
| | - Marcin Mardas
- Department of Oncology, Poznan University of Medical Sciences, 84, 60-569 Poznań, Poland;
| | - Marta Stelmach-Mardas
- Department of Obesity Treatment, Metabolic Disorders and Clinical Dietetics Poznań University of Medical Sciences, Szamarzewskiego 84, 60-569 Poznań, Poland;
- Correspondence: ; Tel.: +48-697424245
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Abstract
PURPOSE OF REVIEW Noncoeliac gluten sensitivity (NCGS) can be suspected after exclusion of coeliac disease and wheat allergy. However, poorly understood pathogenesis of the NCGS, lack of gold standard for diagnosis and agreement in the definition for the NCGS condition, open the space for future investigation. This review aims to give an overview on the diagnosis and effective diet composition in the treatment of NCGS symptoms. RECENT FINDINGS It appears that a diet low in fermentable oligo, di, and monosaccharides and polyols (FODMAPs) and gluten-free diet play a prominent role in the strategy of NCGS management. Considering available evidence with respect to diagnostic tools, it is challenging to prepare a standard guideline for NCGS diagnosis and treatment with clear cut-offs for symptom reduction/improvement that could directly be translated into test results. Nutritional support, including the use of pre/probiotics, has to be tailored to the individual situation of NCGS patients. SUMMARY The exclusion of such components of wheat as amylase/trypsin inhibitors, wheat-germ agglutinins, or free of FODMAPs diet can reduce clinical symptoms of NCGS. The further investigation on microbiota changes may strengthen the knowledge in this area, where the major challenge is to develop biomarkers for NCGS investigation.
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Kloska M, Mańkowska-Wierzbicka D, Człapka-Matyasik M, Dobrowolska A, Grzymisławski M. Oxidative stress in etiopathogenesis of inflammatory bowel diseases. Postepy Biochem 2020; 66:143-150. [PMID: 32700508 DOI: 10.18388/pb.2020_324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/04/2020] [Indexed: 11/10/2022]
Abstract
Inflammatory bowel diseases are a group of chronic diseases of the digestive tract of unknown origin. The etiology of IBD is multifactorial and involves interaction between genetic, environmental and immunological factors with oxidative stress being an inherent part of any one of them. Therefore, the redox equilibrium is crucial to maintain cell homeostasis in the gastrointestinal (GI) tract, which is constantly exposed to large numbers of commensal and pathological bacteria. Distortion of this homeostasis and increase in oxidative stress leads to the propagation of inflammation, mucosal injury in the GI tract and is associated with the development and exacerbation of IBD.
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Affiliation(s)
- Michal Kloska
- Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.
| | - Dorota Mańkowska-Wierzbicka
- Katedra i Klinika Gastroenterologii, Dietetyki i Chorób Wewnętrznych Uniwersytetu Medycznego im. Karola Marcinkowskiego w Poznaniu.
| | | | - Agnieszka Dobrowolska
- Katedra i Klinika Gastroenterologii, Dietetyki i Chorób Wewnętrznych Uniwersytetu Medycznego im. Karola Marcinkowskiego w Poznaniu.
| | - Marian Grzymisławski
- Katedra i Klinika Gastroenterologii, Dietetyki i Chorób Wewnętrznych Uniwersytetu Medycznego im. Karola Marcinkowskiego w Poznaniu.
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Kucharski MA, Wierzbicka A, Tsibulski A, Sotiri E, Dobrowolska A, Mańkowska-Wierzbicka D. Parenteral and Enteral Nutrition: A Bridge to Healing and Biological Therapy in a Patient With Enterocutaneous Fistula and Sepsis Complicated Crohn's Disease. JPEN J Parenter Enteral Nutr 2020; 45:430-433. [PMID: 32386252 DOI: 10.1002/jpen.1875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 12/14/2022]
Abstract
Inflammatory bowel disease (IBD) patients with severe infections, abscess, or sepsis are ineligible for standard treatment using biological and immunosuppressive drug regimens. We report a case of complicated Crohn's disease with ruptured abdominal abscess, presence of enterocutaneous fistula, and sepsis. We also report and discuss patient management with parenteral nutrition (PN) and enteral nutrition (EN) and treatment outcomes. We report a case of a 31-year-old female with a 10-year history of IBD in clinical remission, who, after previous total proctocolectomy with J-pouch, presented to the clinic with severe abdominal pain of 2 days, unintentional weight loss, fatigue, fever, and abdominal abscess, which ruptured, and her clinical state became complicated by sepsis. PN was initiated using individually prepared admixture according to patient requirements, because of inability to tolerate any oral intake. Following the remittance of ileus symptoms, EN was added using a semielemental formula via a nasojejunal tube. Upon completion of the treatment, the fistula resolved, the wound had healed, and Crohn's Disease Activity Index score showed remission. This qualified the patient for initiation of biological therapy with infliximab. Patients with severe infections, abscesses, or sepsis are ineligible for standard IBD treatment using biological and immunosuppressive drug regimens. Furthermore, usually patients' nutrition condition prevents them from combating infection and initiating proper healing process. This case demonstrates the importance of considering nutrition therapy-PN and EN-in unstable patients who cannot be treated with standard pharmacological therapy. Nutrition therapy offers a bridge that allows patients to stabilize and heal before starting standard pharmacological treatment with immunosuppressive agents or biological therapy.
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Affiliation(s)
- Marcin A Kucharski
- Department of Gastroenterology, Metabolic Diseases, Internal Medicine and Dietetics, Heliodor Swiecicki Clinical Hospital, Poznan University of Medical Sciences, Poznan, Poland
| | - Adrianna Wierzbicka
- Department of Gastroenterology, Metabolic Diseases, Internal Medicine and Dietetics, Heliodor Swiecicki Clinical Hospital, Poznan University of Medical Sciences, Poznan, Poland
| | - Alexander Tsibulski
- Department of Gastroenterology, Metabolic Diseases, Internal Medicine and Dietetics, Heliodor Swiecicki Clinical Hospital, Poznan University of Medical Sciences, Poznan, Poland
| | - Emianka Sotiri
- Department of Gastroenterology, Metabolic Diseases, Internal Medicine and Dietetics, Heliodor Swiecicki Clinical Hospital, Poznan University of Medical Sciences, Poznan, Poland
| | - Agnieszka Dobrowolska
- Department of Gastroenterology, Metabolic Diseases, Internal Medicine and Dietetics, Heliodor Swiecicki Clinical Hospital, Poznan University of Medical Sciences, Poznan, Poland
| | - Dorota Mańkowska-Wierzbicka
- Department of Gastroenterology, Metabolic Diseases, Internal Medicine and Dietetics, Heliodor Swiecicki Clinical Hospital, Poznan University of Medical Sciences, Poznan, Poland
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Mańkowska-Wierzbicka D, Michalak S, Karczewski J, Dobrowolska A, Wierzbicka A, Stelmach-Mardas M. Erythrocyte transketolase deficiency in patients suffering from Crohn's disease. Eur Rev Med Pharmacol Sci 2019; 23:8501-8505. [PMID: 31646581 DOI: 10.26355/eurrev_201910_19163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Aim of the study was to assess the possible vitamin B1 deficiency in relation to the exacerbation of Crohn's disease (CD) in adult patients. PATIENTS AND METHODS Forty-nine Crohn's disease (CD) patients with different disease activity (The Crohn's Disease Activity Index-CDAI) were included in the study. Anthropometrical and biochemical parameters, i.e., high sensitive C-reactive protein, were assessed. The spectrophotometric method was used to measure the transketolase activity (TK) in erythrocytes. The normalized transketolase activity ratio (NTKZ) and the percentage of activation with thiamine pyrophosphate (%TPP) were also evaluated. RESULTS The mean values of BMI were close to cut-off: 18.5 kg/m2, indicating a poor nutritional status in CD patients. The patients with moderate-to-severe active CD had a statistically significant higher value of CDAI and hsCRP concentrations compared to those being in the asymptomatic remission or at the mildly active stage of the disease. The level of NTKZ and %TPP were statistically different between the analyzed groups, showing the deficit of vitamin B1 in the group of moderate-to-severe active CD patients (Mean ± SD; NTKZ: 1.99 ± 0.87 vs. 1.54 ± 0.62 U/g Hb; % of TPP: 0.15 ± 0.78 vs. 54.90 ± 38.80). CONCLUSIONS Vitamin B1 deficiency is part of the Crohn's disease manifestation in moderate-to-severe active patients.
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Affiliation(s)
- D Mańkowska-Wierzbicka
- Department of Gastroenterology, Metabolic Diseases, Internal Medicine and Dietetics, Poznan University of Medical Sciences, Poznan, Poland.
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Mańkowska-Wierzbicka D, Karczewski J, Swora-Cwynar E, Dobrowolska A, Stelmach-Mardas M. The Clinical Importance of 21-Day Combined Parenteral and Enteral Nutrition in Active Inflammatory Bowel Disease Patients. Nutrients 2019; 11:nu11092246. [PMID: 31540473 PMCID: PMC6770879 DOI: 10.3390/nu11092246] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 12/13/2022] Open
Abstract
The aim of the study was to show the clinical magnitude of short-term feeding: enteral nutrition (EN) combined with parenteral nutrition (PN) in active Crohn’s disease and ulcerative colitis patients. Among 122 eligible inflammatory bowel disease (IBD) patients, 65 met the inclusion criteria. Combined EN and PN was administered for 21 days, wherein over the first 3–5 days of treatment, trophic enteral nutrition (300 kcal/day) was used with an energy increase of up to 1500 kcal. An EN was administered using a nasogastric tube or, in case of intolerance, using a naso-jejunal tube. For PN, the “All in One” system was used according to individually prepared admixtures (ESPEN Guidelines). In addition to routine blood measurement (i.e., ALAT, ASPAT, GGTP, creatinine, lipid profile), the following parameters were assessed: adiponectin, leptin, (hs)TNF-α, hsIL-6 and hsIL-10, TSH, NT-proBNP, serum vitamin B12 concentration, and tHcy. The results showed a considerable improvement in all clinically significant parameters (p < 0.05), showing the benefits and importance of short-term well-balanced EN combined with PN for nutritional and clinical status in IBD patients with active disease. The daily work at hospitals with active IBD patients demonstrates the potential of continued administration of home-based nutrition by patients.
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Affiliation(s)
- Dorota Mańkowska-Wierzbicka
- Department of Gastroenterology, Metabolic Diseases, Internal Medicine and Dietetics, Poznan University of Medical Sciences, Poznan 60-355, Poland.
| | - Jacek Karczewski
- Department of Gastroenterology, Metabolic Diseases, Internal Medicine and Dietetics, Poznan University of Medical Sciences, Poznan 60-355, Poland.
- Department of Environmental Medicine, Poznan University of Medical Sciences, Poznan 60-806, Poland.
| | - Ewelina Swora-Cwynar
- Department of Gastroenterology, Metabolic Diseases, Internal Medicine and Dietetics, Poznan University of Medical Sciences, Poznan 60-355, Poland.
| | - Agnieszka Dobrowolska
- Department of Gastroenterology, Metabolic Diseases, Internal Medicine and Dietetics, Poznan University of Medical Sciences, Poznan 60-355, Poland.
| | - Marta Stelmach-Mardas
- Department of Biophysics, Poznan University of Medical Sciences, Poznan 60-780, Poland.
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Sawicka-Gutaj N, Zybek-Kocik A, Kloska M, Czarnywojtek A, Sowiński J, Budny B, Woliński K, Ziemnicka K, Mańkowska-Wierzbicka D, Ruchała M. Determinants of Visfatin/NAMPT Serum Concentration and its Leukocyte Expression in Hyperthyroidism. Horm Metab Res 2018; 50:653-660. [PMID: 30184561 DOI: 10.1055/a-0669-1584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We aimed to analyze the potential influence of thyroid autoimmunity on visfatin/NAMPT serum concentration and its leukocyte expression in hyperthyroid patients. This is a single-center, cross-sectional study with consecutive enrollment. All patients with newly diagnosed overt hyperthyroidism in a course of Graves' disease or toxic nodular goiter were included in the study. They underwent physical examination, laboratory investigation, body composition analysis, and thyroid ultrasound. NAMPT mRNA leukocyte expressions were measured using RT-qPCR. Of the 173 patients, 95 were enrolled in further analysis [67 patients with Graves' disease (GD) and 28 with toxic nodular goiter (TNG)]. Control group consisted of 43 healthy volunteers adjusted for age, sex, and BMI. Higher NAMPT/visfatin serum concentration was found in patients with GD comparing with patients with TNG (p=0.03855). We found significant NAMPT leukocyte overexpression in GD patients (n=32) as compared to TNG patients (n=18) and euthyroid controls (n=24) (p=0.005965). Simple linear regression analysis revealed that NAMPT/visfatin serum concentration was significantly associated with NAMPT leukocyte expression, thyroid autoimmunity, age, HOMA-IR, and fat mass percentage (FM%). NAMPT leukocyte expression was related to thyroid autoimmunity, age, and TRAb levels. The stepwise multiple regression analysis revealed FM% and HOMA-IR as independent predictors of visfatin/NAMPT serum levels. In a separate stepwise multiple regression analysis, we confirmed the association between NAMPT leukocyte expression and TRAb levels. We found that fat mass percentage together with HOMA-IR are the most significant predictors of visfatin/NAMPT serum elevation in hyperthyroid patients.
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Affiliation(s)
- Nadia Sawicka-Gutaj
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Ariadna Zybek-Kocik
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Michał Kloska
- Department of Gastroenterology, Metabolic Diseases and Dietetics, Poznan University of Medical Sciences, Poznań, Poland
| | - Agata Czarnywojtek
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
- Department of Pharmacology, Poznan University of Medical Sciences, Poznań, Poland
| | - Jerzy Sowiński
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Bartłomiej Budny
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Kosma Woliński
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Katarzyna Ziemnicka
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Dorota Mańkowska-Wierzbicka
- Department of Gastroenterology, Metabolic Diseases and Dietetics, Poznan University of Medical Sciences, Poznań, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
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Mańkowska-Wierzbicka D, Karczewski J, Poniedziałek B, Grzymisławska M, Staszewski R, Królczyk A, Dobrowolska A, Grzymisławski M. C-reactive protein as a diagnostic and prognostic factor in inflammatory bowel diseases. ACTA ACUST UNITED AC 2016; 70:1124-1130. [PMID: 27892896 DOI: 10.5604/17322693.1223798] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM The study aimed to evaluate high-sensitivity CRP (hsCRP) as a diagnostic and predictive marker in patients with inflammatory bowel disease (IBD). MATERIAL/METHODS Medical history of 106 patients with IBD revealed hsCRP concentrations at diagnosis and during the follow-up period. RESULTS The study showed that the majority of investigated patients had elevated hsCRP concentrations at diagnosis, although the mean concentration was much higher in the group of patients with Crohn's disease (CD) than the group with ulcerative colitis (UC) (P<0.001). The overall decrease in mean hsCRP concentration observed during the follow-up period was larger in the group of CD patients. The analysis showed a correlation between hsCRP concentrations at diagnosis and risk of surgery in the group of CD patients (r=0.408, P=0.002), but not in the group of UC patients. In a logistic regression analysis, surgery in CD patients was associated with age (OR: 0.89, 95% CI: 0.8-1.0, P=0.05) and hsCRP concentration (OR: 1.02, 95% CI: 1.0-1.04, P=0.03) at diagnosis. DISCUSSION HsCRP might be a useful diagnostic marker in differentiating active IBD from other diseases. Particularly important however seems to be the predictive value of hsCRP at diagnosis in prognosing the clinical outcome of the disease in CD patients.
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Affiliation(s)
| | - Jacek Karczewski
- Department of Environmental Medicine, Poznan University of Medical Sciences
| | | | | | - Rafał Staszewski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences
| | | | - Agnieszka Dobrowolska
- Department of Gastroenterology, Human Nutrition and Internal Disases, Poznan University of Medical Sciences
| | - Marian Grzymisławski
- Department of Internal Diseases, Metablism and Nutrition, Poznan University of Medical Sciences
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Sawicka-Gutaj N, Zybek-Kocik A, Klimowicz A, Kloska M, Mańkowska-Wierzbicka D, Sowiński J, Ruchała M. Circulating Visfatin in Hypothyroidism Is Associated with Free Thyroid Hormones and Antithyroperoxidase Antibodies. Int J Endocrinol 2016; 2016:7402469. [PMID: 26884761 PMCID: PMC4739229 DOI: 10.1155/2016/7402469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/27/2015] [Indexed: 01/28/2023] Open
Abstract
We hypothesized that regulation of visfatin in hypothyroidism might be altered by coexisting chronic autoimmune thyroiditis. This is a prospective case-control study of 118 subjects. The autoimmune study group (AIT) consisted of 39 patients newly diagnosed with hypothyroidism in a course of chronic autoimmune thyroiditis. The nonautoimmune study group (TT) consisted of 40 patients thyroidectomized due to the differentiated thyroid cancer staged pT1. The control group comprised 39 healthy volunteers adjusted for age, sex, and BMI with normal thyroid function and negative thyroid antibodies. Exclusion criteria consisted of other autoimmune diseases, active neoplastic disease, diabetes mellitus, and infection, which were reported to alter visfatin level. Fasting blood samples were taken for visfatin, TSH, free thyroxine (FT4), free triiodothyronine (FT3), antithyroperoxidase antibodies (TPOAb), antithyroglobulin antibodies (TgAb), glucose, and insulin levels. The highest visfatin serum concentration was in AIT group, and healthy controls had visfatin level higher than TT (p = 0.0001). Simple linear regression analysis revealed that visfatin serum concentration was significantly associated with autoimmunity (β = 0.1014; p = 0.003), FT4 (β = 0.05412; p = 0.048), FT3 (β = 0.05242; p = 0.038), and TPOAb (β = 0.0002; p = 0.0025), and the relationships were further confirmed in the multivariate regression analysis.
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Affiliation(s)
- Nadia Sawicka-Gutaj
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Przybyszewski Street 49, 60-355 Poznań, Poland
- *Nadia Sawicka-Gutaj:
| | - Ariadna Zybek-Kocik
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Przybyszewski Street 49, 60-355 Poznań, Poland
| | - Aleksandra Klimowicz
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Przybyszewski Street 49, 60-355 Poznań, Poland
| | - Michał Kloska
- Department of Gastroenterology, Human Nutrition and Internal Diseases, Poznan University of Medical Sciences, Przybyszewski Street 49, 60-355 Poznań, Poland
| | - Dorota Mańkowska-Wierzbicka
- Department of Gastroenterology, Human Nutrition and Internal Diseases, Poznan University of Medical Sciences, Przybyszewski Street 49, 60-355 Poznań, Poland
| | - Jerzy Sowiński
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Przybyszewski Street 49, 60-355 Poznań, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Przybyszewski Street 49, 60-355 Poznań, Poland
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Swora-Cwynar E, Karczewski J, Musiał A, Grzymisławski M, Marcinkowska E, Dobrowolska A, Mańkowska-Wierzbicka D. Assessment of nutritional status and feeding methods in patients with inflammatory bowel disease. JMS 2015. [DOI: 10.20883/medical.e14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Aim. The aim of this study was to evaluate diet of patients with IBD, their nutritional status and potential differences as compared to diet of healthy persons.Material and methods. The examination included the patients of Internal, Metabolic Diseases and Dietetics Ward and Gastroenterology, Internal Diseases and Human Nutrition Ward of Heliodor Święcicki Clinic in the Poznan University of Medical Sciences in Poznan. The criterion allowing participation into the study involved a diagnosed ulcerative or Crohn’s disease, basing on histopathology and radiological examination. The study was conducted on 50 patients, 25 women and 25 men. The control of group included 50 persons, 30 women and 20 men, potentially healthy and occupationally active. In the study the authors' own questionnaire was used, which contained questions related to diet and evaluating conditions of nutrition, based on the results of anthropometric measurements and selected biochemical parameters.Results. The study documented that IBD affected diet, which proved to be distinct from that of potentially healthy person. Course of the disease reduced some laboratory parameters in serum: decreased levels of total protein were detected in 40% patients, reduced levels of albumin in 28% patients and of haemoglobin in 72% patients with IBD. Most of patients introduced some modifications and dietary restrictions to reduce the symptoms and prolong remission. Presentation of such attitudes, indicates a need for an effective multidirectional education, which should affect a conscious decision making about the diet. The Body Mass Index and evaluation of nutrition demonstrated that IBD predisposed development of malnutrition: as compared to the control group, 28% of the patients manifested underweight.
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Mańkowska-Wierzbicka D, Karczewski J, Dobrowolska-Zachwieja A, Adamski Z. The microbiome and dermatological diseases. POSTEP HIG MED DOSW 2015; 69:978-985. [PMID: 26400884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
The human skin harbours hundreds of species of commensal organisms, collectively known as the skin microbiota. The composition of the microbiota can be modified by various factors, such as host genotype, diet, antibiotics, hygiene, and pathogen infections, among others. Changes in these factors can cause microbiome disruption known as dysbiosis, leading to the outgrowth of potential pathogenic bacteria or a decrease in the number of beneficial bacteria. Dysbiosis has been implicated in some dermatological diseases. This mini-review aims to discuss the topic of the skin microbiota and its potential effects on various skin diseases.
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Affiliation(s)
| | | | | | - Zygmunt Adamski
- Poznan University of Medical Sciences in Poznan, Poznan, Poland
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