自体粪菌移植可维持特定饮食干预的减重效果
创作:szx 审核:szx 2020年08月28日
  • 90名中心型肥胖或血脂异常患者随机分为3组,分别接受6个月的不同饮食干预:健康饮食指南、地中海饮食、绿色地中海饮食;
  • 饮食干预结束2个月后,患者分别接受aFMT或安慰剂治疗,共服用100粒粪菌胶囊,持续6个月;
  • 饮食干预结束8个月后,不同饮食组的体重反弹无显著差异;
  • 仅在绿色地中海饮食组中,饮食干预显著改变了患者的菌群组成,且aFMT显著抑制了体重、腰围及胰岛素水平的反弹,并促进了减重相关特定细菌及菌群代谢通路的保留。
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Gastroenterology上发表的一项最新研究,90名中心型肥胖或血脂异常患者随机接受6个月的3种不同的饮食干预:健康饮食指南、地中海饮食、绿色地中海饮食(多摄入绿色植物及多酚)。干预结束后,将患者自己的粪菌制成胶囊用于随后的粪菌移植试验。干预结束2个月后,患者分别摄入自体粪菌胶囊或安慰剂,持续治疗6个月。结果发现,仅在绿色地中海饮食组中,饮食干预可显著改变患者的菌群组成,且自体粪菌移植可显著抑制体重、腰围及胰岛素水平的反弹。
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Gastroenterology [IF:17.373]

Effects of Diet-Modulated Autologous Fecal Microbiota Transplantation on Weight Regain

饮食调控下的自体粪菌移植对体重反弹的影响

10.1053/j.gastro.2020.08.041

2020-08-25, Article

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Background & Aims: We evaluated the efficacy and safety of diet-modulated autologous fecal microbiota transplantation (aFMT) for treatment of weight regain after the weight loss phase.
Methods: In the DIRECT-PLUS weight loss trial (May 2017 through July 2018), abdominally obese or dyslipidemic participants in Israel were randomly assigned to (1)healthy dietary guidelines, (2)Mediterranean diet, and (3)green-Mediterranean diet weight-loss groups. All groups received free gym membership and physical activity guidelines. Both iso-caloric Mediterranean groups consumed 28g/day walnuts (+440mg/d polyphenols provided). The green-Mediterranean dieters further consumed green tea (3-4 cups/day) and a Wolffia-globosa (Mankai strain;100g/day) green shake (+800mg/day polyphenols provided). After 6 months (weight-loss phase), 90 eligible participants (mean age, 52 years; mean weight loss, 8.3 kg) provided a fecal sample that was processed into aFMT by frozen, opaque and odorless capsules. The participants were then randomly assigned to groups that received 100 capsules containing their own fecal microbiota or placebo until month 14. The primary outcome was regain of the lost weight over the expected weight regain phase (months 6–14). Secondary outcomes were gastrointestinal symptoms, waist-circumference, glycemic status and changes in the gut microbiome, as measured by metagenomic sequencing and 16s-rRNA. We validated the results in a parallel in-vivo study of mice specifically fed with Mankai, as compared to control chow diet.
Results: Of the 90 participants in the aFMT trial, 96% ingested at least 80 of 100 oral aFMT or placebo frozen capsules over the transplantation period. No aFMT-related adverse events or symptoms were observed. For the primary outcome, although no significant differences in weight regain were observed among the participants in the different lifestyle interventions during months 6–14 (aFMT, 30.4% vs. placebo, 40.6%;P=.28), aFMT significantly attenuated weight regain in the green-Mediterranean group (aFMT, 17.1%, vs placebo, 50%; P=.02), but not in the dietary guidelines (P=.57) or Mediterranean diet (P=.64) groups (P for the interaction=.03). Accordingly, aFMT attenuated waist circumference gain (aFMT, 1.89cm vs placebo, 5.05cm;P=.01) and insulin rebound (aFMT, 1.46±3.6μIU/ml vs placebo, 1.64±4.7μIU/ml;P=.04) in the green Mediterranean group but not in the dietary guidelines or Mediterranean diet (P for the interaction=.04 and .03, respectively). The green-Mediterranean diet was the only intervention to induce a significant change in microbiome composition during the weight loss phase, and to prompt preservation of weight loss-associated specific bacteria and microbial metabolic pathways (mainly microbial sugar transport) following the aFMT. In mice, Mankai-modulated aFMT in the weight loss phase, compared with control diet aFMT, significantly prevented weight regain, and resulted in better glucose tolerance, during a high-fat-diet induced regain phase (P<.05 for all).
Conclusions: Autologous FMT, collected during the weight loss phase and administrated in the regain phase, might preserve weight loss and glycemic control and is associated with specific microbiome signatures. High-polyphenols, green plant-based or Mankai diet better optimizes the microbiome for an aFMT procedure. (ClinicalTrials.gov number, NCT03020186)

First Authors:
Ehud Rinott,Ilan Youngster

Correspondence Authors:
Ilan Youngster,Iris Shai

All Authors:
Ehud Rinott,Ilan Youngster,Anat Yaskolka Meir,Gal Tsaban,Hila Zelicha,Alon Kaplan,Dan Knights,Kieran Tuohy,Francesca Fava,Matthias Uwe Scholz,Oren Ziv,Elad Reuven,Amir Tirosh,Assaf Rudich,Matthias Blüher,Michael Stumvoll,Uta Ceglarek,Karine Clément,Omry Koren,Dong D Wang,Frank B Hu,Meir J Stampfer,Iris Shai

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