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Nieuwe meta-analyses, RCTs en systematic reviews die wij dagelijks monitoren in PubMed. Onafhankelijk geïndexeerd, niet redactioneel bewerkt.
PloS one · 2024
Photobiomodulation, also referred to as Low-Level Light Therapy (LLLT), has emerged as a promising intervention for pruritus, a prevalent and often distressing symptom. This study investigated the efficacy of low-level light therapy (LLLT) in alleviating pruritus, hyperknesis, and alloknesis induced by histamine and Mucuna pruriens. In a double-blind, randomized, sham-controlled trial with a split-body design, healthy volunteers underwent 6 minutes of LLLT and sham treatments in separate upper back quadrants. The histamine model was applied to the upper quadrants, and Mucuna pruriens to the lower quadrants. Pruritus intensity, alloknesis, hyperknesis, flare area, and skin temperature were measured pre and post treatment. Seventeen individuals (eight females, nine males) participated in the study. In the histamine model, LLLT notably reduced itch intensity (difference = 13.9 (95% CI: 10.5 - 17.4), p = 0.001), alloknesis (difference = 0.80 (95% CI: 0.58-1.02), p = 0.001), and hyperknesis (difference = 0.48 (95% CI: 0.09-0.86), p = 0.01). Skin temperature changes were not significantly different between the two groups (difference = -2.0 (95% CI: -6.7-2.6), p = 0.37). For the Mucuna pruriens model, no significant differences were observed in any measures, including itch intensity (difference = 0.8 (95% CI: -2.3 - 3.8), p = 0.61) hyperknesis (difference = 0.08 (95% CI: -0.06-0.33), p = 0.16) and alloknesis (difference = 0. 0.09 (95% CI: -0.08-0.256), p = 0.27). LLLT effectively reduced histamine-induced pruritus, alloknesis, and hyperknesis; however, LLLT was ineffective against Mucuna pruriens-induced pruritus. Further investigations are required to determine LLLT's effectiveness of LLLT in various pruritus models.
Journal of neural transmission (Vienna, Austria : 1996) · 2025
Levodopa remains central to Parkinson's disease (PD) treatment, but long-term use can cause motor complications, highlighting the need for additional therapies. Mucuna pruriens (MP), a natural source of levodopa, shows potential in managing these complications. Further research is needed to compare its pharmacokinetics (PK) and clinical outcomes with traditional levodopa formulations. This randomised, single-blind, crossover trial compared the PK, clinical outcomes, and safety of MP powder against levodopa/benserazide dispersible tablets (Levodopa DT) in PD patients with motor complications. Twelve participants were recruited to receive either 30 g of MP powder or two 100/25 levodopa DT in separate sessions with a two-week washout between sessions. Key PK parameters (AUC, Cmax, Tmax, and t½) were measured. Clinical assessments used standard rating scales and adverse events were recorded. Data from 11 participants were analysed after one withdrawal. MP powder demonstrated significantly higher overall drug exposure, with a geometric mean AUC0-∞ of 12,424.81 compared to 7981.69 ng·h/mL for levodopa DT. The geometric mean ratio was 155.67% (90% CI 134.59-180.04), exceeding the bioequivalence acceptance range of 80-125%. However, the two treatments exhibited similar Tmax and t₁/₂ values, indicating comparable rates of absorption and elimination. Clinically, MP provided a longer ON state without dyskinesia-232.2 min versus 161.8 min for levodopa DT (p = 0.01). Mild and transient adverse events, such as nausea and dizziness, were more frequently associated with MP. MP offers superior drug exposure and extends the ON state without increasing dyskinesia, positioning it as a promising alternative to synthetic levodopa for managing motor symptoms. These findings support MP's potential role in alleviating motor complications in PD treatment.
Journal of Parkinson's disease · 2026
BackgroundParkinson's disease (PD) causes disability and premature mortality if untreated. Limited access to levodopa in low- and middle-income countries leaves many patients undertreated. Mucuna pruriens (MP) is a leguminous plant that contains high concentrations of levodopa.ObjectiveTo demonstrate the non-inferiority of long-term intake of MP powder in terms of safety and efficacy compared to standard levodopa plus dopa-decarboxylase inhibitor (LD + DDCI).MethodsIn this 12-month, multicenter, randomized, open-label phase 2 trial, thirty-two untreated PD patients received levodopa monotherapy with MP powder -derived from roasted seeds without pharmacological processing- or standard LD + DDCI. Dosing was adjusted for body weight and disease stage, with MP doses further calibrated to account for the absence of a DDCI. We measured quality of life using the 39-item PD Questionnaire, motor and non-motor disability using the Movement Disorders Society updated version of the Unified PD Rating Scale (MDS-UPDRS) (parts I to IV) and the Non-Motor Symptoms Questionnaire. Safety measures included recording any adverse event and laboratory test.ResultsMP powder improved quality of life, motor and non-motor symptoms over 12 months, demonstrating similar outcome to LD + DDCI on all endpoints. Adverse events were more frequent with MP (56% vs. 37.5%, p = 0.48), though the difference was not statistically significant. Most were mild, with only 12.5% leading to discontinuation.ConclusionsMP could be a cost-effective alternative for PD individuals with limited access to commercial levodopa formulations. To confirm long-term safety and efficacy, larger international multicenter, double-blind trials with extended follow-up (e.g. 24-36 months) and ethnically diverse cohorts are needed.Registered at PACTR201611001882367.
Nutrients · 2025
Background: Exercise and nutritional interventions are often recommended to help manage risk related to metabolic syndrome (MetSyn). The co-ingestion of Phyllanthus emblica (PE) with trivalent chromium (Cr) has been purported to improve the bioavailability of chromium and enhance endothelial function, reduce platelet aggregation, and help manage blood glucose as well as lipid levels. Shilajit (SJ) has been reported to have anti-inflammatory, adaptogenic, immunomodulatory, and lipid-lowering properties. This study evaluated whether dietary supplementation with Cr, PE, and SJ, or PE alone, during an exercise and diet intervention may help individuals with risk factors to MetSyn experience greater benefits. Methods: In total, 166 sedentary men and women with at least two markers of metabolic syndrome participated in a randomized, placebo-controlled, parallel-arm, and repeated-measure intervention study, of which 109 completed the study (48.6 ± 10 yrs., 34.2 ± 6 kg/m2, 41.3 ± 7% fat). All volunteers participated in a 12-week exercise program (supervised resistance and endurance exercise 3 days/week with walking 10,000 steps/day on non-training days) and were instructed to reduce energy intake by -5 kcals/kg/d. Participants were matched by age, sex, BMI, and body mass for the double-blind and randomized supplementation of a placebo (PLA), 500 mg of PE (PE-500), 1000 mg/d of PE (PE-1000), 400 µg of trivalent chromium (Cr) with 6 mg of PE and 6 mg of SJ (Cr-400), or 800 µg of trivalent chromium with 12 mg of PE and 12 mg of SJ (Cr-800) once a day for 12 weeks. Data were obtained at 0, 6, and 12 weeks of supplementation, and analyzed using general linear model multivariate and univariate analyses with repeated measures, pairwise comparisons, and mean changes from the baseline with 95% confidence intervals (CIs). Results: Compared to PLA responses, there was some evidence (p < 0.05 or approaching significance, p > 0.05 to p < 0.10) that PE and/or Cr with PE and SJ supplementation improved pulse wave velocity, flow-mediated dilation, platelet aggregation, insulin sensitivity, and blood lipid profiles while promoting more optimal changes in body composition, strength, and aerobic capacity. Differences among groups were more consistently seen at 6 weeks rather than 12 weeks. While some benefits were seen at both dosages, greater benefits were more consistently observed with PE-1000 and Cr-800 ingestion. Conclusions: The results suggest that PE and Cr with PE and SJ supplementation may enhance some exercise- and diet-induced changes in markers of health in overweight individuals with at least two risk factors to MetSyn. Registered clinical trial #NCT06641596.
International journal of obesity (2005) · 2024
Gut dysbiosis that resulted from the alteration between host-microbe interaction might worsen obesity-induced systemic inflammation. Gut microbiota manipulation by supplementation of prebiotic inulin may reverse metabolic abnormalities and improve obesity. This study aimed to determine whether inulin supplementation improved intestinal microbiota and microbial functional pathways in children with obesity. Children with obesity whose BMI above median + 2SDs were recruited to a randomized, double-blinded placebo-controlled study. The participants aged 7-15 years were assigned to inulin supplement extracted from Thai Jerusalem artichoke (intervention), maltodextrin (placebo), and dietary fiber advice groups. All participants received similar monthly conventional advice and follow-up for 6 months. Fecal samples were collected for gut microbiome analysis using 16S rRNA sequencing. Phylogenetic Investigation of Communities by Reconstruction of Unobserved States was performed to infer microbial functional pathways. One hundred and forty-three children with available taxonomic and functional pathway abundance profiles were evaluated. A significant increase in alpha-diversity was observed in the inulin group. Inulin supplementation substantially enhanced Bifidobacterium, Blautia, Megasphaera, and several butyrate-producing bacteria, including Agathobacter, Eubacterium coprostanoligenes, and Subdoligranulum, compared to the other groups. The inulin group showed a significant difference in functional pathways of proteasome and riboflavin metabolism. These changes correlated with clinical and metabolic outcomes exclusively in the inulin group. Inulin supplementation significantly promoted gut bacterial diversity and improved gut microbiota dysbiosis in children with obesity. The modulation of functional pathways by inulin suggests its potential to establish beneficial interactions between the gut microbiota and host physiology. Inulin supplementation could be a strategic treatment to restore the balance of intestinal microbiota and regulate their functions in childhood obesity.
Multiple sclerosis and related disorders · 2024
Dietary supplements can modulate the gut microbial ecosystem and affect the immune system. This has potential implications for autoimmune diseases, including multiple sclerosis (MS). Prior studies explored tolerability, symptomatic improvement, and immunologic effects of probiotics in people with MS (pwMS), but no study has examined prebiotics in this population or compared prebiotics with probiotics. This is a randomized, open-label trial of participants with relapsing-remitting MS on B-cell depletion therapy from two MS centers. 22 participants enrolled in the original cross-over study in which probiotic (Visbiome, containing Lactobacillus, Bifidobacterium and Streptococcus species) or prebiotic (Prebiotin, containing oligofructose enriched inulin) supplementation for 6 weeks was randomized, each followed by a washout period. Due to pandemic-related interruptions and expiration of the study supply of probiotics, another 15 participants enrolled in a single-arm study to receive prebiotic supplementation for 6 weeks followed by a washout period. We assessed supplement tolerability and patient-reported outcomes (PRO) relevant to MS (disability, fatigue, mood, and bowel symptoms) before and after each supplement administration period and each washout period. We bio-archived plasma, serum, peripheral blood mononuclear cells and stool samples at each timepoint for future multi-omic assessment. Prebiotics and probiotics had comparable adherence rates and both supplements were well tolerated in pwMS. Participants on either supplement reported minor adverse events, most of which were mild and self-limited. There was a subjective preference for prebiotics over probiotics. Comparing supplement-associated changes in PRO scores from baseline to 6 weeks post-supplementation, there were significant difference between prebiotics and probiotics for the change in patient-reported global symptom burden (MSRS-R Total) and bowel control (BWCS), but only probiotics statistically improved bowel control from baseline to post-supplementation. Supplementation with either prebiotics or probiotics is reasonably well-tolerated and safe. Probiotics improved bowel control, but did not improve other PROs in a 6-week time frame. These data regarding feasibility, tolerability, adherence, and adverse events of supplements will inform future clinical trial designs to definitively compare the efficacy and safety of prebiotics and probiotics. The biological data that will be generated from this study in the future will provide mechanistic insights into the effects of these dietary supplements on MS pathophysiology.
Food & function · 2024
Migraine is a complex neurovascular disorder characterized by recurrent headache attacks that are often accompanied by symptoms such as vomiting, nausea, and sensitivity to sound or light. Preventing migraine attacks is highly important. Recent research has indicated that alterations in gut microbiota may influence the underlying mechanisms of migraines. This study aimed to investigate the effects of inulin supplementation on migraine headache characteristics, quality of life (QOL), and mental health symptoms in women with migraines. In a randomized double-blind placebo-controlled trial, 80 women with migraines aged 20 to 50 years were randomly assigned to receive 10 g day-1 of inulin or a placebo supplement for 12 weeks. Severity, frequency, and duration of migraine attacks, as well as depression, anxiety, stress, QOL, and headache impact test (HIT-6) scores, were examined at the start of the study and after 12 weeks of intervention. In this study, the primary outcome focused on the frequency of headache attacks, while secondary outcomes encompassed the duration and severity of headache attacks, QOL, and mental health. There was a significant reduction in severity (-1.95 vs. -0.84, P = 0.004), duration (-6.95 vs. -2.05, P = 0.023), frequency (-2.09 vs. -0.37, P < 0.001), and HIT-6 score (-10.30 vs. -6.52, P < 0.023) in the inulin group compared with the control. Inulin supplementation improved mental health symptoms, including depression (-4.47 vs. -1.45, P < 0.001), anxiety (-4.37 vs. -0.70, P < 0.001), and stress (-4.40 vs. -1.50, P < 0.001). However, no significant difference was observed between the two groups regarding changes in QOL score. This study provides evidence supporting the beneficial effects of inulin supplement on migraine symptoms and mental health status in women with migraines. Further studies are necessary to confirm these findings. Trial registration: Iranian Registry of Clinical Trials (https://www.irct.ir) (ID: IRCT20121216011763N58).
BMC research notes · 2024
The objective of the present study was to examine the effect of calorie restricted diet (CRD) plus inulin supplementation on serum levels of tryptophan (Trp), kynurenine (Kyn) and Trp/Kyn ratio in obese women with major depressive disorder (MDD). In this double-blind placebo-controlled randomized clinical trial, 51 obese women (BMI = 30-40 kg/m2) with mild MDD were assessed for depression level using Hamilton depression rating scale (HDRS). The patients were randomly allocated into either "Prebiotic group" (received 10 g/day inulin) or "Placebo group" (received 10 g/day maltodextrin). All participants also received individualized CRD. Fasting serum levels of Trp, Kyn, and Trp/Kyn ratio were assessed at baseline and after 8 weeks. Results showed slightly greater increases in serum levels of Trp and Trp/Kyn ratio as well as reductions in serum level of Kyn and HDRS score in prebiotic group than placebo group. However, between group differences in these parameters as well as HDRS score were not statistically significant after adjusting for baseline variables at the end of the trial. Results indicates that CRD accompanied by inulin supplementation (10 g/day) did not influence serum levels of Trp, Kyn and Trp/Kyn ratio as well as HDRS score after 8 weeks. The trial was registered in the Iranian registry of clinical trials at 2018-08-02 ( https://www.irct.ir/ ; registration number: IRCT20100209003320N15).
Clinical nutrition ESPEN · 2025
Alcohol Use Disorder (AUD) is a psychiatric disorder characterized notably by gut microbial dysbiosis and insufficient dietary fiber (DF) intake. This study aims to investigate the effect of DF placebo-controlled intervention in patients suffering from AUD during a three-week period of alcohol withdrawal, in order to discover microbial-derived metabolites that could be involved in metabolic and behavioral status. A randomized, double-blind, placebo-controlled study was performed with 50 AUD patients supplemented with inulin (prebiotic DF) or maltodextrin (placebo) during 17 days. Fecal microbiota composition, plasma and fecal metabolomics (liquid chromatography coupled to mass spectrometry), blood markers of inflammation and hepatic alterations, and psychological assessment (questionnaires) were analyzed before and after the intervention. Fecal metabolomics revealed 14 metabolites significantly modified by inulin versus placebo treatment (increased N8-acetylspermidine and decreased indole-3-butyric acid, 5-amino valeric acid betaine (5-AVAB) and bile acids). Thirteen plasma metabolites differentiated both treatments (higher levels of long-chain fatty acids, medium-chain acylcarnitines and sphingomyelin species, and reduced 3-methylhistidine by inulin versus placebo). Fecal Lachnoclostridium correlated with 6 of the identified fecal metabolites, whereas plasma lipidic moieties positively correlated with fecal Ruminococcus torques group and Flavonifractor. Interestingly, parameters reflecting liver alterations inversely correlated with sphingomyelin (SM 36:2). Three weeks of inulin supplementation during alcohol withdrawal leads to specific and different changes in the plasma and fecal metabolome of AUD patients, some of these gut microbiota-related metabolites being correlated with liver function. NCT03803709, https://clinicaltrials.gov/ct2/show/NCT03803709.
The American journal of clinical nutrition · 2025
Beneficial short-chain fatty acids (SCFAs) are produced through intestinal microbial fiber fermentation. Using stable tracer methodology and compartmental modeling, we observed lower SCFA production in older (OAs) than in young adults (YAs) in both an accessible [that is, systemic circulation; whole-body production] and inaccessible [potentially representing intestine absorbing microbially produced SCFAs (U2)] pool. We now investigated whether fiber supplementation increases SCFA production in OAs and whether concentrations reflect production rate changes. In this randomized, placebo-controlled, double-blind crossover study, 21 YAs (20-29 y) and 40 OAs (59-87 y) adults were supplemented with inulin or placebo (maltodextrin) for 7 d (final intake: 30 g/d). Before and after interventions, participants collected stool and received an intravenous pulse containing [U-13C]-labeled SCFAs followed by blood draws. We measured plasma tracer enrichments, plasma and fecal concentrations by gas chromatography-mass spectrometry and performed compartmental analysis. Data are mean (95% confidence interval). Inulin evoked a 44% increase in butyrate production (μmol/min) in the inaccessible pool {YA: 28-44 [+16.2 (4.3, 28.1); P = 0.038], OA: 14-20 [+6.1 (2.2, 9.9); P = 0.011]} and were not different between YAs and OAs. In addition, a 34% increase in propionate production in YA only. We found a 50%-60% increase in fecal acetate, propionate, and butyrate and a 34% increase in plasma butyrate in OA, whereas in YA only 34% increase in fecal acetate. Plasma but not fecal concentrations correlated positively with SCFA production in the inaccessible pool (R2 = 0.20-0.45; P < 0.001). OAs have a lower SCFA production. Inulin intake increases SCFA production. Tracer pulse approach detects SCFA metabolism changes more sensitively than plasma or fecal concentration measurements (NCT04459156).
Journal of food science · 2025
Colorectal cancer (CRC) incidence rises with age, driven by factors such as diet. Inulin, a soluble fiber found in plants like Jerusalem artichoke and chicory, may influence CRC risk by modulating gut microbiota and improving metabolic profiles. This systematic review and meta-analysis evaluate the effects of inulin on CRC in animal models and explore its underlying mechanisms. A comprehensive search of nine databases led to the selection of 12 studies from an initial pool of 114 articles, based on predefined inclusion criteria. Standardized meta-analyses were performed for eligible studies. Results indicate that inulin supplementation significantly reduced aberrant crypt foci count in rats (SMD = -3.805, 95% CI, -7.348 to -0.262, p < 0.001), increased cecal weight (SMD = 6.723, 95% CI, 3.395-10.051, p = 0.000), enhanced colonic lactobacillus counts (SMD = 1.307, 95% CI, 0.644-1.970, p = 0.000), decreased coliform bacteria (SMD = -1.659, 95% CI, -2.147 to -1.171, p = 0.000), and elevated colonic short-chain fatty acids (SCFAs) levels, including acetate (SMD = 3.50, 95% CI, 1.111-5.890, p < 0.001), propionate (SMD = 3.081, 95% CI, 1.416-4.746, p < 0.001), and butyrate (SMD = 4.471, 95% CI, 2.464-6.478, p < 0.001). This systematic review demonstrates inulin's chemopreventive effects against CRC in animal models by enhancing beneficial gut bacteria (e.g., lactobacillus) and boosting SCFAs. Findings advocate integrating inulin-rich foods/supplements into prevention strategies for precision prebiotic development via SCFA-mediated epigenetic and antitumor mechanisms.
Nutrition bulletin · 2025
Manipulation of the mouse gut microbiome has been shown to increase gut-derived short-chain fatty acids and improve exercise capacity. Associations between exercise performance and gut microbiome composition and metabolites have also been identified in human studies. Yet there is little direct evidence that prebiotics are able to increase acetate production and improve exercise capacity in human participants. We conducted a randomised controlled cross-over trial with 21 healthy and active males (35.0 ± 6.9 years; 24.4 ± 2.7 kg/m2) to investigate the effect of 15 g of inulin (prebiotic) on exercise performance (15 km cycle time trial), compared to placebo. Time to completion of a 15 km time trial was the primary outcome, while plasma acetate concentration and markers of inulin fermentation (breath H2 concentration) and muscle oxygenation were measured to explore potential mechanisms of action. Time to complete the 15 km time trial was not affected by inulin mean difference between inulin and placebo trials: (-10.37 s, 95% CI [-150.8, 130.1 s], p = 0.884). The marker of inulin fermentation (H2 concentration increase from baseline) was significantly higher in inulin compared to placebo condition (+42.61 ppm, 95% CI [30.04, 55.19], p = 0.001 and +31.13 ppm, 95% CI [3.73, 58.51], p = 0.029, respectively), but plasma acetate concentration did not differ between conditions. Likewise, markers of muscle oxygenation were not different between inulin and placebo. Our current results do not support the acute use of prebiotics to improve exercise performance in adults. Possible explanations for the absence of ergogenic effects may be that the timing between prebiotic ingestion and exercise was too short to allow for complete fermentation into acetate, participants were in a fasted rather than a fed state, or that the single dose of supplement was insufficient. These factors, together with advanced methods (stable isotope studies) should be investigated in a follow-up study to elucidate the fate and role of colonic-derived acetate during exercise.
Scientific reports · 2025
Rheumatoid arthritis (RA) is a multifactorial autoimmune disease that causes joint dysfunction and is associated with changes in serum levels of some biomarkers. The present study investigated the effect of inulin supplementation on pain intensity, clinical outcomes, and quality of life in patients with RA.In a randomized, triple-blind, parallel clinical trial, 60 patients over 18 years of age with RA were randomly assigned to receive either 10 g of inulin or maltodextrin per day for 8 weeks. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were assessed using biochemical kits at the beginning and end of the study. Clinical outcomes were also evaluated, including morning stiffness and pain intensity measured by the Visual Analog Scale (VAS), hand grip measured by a sphygmomanometer (Seca), disease activity assessed using the Disease Activity Score 28 (DAS-28), and overall quality of life determined by the Health Assessment Questionnaire (HAQ).The number of swollen joints, tender joints, pain intensity, and DAS-28 significantly decreased in both groups. However, hand grip, morning stiffness, ESR, CRP, and HAQ improved significantly only in the intervention group. After the intervention, in the intervention group compared to the control group, serum CRP levels significantly decreased (P = 0.02), while serum ESR levels showed no significant reduction (P = 0.45). The number of tender joints (P = 0.002), the number of swollen joints (P = 0.04), DAS-28, HAQ, morning stiffness, and hand grip strength (P = 0.02) significantly improved, but pain intensity did not change (P = 0.11).Inulin appears to benefit inflammatory status, disease activity, and clinical outcomes in patients with rheumatoid arthritis. Incorporating it into their treatment protocol could be valuable for managing their condition.Trial registration: Our study was approved in the Iranian Registry of Clinical Trials ( www.irct.ir ) on 10/5/2023, with the registration number IRCT20230506058098N1.
Scientific reports · 2025
The gut microbiota plays a key role in regulating energy balance via gut-brain axis (GBA). Dysbiosis can disrupt this communication, contributing to obesity. This study aimed to assess the effects of inulin supplementation on GBA-related amino acids and bioactive molecules in children with obesity. Children aged 7-15 were randomly assigned to 3 treatment groups for 6 months: inulin supplementation, isocaloric maltodextrin (placebo), or dietary fiber advice. Plasma amino acids and bioactive molecules were analyzed using LC-MS/MS at baseline and month 6. Relationships of changes in GBA-related compounds with changes in gut microbiota were evaluated. By month 6, principal component analysis trajectories showed clustering across all groups, involving 154 children, but indicated potential metabolic shifts, particularly in the inulin group. S-plots identified significant changes in GBA-related compounds, with only the inulin group showing marked increases in putrescine, spermine, and tyrosine from baseline (all P < 0.0001). Inulin supplementation significantly upregulated putrescine over time compared to the placebo group (P = 0.021), suggesting enhanced GBA communication. Changes in specific GBA-related compounds in the inulin group were significantly associated with gut microbiota changes. These findings indicate that inulin effectively modulates GBA-related bioactive molecules, potentially mediating its effect on childhood obesity management through putrescine, spermine, and tyrosine.Clinical Trial Registry number: NCT03968003. Registered 30/05/2019.
European review for medical and pharmacological sciences · 2026
Several factors, as genetics, diet, and gut microbiota, are associated with the development of type 1 diabetes (T1D). Akkermansia muciniphila, an abundant bacterium in human microbiota, has anti-inflammatory properties and can correct metabolic disorders. The effects of the administration of inulin, a prebiotic which increases Akkermansia muciniphila gut levels, are unknown in subjects with T1D. 49 subjects with T1D, age 46 [37-53] years, 30 females (61%), duration of disease 20 [11-27] years, HbA1c 64 [59-72] mmol/mol, were randomized in group A (inulin 3 g twice daily for 3 months + insulin, n=24) and in group B (insulin alone, n=25). Body weight, glycated hemoglobin (HbA1c), daily insulin units, continuous glucose monitoring (CGM) metrics, and Bristol stool scale (BSS) score were collected at enrollment and after 3 months. After 3 months, subjects in group A showed a significant decrease in body weight [group A -2 (-3; 0) kg and group B 0 (-1; 1) kg, p=0.03] and daily insulin units [group A -1.5 UI (-3.1; 0) vs. group B 0.6 (0; 1.7), p=0.01]. After 3 months, changes in HbA1c and CGM were similar between groups. In both groups, there was no change in BSS score (p=0.39) nor in Akkermansia muciniphila gut levels. Inulin was associated with a slight body weight decrease and insulin need reduction, but not with an increase in Akkermansia muciniphila levels. More studies are required to explore this issue.
Nutrients · 2026
Background: Emerging evidence links the gut microbiome to chronic pain processing. Inulin, a prebiotic fibre, modulates the gut microbiome, while physiotherapy-supported exercise (PSE) improves pain and function. We evaluated the effects of inulin supplementation with and without PSE on knee osteoarthritis (OA) pain. Methods: In a 2 × 2 factorial RCT, 117 community-dwelling adults with knee OA received 6 weeks of: (A) 20 g/day inulin, (B) digital PSE (Joint Academy™), (C) inulin +PSE, or (D) 10 g/day maltodextrin. Primary outcome: pain (Numerical Rating Scale). Secondary: 30 s sit-to-stand (30-CST), timed up and go (TUG), grip strength, and quantitative sensory testing. Serum short-chain fatty acids (SCFAs) and glucagon-like peptide-1 (GLP-1) were measured. The study was not powered to detect synergistic interaction. Results: A total of 117 participants (58.1% female; mean ± SD age = 67.5 ± 9.4 years; BMI = 29.5 ± 5.3 kg/m2; NRS = 3.96 ± 2.67) completed the trial. Pain improved with inulin (baseline-adjusted between-group mean difference (Δ) = -1.11 [95%CI -2.18, -0.04], p = 0.045) and PSE (Δ = -1.55 [95%CI -2.52, -0.58], p = 0.002) compared to placebo, with no synergistic effect. PSE improved TUG (p = 0.02) and 30-CST (p = 0.0004), while inulin improved grip strength (p = 0.002), pressure pain thresholds (p = 0.009) and temporal summation (p = 0.025) compared to placebo and had significantly lower dropout rates (3.6%) compared with PSE (21% p < 0.01). Only inulin increased SCFA butyrate (p = 0.0248) and GLP-1 (p = 0.0109), and higher GLP-1 was associated with improved grip strength, suggesting a gut-muscle link. Conclusions: Inulin and PSE each produced meaningful pain reductions. Only inulin improved pain sensitivity and grip strength, the latter paralleled by increased GLP-1, and had much higher rates of retention compared to PSE.
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society · 2024
We aimed to clarify the clinical utility of measuring serum pancreatic enzymes after endoscopic retrograde cholangiopancreatography (ERCP) for the purpose of predicting post-ERCP pancreatitis (PEP) by a meta-analysis of diagnostic test accuracy studies. Studies on the prediction accuracy of PEP by serum amylase or lipase measured at 2, 3, and 4 h after ERCP were collected. A literature search was performed in PubMed and the Cochrane Library database for studies published between January 1980 and March 2023. The quality of individual studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2. Data were analyzed using Meta-DiSc 2.0 software. We searched the databases and identified 20 observational studies (12,313 participants). PEPs were defined according to criteria by Cotton or modified Cotton, revised Atlanta criteria, or the Japanese criteria. Meta-analysis of eight studies (4389 participants) showed a pooled sensitivity of 71.1% (95% confidence interval [CI] 56.1-82.5) and pooled specificity of 91.2% (95% CI 85.9-94.6) for the serum amylase cut-off value at 3 times the upper limit of normal (ULN). Another meta-analysis of five studies (1970 participants) showed a pooled sensitivity of 85.8% (95% CI 61.9-95.7) and pooled specificity of 85.3% (95% CI 81.9-88.1) for the serum lipase cut-off value at 3 times ULN. Despite a high risk of bias due to various reference standards, this updated meta-analysis and the utility assessment by a decision tree showed the utility of serum amylase or lipase levels more than 3 times ULN measured 2-4 h after ERCP for predicting PEP.
Tuberculosis (Edinburgh, Scotland) · 2024
Isoniazid-induced pancreatitis is a potentially serious adverse drug reaction, however, the frequency of its occurrence is unknown. We conducted a systematic review to explore this adverse drug reaction comprehensively. We performed an advanced search in PubMed, Web of Science, Scopus, Ovid, and Embase for studies that reported isoniazid-induced pancreatitis. From the extracted data of eligible cases, we performed a descriptive analysis and a methodological risk of bias assessment using a standardized tool. We included 16 case reports from eight countries comprising 16 patients in our systematic review. Most of the isoniazid-induced pancreatitis cases were extrapulmonary tuberculosis cases. We found the mean age across all case reports was 36.7 years. In all the cases, discontinuation of isoniazid resulted in the resolution of pancreatitis. We found the latency period for isoniazid-induced pancreatitis to be ranged from 12 to 45 days after initiation of isoniazid therapy. A low threshold for screening of pancreatitis by measuring pancreatic enzymes in patients on isoniazid presenting with acute abdominal pain is recommended. This would facilitate an early diagnosis and discontinuation of isoniazid, thus reducing the severity of pancreatitis and preventing the complications of pancreatitis.
Frontiers in endocrinology · 2024
The immune-mediated destruction of insulin-producing β-cells characterizes type 1 diabetes. Nevertheless, exocrine pancreatic enzymes, including amylase, lipase, and trypsin, are also significantly reduced in type 1 diabetes. With an immunotherapy now approved to treat early-stage type 1 diabetes, biomarkers to delineate response to treatment are needed. No study has yet evaluated whether serum exocrine pancreatic enzymes could delineate immunotherapy responders and non-responders. In this novel study, we sought to identify longitudinal trends in the most commonly measured circulating exocrine enzymes before and after treatment with anti-thymocyte globulin (ATG) and pegylated granulocyte colony-stimulating factor (GCSF) in individuals with new-onset type 1 diabetes (n=34). We defined response to immunotherapy as participants with at least 60% of baseline area under the curve (AUC) C-peptide levels after a 2-hour mixed meal tolerance test (MMTT) at two years post-treatment. In the overall study (n=89), 42% of treated and 17% of placebo participants met this definition. Due to constraints of sample availability, we compared longitudinal serum amylase, lipase, and trypsin levels in a subset of responders to therapy (n=4-6), placebo "responders" (n=2), treated non-responders (n=16), and placebo non-responders (n=10). There were no differences in amylase levels between groups at baseline or six months post-treatment. Baseline levels of lipase and trypsin tended to be lower in responders; however, these variations were not significant in this small study sample. Lipase and trypsin improved to 115% of baseline in responders to immunotherapy six months after treatment and declined to 80-90% of baseline in non-responders and placebo participants (p=0.03). This difference was not present before the six-month time point. Our findings provide preliminary evidence that the exocrine pancreatic enzymes lipase and trypsin may be useful biomarkers of response to immunotherapy in type 1 diabetes. Further studies with larger numbers of participants are warranted.
Acta gastro-enterologica Belgica · 2025
The association between dipeptidyl peptidase-4 (DPP-4) inhibitors, known as gliptins, and acute pancreatitis raises growing concern. A systematic search of PubMed, Scopus and Web of Science was conducted for studies published between January 2005 and July 2024. Studies focusing on gliptin-induced pancreatitis were selected based on predefined criteria. While gliptins are effective in managing type 2 diabetes mellitus, several case reports and observational studies suggest a potential risk for inducing acute pancreatitis. Proposed mechanisms include increased pancreatic activity and cellular stress. Clinical presentation often includes abdominal pain and elevated pancreatic enzymes, necessitating prompt diagnosis and discontinuation of the offending agent. Early recognition and management, including discontinuation of the drug and supportive care, are crucial. Balancing benefits and risks of gliptin therapy is essential for ensuring patient safety and optimal outcomes. This review underscores the importance of vigilance among healthcare providers and the need for further research to develop safer therapeutic strategies.