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Fairley JK, Ferreira JA, Fraga LAO, Lyon S, Valadão Cardoso TM, Boson VC, Madureira Nunes AC, Medeiros Cinha EH, de Oliveira LBP, Magueta Silva EB, Marçal PHF, Branco AC, Grossi MAF, Jones DP, Ziegler TR, Collins JM. High-Resolution Plasma Metabolomics Identifies Alterations in Fatty Acid, Energy, and Micronutrient Metabolism in Adults Across the Leprosy Spectrum. J Infect Dis 2024; 229:1189-1199. [PMID: 37740551 PMCID: PMC11011203 DOI: 10.1093/infdis/jiad410] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND High-resolution metabolomics (HRM) is an innovative tool to study challenging infectious diseases like leprosy, where the pathogen cannot be grown with standard methods. Here, we use HRM to better understand associations between disease manifestations, nutrition, and host metabolism. METHODS From 2018 to 2019, adults with leprosy and controls were recruited in Minas Gerais, Brazil. Plasma metabolites were detected using an established HRM workflow and characterized by accurate mass, mass to charge ratio m/z and retention time. The mummichog informatics package compared metabolic pathways between cases and controls and between multibacillary (MB) and paucibacillary (PB) leprosy. Additionally, select individual metabolites were quantified and compared. RESULTS Thirty-nine cases (62% MB and 38% PB) and 25 controls were enrolled. We found differences (P < .05) in several metabolic pathways, including fatty acid metabolism, carnitine shuttle, retinol, vitamin D3, and C-21 steroid metabolism, between cases and controls with lower retinol and associated metabolites in cases. Between MB and PB, leukotrienes, prostaglandins, tryptophan, and cortisol were all found to be lower in MB (P < .05). DISCUSSION Metabolites associated with several nutrient-related metabolic pathways appeared differentially regulated in leprosy, especially MB versus PB. This pilot study demonstrates the metabolic interdependency of these pathways, which may play a role in the pathophysiology of disease.
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Affiliation(s)
- Jessica K Fairley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - José A Ferreira
- Faculdade da Saúde e Écologia Humana, FASEH, Vespasiano, Minas Gerais, Brazil
| | - Lucia A O Fraga
- Department of Health Sciences, Universidade Federal de Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Sandra Lyon
- Faculdade da Saúde e Écologia Humana, FASEH, Vespasiano, Minas Gerais, Brazil
- Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Victor Campos Boson
- Faculdade da Saúde e Écologia Humana, FASEH, Vespasiano, Minas Gerais, Brazil
| | | | - Eloisa H Medeiros Cinha
- Department of Health Sciences, Universidade Federal de Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Lorena B P de Oliveira
- Department of Health Sciences, Universidade Federal de Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Erica B Magueta Silva
- Department of Health Sciences, Universidade Federal de Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Pedro H F Marçal
- Department of Health Sciences, Universidade Federal de Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Alexandre C Branco
- Centro de Referência em Doenças Endêmicas e Programs Especiais, Governador Valadares, Minas Gerais, Brazil
| | | | - Dean P Jones
- Division of Pulmonary, Critical Care, and Allergy, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jeffrey M Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Sivapiromrat AK, Suppakitjanusant P, Wang Y, Hu C, Binongo J, Hunt WR, Weinstein S, Jathal I, Alvarez JA, Chassaing B, Ziegler TR, Gewirtz AT, Tangpricha V. Vitamin D and prebiotics for intestinal health in cystic fibrosis: Rationale and design for a randomized, placebo-controlled, double-blind, 2 x 2 trial of administration of prebiotics and cholecalciferol (vitamin D 3) (Pre-D trial) in adults with cystic fibrosis. Contemp Clin Trials Commun 2024; 38:101278. [PMID: 38435430 PMCID: PMC10904905 DOI: 10.1016/j.conctc.2024.101278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 01/18/2024] [Accepted: 02/17/2024] [Indexed: 03/05/2024] Open
Abstract
Individuals with cystic fibrosis (CF) have dysfunctional intestinal microbiota and increased gastrointestinal (GI) inflammation also known as GI dysbiosis. It is hypothesized that administration of high-dose cholecalciferol (vitamin D3) together with a prebiotic (inulin) will be effective, and possibly additive or synergistic, in reducing CF-related GI and airway dysbiosis. Thus, a 2 x 2 factorial design, placebo-controlled, double-blinded, pilot and feasibility, clinical trial was proposed to test this hypothesis. Forty adult participants with CF were block-randomized into one of four groups: 1) high-dose oral vitamin D3 (50,000 IU weekly) plus oral prebiotic placebo daily; 2) oral prebiotic (12 g inulin daily) plus oral placebo vitamin D3 weekly; 3) combined oral vitamin D3 weekly and oral prebiotic inulin daily; and 4) oral vitamin D3 placebo weekly and oral prebiotic placebo. The primary endpoints included 12-week changes in the microbial bacterial communities, gut and airway microbiota richness and diversity before and after the intervention. This pilot study examined whether vitamin D3 with or without prebiotics supplementation was feasible, changed airway and gut microbiota, and reduced dysbiosis, which in turn, may improve health outcomes and quality of life of patients with CF.
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Affiliation(s)
- Alisa K. Sivapiromrat
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Emory College, Emory University, Atlanta, GA, USA
| | - Pichatorn Suppakitjanusant
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yanling Wang
- Center for Inflammation, Immunity & Infection, Institute for Biomedical Sciences, Georgia State University, Atlanta, GA, USA
| | - Chengcheng Hu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jose Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - William R. Hunt
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Jessica A. Alvarez
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Benoit Chassaing
- INSERM U1016, Team “Mucosal Microbiota in Chronic Inflammatory Diseases”, CNRS, UMR, 8104, Université Paris Cité, Paris, France
| | - Thomas R. Ziegler
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - Andrew T. Gewirtz
- Center for Inflammation, Immunity & Infection, Institute for Biomedical Sciences, Georgia State University, Atlanta, GA, USA
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
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Sivapiromrat AK, Hunt WR, Alvarez JA, Ziegler TR, Tangpricha V. Vitamin D for glycemic control following an acute pulmonary exacerbation: A secondary analysis of a multicenter, double-blind, randomized, placebo-controlled trial in adults with cystic fibrosis. medRxiv 2024:2024.01.04.24300862. [PMID: 38343807 PMCID: PMC10854353 DOI: 10.1101/2024.01.04.24300862] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Individuals with cystic fibrosis (CF) often incur damage to pancreatic tissue due to a dysfunctional cystic fibrosis transmembrane conductance regulator (CFTR) protein, leading to altered chloride transport on epithelial surfaces and subsequent development of cystic fibrosis-related diabetes (CFRD). Vitamin D deficiency has been associated with the development of CFRD. This was a secondary analysis of a multicenter, double-blind, randomized, placebo-controlled study in adults with CF hospitalized for an acute pulmonary exacerbation (APE), known as the Vitamin D for the Immune System in Cystic Fibrosis (DISC) trial (NCT01426256). This was a pre-planned secondary analysis to examine if a high-dose bolus of cholecalciferol (vitamin D3) can mitigate declined glucose tolerance commonly associated with an acute pulmonary exacerbation (APE). Glycemic control was assessed by hemoglobin A1c (HbA1c) and fasting blood glucose levels before and 12 months after the study intervention. Within 72 hours of hospital admission, participants were randomly assigned to a single dose of oral vitamin D3 (250,000 IU) or placebo, and subsequently, received 50,000 IU of vitamin D3 or placebo every other week, beginning at month 3 and ending on month 12. Forty-nine of the 91 participants in the parent study were eligible for the secondary analysis. There were no differences in 12-month changes in HbA1c or fasting blood glucose in participants randomized to vitamin D or placebo. A high-dose bolus of vitamin D3 followed by maintenance vitamin D3 supplementation did not improve glycemic control in patients with CF after an APE.
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Affiliation(s)
- Alisa K. Sivapiromrat
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - William R. Hunt
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jessica A. Alvarez
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Thomas R. Ziegler
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
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Alvarez-Nuncio MDC, Ziegler TR. Micronutrient status and protein-energy malnutrition in free-living older adults: a current perspective. Curr Opin Gastroenterol 2024; 40:99-105. [PMID: 38193299 PMCID: PMC10872245 DOI: 10.1097/mog.0000000000001000] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW This review addresses the newest findings on micronutrient status and protein-energy malnutrition in the increasingly aging global population; understanding the nutritional challenges they face is vital for healthcare, well being, and public health. RECENT FINDINGS The review examines deficiencies in macro- and micronutrients among nonhospitalized, free-living older adults, revealing significant associated health consequences, including frailty, cognitive decline, and reduced quality of life. Deficiencies in fat-soluble vitamins such as A, D, and E, are common in older populations, emphasizing the need for close monitoring for status of these. Furthermore, water-soluble vitamin deficiencies, especially vitamins B12 and C are also common, and pose health risks, including neurological disorders and cognitive decline. Iron and iodine deficiencies contribute to anemia, and neurocognitive disorders. Finally, protein-energy malnutrition is common in older adults living in high-resource countries and may occur concomitant with depletion of one or more micronutrients. SUMMARY Addressing specific nutritional deficiencies is fundamental to enhancing the wellbeing and quality of life for free-living older adults. Protein-energy malnutrition, impacting over 25% of those aged 65 and above, results in a range of health issues, including poor wound healing, susceptibility to infections, anemia, and delayed convalescence. These concerns are aggravated by inadequate energy, macronutrient, and micronutrient intake, affecting muscle strength and overall health. Future research should focus on tailored appropriate monitoring of at-risk individuals, specific nutritional interventions, and dietary strategies to mitigate these issues and improve health outcomes among older adults.
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Affiliation(s)
| | - Thomas R Ziegler
- Department of Medicine, Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA, USA
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Hartman TJ, Christie J, Wilson A, Ziegler TR, Methe B, Flanders WD, Rolls BJ, Loye Eberhart B, Li JV, Huneault H, Cousineau B, Perez MR, O'Keefe SJD. Fibre-rich Foods to Treat Obesity and Prevent Colon Cancer trial study protocol: a randomised clinical trial of fibre-rich legumes targeting the gut microbiome, metabolome and gut transit time of overweight and obese patients with a history of noncancerous adenomatous polyps. BMJ Open 2024; 14:e081379. [PMID: 38316601 PMCID: PMC10860035 DOI: 10.1136/bmjopen-2023-081379] [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] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/15/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Recently published studies support the beneficial effects of consuming fibre-rich legumes, such as cooked dry beans, to improve metabolic health and reduce cancer risk. In participants with overweight/obesity and a history of colorectal polyps, the Fibre-rich Foods to Treat Obesity and Prevent Colon Cancer randomised clinical trial will test whether a high-fibre diet featuring legumes will simultaneously facilitate weight reduction and suppress colonic mucosal biomarkers of colorectal cancer (CRC). METHODS/DESIGN This study is designed to characterise changes in (1) body weight; (2) biomarkers of insulin resistance and systemic inflammation; (3) compositional and functional profiles of the faecal microbiome and metabolome; (4) mucosal biomarkers of CRC risk and (5) gut transit. Approximately 60 overweight or obese adults with a history of noncancerous adenomatous polyps within the previous 3 years will be recruited and randomised to one of two weight-loss diets. Following a 1-week run-in, participants in the intervention arm will receive preportioned high-fibre legume-rich entrées for two meals/day in months 1-3 and one meal/day in months 4-6. In the control arm, entrées will replace legumes with lean protein sources (eg, chicken). Both groups will receive in-person and written guidance to include nutritionally balanced sides with energy intake to lose 1-2 pounds per week. ETHICS AND DISSEMINATION The National Institutes of Health fund this ongoing 5-year study through a National Cancer Institute grant (5R01CA245063) awarded to Emory University with a subaward to the University of Pittsburgh. The study protocol was approved by the Emory Institutional Review Board (IRB approval number: 00000563). TRIAL REGISTRATION NUMBER NCT04780477.
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Affiliation(s)
- Terryl J Hartman
- Department of Epidemiology, Rollins School of Public Health and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
- Nutrition and Health Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jennifer Christie
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Annette Wilson
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas R Ziegler
- Department of Medicine, Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Barbara Methe
- Pulmonary, Allergy and Critical Care Medicine, Center for the Microbiome and Medicine, University of Pittsburg, Pittsburgh, Pennsylvania, USA
| | - William Dana Flanders
- Department of Biostatistics and Bioinformatics, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Barbara J Rolls
- Department of Nutritional Sciences, The Pennsylvania State University, State College, Pennsylvania, USA
| | - Blaine Loye Eberhart
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jia V Li
- Section of Nutrition Research, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Commonwealth Building, Hammersmith Hospital Campus, Imperial College London, South Kensington, London, UK
| | - Helaina Huneault
- Nutrition and Health Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ben Cousineau
- Nutrition and Health Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Miriam R Perez
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stephen J D O'Keefe
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Levine DA, Mathew NE, Jung EH, Yan J, Newman NJ, Thulasi P, Yeh S, Ziegler TR, Wells J, Jain N. Characteristics of Vitamin A Deficiency Retinopathy at a Tertiary Referral Center in the United States. Ophthalmol Retina 2024; 8:126-136. [PMID: 37673395 DOI: 10.1016/j.oret.2023.08.021] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/14/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE To explore the risk factors and fundus imaging features of vitamin A deficiency retinopathy (VADR) in an academic tertiary referral center in Atlanta, GA, United States, and to propose guidance regarding diagnostic workup and management of affected patients. DESIGN Single-center retrospective case series. SUBJECTS Nine patients seen between 2015 and 2021 at the Emory Eye Center diagnosed with VADR. METHODS Retrospective chart review. MAIN OUTCOME MEASURES Baseline serum retinol level, Snellen visual acuity, multimodal fundus imaging findings, and electroretinography findings. RESULTS Nine patients, 4 (44.4%) female, with a median (range) age of 68 (50-75) years were identified. The most common underlying etiologies for vitamin A deficiency included history of gastrointestinal surgery (55.6%), liver disease (44.4%), and nutritional depletion due to low-quality diet (44.4%). Only 1 (11.1%) patient had a history of bariatric surgery. Four (44.4%) patients were on some form of vitamin A supplementation before the diagnosis of VADR. Median (range) serum retinol level was 0.06 (< 0.06-0.19) mg/L. All patients had macular subretinal hyperreflective deposits resembling subretinal drusenoid deposits, although in some cases, these were scant and sparsely distributed. Six eyes of 3 patients with longstanding deficiency had defects in the external limiting membrane (ELM). Three of these eyes additionally had macular areas of complete retinal pigment epithelium and outer retinal atrophy (cRORA). Full-field electroretinography demonstrated severe rod dysfunction and mild to moderate cone system dysfunction. Many findings of VADR were reversible with vitamin A repletion. However, all eyes with ELM defects or cRORA had persistence or continued growth of these lesions. CONCLUSION Vitamin A deficiency retinopathy is uncommon in the developed world. However, given that early intervention can lead to dramatic visual improvement and avoid potentially permanent retinal damage, retina specialists should be familiar with its clinical presentation. The presence of nyctalopia and subretinal hyperreflective deposits in a patient with a history of gastrointestinal surgery, liver disease, and/or poor diet can be suggestive of this diagnosis, even in the presence of ongoing vitamin A supplementation. Vitamin A supplementation can vary in route and dosage and can be tailored to the individual with serial testing of serum retinol. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- David A Levine
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Namita E Mathew
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Emily H Jung
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jiong Yan
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia; Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Praneetha Thulasi
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Steven Yeh
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Thomas R Ziegler
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jill Wells
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Nieraj Jain
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
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Sivapiromrat AK, Suppakitjanusant P, Wang Y, Binongo J, Hunt WR, Gewirtz A, Alvarez JA, Hu C, Weinstein S, Jathal I, Ziegler TR, Tangpricha V. Vitamin D and Prebiotics for Intestinal Health in Cystic Fibrosis: Rationale and design for a randomized, placebo-controlled, double-blind, 2 × 2 trial of administration of prebiotics and cholecalciferol (vitamin D 3) (Pre-D Trial) in adults with cystic fibrosis. medRxiv 2024:2024.01.04.24300860. [PMID: 38343811 PMCID: PMC10854319 DOI: 10.1101/2024.01.04.24300860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Individuals with cystic fibrosis (CF) have dysfunctional intestinal microbiota and increased gastrointestinal (GI) inflammation also known as GI dysbiosis. It is hypothesized that administration of high-dose cholecalciferol (vitamin D3) together with a prebiotic (inulin) will be effective, and possibly additive or synergistic, in reducing CF-related GI dysbiosis and improving intestinal functions. Thus, a 2 × 2 factorial design, placebo-controlled, double-blind, clinical trial was proposed to test this hypothesis. Forty adult participants with CF will be block-randomized into one of four groups: 1) high-dose oral vitamin D3 (50,000 IU weekly) plus oral prebiotic placebo daily; 2) oral prebiotic (12 g inulin daily) plus oral placebo vitamin D3 weekly; 3) combined oral vitamin D3 weekly and oral prebiotic inulin daily; and 4) oral vitamin D3 placebo weekly and oral prebiotic placebo. The primary endpoints will include 12-week changes in the reduced relative abundance of gammaproteobacteria, and gut microbiota richness and diversity before and after the intervention. This clinical study will examine whether vitamin D3 with or without prebiotics will improve intestinal health and reduce GI dysbiosis, which in turn, should improve health outcomes and quality of life of patients with CF.
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Affiliation(s)
| | - Pichatorn Suppakitjanusant
- Emory University, Atlanta, GA, USA
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yanling Wang
- Center for Inflammation, Immunity & Infection, Institute for Biomedical Sciences, Georgia State University, Atlanta, GA, USA
| | - Jose Binongo
- Emory University, Atlanta, GA, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - William R Hunt
- Emory University, Atlanta, GA, USA
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew Gewirtz
- Center for Inflammation, Immunity & Infection, Institute for Biomedical Sciences, Georgia State University, Atlanta, GA, USA
| | - Jessica A Alvarez
- Emory University, Atlanta, GA, USA
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Chengcheng Hu
- Emory University, Atlanta, GA, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Thomas R Ziegler
- Emory University, Atlanta, GA, USA
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Vin Tangpricha
- Emory University, Atlanta, GA, USA
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Taibl KR, Bellissimo MP, Smith MR, Liu KH, Tran VT, Jones DP, Ziegler TR, Alvarez JA. Characterizing substrate utilization during the fasted state using plasma high-resolution metabolomics. Nutrition 2023; 116:112160. [PMID: 37566924 PMCID: PMC10787037 DOI: 10.1016/j.nut.2023.112160] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/29/2023] [Accepted: 07/09/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVES High-resolution metabolomics enables global assessment of metabolites and molecular pathways underlying physiologic processes, including substrate utilization during the fasted state. The clinical index for substrate utilization, respiratory exchange ratio (RER), is measured via indirect calorimetry. The aim of this pilot study was to use metabolomics to identify metabolic pathways and plasma metabolites associated with substrate utilization in healthy, fasted adults. METHODS This cross-sectional study included 33 adults (mean age 27.7 ± 4.9 y, mean body mass index 24.8 ± 4 kg/m2). Participants underwent indirect calorimetry to determine resting RER after an overnight fast. Untargeted metabolomics was performed on fasted plasma samples using dual-column liquid chromatography and ultra-high-resolution mass spectrometry. Linear regression and pathway enrichment analyses identified pathways and metabolites associated with substrate utilization measured with indirect calorimetry. RESULTS RER was significantly associated with 1389 metabolites enriched within 13 metabolic pathways (P < 0.05). Lipid-related findings included general pathways, such as fatty acid activation, and specific pathways, such as C21-steroid hormone biosynthesis and metabolism, butyrate metabolism, and carnitine shuttle. Amino acid pathways included those central to metabolism, such as glucogenic amino acids, and pathways needed to maintain reduction-oxidation reactions, such as methionine and cysteine metabolism. Galactose and pyrimidine metabolism were also associated with RER (all P < 0.05). CONCLUSIONS The fasting plasma metabolome reflects the diverse macronutrient pathways involved in carbohydrate, amino acid, and lipid metabolism during the fasted state in healthy adults. Future studies should consider the utility of metabolomics to profile individual nutrient requirements and compare findings reported here to clinical populations.
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Affiliation(s)
- Kaitlin R Taibl
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - Moriah P Bellissimo
- Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States
| | - Matthew Ryan Smith
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Ken H Liu
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
| | - ViLinh T Tran
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Dean P Jones
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States; Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, Georgia, United States
| | - Jessica A Alvarez
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States; Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, Georgia, United States.
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Gundogan K, Nellis MM, Ozer NT, Ergul SS, Sahin GG, Temel S, Yuksel RC, Teeny S, Alvarez JA, Sungur M, Jones DP, Ziegler TR. High-Resolution Plasma Metabolomics and Thiamine Status in Critically Ill Adult Patients. Res Sq 2023:rs.3.rs-3597052. [PMID: 38014088 PMCID: PMC10680934 DOI: 10.21203/rs.3.rs-3597052/v1] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND AIM Thiamine (Vitamin B1) is an essential micronutrient and a co-factor for metabolic functions related to energy metabolism. We determined the association between whole blood thiamine pyrophosphate (TPP) concentrations and plasma metabolites using high resolution metabolomics in critically ill patients. Methods Cross-sectional study performed in Erciyes University Hospital, Kayseri, Turkey and Emory University, Atlanta, GA, USA. Participants were ≥ 18 years of age, with an expected length of ICU stay longer than 48 hours, receiving furosemide therapy for at least 6 months before ICU admission. Results Blood for TPP and metabolomics was obtained on the day of ICU admission. Whole blood TPP concentrations were measured using high-performance liquid chromatography (HPLC). Liquid chromatography/mass spectrometry was used for plasma high-resolution metabolomics. Data was analyzed using regression analysis of TPP levels against all plasma metabolomic features in metabolome-wide association studies. We also compared metabolomic features from patients in the highest TPP concentration tertile to patients in the lowest TPP tertile as a secondary analysis. We enrolled 76 participants with a median age of 69 (range, 62.5-79.5) years. Specific metabolic pathways associated with whole blood TPP levels, using both regression and tertile analysis, included pentose phosphate, fructose and mannose, branched chain amino acid, arginine and proline, linoleate, and butanoate pathways. Conclusions Plasma high-resolution metabolomics analysis showed that whole blood TPP concentrations are significantly associated with metabolites and metabolic pathways linked to the metabolism of energy, amino acids, lipids, and the gut microbiome in adult critically ill patients.
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10
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Baggs GE, Middleton C, Nelson JL, Pereira SL, Hegazi RM, Matarese L, Matheson E, Ziegler TR, Tappenden KA, Deutz N. Impact of a specialized oral nutritional supplement on quality of life in older adults following hospitalization: Post-hoc analysis of the NOURISH trial. Clin Nutr 2023; 42:2116-2123. [PMID: 37757502 DOI: 10.1016/j.clnu.2023.09.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND & AIMS Both during and after hospitalization, nutritional care with daily intake of oral nutritional supplements (ONS) improves health outcomes and decreases risk of mortality in malnourished older adults. In a post-hoc analysis of data from hospitalized older adults with malnutrition risk, we sought to determine whether consuming a specialized ONS (S-ONS) containing high protein and beta-hydroxy-beta-methylbutyrate (HMB) can also improve Quality of Life (QoL). METHODS We analyzed data from the NOURISH trial-a randomized, placebo-controlled, multi-center, double-blind study conducted in patients with congestive heart failure, acute myocardial infarction, pneumonia, or chronic obstructive pulmonary disease. Patients received standard care + S-ONS or placebo beverage (target 2 servings/day) during hospitalization and for 90 days post-discharge. SF-36 and EQ-5D QoL outcomes were assessed at 0-, 30-, 60-, and 90-days post-discharge. To account for the missing QoL observations (27.7%) due to patient dropout, we used multiple imputation. Data represent differences between least squares mean (LSM) values with 95% Confidence Intervals for groups receiving S-ONS or placebo treatments. RESULTS The study population consisted of 622 patients of mean age ±standard deviation: 77.9 ± 8.4 years and of whom 52.1% were females. Patients consuming placebo had lower (worse) QoL domain scores than did those consuming S-ONS. Specifically for the SF-36 health domain scores, group differences (placebo vs S-ONS) in LSM were significant for the mental component summary at day 90 (-4.23 [-7.75, -0.71]; p = 0.019), the domains of mental health at days 60 (-3.76 [-7.40, -0.12]; p = 0.043) and 90 (-4.88 [-8.41, -1.34]; p = 0.007), vitality at day 90 (-3.33 [-6.65, -0.01]; p = 0.049) and social functioning at day 90 (-4.02 [-7.48,-0.55]; p = 0.023). Compared to placebo, differences in LSM values for the SF-36 general health domain were significant with improvement in the S-ONS group at hospital discharge and beyond: day 0 (-2.72 [-5.33, -0.11]; p = 0.041), day 30 (-3.08 [-6.09, -0.08]; p = 0.044), day 60 (-3.95 [-7.13, -0.76]; p = 0.015), and day 90 (-4.56 [-7.74, -1.38]; p = 0.005). CONCLUSIONS In hospitalized older adults with cardiopulmonary diseases and evidence of poor nutritional status, daily intake of S-ONS compared to placebo improved post-discharge QoL scores for mental health/cognition, vitality, social functioning, and general health. These QoL benefits complement survival benefits found in the original NOURISH trial analysis. CLINICAL TRIAL REGISTRATION NCT01626742.
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Affiliation(s)
| | - Carly Middleton
- Abbott Nutrition Research and Development, Columbus, OH, USA
| | | | | | - Refaat M Hegazi
- Abbott Nutrition Research and Development, Columbus, OH, USA
| | - Laura Matarese
- Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Eric Matheson
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Nicolaas Deutz
- Center for Translational Research in Aging & Longevity, Texas A&M University, College Station, TX, USA
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11
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Woodworth MH, Conrad RE, Haldopoulos M, Pouch SM, Babiker A, Mehta AK, Sitchenko KL, Wang CH, Strudwick A, Ingersoll JM, Philippe C, Lohsen S, Kocaman K, Lindner BG, Hatt JK, Jones RM, Miller C, Neish AS, Friedman-Moraco R, Karadkhele G, Liu KH, Jones DP, Mehta CC, Ziegler TR, Weiss DS, Larsen CP, Konstantinidis KT, Kraft CS. Fecal microbiota transplantation promotes reduction of antimicrobial resistance by strain replacement. Sci Transl Med 2023; 15:eabo2750. [PMID: 37910603 PMCID: PMC10821315 DOI: 10.1126/scitranslmed.abo2750] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/05/2023] [Indexed: 11/03/2023]
Abstract
Multidrug-resistant organism (MDRO) colonization is a fundamental challenge in antimicrobial resistance. Limited studies have shown that fecal microbiota transplantation (FMT) can reduce MDRO colonization, but its mechanisms are poorly understood. We conducted a randomized, controlled trial of FMT for MDRO decolonization in renal transplant recipients called PREMIX (NCT02922816). Eleven participants were enrolled and randomized 1:1 to FMT or an observation period followed by delayed FMT if stool cultures were MDRO positive at day 36. Participants who were MDRO positive after one FMT were treated with a second FMT. At last visit, eight of nine patients who completed all treatments were MDRO culture negative. FMT-treated participants had longer time to recurrent MDRO infection versus PREMIX-eligible controls who were not treated with FMT. Key taxa (Akkermansia muciniphila, Alistipes putredinis, Phocaeicola dorei, Phascolarctobacterium faecium, Alistipes species, Mesosutterella massiliensis, Barnesiella intestinihominis, and Faecalibacterium prausnitzii) from the single feces donor used in the study that engrafted in recipients and metabolites such as short-chain fatty acids and bile acids in FMT-responding participants uncovered leads for rational microbiome therapeutic and diagnostic development. Metagenomic analyses revealed a previously unobserved mechanism of MDRO eradication by conspecific strain competition in an FMT-treated subset. Susceptible Enterobacterales strains that replaced baseline extended-spectrum β-lactamase-producing strains were not detectable in donor microbiota manufactured as FMT doses but in one case were detectable in the recipient before FMT. These data suggest that FMT may provide a path to exploit strain competition to reduce MDRO colonization.
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Affiliation(s)
- Michael H. Woodworth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine; Atlanta, Georgia, 30322, USA
- Emory Antibiotic Resistance Center; Atlanta, Georgia, 30322, USA
| | - Roth E Conrad
- Ocean Science & Engineering, School of Biological Sciences, Georgia Institute of Technology; Atlanta, Georgia, 30332, USA
| | | | - Stephanie M. Pouch
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine; Atlanta, Georgia, 30322, USA
- Emory Antibiotic Resistance Center; Atlanta, Georgia, 30322, USA
| | - Ahmed Babiker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine; Atlanta, Georgia, 30322, USA
- Emory Antibiotic Resistance Center; Atlanta, Georgia, 30322, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine; Atlanta, Georgia, 30322, USA
| | - Aneesh K. Mehta
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine; Atlanta, Georgia, 30322, USA
- Emory Transplant Center; Atlanta, Georgia, 30322, USA
| | - Kaitlin L. Sitchenko
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine; Atlanta, Georgia, 30322, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine; Atlanta, Georgia, 30322, USA
| | - Charlotte H. Wang
- Emory College of Arts and Sciences, Emory University; Atlanta, Georgia, 30322, USA
| | - Amanda Strudwick
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine; Atlanta, Georgia, 30322, USA
| | - Jessica M. Ingersoll
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine; Atlanta, Georgia, 30322, USA
| | - Cécile Philippe
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine; Atlanta, Georgia, 30322, USA
| | - Sarah Lohsen
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine; Atlanta, Georgia, 30322, USA
| | - Kumru Kocaman
- School of Civil and Environmental Engineering, Georgia Institute of Technology; Atlanta, Georgia, 30332, USA
| | - Blake G. Lindner
- School of Civil and Environmental Engineering, Georgia Institute of Technology; Atlanta, Georgia, 30332, USA
| | - Janet K. Hatt
- School of Civil and Environmental Engineering, Georgia Institute of Technology; Atlanta, Georgia, 30332, USA
| | - Rheinallt M. Jones
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Emory University School of Medicine; Atlanta, Georgia, 30322, USA
| | - Candace Miller
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine; Atlanta, Georgia, 30322, USA
| | - Andrew S. Neish
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine; Atlanta, Georgia, 30322, USA
| | - Rachel Friedman-Moraco
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine; Atlanta, Georgia, 30322, USA
| | | | - Ken H. Liu
- Clinical Biomarkers Laboratory, Department of Medicine, Emory University; Atlanta, Georgia, 30322, USA
| | - Dean P. Jones
- Clinical Biomarkers Laboratory, Department of Medicine, Emory University; Atlanta, Georgia, 30322, USA
| | - C. Christina Mehta
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University; Atlanta, GA, 30322, USA
| | - Thomas R. Ziegler
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine; Atlanta, Georgia, 30322, USA
| | - David S. Weiss
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine; Atlanta, Georgia, 30322, USA
- Emory Antibiotic Resistance Center; Atlanta, Georgia, 30322, USA
| | | | | | - Colleen S. Kraft
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine; Atlanta, Georgia, 30322, USA
- Emory Antibiotic Resistance Center; Atlanta, Georgia, 30322, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine; Atlanta, Georgia, 30322, USA
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12
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Royer CJ, Rodriguez-Marino N, Yaceczko MD, Rivera-Rodriguez DE, Ziegler TR, Cervantes-Barragan L. Low dietary fiber intake impairs small intestinal Th17 and intraepithelial T cell development over generations. Cell Rep 2023; 42:113140. [PMID: 37768824 PMCID: PMC10765424 DOI: 10.1016/j.celrep.2023.113140] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 07/10/2023] [Accepted: 08/30/2023] [Indexed: 09/30/2023] Open
Abstract
Dietary fiber strongly impacts the microbiota. Here, we show that a low-fiber diet changes the small intestinal (SI) microbiota and impairs SI Th17, TCRαβ+CD8αβ+ and TCRαβ+CD8αα+ intraepithelial T cell development. We restore T cell development with dietary fiber supplementation, but this defect becomes persistent over generations with constant low-fiber diets. Offspring of low-fiber diet-fed mice have reduced SI T cells even after receiving a fiber-rich diet due to loss of bacteria important for T cell development. In these mice, only a microbiota transplant from a fiber-rich diet-fed mouse and a fiber-rich diet can restore T cell development. Low-fiber diets reduce segmented filamentous bacteria (SFB) abundance, impairing its vertical transmission. SFB colonization and a fiber-rich diet partially restore T cell development. Finally, we observe that low-fiber diet-induced T cell defects render mice more susceptible to Citrobacter rodentium infection. Together, these results demonstrate the importance of fiber to microbiota vertical transmission and host immune system development.
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Affiliation(s)
- Charlotte J Royer
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Naomi Rodriguez-Marino
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Madelyn D Yaceczko
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Dormarie E Rivera-Rodriguez
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322, USA; Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA 30322, USA; Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism, and Lipids and Center for Clinical and Molecular Nutrition, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Luisa Cervantes-Barragan
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322, USA.
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13
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Daley TC, Cousineau BA, Nesbeth PDC, Ivie EA, Bellissimo MP, Easley KA, Vellanki P, Vos MB, Hunt WR, Stecenko AA, Ziegler TR, Alvarez JA. Quality of dietary macronutrients is associated with glycemic outcomes in adults with cystic fibrosis. Front Nutr 2023; 10:1158452. [PMID: 37799765 PMCID: PMC10548231 DOI: 10.3389/fnut.2023.1158452] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/18/2023] [Indexed: 10/07/2023] Open
Abstract
Objective Poor diet quality contributes to metabolic dysfunction. This study aimed to gain a greater understanding of the relationship between dietary macronutrient quality and glucose homeostasis in adults with cystic fibrosis (CF). Design This was a cross-sectional study of N = 27 adults with CF with glucose tolerance ranging from normal (n = 9) to prediabetes (n = 6) to being classified as having cystic fibrosis-related diabetes (CFRD, n = 12). Fasted blood was collected for analysis of glucose, insulin, and C-peptide. Insulin resistance was assessed by Homeostatic Model Assessment for Insulin Resistance (HOMA2-IR). Subjects without known CFRD also underwent a 2-h oral glucose tolerance test. Three-day food records were used to assess macronutrient sources. Dietary variables were adjusted for energy intake. Statistical analyses included ANOVA, Spearman correlations, and multiple linear regression. Results Individuals with CFRD consumed less total fat and monounsaturated fatty acids (MUFA) compared to those with normal glucose tolerance (p < 0.05). In Spearman correlation analyses, dietary glycemic load was inversely associated with C-peptide (rho = -0.28, p = 0.05). Total dietary fat, MUFA, and polyunsaturated fatty acids (PUFA) were positively associated with C-peptide (rho = 0.39-0.41, all p < 0.05). Plant protein intake was inversely related to HOMA2-IR (rho = -0.28, p = 0.048). Associations remained significant after adjustment for age and sex. Discussion Improvements in diet quality are needed in people with CF. This study suggests that higher unsaturated dietary fat, higher plant protein, and higher carbohydrate quality were associated with better glucose tolerance indicators in adults with CF. Larger, prospective studies in individuals with CF are needed to determine the impact of diet quality on the development of CFRD.
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Affiliation(s)
- Tanicia C. Daley
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Benjamin A. Cousineau
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Paula-Dene C. Nesbeth
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Elizabeth A. Ivie
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Moriah P. Bellissimo
- Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Kirk A. Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, GA, United States
| | - Priyathama Vellanki
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Miriam B. Vos
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - William R. Hunt
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Arlene A. Stecenko
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Thomas R. Ziegler
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Jessica A. Alvarez
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
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14
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McGee RE, Blumberg HM, Ziegler TR, Ofotokun I, Bhatti PT, Paulsen DF, Quarshie A, Somanath PR, Comeau DL. Mentor training for junior faculty: a brief evaluation report from the Georgia Clinical and Translational Science Alliance. J Investig Med 2023; 71:577-585. [PMID: 37085987 PMCID: PMC10989736 DOI: 10.1177/10815589231168601] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
To provide a foundation for mentoring, junior faculty participated in a mentor training workshop informed by the Mentoring Clinical and Translational Researchers curriculum. The goal was to develop skills and behaviors that engender more rewarding and inclusive mentoring practices. Attendees responded to baseline and follow-up surveys assessing perceived mentoring skills. Follow-up surveys included closed- and open-ended questions about the value and satisfaction of the training, and intended behavior changes. Junior faculty respondents (n = 39) reported significantly higher overall mentoring skills after the training (t = -2.6, p = 0.012) with a medium effect size (Cohen's D = 0.59). Domains with statistically significant improvement from baseline to follow-up included aligning mentor-mentee expectations and assessing understanding. Thirty-eighty (97%) found the training valuable, and 32 (82%) indicated they would change mentoring-related behaviors because of the training. Intended behavior changes described in open-ended responses aligned with mentoring skills assessed (e.g., aligning expectations). An additional competency domain of evaluating mentoring relationships was also described. A mentor training workshop for junior faculty appeared to contribute to changes in mentoring skills and intended behaviors. Mentor training has the potential to enhance mentorship, which is critical to strengthening a diverse pipeline of clinical and translational science researchers.
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Affiliation(s)
- Robin E McGee
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Henry M Blumberg
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Emory University, Atlanta, GA, USA
- Department of Epidemiology and Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Thomas R Ziegler
- Department of Medicine, Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA, USA
| | - Ighovwerha Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Emory University, Atlanta, GA, USA
| | - Pamela T Bhatti
- School of Electrical and Computer Engineering, College of Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Douglas F Paulsen
- Department of Pathology and Anatomy, Morehouse School of Medicine, Atlanta, GA, USA
| | - Alexander Quarshie
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Payaningal R Somanath
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Augusta, GA, USA
| | - Dawn L Comeau
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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15
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Schoen MS, Boland KM, Christ SE, Cui X, Ramakrishnan U, Ziegler TR, Alvarez JA, Singh RH. Total choline intake and working memory performance in adults with phenylketonuria. Orphanet J Rare Dis 2023; 18:222. [PMID: 37516884 PMCID: PMC10386684 DOI: 10.1186/s13023-023-02842-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Despite early diagnosis and compliance with phenylalanine (Phe)-restricted diets, many individuals with phenylketonuria (PKU) still exhibit neurological changes and experience deficits in working memory and other executive functions. Suboptimal choline intake may contribute to these impairments, but this relationship has not been previously investigated in PKU. The objective of this study was to determine if choline intake is correlated with working memory performance, and if this relationship is modified by diagnosis and metabolic control. METHODS This was a cross-sectional study that included 40 adults with PKU and 40 demographically matched healthy adults. Web-based neurocognitive tests were used to assess working memory performance and 3-day dietary records were collected to evaluate nutrient intake. Recent and historical blood Phe concentrations were collected as measures of metabolic control. RESULTS Working memory performance was 0.32 z-scores (95% CI 0.06, 0.58) lower, on average, in participants with PKU compared to participants without PKU, and this difference was not modified by total choline intake (F[1,75] = 0.85, p = 0.36). However, in a subgroup with complete historical blood Phe data, increased total choline intake was related to improved working memory outcomes among participants with well controlled PKU (Phe = 360 µmol/L) after adjusting for intellectual ability and mid-childhood Phe concentrations (average change in working memory per 100 mg change in choline = 0.11; 95% CI 0.02, 0.20; p = 0.02). There also was a trend, albeit nonsignificant (p = 0.10), for this association to be attenuated with increased Phe concentrations. CONCLUSIONS Clinical monitoring of choline intake is essential for all individuals with PKU but may have important implications for working memory functioning among patients with good metabolic control. Results from this study should be confirmed in a larger controlled trial in people living with PKU.
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Affiliation(s)
- Meriah S Schoen
- Department of Human Genetics, Emory University School of Medicine, 101 Woodruff Circle, Suite 7130, Atlanta, GA, 30322, USA.
| | - Kelly M Boland
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Shawn E Christ
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Xiangqin Cui
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Thomas R Ziegler
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jessica A Alvarez
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Rani H Singh
- Department of Human Genetics, Emory University School of Medicine, 101 Woodruff Circle, Suite 7130, Atlanta, GA, 30322, USA
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16
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Heindel JJ, Alvarez JA, Atlas E, Cave MC, Chatzi VL, Collier D, Corkey B, Fischer D, Goran MI, Howard S, Kahan S, Kayhoe M, Koliwad S, Kotz CM, La Merrill M, Lobstein T, Lumeng C, Ludwig DS, Lustig RH, Myers P, Nadal A, Trasande L, Redman LM, Rodeheffer MS, Sargis RM, Stephens JM, Ziegler TR, Blumberg B. Obesogens and Obesity: State-of-the-Science and Future Directions Summary from a Healthy Environment and Endocrine Disruptors Strategies Workshop. Am J Clin Nutr 2023; 118:329-337. [PMID: 37230178 PMCID: PMC10731763 DOI: 10.1016/j.ajcnut.2023.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/13/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023] Open
Abstract
On September 7 and 8, 2022, Healthy Environment and Endocrine Disruptors Strategies, an Environmental Health Sciences program, convened a scientific workshop of relevant stakeholders involved in obesity, toxicology, or obesogen research to review the state of the science regarding the role of obesogenic chemicals that might be contributing to the obesity pandemic. The workshop's objectives were to examine the evidence supporting the hypothesis that obesogens contribute to the etiology of human obesity; to discuss opportunities for improved understanding, acceptance, and dissemination of obesogens as contributors to the obesity pandemic; and to consider the need for future research and potential mitigation strategies. This report details the discussions, key areas of agreement, and future opportunities to prevent obesity. The attendees agreed that environmental obesogens are real, significant, and a contributor at some degree to weight gain at the individual level and to the global obesity and metabolic disease pandemic at a societal level; moreover, it is at least, in theory, remediable.
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Affiliation(s)
- Jerrold J Heindel
- Healthy Environment and Endocrine Disruptor Strategies, Boseman, Montana, United States.
| | - Jessica A Alvarez
- Department of Medicine, Emory University, Atlanta, GA, United States
| | | | - Matthew C Cave
- Department of Medicine, Pharmacology and Toxicology, Biochemistry and Molecular Genetics, University of Louisville, Lousiville, KY, United States
| | - Vaia Lida Chatzi
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - David Collier
- Department of Pediatrics, East Carolina University, Greenville, NC, United States
| | - Barbara Corkey
- Chobanian and Avedesian School of Medicine, Boston University, Boston, MA, United States
| | | | - Michael I Goran
- Department of Pediatrics, Keck School of Medicine, USC, Los Angeles, CA, United States
| | - Sarah Howard
- Healthy Environment and Endocrine Disruptor Strategies, Boseman, Montana, United States
| | - Scott Kahan
- National Center for Weight and Wellness, Johns Hopkins Blumberg School of Public Health, Baltimore, MD, United States
| | | | - Suneil Koliwad
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Catherine M Kotz
- Department of Integrative Biology and Physiology, University of Minnesota and Minneapolis VA Health Care System, Minneapolis, MN, United States
| | - Michele La Merrill
- Department of Environmental Toxicology, University of California, Davis, CA, United States
| | - Tim Lobstein
- World Obesity Federation, London, United Kingdom
| | - Carey Lumeng
- Department of Pediatrics, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, United States
| | - David S Ludwig
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, United States
| | - Robert H Lustig
- Department of Physiology, Miguel Hernandez University of Elche, Elche, Spain
| | - Pete Myers
- Environmental Health Sciences, Boseman, MT, United States
| | - Angel Nadal
- Department of Physiology, Miguel Hernandez University of Elche, Elche, Spain
| | - Leonardo Trasande
- Department of Pediatrics, New York University Langone Health, New York, NY, United States; Department of Population Health, New York University Langone Health, New York, NY, United States
| | - Leanne M Redman
- Department of Reproductive Endocrinology & Women's Health, Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Matthew S Rodeheffer
- Department of Comparative Medicine, Yale University, New Haven, CT, United States
| | - Robert M Sargis
- Department of Endocrinology, Diabetes and Metabolism, University of Illinois at Chicago, Chicago, IL, United States
| | - Jacqueline M Stephens
- Department of Pediatrics, New York University Langone Health, New York, NY, United States
| | - Thomas R Ziegler
- Department of Medicine, Emory University, Atlanta, GA, United States
| | - Bruce Blumberg
- Department of Developmental and Cell BiologyUniversity of California Irvine, Irvine, CA, United States
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17
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Gundogan K, Sahin GG, Ergul SS, Ozer NT, Temel S, Akbas T, Ercan T, Yildiz H, Dizdar OS, Simsek Z, Aydın K, Ulu R, Zerman A, Dal HC, Aydin E, Ozyilmaz E, Ateş N, Gonderen K, Yalcin N, Topeli A, Tok G, Edipoglu O, Ergan B, Aydemir FD, Akbudak IH, Ergun R, Yuksel RC, Sungur M, Griffith DP, Ziegler TR. Evaluation of whole blood thiamine pyrophosphate concentrations in critically ill patients receiving chronic diuretic therapy prior to admission to Turkish intensive care units: A pragmatic, multicenter, prospective study. J Crit Care 2023; 77:154326. [PMID: 37186999 DOI: 10.1016/j.jcrc.2023.154326] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND/OBJECTIVES Thiamine plays a pivotal role in energy metabolism. The aim of the study was to determine serial whole blood TPP concentrations in critically ill patients receiving chronic diuretic treatment before ICU admission and to correlate TPP levels with clinically determined serum phosphorus concentrations. SUBJECTS/METHODS This observational study was performed in 15 medical ICUs. Serial whole blood TPP concentrations were measured by HPLC at baseline and at days 2, 5 and 10 after ICU admission. RESULTS A total of 221 participants were included. Of these, 18% demonstrated low TPP concentrations upon admission to the ICU, while 26% of participants demonstrated low levels at some point during the 10-day study period. Hypophosphatemia was detected in 30% of participants at some point during the 10-day period of observation. TPP levels were significantly and positively correlated with serum phosphorus levels at each time point (P < 0.05 for all). CONCLUSIONS Our results show that 18% of these critically ill patients exhibited low whole blood TPP concentrations on ICU admission and 26% had low levels during the initial 10 ICU days, respectively. The modest correlation between TPP and phosphorus concentrations suggests a possible association due to a refeeding effect in ICU patients requiring chronic diuretic therapy.
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Affiliation(s)
- Kursat Gundogan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye; Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye.
| | - Gulsah G Sahin
- Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Serap S Ergul
- Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Nurhayat T Ozer
- Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Sahin Temel
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye
| | - Turkay Akbas
- Division of Intensive Care Medicine, Department of Internal Medicine, Duzce University School of Medicine, Duzce, Turkiye
| | - Talha Ercan
- Division of Intensive Care Medicine, Department of Internal Medicine, Duzce University School of Medicine, Duzce, Turkiye
| | - Hamit Yildiz
- Department of Internal Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Turkiye
| | - Oguzhan S Dizdar
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkiye
| | - Zuhal Simsek
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkiye
| | - Kaniye Aydın
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkiye
| | - Ramazan Ulu
- Department of Nephrology, Firat Medical Faculty, Elazig, Turkiye
| | - Avsar Zerman
- Department of Intensive Care Unit, Kirsehir Ahi Evran University, Kirsehir, Turkiye
| | - Hayriye C Dal
- Department of Intensive Care Unit, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkiye
| | - Emre Aydin
- Department of Nephrology, School of Medicine, Dicle University, Diyarbakır, Turkiye
| | - Ezgi Ozyilmaz
- Division of Intensive Care Medicine, Department of Internal Medicine, Cukurova University School of Medicine, Adana, Turkiye
| | - Nazire Ateş
- Division of Intensive Care Medicine, Department of Internal Medicine, Cukurova University School of Medicine, Adana, Turkiye
| | - Kamil Gonderen
- Clinic of Intensive Care Unit, Kütahya Evliya Çelebi Training and Research Hospital, Kütahya, Turkiye
| | - Nazif Yalcin
- Clinic of Intensive Care Unit, Kütahya Evliya Çelebi Training and Research Hospital, Kütahya, Turkiye
| | - Arzu Topeli
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkiye
| | - Gulay Tok
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkiye
| | - Ozlem Edipoglu
- Department of Intensive Care Unit, Health Sciences University, İzmir Dr.Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkiye
| | - Begum Ergan
- Division of Intensive Care Medicine, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkiye
| | - Ferhan D Aydemir
- Division of Intensive Care Medicine, Canakkale Mehmet Akif Ersoy State Hospital, Canakkale, Turkiye
| | - Ismail H Akbudak
- Division of Intensive Care Medicine, Department of Internal Medicine, Pamukkale University School of Medicine, Denizli, Turkiye
| | - Recai Ergun
- Department of Chest Diseases, Selçuk University Faculty of Medicine, Konya, Turkiye
| | - Recep C Yuksel
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye
| | - Murat Sungur
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye; Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Daniel P Griffith
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, GA, USA
| | - Thomas R Ziegler
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, GA, USA; Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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18
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Kearns MD, Binongo JNG, Watson D, Alvarez JA, Lodin D, Ziegler TR, Tangpricha V. Correction: The effect of a single, large bolus of vitamin D in healthy adults over the winter and following year: a randomized, double-blind, placebo-controlled trial. Eur J Clin Nutr 2023:10.1038/s41430-023-01277-9. [PMID: 37161066 DOI: 10.1038/s41430-023-01277-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- M D Kearns
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA, USA
| | - J N G Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, GA, USA
| | - D Watson
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, GA, USA
| | - J A Alvarez
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA, USA
| | - D Lodin
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA, USA
| | - T R Ziegler
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA, USA
| | - V Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA, USA.
- Atlanta Veterans Affairs Medical Center, Section of Endocrinology, Atlanta, GA, USA.
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19
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Martin SE, Kraft CS, Ziegler TR, Millson EC, Rishishwar L, Martin GS. The Role of Diet on the Gut Microbiome, Mood and Happiness. medRxiv 2023:2023.03.18.23287442. [PMID: 36993403 PMCID: PMC10055576 DOI: 10.1101/2023.03.18.23287442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
The gut microbiome may be both helpful and harmful, and not only is it affected by diet, it has also been shown to affect mental health including personality, mood, anxiety and depression. In this clinical study we assessed dietary nutrient composition, mood, happiness, and the gut microbiome in order to understand the role of diet in the gut microbiome and how that affects mood and happiness. For this pilot study, we enrolled 20 adults to follow this protocol: recording a 2-day food log, sampling their gut microbiome, and completing five validated surveys of mental health, mood, happiness and well-being, followed by a minimum 1 week diet change and repeating the food log, microbiome sampling and the 5 surveys. The change from a predominantly Western diet to vegetarian, Mediterranean and ketogenic diets led to changes in calorie and fiber intake. After the diet change, we observed significant changes in measures of anxiety, well-being and happiness, and without changes in gut microbiome diversity. We found strong correlations between greater consumption of fat and protein to lower anxiety and depression, while consuming higher percentages of carbohydrates was associated with increased stress, anxiety, and depression. We also found strong negative correlations between total calories and total fiber intake with gut microbiome diversity without correlations to measures of mental health, mood or happiness. We have shown that changing diet affects mood and happiness, that greater fat and carbohydrate intake is directly associated with anxiety and depression and inversely correlated with gut microbiome diversity. This study is an important step towards understanding how our diet affects the gut microbiome and in turn our mood, happiness and mental health.
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Affiliation(s)
| | | | | | - Erin C Millson
- Georgia Clinical and Translational Science Alliance (CTSA)
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20
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Reiter DA, Bellissimo MP, Zhou L, Boebinger S, Wells GD, Jones DP, Ziegler TR, Alvarez JA, Fleischer CC. Increased Adiposity is Associated with Altered Skeletal Muscle Energetics. J Appl Physiol (1985) 2023; 134:1083-1092. [PMID: 36759162 PMCID: PMC10125027 DOI: 10.1152/japplphysiol.00387.2022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
The objective of this pilot study was to characterize relationships between skeletal muscle energy metabolism and body composition in healthy adults with varied amounts and distribution of adipose tissue. In vivo muscle energetics were quantified using dynamic 31P magnetic resonance spectroscopy with knee extension exercise standardized to subject lean body mass. Spearman correlation analysis examined relationships between muscle metabolism indices and measures of adiposity including body mass index (BMI), total body fat, and quadriceps intermuscular adipose tissue (IMAT). Post-hoc partial correlations were examined controlling for additional body composition measures. Kruskal-Wallis tests with Dunn-Sidak post-hoc comparisons evaluated group differences in energy metabolism based on body composition profiles (i.e. lean, normal-weight obese, and overweight-obese) and IMAT tertiles. BMI negatively correlated with end-exercise muscle pH after correcting for IMAT and total body fat (r=-0.46, p=.034). Total adiposity negatively correlated with maximum oxidative capacity after correcting for IMAT (r=-0.54, p=.013). IMAT positively correlated with muscle proton buffering capacity after correcting for total body fat (r=0.53, p=.023). Body composition groups showed differences in end-exercise fall in [PCr] with normalized workload (p=.036; post-hoc: overweight-obese < lean, p=.029) and maximum oxidative capacity (p=.021; post-hoc: normal-weight obese < lean, p=.016). IMAT tertiles showed differences in end-exercise fall in [PCr] with normalized workload (p=.035; post-hoc: 3rd < 1st, p=.047). Taken together, these results support increased adiposity is associated with reduced muscle energetic efficiency with more reliance on glycolysis, and when accompanied with reduced lean mass, is associated with reduced maximum oxidative capacity.
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Affiliation(s)
- David A Reiter
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States.,Department of Orthopedics, Emory University School of Medicine, Atlanta, Georgia, United States.,Department of Biomedical Engineering, Emory University and Georgia Tech, Atlanta, Georgia, United States
| | - Moriah P Bellissimo
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States.,Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Lei Zhou
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Scott Boebinger
- Department of Biomedical Engineering, Emory University and Georgia Tech, Atlanta, Georgia, United States
| | - Greg D Wells
- Translational Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Dean P Jones
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Thomas R Ziegler
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Jessica A Alvarez
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Candace C Fleischer
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States.,Department of Biomedical Engineering, Emory University and Georgia Tech, Atlanta, Georgia, United States
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21
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Lamon-Fava S, Liu M, Dunlop BW, Kinkead B, Schettler PJ, Felger JC, Ziegler TR, Fava M, Mischoulon D, Rapaport MH. Clinical response to EPA supplementation in patients with major depressive disorder is associated with higher plasma concentrations of pro-resolving lipid mediators. Neuropsychopharmacology 2023; 48:929-935. [PMID: 36635595 PMCID: PMC10156711 DOI: 10.1038/s41386-022-01527-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 01/14/2023]
Abstract
Chronic inflammation has been implicated in the pathophysiology of major depressive disorder (MDD). Activating the resolution of inflammation through ω-3 fatty acid supplementation may prove to be a successful therapeutic strategy for the treatment of MDD. Patients with MDD, body mass index >25 kg/m2, and plasma high-sensitivity C-reactive protein ≥3 μg/mL (n = 61) were enrolled in a 12-week randomized trial consisting of 4 parallel arms: EPA 1, 2, and 4 g/d, and placebo. The supplement contained EPA and DHA in a 3.9:1 ratio. Depression symptoms were assessed using the IDS-C30 scale. Plasma fatty acids and pro-resolving lipid mediators (SPMs) were measured in 42 study completers at baseline and at the end of treatment by liquid chromatography/mass spectrometry. The response rate (≥50% reduction in IDS-30 score) was higher in the 4 g/d EPA arm than placebo (Cohen d = 0.53). In the 4 g/d EPA arm, responders had significantly greater increases in 18-hydroxyeicosapentaenoic acid (18-HEPE) and 13-hydroxydocosahexaenoic acid (13-HDHA) than non-responders (p < 0.05). Within the 4 g/d EPA arm, the increase in 18-HEPE was significantly associated with reductions in plasma hs-CRP concentrations (p < 0.05) and IDS-C30 scores (p < 0.01). In summary, response rates were greater among patients with MDD randomized to EPA 4 g/d supplementation and in those who showed a greater ability to activate the synthesis of 18-HEPE. The inverse association of 18-HEPE with both systemic inflammation and symptoms of depression highlights the activation of the resolution of inflammation as a likely mechanism in the treatment of MDD with ω-3 fatty acid supplementation.
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Affiliation(s)
- Stefania Lamon-Fava
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA.
| | - Minying Liu
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Becky Kinkead
- Huntsman Mental Health Institute, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Pamela J Schettler
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Jennifer C Felger
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | | | - Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Mark Hyman Rapaport
- Huntsman Mental Health Institute, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
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22
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Mischoulon D, Dunlop BW, Kinkead B, Schettler PJ, Lamon-Fava S, Rakofsky JJ, Nierenberg AA, Clain AJ, Mletzko Crowe T, Wong A, Felger JC, Sangermano L, Ziegler TR, Cusin C, Fisher LB, Fava M, Rapaport MH. Omega-3 Fatty Acids for Major Depressive Disorder With High Inflammation: A Randomized Dose-Finding Clinical Trial. J Clin Psychiatry 2022; 83. [PMID: 36005883 DOI: 10.4088/jcp.21m14074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Objective: This study compared the impact of 3 eicosapentaenoic acid (EPA) doses versus placebo on inflammatory biomarkers and depressive symptoms. Methods: Sixty-one unmedicated adults (75% female; 45.5 ± 13.8 years) with DSM-5 major depressive disorder (MDD), body mass index > 25 kg/m2, and plasma high-sensitivity C-reactive protein (hs-CRP) ≥ 3.0 mg/L were randomly assigned to receive EPA 1 g/d, 2 g/d, or 4 g/d or placebo for 12 weeks. Prespecified endpoints were a ≥ 0.40 effect size decrease in plasma interleukin (IL)-6, peripheral blood mononuclear cell (PBMC) cytokines, and lipopolysaccharide-stimulated tumor necrosis factor (TNF) production. Response was defined as a ≥ 50% decrease of Inventory of Depressive Symptomatology, Clinician-Rated version (IDS-C30) scores. We compared outcomes for the 3 EPA doses versus placebo. Results: In 45 completers, only median PBMC TNF decreased at 2 g/d EPA. No EPA dose produced a ≥ 0.35 effect size reduction in plasma IL-6 or mitogen-stimulated TNF. Response rates for EPA 4 g/d were 64%, versus 40% for placebo (odds ratio [OR] = 2.63; Cohen d = 0.53), 38% for EPA 1 g/d, and 36% for EPA 2 g/d (all P > .05). EPA 4 g/d showed a significant correlation between percent decrease in plasma hs-CRP and IDS-C30 symptom reduction at 12 weeks (Spearman ρ = 0.691, P = .019). Conclusions: EPA 4 g/d demonstrated a medium effect size for response rates versus placebo. This dose may alleviate MDD in overweight individuals with elevated inflammatory markers, and change in hs-CRP may be correlated with clinical response. Trial Registration: ClinicalTrials.gov identifier: NCT02553915.
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Affiliation(s)
- David Mischoulon
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Co-first authors (contributed equally to the work and the writing).,Corresponding author: David Mischoulon, MD, PhD, 1 Bowdoin Sq, 6th Floor, Boston, MA 02114
| | - Boadie W Dunlop
- Department of Psychiatry, Emory University, Atlanta, Georgia.,Co-first authors (contributed equally to the work and the writing)
| | - Becky Kinkead
- Department of Psychiatry, Emory University, Atlanta, Georgia
| | | | - Stefania Lamon-Fava
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | | | - Andrew A Nierenberg
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Alisabet J Clain
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Andrea Wong
- Department of Psychiatry, Emory University, Atlanta, Georgia
| | | | - Lisa Sangermano
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Cristina Cusin
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Lauren B Fisher
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Maurizio Fava
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Co-senior authors (contributed equally to the leadership and study design)
| | - Mark Hyman Rapaport
- Department of Psychiatry, Emory University, Atlanta, Georgia.,Huntsman Mental Health Institute, Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah.,Co-senior authors (contributed equally to the leadership and study design)
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23
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Bellissimo MP, Fleischer CC, Reiter DA, Goss AM, Zhou L, Smith MR, Kohlmeier J, Tirouvanziam R, Tran PH, Hao L, Crain BH, Wells GD, Jones DP, Ziegler TR, Alvarez JA. Sex differences in the relationships between body composition, fat distribution, and mitochondrial energy metabolism: a pilot study. Nutr Metab (Lond) 2022; 19:37. [PMID: 35597962 PMCID: PMC9123728 DOI: 10.1186/s12986-022-00670-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/09/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Adiposity and mitochondrial dysfunction are related factors contributing to metabolic disease development. This pilot study examined whether in vivo and ex vivo indices of mitochondrial metabolism were differentially associated with body composition in males and females. METHODS Thirty-four participants including 19 females (mean 27 yr) and 15 males (mean 29 yr) had body composition assessed by dual energy x-ray absorptiometry and magnetic resonance (MR) imaging. Monocyte reserve capacity and maximal oxygen consumption rate (OCR) were determined ex vivo using extracellular flux analysis. In vivo quadriceps mitochondrial function was measured using 31P-MR spectroscopy based on post-exercise recovery kinetics (τPCr). The homeostatic model assessment of insulin resistance (HOMA-IR) was calculated from fasting glucose and insulin levels. Variables were log-transformed, and Pearson correlations and partial correlations were used for analyses. RESULTS Mitochondrial metabolism was similar between sexes (p > 0.05). In males only, higher fat mass percent (FM%) was correlated with lower reserve capacity (r = - 0.73; p = 0.002) and reduced muscle mitochondrial function (r = 0.58, p = 0.02). Thigh subcutaneous adipose tissue was inversely related to reserve capacity in males (r = - 0.75, p = 0.001), but in females was correlated to higher maximal OCR (r = 0.48, p = 0.046), independent of FM. In females, lean mass was related to greater reserve capacity (r = 0.47, p = 0.04). In all participants, insulin (r = 0.35; p = 0.04) and HOMA-IR (r = 0.34; p = 0.05) were associated with a higher τPCr. CONCLUSIONS These novel findings demonstrate distinct sex-dependent associations between monocyte and skeletal muscle mitochondrial metabolism with body composition. With further study, increased understanding of these relationships may inform sex-specific interventions to improve mitochondrial function and metabolic health.
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Affiliation(s)
- Moriah P Bellissimo
- Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, USA
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Candace C Fleischer
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - David A Reiter
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Amy M Goss
- Department of Nutrition Sciences, School of Health Professionals, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lei Zhou
- Center for Systems Imaging Core, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew Ryan Smith
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jacob Kohlmeier
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA
| | - Rabindra Tirouvanziam
- Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep/Apnea, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Phong H Tran
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Li Hao
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Benjamin H Crain
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Greg D Wells
- Translational Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Dean P Jones
- Emory Center for Clinical and Molecular Nutrition, Emory University, 101 Woodruff Circle NE, WMRB 1313, Atlanta, GA, 30322, USA
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Emory Center for Clinical and Molecular Nutrition, Emory University, 101 Woodruff Circle NE, WMRB 1313, Atlanta, GA, 30322, USA
- Atlanta Department of Veterans Affairs Medical Center, Decatur, GA, USA
| | - Jessica A Alvarez
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
- Emory Center for Clinical and Molecular Nutrition, Emory University, 101 Woodruff Circle NE, WMRB 1313, Atlanta, GA, 30322, USA.
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24
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Gundogan K, Yucesoy FS, Ozer NT, Temel S, Sahin S, Sahin GG, Sungur M, Esmaoglu A, Talih T, Yazici C, Griffith DP, Ziegler TR. Serum Micronutrient Levels in Critically III Patients Receiving Continuous Renal Replacement Therapy: A Prospective, Observational Study. JPEN J Parenter Enteral Nutr 2022; 46:1141-1148. [PMID: 35383966 DOI: 10.1002/jpen.2378] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/05/2022] [Revised: 03/04/2022] [Accepted: 03/24/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) treated with continuous renal replacement therapy (CRRT) may deplete micronutrient levels. Patients are also at risk for micronutrient depletion due to underlying illness(s), poor nutrient intake prior to intensive care unit (ICU) admission and/or increased requirements. We determined vitamin and trace element status before, during and after CRRT in critically ill patients. METHODS This prospective observational study performed in mixed medical and surgical ICU patients. Serial serum vitamin B6 and vitamin C concentrations were measured by HPLC and folic acid by ECLIA. Serum chromium, copper, selenium, and zinc were measured using ICP-MS. Serum ceruloplasmin was measured by the Erel method. RESULTS Fifty adult ICU patients with AKI were recruited. The median APACHE II score on ICU admission was high at 24.0 (6.0-33.0). The median days on CRRT was 2.0 (2.0-4.0) days. At baseline (within 10-15 minutes of CRRT initiation), serum vitamin C, selenium and zinc were below normal. Serum vitamin B6 levels at 72 hours on CRRT were significantly lower than at 24 hours (p=0.011). Serum vitamin C values fell significantly at 24 and 72 hours during CRRT (p=0.030 and p=0.001), respectively, and remained low 24 and 48 hours after CRRT was stopped (p=0.021). At baseline and during CRRT, 96% of participants had at least two or more micronutrient levels below the normal range. CONCLUSION Serum vitamin C, selenium and zinc concentrations were below the normal range at baseline. CRRT was associated with a significant further decrease in levels of vitamin C, selenium and zinc. CLINICAL RELEVANCY STATEMENT Critically ill patients who were experienced CRRT had serum vitamin C, selenium and zinc below the normal range during and after CRRT. Also, 96% of participants had at least two or more micronutrient levels below normal at baseline and during CRRT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kursat Gundogan
- Department of Internal Medicine, Division of Intensive Care, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Faruk S Yucesoy
- Department of Anesthesiology and Reanimation, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Nurhayat T Ozer
- Division of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkey
| | - Sahin Temel
- Department of Internal Medicine, Division of Intensive Care, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Serap Sahin
- Division of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkey
| | - Gulsah G Sahin
- Division of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkey
| | - Murat Sungur
- Department of Internal Medicine, Division of Intensive Care, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Aliye Esmaoglu
- Department of Anesthesiology and Reanimation, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Tutkun Talih
- Department of General Surgery, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Cevat Yazici
- Department of Clinical Biochemistry, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Daniel P Griffith
- Department of Pharmaceutical Services, Emory University Hospital, Atlanta, Georgia, USA.,Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA
| | - Thomas R Ziegler
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA.,Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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25
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Nadeem S, Tangpricha V, Ziegler TR, Rhodes JE, Leong T, Xiang Y, Greenbaum LA. Randomized trial of two maintenance doses of vitamin D in children with chronic kidney disease. Pediatr Nephrol 2022; 37:415-422. [PMID: 34392411 DOI: 10.1007/s00467-021-05228-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/22/2021] [Accepted: 07/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Correction of nutritional vitamin deficiency is recommended in children with chronic kidney disease (CKD). The optimal daily dose of vitamin D to achieve or maintain vitamin D sufficiency is unknown. METHODS We conducted a phase III, double-blind, randomized trial of two doses of vitamin D3 in children ≥ 9 years of age with CKD stages 3-5 or kidney transplant recipients. Patients were randomized to 1000 IU or 4000 IU of daily vitamin D3 orally. We measured 25-hydroxvitamin D (25(OH)D) levels at baseline, 3 months and 6 months. The primary efficacy outcome was the percentage of patients who were vitamin D replete (25(OH)D ≥ 30 ng/mL) at 6 months. RESULTS Ninety-eight patients were enrolled: 49 randomized into each group. Eighty (81.6%) patients completed the study and were analyzed. Baseline plasma 25(OH)D levels were ≥ 30 ng/mL in 12 (35.3%) and 12 (27.3%) patients in the 1000 IU and 4000 IU treatment groups, respectively. At 6 months, plasma 25(OH)D levels were ≥ 30 ng/mL in 33.3% (95% CI: 18.0-51.8%) and 74.4% (95% CI: 58.8-86.5%) in the 1000 IU and 4000 IU treatment groups, respectively (p = 0.0008). None of the patients developed vitamin D toxicity or hypercalcemia. CONCLUSIONS In children with CKD, 1000 IU of daily vitamin D3 is unlikely to achieve or maintain a plasma 25(OH)D ≥ 30 ng/mL. In children with CKD stages 3-5, a dose of vitamin D3 4000 IU daily was effective in achieving or maintaining vitamin D sufficiency. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01909115.
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Affiliation(s)
- Shahid Nadeem
- Department of Pediatrics, University of Texas Southwestern Medical Center, 1935 Medical District Drive, Dallas, TX, USA.
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Emory University, Atlanta, GA, USA
| | - James E Rhodes
- Investigational Drug Service Pharmacy, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Traci Leong
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Yijin Xiang
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Larry A Greenbaum
- Division of Pediatric Nephrology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
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26
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Liu KH, Owens JA, Saeedi B, Cohen CE, Bellissimo MP, Naudin C, Darby T, Druzak S, Maner-Smith K, Orr M, Hu X, Fernandes J, Camacho MC, Hunter-Chang S, VanInsberghe D, Ma C, Ganesh T, Yeligar SM, Uppal K, Go YM, Alvarez JA, Vos MB, Ziegler TR, Woodworth MH, Kraft CS, Jones RM, Ortlund E, Neish AS, Jones DP. Microbial metabolite delta-valerobetaine is a diet-dependent obesogen. Nat Metab 2021; 3:1694-1705. [PMID: 34931082 PMCID: PMC8711632 DOI: 10.1038/s42255-021-00502-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/04/2021] [Indexed: 12/17/2022]
Abstract
Obesity and obesity-related metabolic disorders are linked to the intestinal microbiome. However, the causality of changes in the microbiome-host interaction affecting energy metabolism remains controversial. Here, we show the microbiome-derived metabolite δ-valerobetaine (VB) is a diet-dependent obesogen that is increased with phenotypic obesity and is correlated with visceral adipose tissue mass in humans. VB is absent in germ-free mice and their mitochondria but present in ex-germ-free conventionalized mice and their mitochondria. Mechanistic studies in vivo and in vitro show VB is produced by diverse bacterial species and inhibits mitochondrial fatty acid oxidation through decreasing cellular carnitine and mitochondrial long-chain acyl-coenzyme As. VB administration to germ-free and conventional mice increases visceral fat mass and exacerbates hepatic steatosis with a western diet but not control diet. Thus, VB provides a molecular target to understand and potentially manage microbiome-host symbiosis or dysbiosis in diet-dependent obesity.
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Affiliation(s)
- Ken H Liu
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Joshua A Owens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Bejan Saeedi
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Catherine E Cohen
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Moriah P Bellissimo
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Crystal Naudin
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Trevor Darby
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Samuel Druzak
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Kristal Maner-Smith
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael Orr
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Xin Hu
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jolyn Fernandes
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Mary Catherine Camacho
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Sarah Hunter-Chang
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - David VanInsberghe
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Chunyu Ma
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Thota Ganesh
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, USA
| | - Samantha M Yeligar
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Health Care System, Decatur, GA, USA
| | - Karan Uppal
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Young-Mi Go
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jessica A Alvarez
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Miriam B Vos
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael H Woodworth
- Division of Infectious Disease, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Colleen S Kraft
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Division of Infectious Disease, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Rheinallt M Jones
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric Ortlund
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew S Neish
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Dean P Jones
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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27
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Ko YA, Chen Z, Liu C, Hu Y, Quyyumi AA, Waller LA, Higgins M, Ziegler TR, Brigham KL, Martin GS. Developing a synthetic control group using electronic health records: Application to a single-arm lifestyle intervention study. Prev Med Rep 2021; 24:101572. [PMID: 34976636 PMCID: PMC8683890 DOI: 10.1016/j.pmedr.2021.101572] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 11/14/2022] Open
Abstract
The electronic health records (EHR) infrastructure offers a tremendous resource for identifying controls who match the characteristics of study participants in a single-arm trial. The objectives are to (1) demonstrate the feasibility of curating a synthetic control group for an existing study cohort through EHR data extraction and (2) evaluate the effect of a lifestyle intervention on selected cardiovascular health metrics. A total of 711 university employees were recruited between 2008 and 2012 to participate in a health partner intervention to improve cardiovascular health and were followed for five years. Data of nearly 8000 eligible subjects were extracted from the EHR to create a synthetic control cohort during the same study period. To minimize confounding, crude comparison, exact matching, propensity score matching, and doubly robust estimation were used to compare the selected cardiovascular health metrics at 1 and 5 years of follow-up. Blood pressure and body mass index improved in the intervention group compared to the EHR synthetic controls. The findings of changes in lipid measurements were somewhat unexpected. When analyzing the subgroup without lipid-lowering medications, the intervention group exhibited better control of cholesterol levels over time than did our synthetic controls. Some measurements in the EHR system may be more robust for synthetic selection than others. EHR synthetic controls can provide an alternative to estimate intervention effects appropriately in single-arm studies for these measurements.
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28
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Knight JO, Cotten LF, Ziegler TR, Vellanki P. A Case of Severe Hypocalcemia Caused by Malabsorption Due to Partial Gastrectomy and Small Bowel Resection. AACE Clin Case Rep 2021; 7:323-326. [PMID: 34522774 PMCID: PMC8426615 DOI: 10.1016/j.aace.2021.04.002] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Calcium is an essential mineral involved in the functioning of nearly every human cell. Calcium levels are regulated by dietary absorption, vitamin D status, and parathyroid hormone (PTH). This report describes a patient in whom childhood bowel resection and partial gastrectomy resulted in malabsorptive hypocalcemia in adulthood. Case Report A 21-year-old man presented with syncope and a fall resulting in a right femoral neck fracture. His medical history included small bowel obstructions at age 9 requiring bowel resection, and at age 12 with gastric perforation and partial gastrectomy. Laboratory values showed calcium level of 4.9 mg/dL (8.9-10.3 mg/dL). PTH level was 273 pg/mL (12.0-88.0 pg/mL), 25-hydroxy-vitamin D was 28 ng/dL (30-100 ng/mL), and 1,25-dihydroxy-vitamin D was 54 pg/dL (18-72 pg/mL). Furthermore, magnesium and phosphorus levels were 2.1 mg/dL (1.5-2.6 mg/dL) and 4.4 mg/dL (2.4-4.7 mg/dL), respectively. Calcium levels improved to 9.5 mg/dL on 10% calcium gluconate drip but could not be maintained above 7 mg/dL on oral calcium carbonate supplementation, despite doses as high as 3750 mg three times daily with calcitriol 0.75 mcg twice daily. After switching from calcium carbonate to calcium citrate 3500 mg three times daily, the calcium level improved and was maintained between 8.3 and 9.0 mg/dL. Discussion High calcium needs, other nutrient deficiencies, and response to calcium citrate versus calcium carbonate suggest malabsorption from achlorhydria and small bowel resection. Conclusion This case emphasizes the gastrointestinal physiology in calcium homeostasis and highlights the recognition of hypocalcemia as a complication of gastric and bowel resection.
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Affiliation(s)
- John O Knight
- Division of Endocrinology, Metabolism, and Lipids, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Lucia F Cotten
- Division of Endocrinology, Metabolism, and Lipids, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism, and Lipids, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Priyathama Vellanki
- Division of Endocrinology, Metabolism, and Lipids, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
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29
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Liu KH, Lee CM, Singer G, Bais P, Castellanos F, Woodworth MH, Ziegler TR, Kraft CS, Miller GW, Li S, Go YM, Morgan ET, Jones DP. Large scale enzyme based xenobiotic identification for exposomics. Nat Commun 2021; 12:5418. [PMID: 34521839 PMCID: PMC8440538 DOI: 10.1038/s41467-021-25698-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 08/18/2021] [Indexed: 01/14/2023] Open
Abstract
Advances in genomics have revealed many of the genetic underpinnings of human disease, but exposomics methods are currently inadequate to obtain a similar level of understanding of environmental contributions to human disease. Exposomics methods are limited by low abundance of xenobiotic metabolites and lack of authentic standards, which precludes identification using solely mass spectrometry-based criteria. Here, we develop and validate a method for enzymatic generation of xenobiotic metabolites for use with high-resolution mass spectrometry (HRMS) for chemical identification. Generated xenobiotic metabolites were used to confirm identities of respective metabolites in mice and human samples based upon accurate mass, retention time and co-occurrence with related xenobiotic metabolites. The results establish a generally applicable enzyme-based identification (EBI) for mass spectrometry identification of xenobiotic metabolites and could complement existing criteria for chemical identification.
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Affiliation(s)
- Ken H. Liu
- grid.189967.80000 0001 0941 6502Clinical Biomarkers Laboratory, Department of Medicine, Emory University, Atlanta, Georgia USA
| | - Choon M. Lee
- grid.189967.80000 0001 0941 6502Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, Georgia USA
| | - Grant Singer
- grid.189967.80000 0001 0941 6502Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, Georgia USA
| | - Preeti Bais
- The Jackson Laboratory for Genomic Medicine, Atlanta, Connecticut USA
| | | | - Michael H. Woodworth
- grid.189967.80000 0001 0941 6502Division of Infectious Disease, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia USA
| | - Thomas R. Ziegler
- grid.189967.80000 0001 0941 6502Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia USA
| | - Colleen S. Kraft
- grid.189967.80000 0001 0941 6502Division of Infectious Disease, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia USA ,grid.189967.80000 0001 0941 6502Emory University School of Medicine, Department of Pathology and Laboratory Medicine, Atlanta, Georgia USA
| | - Gary W. Miller
- grid.21729.3f0000000419368729Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York USA
| | - Shuzhao Li
- The Jackson Laboratory for Genomic Medicine, Atlanta, Connecticut USA
| | - Young-Mi Go
- grid.189967.80000 0001 0941 6502Clinical Biomarkers Laboratory, Department of Medicine, Emory University, Atlanta, Georgia USA
| | - Edward T. Morgan
- grid.189967.80000 0001 0941 6502Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, Georgia USA
| | - Dean P. Jones
- grid.189967.80000 0001 0941 6502Clinical Biomarkers Laboratory, Department of Medicine, Emory University, Atlanta, Georgia USA
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Bellissimo MP, Jones DP, Martin GS, Alvarez JA, Ziegler TR. Plasma high-resolution metabolomic phenotyping of lean mass in a United States adult cohort. JPEN J Parenter Enteral Nutr 2021; 45:1635-1644. [PMID: 34111906 DOI: 10.1002/jpen.2201] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Rapid loss of lean mass during catabolic states is associated with impaired convalescence and increased mortality rates. An understanding of metabolic pathways related to lean mass is needed to enable future interventions designed to combat malnutrition. This study assessed the plasma metabolome in relation to lean mass in clinically stable working adults in a US cohort. METHODS This cross-sectional study included 180 adults (mean ± SD, aged 49.7 ± 10.0 years; body mass index, 27.3 ± 5.5 kg/m2 ; 64% female [n=116]). Fasting plasma was analyzed using high-resolution metabolomics (HRM) via liquid chromatography/mass spectrometry. Lean mass was assessed by dual-energy x-ray absorptiometry and expressed as lean mass index (LMI, lean mass kg/height m2 ). Multiple linear regression, metabolic pathway enrichment, and module analyses were used to characterize systemic metabolism associated with LMI. RESULTS Of 5360 metabolites used in analyses, 593 were related to LMI, either upregulated or downregulated (P < .05). These were enriched within 11 metabolic pathways, including branched-chain amino acid degradation, metabolism of alanine and aspartate and other amino acids, butyrate, purines, and niacin metabolism. Module analysis revealed central associations between LMI and L-glutamate, L-leucine/L-isoleucine, L-valine, L-phenylalanine, L-methionine, and L-aspartate, among other validated metabolites. CONCLUSION These novel plasma HRM data demonstrate the wide-reaching associations of lean mass with systemic metabolism in a single snapshot. Such data may inform targeted nutrition support interventions designed to mitigate loss of lean mass and promote regaining skeletal muscle mass and function after illness or injury.
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Affiliation(s)
- Moriah P Bellissimo
- Division of Cardiology, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Dean P Jones
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, Georgia, USA
| | - Greg S Martin
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, Georgia, USA
| | - Jessica A Alvarez
- Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, Georgia, USA.,Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Thomas R Ziegler
- Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, Georgia, USA.,Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta Department of Veterans Affairs Medical Center, Decatur, Georgia, USA
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Bellissimo MP, Hsu E, Hao L, Easley K, Martin GS, Ziegler TR, Alvarez JA. Relationships between plasma apelin and adiponectin with normal weight obesity, body composition, and cardiorespiratory fitness in working adults. J Clin Transl Endocrinol 2021; 24:100257. [PMID: 34178605 PMCID: PMC8213890 DOI: 10.1016/j.jcte.2021.100257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/18/2021] [Accepted: 05/31/2021] [Indexed: 12/18/2022]
Abstract
Background A significant proportion of adults have normal weight obesity (NWO), defined as a normal body mass index (BMI) but disproportionately high body fat percentage. Individuals with NWO may have increased risk of cardiometabolic disorders and lower exercise tolerance, but it is unclear if this obesity phenotype is linked with dysregulated production of adipokines or myokines such as adiponectin and apelin, respectively. Methods This cross-sectional, secondary analysis included 177 working adults (mean age 49.6 ± 9.9 yrs, 64% female). Plasma high-molecular weight adiponectin and apelin levels were measured by ELISA. Body composition and fat distribution were assessed using dual energy X-ray absorptiometry. Exercise tolerance (VO2 maximum) was determined by treadmill testing. NWO was defined as a BMI <25 kg/m2 and body fat >30% for women or >23% for men. Participants were categorized as lean, NWO, or overweight-obese. Results A total of 14.7% of subjects were categorized as lean, 23.7% as having NWO, and 61.6% as having overweight-obesity. Plasma adiponectin levels were elevated in the overweight-obesity group (P < 0.05) compared to the lean and NWO groups, which did not differ from each other (P > 0.05). Adiponectin concentrations were inversely associated with BMI, fat mass, fat mass percent, visceral fat, and trunk to leg fat ratio and positively associated with leg fat mass (all P < 0.001). Plasma apelin levels were similar between the three body composition groups (P < 0.05) and were not significantly associated with any body composition indices. Apelin concentrations were inversely related to VO2 maximum (β = −0.03 ± 0.01, p = 0.002). Conclusion Plasma adiponectin and apelin levels did not distinguish between lean and NWO groups. Positive relationships with leg fat mass and adiponectin suggest the importance of assessing body composition and fat distribution when studying adipokines and cardiometabolic disorders. Further investigations are needed to understand relationships between exercise, body composition, and apelin secretion.
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Affiliation(s)
- Moriah P Bellissimo
- Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Emory Hsu
- Santa Clara Valley Medical Center, San Jose, CA, USA.,Stanford School of Medicine, Palo Alto, CA, USA
| | - Li Hao
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Kirk Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Greg S Martin
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, GA, USA.,Section of Endocrinology, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Jessica A Alvarez
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, GA, USA
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Deutz NE, Ziegler TR, Matheson EM, Matarese LE, Tappenden KA, Baggs GE, Nelson JL, Luo M, Hegazi R, Jonnalagadda SS. Reduced mortality risk in malnourished hospitalized older adult patients with COPD treated with a specialized oral nutritional supplement: Sub-group analysis of the NOURISH study. Clin Nutr 2021; 40:1388-1395. [DOI: 10.1016/j.clnu.2020.08.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/05/2020] [Accepted: 08/26/2020] [Indexed: 01/22/2023]
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Bellissimo MP, Ziegler TR, Jones DP, Liu KH, Fernandes J, Roberts JL, Weitzmann MN, Pacifici R, Alvarez JA. Plasma high-resolution metabolomics identifies linoleic acid and linked metabolic pathways associated with bone mineral density. Clin Nutr 2021; 40:467-475. [PMID: 32620447 PMCID: PMC7714706 DOI: 10.1016/j.clnu.2020.05.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/16/2020] [Accepted: 05/25/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND & AIMS There is a considerable degree of variation in bone mineral density (BMD) within populations. Use of plasma metabolomics may provide insight into established and novel determinants of BMD variance, such as nutrition and gut microbiome composition, to inform future prevention and treatment strategies for loss of BMD. Using high-resolution metabolomics (HRM), we examined low-molecular weight plasma metabolites and nutrition-related metabolic pathways associated with BMD. METHODS This cross-sectional study included 179 adults (mean age 49.5 ± 10.3 yr, 64% female). Fasting plasma was analyzed using ultra-high-resolution mass spectrometry with liquid chromatography. Whole body and spine BMD were assessed by dual energy X-ray absorptiometry and expressed as BMD (g/cm2) or Z-scores. Multiple linear regression, pathway enrichment, and module analyses were used to determine key plasma metabolic features associated with bone density. RESULTS Of 10,210 total detected metabolic features, whole body BMD Z-score was associated with 710 metabolites, which were significantly enriched in seven metabolic pathways, including linoleic acid, fatty acid activation and biosynthesis, and glycerophospholipid metabolism. Spine BMD was associated with 970 metabolites, significantly enriched in pro-inflammatory pathways involved in prostaglandin formation and linoleic acid metabolism. In module analyses, tryptophan- and polyamine-derived metabolites formed a network that was significantly associated with spine BMD, supporting a link with the gut microbiome. CONCLUSIONS Plasma HRM provides comprehensive information relevant to nutrition and components of the microbiome that influence bone health. This data supports pro-inflammatory fatty acids and the gut microbiome as novel regulators of postnatal bone remodeling.
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Affiliation(s)
- Moriah P Bellissimo
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, GA, USA
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, GA, USA; Atlanta Department of Veterans Affairs Medical Center, Decatur, GA, USA; Emory Microbiome Research Center, Emory University, Atlanta, GA, USA.
| | - Dean P Jones
- Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, GA, USA; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Ken H Liu
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jolyn Fernandes
- Department of Pediatrics, Section of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Joseph L Roberts
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - M Neale Weitzmann
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Atlanta Department of Veterans Affairs Medical Center, Decatur, GA, USA; Emory Microbiome Research Center, Emory University, Atlanta, GA, USA
| | - Roberto Pacifici
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Emory Microbiome Research Center, Emory University, Atlanta, GA, USA; Immunology and Molecular Pathogenesis Program, Emory University, Atlanta, GA, USA
| | - Jessica A Alvarez
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, GA, USA; Emory Microbiome Research Center, Emory University, Atlanta, GA, USA.
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Li Z, Liang D, Ye D, Chang HH, Ziegler TR, Jones DP, Ebelt ST. Application of high-resolution metabolomics to identify biological pathways perturbed by traffic-related air pollution. Environ Res 2021; 193:110506. [PMID: 33245887 PMCID: PMC7855798 DOI: 10.1016/j.envres.2020.110506] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 05/02/2023]
Abstract
BACKGROUND Substantial research has investigated the adverse effects of traffic-related air pollutants (TRAP) on human health. Convincing associations between TRAP and respiratory and cardiovascular diseases are known, but the underlying biological mechanisms are not well established. High-resolution metabolomics (HRM) is a promising platform for untargeted characterization of molecular mechanisms between TRAP and health indexes. OBJECTIVES We examined metabolic perturbations associated with short-term exposures to TRAP, including carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), fine particulate matter (PM2.5), organic carbon (OC), and elemental carbon (EC) among 180 participants of the Center for Health Discovery and Well-Being (CHDWB), a cohort of Emory University-affiliated employees. METHODS A cross-sectional study was conducted on baseline visits of 180 CHDWB participants enrolled during 2008-2012, in whom HRM profiling was determined in plasma samples using liquid chromatography-high-resolution mass spectrometry with positive and negative electrospray ionization (ESI) modes. Ambient pollution concentrations were measured at an ambient monitor near downtown Atlanta. Metabolic perturbations associated with TRAP exposures were assessed following an untargeted metabolome-wide association study (MWAS) framework using feature-specific Tobit regression models, followed by enriched pathway analysis and chemical annotation. RESULTS Subjects were predominantly white (76.1%) and non-smokers (95.6%), and all had at least a high school education. In total, 7821 and 4123 metabolic features were extracted from the plasma samples by the negative and positive ESI runs, respectively. There are 3421 features significantly associated with at least one air pollutant by negative ion mode, and 1691 features by positive ion mode. Biological pathways enriched by features associated with the pollutants are primarily involved in nucleic acids damage/repair (e.g., pyrimidine metabolism), nutrient metabolism (e.g., fatty acid metabolism), and acute inflammation (e.g., histidine metabolism and tyrosine metabolism). NO2 and EC were associated most consistently with these pathways. We confirmed the chemical identity of 8 metabolic features in negative ESI and 2 features in positive ESI, including metabolites closely linked to oxidative stress and inflammation, such as histamine, tyrosine, tryptophan, and proline. CONCLUSIONS We identified a range of ambient pollutants, including components of TRAP, associated with differences in the metabolic phenotype among the cohort of 180 subjects. We found Tobit models to be a robust approach to handle missing data among the metabolic features. The results were encouraging of further use of HRM and MWAS approaches for characterizing molecular mechanisms underlying exposure to TRAP.
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Affiliation(s)
- Zhenjiang Li
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Donghai Liang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Dongni Ye
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Thomas R Ziegler
- Division of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Dean P Jones
- Division of Pulmonary, Allergy, and Critical Care Medicine, School of Medicine, Emory University, Atlanta, United States
| | - Stefanie T Ebelt
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, USA.
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Lamon-Fava S, So J, Mischoulon D, Ziegler TR, Dunlop BW, Kinkead B, Schettler PJ, Nierenberg AA, Felger JC, Maddipati KR, Fava M, Rapaport MH. Dose- and time-dependent increase in circulating anti-inflammatory and pro-resolving lipid mediators following eicosapentaenoic acid supplementation in patients with major depressive disorder and chronic inflammation. Prostaglandins Leukot Essent Fatty Acids 2021; 164:102219. [PMID: 33316626 PMCID: PMC7855824 DOI: 10.1016/j.plefa.2020.102219] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Eicosapentaenoic acid (EPA) supplementation is an effective treatment option in major depressive disorder (MDD) associated with chronic low-grade inflammation. EPA is the precursor of specialized pro-resolving lipid mediators (SPMs) termed resolvins (Rv), that serve important roles in the resolution of inflammation. The objective of this study was to assess the effects of different doses of EPA on plasma concentrations of EPA metabolites and SPMs in MDD patients. METHODS In a 2-site study, 61 MDD patients with body mass index >25 kg/m2 and serum high-sensitivity C-reactive protein ≥3 μg/mL were enrolled in a 12-week randomized trial comparing EPA 1, 2, and 4 g/d to placebo. Plasma EPA (mol%) and SPMs (pg/mL) were measured in 42 study completers at baseline and at the end of treatment by liquid chromatography/mass spectrometry. RESULTS Plasma EPA and SPM concentrations did not change in the placebo group during 12 weeks of treatment. Plasma EPA and EPA-derived metabolites increased significantly and dose-dependently in all EPA supplementation arms. The increase in 18-hydroxyeicosapentaenoic acid (18-HEPE), the precursor of RvE1-3, was significantly greater with the 4 g/d EPA dose than the other doses from week 4 to 12. RvE1 was undetected in all treatment groups, while RvE2 was detected in half of the subjects both at baseline and after treatment, with dose-dependent increases. RvE3 was detected only after supplementation, dose-dependently. A significant reduction in plasma arachidonic acid (AA), relative to baseline, was observed in all EPA arms. This was in contrast with an increase in AA-derived SPM lipoxin B4 (LXB4) in the 4 g/d arm. CONCLUSIONS Our results show a robust effect of EPA 4 g/d supplementation in increasing plasma EPA and 18-HEPE levels, associated with improved conversion to RvE2-3, and LXB4 levels.
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Affiliation(s)
- Stefania Lamon-Fava
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA.
| | - Jisun So
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | | | - Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA
| | - Becky Kinkead
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA
| | - Pamela J Schettler
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA
| | | | - Jennifer C Felger
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA
| | - Krishna Rao Maddipati
- Department of Pathology, Lipidomics Core Facility, Wayne State University, Detroit, MI
| | - Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Mark Hyman Rapaport
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA
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Bellissimo MP, Bettermann EL, Tran PH, Crain BH, Ferranti EP, Binongo JN, Hartman TJ, Jones DP, Ziegler TR, Alvarez JA. Physical Fitness but Not Diet Quality Distinguishes Lean and Normal Weight Obese Adults. J Acad Nutr Diet 2020; 120:1963-1973.e2. [PMID: 33011149 PMCID: PMC7686254 DOI: 10.1016/j.jand.2020.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 06/27/2020] [Accepted: 07/19/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals with normal weight obesity (NWO) have increased cardiometabolic disease and mortality risk, but factors contributing to NWO development are unknown. OBJECTIVE The objective of this study was to determine whether diet quality scores and physical fitness levels differed between adults classified as lean, NWO, and overweight-obese. Secondary objectives of the study were to compare clinical biomarkers and food groups and macronutrient intakes between the three groups, and to test for associations between body composition components with diet quality scores and physical fitness levels. DESIGN This is a secondary data analysis from a cross-sectional study that included metropolitan university and health care system employees. Body composition was measured by dual energy x-ray absorptiometry. Individuals with a body mass index <25 kg/m2 and body fat >23% for men and >30% for women were classified as having NWO. Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension score, and Mediterranean Diet Score were calculated from Block food frequency questionnaires. Physical fitness was assessed by measuring maximal oxygen uptake (VO2 maximum) during treadmill testing. PARTICIPANTS/SETTING This study included 693 adults (65% women, mean age 48.9 ± 11.5 years) enrolled between 2007 and 2013 in Atlanta, GA. MAIN OUTCOME MEASURES The main outcome measures were Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension, and Mediterranean Diet Score diet quality scores and maximal oxygen uptake. STATISTICAL ANALYSES Multiple linear regression analyses with post hoc comparisons were used to investigate group differences in fitness, diet quality, and biomarkers. Regression analyses were also used to examine relationships between diet quality scores and fitness with body composition. RESULTS VO2 maximum was significantly lower in the NWO compared with the lean group (36.2 ± 0.8 mL/min/kg vs 40.2 ± 1.0 mL/min/kg; P < 0.05). Individuals with NWO reported similar diet quality to lean individuals and more favorable Alternate Healthy Eating Index and Dietary Approaches to Stop Hypertension scores than individuals with overweight-obesity (P < 0.05). Diet quality scores and physical fitness levels were inversely associated with percent body fat and visceral adipose tissue (P < 0.05), regardless of weight status. Individuals with NWO exhibited higher fasting blood insulin concentrations, insulin resistance, low-density lipoprotein cholesterol, and triglyceride levels, and significantly lower high-density lipoprotein cholesterol levels than lean individuals (P < 0.05). CONCLUSIONS Physical fitness was significantly decreased in individuals with NWO compared with lean individuals. Higher diet quality was associated with decreased total and visceral fat but did not distinguish individuals with NWO from lean individuals.
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Affiliation(s)
- Moriah P. Bellissimo
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University; Atlanta, GA, USA
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine; Atlanta, GA, USA
- Emory Center for Clinical and Molecular Nutrition, Emory University; Atlanta, GA, USA
| | - Erika L. Bettermann
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine; Atlanta, GA, USA
| | - Phong H. Tran
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine; Atlanta, GA, USA
| | - Benjamin H. Crain
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine; Atlanta, GA, USA
| | - Erin P. Ferranti
- Nell Hodgson School of Nursing, Emory University; Atlanta, GA, USA
| | - Jose N. Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University; Atlanta, GA, USA
| | - Terryl J. Hartman
- Department of Epidemiology, Rollins School of Public Health, Emory University; Atlanta, GA, USA
| | - Dean P. Jones
- Emory Center for Clinical and Molecular Nutrition, Emory University; Atlanta, GA, USA
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine; Atlanta, GA, USA
- Clinical Biomarkers Laboratory, Department of Medicine, Emory University School of Medicine; Atlanta, GA, USA
| | - Thomas R. Ziegler
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine; Atlanta, GA, USA
- Emory Center for Clinical and Molecular Nutrition, Emory University; Atlanta, GA, USA
- Section of Endocrinology, Atlanta Veterans Affairs Medical Center; Decatur, GA, USA
| | - Jessica A. Alvarez
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine; Atlanta, GA, USA
- Emory Center for Clinical and Molecular Nutrition, Emory University; Atlanta, GA, USA
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Bellissimo MP, Roberts JL, Jones DP, Liu KH, Taibl KR, Uppal K, Weitzmann MN, Pacifici R, Drissi H, Ziegler TR, Alvarez JA. Metabolomic Associations with Serum Bone Turnover Markers. Nutrients 2020; 12:nu12103161. [PMID: 33081124 PMCID: PMC7602719 DOI: 10.3390/nu12103161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 12/21/2022] Open
Abstract
Bone is a dynamic tissue that is in a constant state of remodeling. Bone turnover markers (BTMs), procollagen type I N-terminal propeptide (P1NP) and C-terminal telopeptides of type I collagen (CTX), provide sensitive measures of bone formation and resorption, respectively. This study used ultra-high-resolution metabolomics (HRM) to determine plasma metabolic pathways and targeted metabolites related to the markers of bone resorption and formation in adults. This cross-sectional clinical study included 34 adults (19 females, mean 27.8 years), without reported illnesses, recruited from a US metropolitan area. Serum BTM levels were quantified by an ELISA. Plasma HRM utilized dual-column liquid chromatography and mass spectrometry to identify metabolites and metabolic pathways associated with BTMs. Metabolites significantly associated with P1NP (p < 0.05) were significantly enriched in pathways linked to the TCA cycle, pyruvate metabolism, and metabolism of B vitamins important for energy production (e.g., niacin, thiamin). Other nutrition-related metabolic pathways associated with P1NP were amino acid (proline, arginine, glutamate) and vitamin C metabolism, which are important for collagen formation. Metabolites associated with CTX levels (p < 0.05) were enriched within lipid and fatty acid beta-oxidation metabolic pathways, as well as fat-soluble micronutrient pathways including, vitamin D metabolism, vitamin E metabolism, and bile acid biosynthesis. P1NP and CTX were significantly related to microbiome-related metabolites (p < 0.05). Macronutrient-related pathways including lipid, carbohydrate, and amino acid metabolism, as well as several gut microbiome-derived metabolites were significantly related to BTMs. Future research should compare metabolism BTMs relationships reported here to aging and clinical populations to inform targeted therapeutic interventions.
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Affiliation(s)
- Moriah P. Bellissimo
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA; (K.R.T.); (M.N.W.); (R.P.); (T.R.Z.); (J.A.A.)
- Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, GA 30322, USA;
- Correspondence:
| | - Joseph L. Roberts
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA 30322, USA; (J.L.R.); (H.D.)
- Atlanta Department of Veterans Affairs Medical Center, Decatur, GA 30033, USA
| | - Dean P. Jones
- Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, GA 30322, USA;
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA; (K.H.L.); (K.U.)
| | - Ken H. Liu
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA; (K.H.L.); (K.U.)
| | - Kaitlin R. Taibl
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA; (K.R.T.); (M.N.W.); (R.P.); (T.R.Z.); (J.A.A.)
| | - Karan Uppal
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA; (K.H.L.); (K.U.)
| | - M. Neale Weitzmann
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA; (K.R.T.); (M.N.W.); (R.P.); (T.R.Z.); (J.A.A.)
- Atlanta Department of Veterans Affairs Medical Center, Decatur, GA 30033, USA
- Emory Microbiome Research Center, Emory University, Atlanta, GA 30322, USA
| | - Roberto Pacifici
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA; (K.R.T.); (M.N.W.); (R.P.); (T.R.Z.); (J.A.A.)
- Emory Microbiome Research Center, Emory University, Atlanta, GA 30322, USA
| | - Hicham Drissi
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA 30322, USA; (J.L.R.); (H.D.)
- Atlanta Department of Veterans Affairs Medical Center, Decatur, GA 30033, USA
| | - Thomas R. Ziegler
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA; (K.R.T.); (M.N.W.); (R.P.); (T.R.Z.); (J.A.A.)
- Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, GA 30322, USA;
- Atlanta Department of Veterans Affairs Medical Center, Decatur, GA 30033, USA
- Emory Microbiome Research Center, Emory University, Atlanta, GA 30322, USA
| | - Jessica A. Alvarez
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA; (K.R.T.); (M.N.W.); (R.P.); (T.R.Z.); (J.A.A.)
- Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, GA 30322, USA;
- Emory Microbiome Research Center, Emory University, Atlanta, GA 30322, USA
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Valvi D, Walker DI, Inge T, Bartell SM, Jenkins T, Helmrath M, Ziegler TR, La Merrill MA, Eckel SP, Conti D, Liang Y, Jones DP, McConnell R, Chatzi L. Environmental chemical burden in metabolic tissues and systemic biological pathways in adolescent bariatric surgery patients: A pilot untargeted metabolomic approach. Environ Int 2020; 143:105957. [PMID: 32683211 PMCID: PMC7708399 DOI: 10.1016/j.envint.2020.105957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 05/02/2023]
Abstract
BACKGROUND Advances in untargeted metabolomic technologies have great potential for insight into adverse metabolic effects underlying exposure to environmental chemicals. However, important challenges need to be addressed, including how biological response corresponds to the environmental chemical burden in different target tissues. AIM We performed a pilot study using state-of-the-art ultra-high-resolution mass spectrometry (UHRMS) to characterize the burden of lipophilic persistent organic pollutants (POPs) in metabolic tissues and associated alterations in the plasma metabolome. METHODS We studied 11 adolescents with severe obesity at the time of bariatric surgery. We measured 18 POPs that can act as endocrine and metabolic disruptors (i.e. 2 dioxins, 11 organochlorine compounds [OCs] and 5 polybrominated diphenyl ethers [PBDEs]) in visceral and subcutaneous abdominal adipose tissue (vAT and sAT), and liver samples using gas chromatography with UHRMS. Biological pathways were evaluated by measuring the plasma metabolome using high-resolution metabolomics. Network and pathway enrichment analysis assessed correlations between the tissue-specific burden of three frequently detected POPs (i.e. p,p'-dichlorodiphenyldichloroethene [DDE], hexachlorobenzene [HCB] and PBDE-47) and plasma metabolic pathways. RESULTS Concentrations of 4 OCs and 3 PBDEs were quantifiable in at least one metabolic tissue for > 80% of participants. All POPs had the highest median concentrations in adipose tissue, especially sAT, except for PBDE-154, which had comparable average concentrations across all tissues. Pathway analysis showed high correlations between tissue-specific POPs and metabolic alterations in pathways of amino acid metabolism, lipid and fatty acid metabolism, and carbohydrate metabolism. CONCLUSIONS Most of the measured POPs appear to accumulate preferentially in adipose tissue compared to liver. Findings of plasma metabolic pathways potentially associated with tissue-specific POPs concentrations merit further investigation in larger populations.
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Affiliation(s)
- Damaskini Valvi
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Douglas I Walker
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Thomas Inge
- Children's Hospital Colorado and University of Colorado, Denver, United States
| | - Scott M Bartell
- Program in Public Health and Department of Statistics, University of California, Irvine, CA, United States
| | - Todd Jenkins
- Cincinnati Children's Hospital and University of Cincinnati Departments of Pediatrics and Surgery, Cincinnati, OH, United States
| | - Michael Helmrath
- Cincinnati Children's Hospital and University of Cincinnati Departments of Pediatrics and Surgery, Cincinnati, OH, United States
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Michele A La Merrill
- Department of Environmental Toxicology, University of California, Davis, CA, United States
| | - Sandrah P Eckel
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States
| | - David Conti
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States
| | - Yongliang Liang
- Clinical Biomarkers Laboratory, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Dean P Jones
- Clinical Biomarkers Laboratory, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Rob McConnell
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States
| | - Leda Chatzi
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States
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Ko YA, Hu Y, Quyyumi AA, Waller LA, Voit EO, Ziegler TR, Lampl M, Martin GS. Comparison of physical examination and laboratory data between a clinical study and electronic health records. PLoS One 2020; 15:e0236189. [PMID: 32697795 PMCID: PMC7375598 DOI: 10.1371/journal.pone.0236189] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/30/2020] [Indexed: 11/18/2022] Open
Abstract
Research based on secondary analysis of data stored in electronic health records (EHR) has gained popularity, but whether the data are consistent with those collected under a study setting is unknown. The objective is to assess the agreement between data obtained in a prospective study and routine-care data extracted retrospectively from the EHR. We compared the data collected in a longitudinal lifestyle intervention study with those recorded in the EHR system over 5 years. A total of 225 working adults were recruited at an academic institution between 2008–2012, whose EHR data were also available during the same time period. After aligning the participants’ study visit dates with their hospital encounter dates, data on blood pressure, body mass index (BMI), and laboratory measurements (including high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, and total cholesterol) were compared via a paired t-test for equivalence with pre-specified margins. Summary statistics were used to compare smoking status and medication prescriptions. Overall, data were consistent between the two sources (i.e., BMI, smoking status, medication prescriptions), whereas some differences were found in cholesterol measurements (i.e., HDL and total cholesterol), possibly due to different lab assays and subject’s fasting status. In conclusion, some EHR data are fairly consistent with those collected in a clinical study, whereas others may require further examination. Researchers should evaluate the consistency and quality of EHR data and compare them with other sources of data when possible.
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Affiliation(s)
- Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Yingtian Hu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Arshed A. Quyyumi
- Division of Cardiology, School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Lance A. Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Eberhard O. Voit
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Thomas R. Ziegler
- Division of Endocrinology, School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Michelle Lampl
- Department of Anthropology, Emory University, Atlanta, Georgia, United States of America
| | - Greg S. Martin
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, School of Medicine, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
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Gündoğan K, Doğan E, Özer NT, Güneş Şahin G, Şahin S, Sungur M, Akbudak IH, Muhtaroğlu S, Güven M, Ziegler TR. The association between the route of nutrition and serum levels of adipokines in critical illness: a pilot study. Turk J Med Sci 2020; 50:877-884. [PMID: 32336076 PMCID: PMC7379413 DOI: 10.3906/sag-1911-165] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/24/2020] [Indexed: 12/27/2022] Open
Abstract
Background/aim Adipokines play an important role in the regulation of metabolism. In critical illness, they alter serum levels and are suspected to worsen clinical outcomes. But the effect of the route of nutrition on adipokines is not known. The purpose of this study was to evaluate the association between the route of nutrition and adipokine levels in critically ill patients. Materials and methods This prospective study was performed in an intensive care unit (ICU). Patients admitted to the ICU for least 72 h and receiving either enteral nutrition (EN) via tube feeding or parenteral nutrition (PN) were enrolled. Serum was obtained at baseline, 24 h, and 72 h for concentrations of leptin, adiponectin, resistin, glucagon–like peptide 1 (GLP–1), insulin–like growth factors 1 (IGF–1), and ghrelin. Results A total of 26 patients were included in the study. Thirteen patients received EN and 13 patients received PN. In the PN group, leptin level significantly increased (P = 0.037), adiponectin and ghrelin significantly decreased during follow up (P = 0.037, P = 0.008, respectively). There was no significant change between all adipokines in the EN group and resistin, IGF–1 and GLP–1 in the PN group during follow up. Resistin levels were markedly lower in the EN group at both 24 h (P = 0.015) and 72 h (P = 0.006) while GLP–1 levels were higher in the EN group at baseline, 24 h, and 72 h (P = 0.018, P = 0.005, and P = 0.003, respectively). There were no differences in leptin, adiponectin, IGF–1, and ghrelin levels over time. Conclusion The delivery of EN in critical illness was associated with decreased resistin levels and increased GLP–1 levels. Thus, the route of nutrition may impact the clinical outcome in critical illness due to adipokines.
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Affiliation(s)
- Kürşat Gündoğan
- Division of Medical Intensive Care, Department of Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Ender Doğan
- Department of Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Nurhayat Tuğra Özer
- Department of Clinical Nutrition, Institute of Health Sciences, Erciyes University, Kayseri, Turkey
| | - Gülşah Güneş Şahin
- Department of Clinical Nutrition, Institute of Health Sciences, Erciyes University, Kayseri, Turkey
| | - Serap Şahin
- Department of Clinical Nutrition, Institute of Health Sciences, Erciyes University, Kayseri, Turkey
| | - Murat Sungur
- Division of Medical Intensive Care, Department of Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Ismail Hakki Akbudak
- Division of Medical Intensive Care, Department of Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | | | - Muhammet Güven
- Division of Medical Intensive Care, Department of Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Thomas R Ziegler
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA,Division of Endocrinology, Metabolism and Lipids, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
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Collins JM, Siddiqa A, Jones DP, Liu K, Kempker RR, Nizam A, Shah NS, Ismail N, Ouma SG, Tukvadze N, Li S, Day CL, Rengarajan J, Brust JC, Gandhi NR, Ernst JD, Blumberg HM, Ziegler TR. Tryptophan catabolism reflects disease activity in human tuberculosis. JCI Insight 2020; 5:137131. [PMID: 32369456 DOI: 10.1172/jci.insight.137131] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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: 02/12/2020] [Accepted: 04/22/2020] [Indexed: 12/26/2022] Open
Abstract
There is limited understanding of the role of host metabolism in the pathophysiology of human tuberculosis (TB). Using high-resolution metabolomics with an unbiased approach to metabolic pathway analysis, we discovered that the tryptophan pathway is highly regulated throughout the spectrum of TB infection and disease. This regulation is characterized by increased catabolism of tryptophan to kynurenine, which was evident not only in active TB disease but also in latent TB infection (LTBI). Further, we found that tryptophan catabolism is reversed with effective treatment of both active TB disease and LTBI in a manner commensurate with bacterial clearance. Persons with active TB and LTBI also exhibited increased expression of indoleamine 2,3-dioxygenase-1 (IDO-1), suggesting IDO-1 mediates observed increases in tryptophan catabolism. Together, these data indicate IDO-1-mediated tryptophan catabolism is highly preserved in the human response to Mycobacterium tuberculosis and could be a target for biomarker development as well as host-directed therapies.
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Affiliation(s)
- Jeffrey M Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amnah Siddiqa
- Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA
| | - Dean P Jones
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ken Liu
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Russell R Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Azhar Nizam
- Department of Biostatistics and Bioinformatics
| | - N Sarita Shah
- Department of Epidemiology, and.,Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Nazir Ismail
- Centre for Tuberculosis, National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa.,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.,Department of Internal Medicine, University of Witwatersrand, Johannesburg, South Africa
| | | | - Nestani Tukvadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Shuzhao Li
- Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA
| | - Cheryl L Day
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, USA.,Emory Vaccine Center and.,Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - Jyothi Rengarajan
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Emory Vaccine Center and.,Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - James Cm Brust
- Division of General Internal Medicine and.,Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Neel R Gandhi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Epidemiology, and.,Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Joel D Ernst
- Division of Experimental Medicine, Department of Medicine, UCSF School of Medicine, San Francisco, California, USA
| | - Henry M Blumberg
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Epidemiology, and.,Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.,Emory Vaccine Center and
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism, and Lipids and.,Emory Center for Clinical and Molecular Nutrition, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Section of Endocrinology, Atlanta Veterans Affairs Medical Center, Atlanta Georgia, USA
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Serra MC, Ryan AS, Hafer-Macko CE, Yepes M, Nahab FB, Ziegler TR. Dietary and Serum Omega-6/Omega-3 Fatty Acids Are Associated with Physical and Metabolic Function in Stroke Survivors. Nutrients 2020; 12:nu12030701. [PMID: 32155696 PMCID: PMC7146193 DOI: 10.3390/nu12030701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/27/2020] [Accepted: 03/03/2020] [Indexed: 12/28/2022] Open
Abstract
The purpose of this study was to quantify habitual dietary and systemic omega-6 and omega-3 fatty acids and their ratios and to determine their relationship with physical and metabolic function in a cohort of chronic adult stroke survivors. Twenty-five older chronic stroke survivors (age: 63 ± 8 years; BMI: 31 ± 7 kg/m2; mean ± SD) were assessed for fitness (VO2peak), gait speed (GS), 3 m timed up and go (TUG), and six-minute walk distance (6MWD). Plasma lipid and glucose profiles were measured, and HOMA-IR calculated. Dietary (5-day food records) and serum (mass spectrometry) omega-6/omega-3 profiles were assessed. Participants were severely deconditioned (VO2peak: 19 ± 4 mL/kg/min; GS: 0.88 ± 0.28 m/s; TUG: 12.6 ± 5.9 s; 6MWD: 295 ± 121 m) and at elevated metabolic risk (HOMA-IR: 6.3 ± 4.5). The dietary intake ratio of omega-6/omega-3 fatty acids averaged 12.6 ± 7.1 and the serum concentration ratio was 1.21 ± 0.37, which were correlated (r = 0.88, p < 0.01). Higher dietary intake and serum concentrations of omega-6/omega-3 fatty acids were associated with lower 6MWD and higher HOMA-IR, while a higher serum omega-6/omega-3 concentration index was associated with lower VO2peak (p's < 0.05). These preliminary data suggest that both dietary omega-6 and omega-3 fatty acids (quantitated as their intake ratio) and the serum concentration ratio of omega-6/omega-3 may be important indices of physical dysfunction and insulin resistance in chronic stroke survivors.
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Affiliation(s)
- Monica C. Serra
- San Antonio GRECC, South Texas Veterans Health Care System and Division of Geriatrics, Gerontology & Palliative Medicine and the Sam & Ann Barshop Institute for Longevity & Aging Studies, UT Health San Antonio, San Antonio, TX 78229, USA
- Correspondence: ; Tel.: +1-(210)-949-9759
| | - Alice S. Ryan
- VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore, MD 21201, USA; (A.S.R.); (C.E.H.-M.)
| | - Charlene E. Hafer-Macko
- VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore, MD 21201, USA; (A.S.R.); (C.E.H.-M.)
| | - Manuel Yepes
- Emory University School of Medicine, Atlanta, GA 30322, USA; (M.Y.); (F.B.N.); (T.R.Z.)
| | - Fadi B. Nahab
- Emory University School of Medicine, Atlanta, GA 30322, USA; (M.Y.); (F.B.N.); (T.R.Z.)
| | - Thomas R. Ziegler
- Emory University School of Medicine, Atlanta, GA 30322, USA; (M.Y.); (F.B.N.); (T.R.Z.)
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Bellissimo MP, Cai Q, Ziegler TR, Liu KH, Tran PH, Vos MB, Martin GS, Jones DP, Yu T, Alvarez JA. Plasma High-Resolution Metabolomics Differentiates Adults with Normal Weight Obesity from Lean Individuals. Obesity (Silver Spring) 2019; 27:1729-1737. [PMID: 31689010 PMCID: PMC6839782 DOI: 10.1002/oby.22654] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/30/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study explored underlying metabolism-related dysfunction by examining metabolomic profiles in adults categorized as lean, as having normal weight obesity (NWO), or as having overweight/obesity. METHODS Participants (N = 179) had fasting plasma analyzed by liquid chromatography and high-resolution mass spectrometry for high-resolution metabolomics. Body composition was assessed by dual-energy x-ray absorptiometry. NWO was defined as BMI < 25 and body fat > 30% for women and > 23% for men. Differentiating metabolomic features were determined by using linear regression models and likelihood ratio tests with false discovery rate correction. Mummichog was used for pathway and network analyses. RESULTS A total of 222 metabolites significantly differed between the groups at a false discovery rate of q = 0.2. Linoleic acid, β-alanine, histidine, and aspartate/asparagine metabolism pathways were significantly enriched (all P < 0.01) by metabolites that were similarly upregulated in the NWO and overweight/obesity groups compared with the lean group. A module analysis linked branched-chain amino acids and amino acid metabolites as elevated in the NWO and overweight/obesity groups compared with the lean group (all P < 0.05). CONCLUSIONS Metabolomic profiles of individuals with NWO reflected similar metabolic disruption as those of individuals with overweight/obesity. High-resolution metabolomics may help identify people at risk for developing obesity-related disease, despite normal BMI.
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Affiliation(s)
- Moriah P Bellissimo
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, Georgia, USA
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, Georgia, USA
| | - Qingpo Cai
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, Georgia, USA
- Section of Endocrinology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Ken H Liu
- Clinical Biomarkers Laboratory, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Phong H Tran
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Miriam B Vos
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Greg S Martin
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Dean P Jones
- Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, Georgia, USA
- Clinical Biomarkers Laboratory, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Tianwei Yu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jessica A Alvarez
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, Georgia, USA
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Gundogan K, Dave NJ, Griffith DP, Zhao VM, McNally TA, Easley KA, Haack CI, Galloway JR, Ziegler TR. Ethanol Lock Therapy Markedly Reduces Catheter-Related Blood Stream Infections in Adults Requiring Home Parenteral Nutrition: A Retrospective Study From a Tertiary Medical Center. JPEN J Parenter Enteral Nutr 2019; 44:661-667. [PMID: 31456260 DOI: 10.1002/jpen.1698] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/16/2019] [Accepted: 08/03/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND The use of central venous catheter (CVC) access for home parenteral nutrition (HPN) is associated with catheter-related bloodstream infections (CRBSIs). There are limited data on the use of ethanol lock therapy (ELT) to prevent CRBSI in adult HPN patients. Our aim was to determine whether the routine institution of ELT decreased the incidence of CRBSI compared with historic controls at Emory University Hospital (EUH) in Atlanta, Georgia, USA. METHODS EUH medical records of adult HPN patients discharged with a tunneled, silicone CVC on ELT were retrospectively studied during a pre-hoc determined 14-month observation period (n = 87; 13,386 catheter days) and compared with clinically similar HPN patients from the same institution before institution of the ELT protocol for all appropriate patients. The ELT protocol involved instilling 2 mL of 70% ethanol into each catheter lumen daily after the HPN cycle, following initial flushing with normal saline. RESULTS Only 5 of 87 patients (5.7%) who received ELT were diagnosed with a CRBSI (0.45/1000 catheter days) during observation. We compared these data with our previously published clinically matched patient population from EUH (n = 22) receiving HPN via a silicone CVC without ELT. Of these historical controls, 45.5% were diagnosed with 1 or more CRBSIs (8.7/1000 catheter days) during observation (P < .001 vs the current ELT cohort). CONCLUSIONS In this retrospective study with historical controls from the same academic center, institution of ELT in adults requiring HPN via a silicone CVC was associated with a marked (19-fold) reduction in CRBSI.
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Affiliation(s)
- Kursat Gundogan
- Division of Medical Intensive Care, Department of Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Nisha J Dave
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA.,Pharmaceutical Services, Emory University Hospital, Atlanta, Georgia, USA
| | - Daniel P Griffith
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA.,Pharmaceutical Services, Emory University Hospital, Atlanta, Georgia, USA
| | - Vivian M Zhao
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA.,Pharmaceutical Services, Emory University Hospital, Atlanta, Georgia, USA
| | - Therese A McNally
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA.,Nursing Services, Emory University Hospital, Atlanta, Georgia, USA
| | - Kirk A Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Carla I Haack
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA.,Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John R Galloway
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA.,Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.,Center for Clinical and Molecular Nutrition, Emory University, Atlanta, Georgia, USA
| | - Thomas R Ziegler
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA.,Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Center for Clinical and Molecular Nutrition, Emory University, Atlanta, Georgia, USA.,Section of Endocrinology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
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Rice TW, Files DC, Morris PE, Bernard AC, Ziegler TR, Drover JW, Kress JP, Ham KR, Grathwohl DJ, Huhmann MB, Gautier JBO. Dietary Management of Blood Glucose in Medical Critically Ill Overweight and Obese Patients: An Open-Label Randomized Trial. JPEN J Parenter Enteral Nutr 2019; 43:471-480. [PMID: 30260488 PMCID: PMC7379263 DOI: 10.1002/jpen.1447] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/03/2018] [Accepted: 08/16/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Enteral nutrition (EN) increases hyperglycemia due to high carbohydrate concentrations while providing insufficient protein. The study tested whether an EN formula with very high-protein- and low-carbohydrate-facilitated glucose control delivered higher protein concentrations within a hypocaloric protocol. METHODS This was a multicenter, randomized, open-label clinical trial with parallel design in overweight/obese mechanically ventilated critically ill patients prescribed 1.5 g protein/kg ideal body weight/day. Patients received either an experimental very high-protein (37%) and low-carbohydrate (29%) or control high-protein (25%) and conventional-carbohydrate (45%) EN formula. RESULTS A prespecified interim analysis was performed after enrollment of 105 patients (52 experimental, 53 control). Protein and energy delivery for controls and experimental groups on days 1-5 were 1.2 ± 0.4 and 1.1 ± 0.3 g/kg ideal body weight/day (P = .83), and 18.2 ± 6.0 and 12.5 ± 3.7 kcals/kg ideal body weight/day (P < .0001), respectively. The combined rate of glucose events outside the range of >110 and ≤150 mg/dL were not different (P = .54, primary endpoint); thereby the trial was terminated. The mean blood glucose for the control and the experimental groups were 138 (-SD 108, +SD 177) and 126 (-SD 99, +SD 160) mg/dL (P = .004), respectively. Mean rate of glucose events >150 mg/dL decreased (Δ = -13%, P = .015), whereas that of 80-110 mg/dL increased (Δ = 14%, P = .0007). Insulin administration decreased 10.9% (95% CI, -22% to 0.1%; P = .048) in the experimental group relative to the controls. Glycemic events ≤80 mg/dL and rescue dextrose use were not different (P = .23 and P = .53). CONCLUSIONS A very high-protein and low-carbohydrate EN formula in a hypocaloric protocol reduces hyperglycemic events and insulin requirements while increasing glycemic events between 80-110 mg/dL.
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Affiliation(s)
- Todd W. Rice
- Division of AllergyPulmonaryand Critical Care MedicineDepartment of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - D. Clark Files
- Department of Internal Medicine—PulmonaryCritical CareAllergy and Immunologic DiseasesWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | | | | | - Thomas R. Ziegler
- Division of Endocrinology, Metabolism and LipidsEmory UniversityAtlantaGeorgiaUSA
| | - John W. Drover
- Department of Critical Care MedicineQueen's University and Kingston Health Science CenterKingstonOntarioCanada
| | - John P. Kress
- The University of Chicago MedicineChicagoIllinoisUSA
| | - Kealy R. Ham
- Department of Critical Care MedicineRegions HospitalUniversity of MinnesotaSt. PaulMinnesotaUSA
| | | | | | - Juan B. Ochoa Gautier
- Nestlé Health ScienceBridgewaterNew JerseyUSA
- Geisinger Medical CenterDanvillePennsylvaniaUSA
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Wischmeyer PE, Mintz-Cole RA, Baird CH, Easley KA, May AK, Sax HC, Kudsk KA, Hao L, Tran PH, Jones DP, Blumberg HM, Ziegler TR. Role of heat shock protein and cytokine expression as markers of clinical outcomes with glutamine-supplemented parenteral nutrition in surgical ICU patients. Clin Nutr 2019; 39:563-573. [PMID: 30981628 DOI: 10.1016/j.clnu.2019.02.045] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Nutrients, such as glutamine (GLN), have been shown to effect levels of a family of protective proteins termed heat shock proteins (HSPs) in experimental and clinical critical illness. HSPs are believed to serve as extracellular inflammatory messengers and intracellular cytoprotective molecules. Extracellular HSP70 (eHSP70) has been termed a chaperokine due to ability to modulate the immune response. Altered levels of eHSP70 are associated with various disease states. Larger clinical trial data on GLN effect on eHSP expression and eHSP70's association with inflammatory mediators and clinical outcomes in critical illness are limited. OBJECTIVE Explore effect of longitudinal change in serum eHSP70, eHSP27 and inflammatory cytokine levels on clinical outcomes such as pneumonia and mortality in adult surgical intensive care unit (SICU) patients. Further, evaluate effect of parenteral nutrition (PN) supplemented with GLN (GLN-PN) versus GLN-free, standard PN (STD-PN) on serum eHSP70 and eHSP27 concentrations. METHODS Secondary observational analysis of a multicenter clinical trial in 150 adults after cardiac, vascular, or gastrointestinal surgery requiring PN support and SICU care conducted at five academic medical centers. Patients received isocaloric, isonitrogenous PN, with or without GLN dipeptide. Serum eHSP70 and eHSP27, interleukin-6 (IL-6), and 8 (IL-8) concentrations were analyzed in patient serum at baseline (prior to study PN) and over 28 days of follow up. RESULTS eHSP70 declined over time in survivors during 28 days follow-up, but non-survivors had significantly higher eHSP70 concentrations compared to survivors. In patients developing pneumonia, eHSP70, eHSP27, IL-8, and IL-6 were significantly elevated. Adjusted relative risk for hospital mortality was reduced 75% (RR = 0.25, p = 0.001) for SICU patients with a faster decline in eHSP70. The area under the receiver operating characteristic curve was 0.85 (95% CI: 0.76 to 0.94) for the final model suggesting excellent discrimination between SICU survivors and non-survivors. GLN-PN did not alter eHSP70 or eHSP27 serum concentrations over time compared to STD-PN. CONCLUSION Our results suggest that serum HSP70 concentration may be an important marker for severity of illness and likelihood of recovery in the SICU. GLN-supplemented-PN did not increase eHSP70.
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Affiliation(s)
- Paul E Wischmeyer
- Duke University Hospital, Department of Anesthesiology and Duke Clinical Research Institute, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Rachael A Mintz-Cole
- Duke University Hospital, Department of Anesthesiology and Duke Clinical Research Institute, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Christine H Baird
- University of Colorado Denver Anschutz Medical Campus, Anesthesiology, 12700 E. 19th Avenue Box 8602, Aurora, CO 80045, USA.
| | - Kirk A Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Addison K May
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37240, USA.
| | - Harry C Sax
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA.
| | - Kenneth A Kudsk
- Department of Surgery, University of Wisconsin, Schools of Medicine and Public Health, Madison, Madison, WI 53792, USA.
| | - Li Hao
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.
| | - Phong H Tran
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.
| | - Dean P Jones
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA; Center for Clinical and Molecular Nutrition, Emory University School of Medicine, Atlanta, GA 30322, USA.
| | - Henry M Blumberg
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA; Center for Clinical and Molecular Nutrition, Emory University School of Medicine, Atlanta, GA 30322, USA; Atlanta Veterans Affairs Medical Center, Decatur, GA 30033, USA.
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Tangpricha V, Lukemire J, Chen Y, Binongo JNG, Judd SE, Michalski ES, Lee MJ, Walker S, Ziegler TR, Tirouvanziam R, Zughaier SM, Chesdachai S, Hermes WA, Chmiel JF, Grossmann RE, Gaggar A, Joseph PM, Alvarez JA. Vitamin D for the Immune System in Cystic Fibrosis (DISC): a double-blind, multicenter, randomized, placebo-controlled clinical trial. Am J Clin Nutr 2019; 109:544-553. [PMID: 30793177 PMCID: PMC6408205 DOI: 10.1093/ajcn/nqy291] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 06/19/2018] [Accepted: 08/30/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patients with cystic fibrosis (CF) have increased risk of vitamin D deficiency owing to fat malabsorption and other factors. Vitamin D deficiency has been associated with increased risk of pulmonary exacerbations of CF. OBJECTIVES The primary objective of this study was to examine the impact of a single high-dose bolus of vitamin D3 followed by maintenance treatment given to adults with CF during an acute pulmonary exacerbation on future recurrence of pulmonary exacerbations. METHODS This was a multicenter, double-blind, placebo-controlled, intent-to-treat clinical trial. Subjects with CF were randomly assigned to oral vitamin D3 given as a single dose of 250,000 International Units (IU) or to placebo within 72 h of hospital admission for an acute pulmonary exacerbation, followed by 50,000 IU of vitamin D3 or an identically matched placebo pill taken orally every other week starting at 3 mo after random assignment. The primary outcome was the composite endpoint of the time to next pulmonary exacerbation or death within 1 y. The secondary outcomes included circulating concentrations of the antimicrobial peptide cathelicidin and recovery of lung function as assessed by the percentage of predicted forced expiratory volume in 1 s (FEV1%). RESULTS A total of 91 subjects were enrolled in the study. There were no differences between the vitamin D3 and placebo groups in time to next pulmonary exacerbation or death at 1 y. In addition, there were no differences in serial recovery of lung function after pulmonary exacerbation by FEV1% or in serial concentrations of plasma cathelicidin. CONCLUSIONS Vitamin D3 initially given at the time of pulmonary exacerbation of CF did not alter the time to the next pulmonary exacerbation, 12-mo mortality, serial lung function, or serial plasma cathelicidin concentrations. This trial was registered at clinicaltrials.gov as NCT01426256.
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Affiliation(s)
- Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA,Nutrition Health Sciences Program, Emory University School of Public Health, Atlanta, GA,Emory Cystic Fibrosis Center, Atlanta, GA,Atlanta VA Medical Center, Atlanta, GA,Address correspondence to VT (e-mail: )
| | | | | | | | - Suzanne E Judd
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, AL
| | - Ellen S Michalski
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA,Nutrition Health Sciences Program, Emory University School of Public Health, Atlanta, GA
| | - Moon J Lee
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | | | - Thomas R Ziegler
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA,Nutrition Health Sciences Program, Emory University School of Public Health, Atlanta, GA,Emory Cystic Fibrosis Center, Atlanta, GA,Atlanta VA Medical Center, Atlanta, GA
| | - Rabin Tirouvanziam
- Emory Cystic Fibrosis Center, Atlanta, GA,Division of Pulmonary, Allergy & Immunology, Cystic Fibrosis, and Sleep, Department of Pediatrics, Emory University, Atlanta, GA
| | | | - Supavit Chesdachai
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Wendy A Hermes
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - James F Chmiel
- Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH
| | | | - Amit Gaggar
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, The University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham, AL
| | - Patricia M Joseph
- Division of Pulmonary, Critical Care & Sleep, Department of Medicine, University of Cincinnati, Cincinnati, OH
| | - Jessica A Alvarez
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA,Nutrition Health Sciences Program, Emory University School of Public Health, Atlanta, GA,Emory Cystic Fibrosis Center, Atlanta, GA
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Jolliffe DA, Ganmaa D, Wejse C, Raqib R, Haq MA, Salahuddin N, Daley PK, Ralph AP, Ziegler TR, Martineau AR. Adjunctive vitamin D in tuberculosis treatment: meta-analysis of individual participant data. Eur Respir J 2019; 53:13993003.02003-2018. [DOI: 10.1183/13993003.02003-2018] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/12/2018] [Indexed: 01/12/2023]
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Gundogan K, Akbudak IH, Bulut K, Temel S, Sungur M, Guven M, Dave NJ, Griffith DP, Ziegler TR. Thiamin Status in Adults Receiving Chronic Diuretic Therapy Prior to Admission to a Medical Intensive Care Unit: A Pilot Study. Nutr Clin Pract 2019; 34:565-571. [DOI: 10.1002/ncp.10241] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kursat Gundogan
- Division of Medical Intensive Care; Department of Medicine; Enteral and Parenteral Nutrition Unit; Erciyes University School of Medicine; Kayseri Turkey
| | - Ismail Hakki Akbudak
- Division of Medical Intensive Care; Department of Medicine; Enteral and Parenteral Nutrition Unit; Erciyes University School of Medicine; Kayseri Turkey
| | - Kadir Bulut
- Division of Medical Intensive Care; Department of Medicine; Enteral and Parenteral Nutrition Unit; Erciyes University School of Medicine; Kayseri Turkey
| | - Sahin Temel
- Division of Medical Intensive Care; Department of Medicine; Enteral and Parenteral Nutrition Unit; Erciyes University School of Medicine; Kayseri Turkey
| | - Murat Sungur
- Division of Medical Intensive Care; Department of Medicine; Enteral and Parenteral Nutrition Unit; Erciyes University School of Medicine; Kayseri Turkey
| | - Muhammet Guven
- Division of Medical Intensive Care; Department of Medicine; Enteral and Parenteral Nutrition Unit; Erciyes University School of Medicine; Kayseri Turkey
| | - Nisha J. Dave
- Nutrition and Metabolic Support Service; Emory University Hospital; Atlanta Georgia USA
| | - Daniel P. Griffith
- Nutrition and Metabolic Support Service; Emory University Hospital; Atlanta Georgia USA
| | - Thomas R. Ziegler
- Nutrition and Metabolic Support Service; Emory University Hospital; Atlanta Georgia USA
- Division of Endocrinology; Metabolism and Lipids; Emory University School of Medicine; Atlanta Georgia USA
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Loman BR, Luo M, Baggs GE, Mitchell DC, Nelson JL, Ziegler TR, Deutz NE, Matarese LE. Specialized High-Protein Oral Nutrition Supplement Improves Home Nutrient Intake of Malnourished Older Adults Without Decreasing Usual Food Intake. JPEN J Parenter Enteral Nutr 2018; 43:794-802. [PMID: 30565718 PMCID: PMC6924274 DOI: 10.1002/jpen.1467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/08/2018] [Indexed: 11/09/2022]
Abstract
Background Reduced nutrient intake is common in patients after hospitalization, contributing to increased risk for readmission and mortality. Oral nutrition supplements can improve nutrition status and clinical outcomes, but intake of food is prioritized by clinicians. This study examines the impact of a high‐protein oral nutrition supplement (S‐ONS) on nutrient intake post discharge. Methods In a subset of patients (14 S‐ONS and 16 placebo) from the NOURISH (Nutrition effect On Unplanned ReadmIssions and Survival in Hospitalized patients) trial, 24‐hour dietary recalls were conducted on 3 randomly selected days during the weeks of 30, 60, and 90 days post discharge. Nutrient intake was estimated using Nutrition Data System for Research software. Adequate energy and protein intake were defined as 30 kcal/kg/d and 1.2 g/kg/d, respectively. Dietary Reference Intakes (DRIs) were used for other nutrients. Results Less than half of patients met the requirements for energy, protein, and 12 micronutrients from food intake alone during the study. Energy and protein intakes from food were not diminished relative to placebo. Considering nutrient intake from both food and S‐ONS, 50% and 71% of patients receiving S‐ONSs met energy and protein goals respectively at 90 days (compared with 29% and 36%, in the placebo group), and 100% met the DRI for total carbohydrate, iron, phosphorus, copper, selenium, thiamin, and riboflavin at all time points, all of which were consumed at higher amounts vs placebo. Conclusion Three months of S‐ONS consumption increases intake of numerous nutrients without decreasing nutrient intake from food in older malnourished adults post discharge.
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Affiliation(s)
- Brett R Loman
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Division of Nutritional Sciences, College of Agricultural, Consumer, and Environmental Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Menghua Luo
- Research and Development, Abbott Nutrition, Columbus, Ohio, USA
| | | | - Diane C Mitchell
- Department of Nutritional Sciences, Penn State University, University Park, Pennsylvania, USA
| | | | - Thomas R Ziegler
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nicolaas E Deutz
- Center for Translational Research in Aging & Longevity, Department of Health & Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Laura E Matarese
- Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
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