HUMAN MICROBIOTA AND MICROBIOME

Mikrobiotu čovjeka čine svi mikroorganizmi koji žive u simbiozi s ljudskim tijelom, a humani mikrobiom sadrži i do stotinu puta veći broj gena negoli ljudski genom. Iako mikroorganizme možemo naći u raznim nišama ljudskog tijela, najbrojnija je mikrobiota probavnog sustava. Mikrobiota je varijabilna među zdravim ljudima i jedinstvena za pojedinca te na nju utječe mnoštvo različitih čimbenika. I dalje je nepoznanica što je točno zdrava mikrobiota, ali poznate su neke od njenih uloga u odvijanju fi zioloških procesa u stanju zdravlja. S druge strane, u slučaju narušene ravnoteže, disbioze, može doći do razvoja bolesti. Disbioza se često povezuje s nastankom brojnih patoloških stanja od kojih su najviše istražena pretilost, kronične upalne bolesti crijeva, sindrom iritabilnog kolona, kolorektalni karcinom, alergijske bolesti djece te bolesti usne šupljine. Razvoj metoda koje ne ovise o kultivaciji mikroorganizama značajno je unaprijedio proučavanje mikrobiote i doprinjeo boljem razumijevanju interakcije populacija nepatogenih mikroorganizama međusobno i sa svojim domaćinom. Time je otvoren put proučavanju utjecaja mikrobiote na razvoj bolesti i primjene modifi kacije mikrobiote u preventivne i terapijske svrhe.Human microbiota consists of all microorganisms living in symbiosis with the human body, and human microbiome contains 100-fold more genes than the human genome. Although microorganisms can be found in various niches of the human body, the most numerous is the gut microbiota. The microbiota is variable among healthy people and unique for an individual, and it is infl uenced by many different factors. It is still unclear what exactly a healthy microbiota is, but some of its roles in physiological processes in health are known. On the other hand, in case of imbalance of the microbiota, or dysbiosis, diseases may develop. Dysbiosis is often associated with the emergence of many pathological conditions, of which the most studied are obesity, chronic infl ammatory bowel disease, irritable bowel syndrome, colorectal cancer, allergic diseases of children, and oral cavity diseases. Development of methods that do not depend on the cultivation of microorganisms has signifi cantly improved the study of microbiota and contributed to better understanding of the interaction of nonpathogenic microorganism populations with each other and with their host. This is paving the way for studying the infl uence of microbiota on the development of diseases, as well as applying microbiota modifi cation for preventive and therapeutic purpose

Razvoj i validacija upitnika o učestalosti konzumiranja hrane i pića za populaciju adolescenata u Hrvatskoj

Research background. Food frequency questionnaire (FFQ) is an important method for the estimation of dietary intake in epidemiologic studies. The aim of the study is to develop a FFQ and evaluate its relative validity for adolescents 12 to 18 years old. Experimental approach. FFQ was developed from a previously validated youth/adolescent diet questionnaire (YAQ) by modifying it in order to include Croatian national foods. The final version of the FFQ (FFQ-m) comprised 87 food items. The reference method was a set of two 3-day food records (3DFR) administered twice during the 3 non-consecutive days, one month apart. The FFQ-m was administered approximately on the last day of the second applied dietary food record. Adolescents were recruited from randomly selected elementary and high schools in urban and rural areas of Croatia. FFQ-m was validated on a sample of 84 adolescents (70.2% female). Nutritional intake from FFQ-m and 3DFR were analysed for each participant. Spearman correlation coefficients (r) and Bland-Altman method were used to assess the validity of the FFQ-m compared to 3DFR. Anthropometric parameters were assessed in 78 adolescents. Results and conclusions. The mean nutrient intake estimated by the FFQ-m was higher than that of the 3DFR. The average correlation coefficient for energy and nutrients in our validation study was 0.40. On average, 76.5% of adolescents were classified in the same or adjacent quartile of the nutrient intake. Bland-Altman analysis showed good agreement with all macronutrients and some micronutrients (sodium, phosphorus, potassium, calcium, magnesium and iron). A simple self-administered questionnaire completed by adolescents is a valid tool for measuring energy and nutrient intake among adolescent population. Novelty and scientific contribution. This is the first FFQ developed and validated for population of adolescents in Croatia. It will contribute to further research of nutritional intake in the population of adolescents, especially those from the region.Pozadina istraživanja. Upitnik o učestalosti konzumiranja hrane i pića važan je dijetetički alat koji se koristi za procjenu unosa hranjiva u epidemiološkim istraživanjima. Svrha je ovog istraživanja bila razviti i validirati upitnik za populaciju adolescenata od 12 do 18 godina starosti. Eksperimentalni pristup. Ovaj upitnik je razvijen prilagodbom prethodno validiranog prehrambenog upitnika za djecu odnosno adolescente, i to uključivanjem karakterističnih hrvatskih prehrambenih proizvoda. Konačna verzija upitnika obuhvaćala je 87 namirnica i jela. Kao referentna metoda upotrijebljena su dva trodnevna dnevnika prehrane, vođena u dva navrata s razmakom od mjesec dana. Upitnik je proveden pri kraju vođenja drugog dnevnika prehrane. Adolescenti su regrutirani iz nasumično izabranih osnovnih i srednjih škola iz urbanih i ruralnih dijelova Hrvatske. Upitnik je validiran na uzorku od 84 adolescenata (70,2 % ženskog spola). Unos hranjiva je utvrđen za svakog ispitanika zasebno iz podataka prikupljenih upitnikom i iz dnevnika prehrane. Za validaciju su korišteni Spearmanov koeficijent korelacije (r) i Bland-Altmanova metoda. Antropometrijske mjere određene su kod 78 adolescenata. Rezultati i zaključci. Srednja vrijednost unosa hranjiva određena upitnikom bila je veća od one određene iz dnevnika prehrane. Prosječni koeficijent korelacije za unose energije i hranjiva iznosio je 0,4. U prosjeku je 76,5 % adolescenata spadalo u istu ili susjednu kvartilu unosa hranjiva. Bland-Altmanovom analizom utvrđeno je dobro podudaranje između rezultata upitnika i podataka iz trodnevnog dnevnika prehrane za sva makrohranjiva i neka mikrohranjiva (natrij, fosfor, kalij, kalcij, magnezij i željezo). Ovaj upitnik je prikladan za određivanje unosa energije i hranjiva među adolescentima Novina i znanstveni doprinos. Ovo je prvi upitnik koji je razvijen za populaciju adolescenata u Hrvatskoj, te će se moći koristiti u budućim istraživanjima za procjenu unosa hranjiva u toj populaciji

Public Health Response to the SARS-CoV-2 Pandemic: Concern about Ultra-Processed Food Consumption

Introduction: There is scientific consistency in the concept of ultra-processed foods (UPFs) as a descriptor of an unhealthy diet. The most recent literature points to troubling evidence that policies adopted to address the SARS-CoV-2 pandemic may have contributed to diverting eating habits toward a poorer diet. Considering the historically unique SARS-CoV-2 pandemic lockdown scenario, and the health burden imposed by UPFs on human health, it is critical to investigate how the epidemic has influenced UPF intake directly. Reviewing the literature, we aimed to assess the changes in the consumption of UPFs during the pandemic lockdown compared to previous habits in the general population. Methods: Consulting six databases, we examined articles investigating the consumption of UPFs according to the NOVA classification both before the SARS-CoV-2 pandemic and during lockdowns. In total, 28 reports were included in the final analysis. Results: A clear trend of an increasing consumption of sweets (chocolate, candy, cookies, pastries, cakes, desserts, and confectionery, 31.75% increase vs. 21.06% decrease), packaged fatty or salty snacks (23.71% increase vs. 20.73% decrease), and baked goods (bread products, pizza, and sandwiches, 28.03% increase vs. 13.5% decrease) emerged, versus a decrease in ready-to-eat dishes (16.2% increase vs. 22.62% decrease) and ready-made meals (10.6% increase vs. 31.43% decrease), such as instant soups, canned foods, fast food, and chips, as well as sugary drinks in general (14.55% increase vs. 22.65% decrease). No trend was observed for processed meat consumption. Conclusion: The current pandemic scenario raises concerns about the increased consumption of UPFs, especially sweets, snacks, and baked goods, and points to an urgent need to implement policy strategies to manage the trade in these foods from a preventive perspective

Role of Dietary Carotenoids in Frailty Syndrome: A Systematic Review

Unbalanced diets and altered micronutrient intake are prevalent in the aging adult population. We conducted a systematic review to appraise the evidence regarding the association between single (α-carotene, β-carotene, lutein, lycopene, β-cryptoxanthin) or total carotenoids and frailty syndrome in the adult population. The literature was screened from study inception to December 2021, using six different electronic databases. After establishing inclusion criteria, two independent researchers assessed the eligibility of 180 retrieved articles. Only 11 fit the eligibility requirements, reporting five carotenoid entries. No exclusion criteria were applied to outcomes, assessment tools, i.e., frailty constructs or surrogates, recruitment setting, general health status, country, and study type (cohort or cross-sectional). Carotenoid exposure was taken as either dietary intake or serum concentrations. Cross-sectional design was more common than longitudinal design (n = 8). Higher dietary and plasma levels of carotenoids, taken individually or cumulatively, were found to reduce the odds of physical frailty markedly, and the evidence showed consistency in the direction of association across all selected studies. Overall, the methodological quality was rated from moderate (27%) to high (73%). Prevention of micronutrient deficiencies has some potential to counteract physical decline. Considering carotenoids as biological markers, when monitoring micronutrient status, stressing increased fruit and vegetable intake may be part of potential multilevel interventions to prevent or better manage disability

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Dietary Patterns Associated with Diabetes in an Older Population from Southern Italy Using an Unsupervised Learning Approach

Dietary behaviour is a core element in diabetes self-management. There are no remarkable differences between nutritional guidelines for people with type 2 diabetes and healthy eating recommendations for the general public. This study aimed to evaluate dietary differences between subjects with and without diabetes and to describe any emerging dietary patterns characterizing diabetic subjects. In this cross-sectional study conducted on older adults from Southern Italy, eating habits in the “Diabetic” and “Not Diabetic” groups were assessed with FFQ, and dietary patterns were derived using an unsupervised learning algorithm: principal component analysis. Diabetic subjects (n = 187) were more likely to be male, slightly older, and with a slightly lower level of education than subjects without diabetes. The diet of diabetic subjects reflected a high-frequency intake of dairy products, eggs, vegetables and greens, fresh fruit and nuts, and olive oil. On the other hand, the consumption of sweets and sugary foods was reduced compared to non-diabetics (23.74 ± 35.81 vs. 16.52 ± 22.87; 11.08 ± 21.85 vs. 7.22 ± 15.96). The subjects without diabetes had a higher consumption of red meat, processed meat, ready-to-eat dishes, alcoholic drinks, and lower vegetable consumption. The present study demonstrated that, in areas around the Mediterranean Sea, older subjects with diabetes had a healthier diet than their non-diabetic counterparts

A nanostructural view of the cell wall disassembly process during fruit ripening and postharvest storage by atomic force microscopy

Background: The mechanical properties of parenchyma cell walls and the strength and extension of adhesion areas between adjacent cells, jointly with cell turgor, are main determinants of firmness of fleshy fruits. These traits are modified during ripening leading to fruit softening. Cell wall modifications involve the depolymerisation of matrix glycans and pectins, the solubilisation of pectins and the loss of neutral sugars from pectin side chains. These changes weaken the cell walls and increase cell separation, which in combination with a reduction in cell turgor, bring about textural changes. Atomic force microscopy (AFM) has been used to characterize the nanostructure of cell wall polysaccharides during the ripening and postharvest storage of several fruits. This technique allows the imaging of individual polymers at high magnification with minimal sample preparation. Scope and approach: This paper reviews the main features of the cell wall disassembly process associated to fruit softening from a nanostructural point of view, as has been provided by AFM studies. Key findings and conclusions: AFM studies show that pectin size, ramification and complexity is reduced during fruit ripening and storage, and in most cases these changes correlate with softening. Postharvest treatments that improve fruit quality have been proven to preserve pectin structure, suggesting a clear link between softening and pectin metabolism. Nanostructural characterization of cellulose and hemicellulose during ripening has been poorly explored by AFM and the scarce results available are not conclusive. Globally, AFM could be a powerful tool to gain insights about the bases of textural fruit quality in fresh and stored fruits

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Utjecaj prehrane na crijevnu mikrobiotu u pedijatrijskih bolesnika s upalnim bolestima crijeva

The diet has a profound effect on the gut microbiota and development of inflammatory bowel disease (IBD). Characteristics of the gut microbiota were determined in children with IBD at the time of diagnosis and on the 2nd and the last day of exclusive enteral nutrition (EEN). Children with IBD demonstrate significant differences in dietary intake (lower intake of energy, calcium and fruits) and lower lean mass-for-age z-scores at diagnosis. Moreover, lower abundance of the phylum Firmicutes and higher abundance of the phylum Proteobacteria was observed in patients compared to healthy siblings and healthy controls at the time of diagnosis. EEN leads to similar changes in the microbiota composition in children with CD and their healthy siblings.Prehrana ima značajan utjecaj na crijevnu mikrobiotu i razvoj kroničnih upalnih bolesti crijeva (IBD). Karakteristike crijevne mikrobiote u djece s IBD-om određene su u vrijeme dijagnoze, te na drugi i posljednji dan isključive enteralne prehrane (EEN). Djeca s IBD-om pokazuju značajnu razliku u prehrambenom unosu (niži unos energije, kalcija i voća), te niži z-score za nemasnu tjelesnu masu u vrijeme dijagnoze u usporedbi sa zdravim kontrolama. Nadalje, utvrdili smo manju zastupljenost bakterija iz reda Firmicutes, te veću zastupljeno iz reda Proteobacteria kod djece s IBD-om u vrijeme dijagnoze. EEN dovodi do sličnih promjena u sastavu mikrobiote u djece sa CD-om i njihovih zdravih braće i sestara

Evaluation of dietary habits among persons with hypertension

Svjetska zdravstvena organizacija procijenjuje da jedna od tri osobe u svijetu starija od 25 godine ima povišeni krvni tlak. Cilj ovoga rada bio je utvrditi prehrambene navike osoba s hipertenzijom te njihovu svjesnost o izvorima soli u prehrani i posljedicama njezinog pretjeranog unosa. Istraživanje je obuhvaćalo ukupno 12 ispitanika s dijagnosticiranom hipertenzijom prosječne starosti 55,17 ± 8,26 godina. Za procjenu njihove prehrane korištena je metoda 24-satnog prisjećanja, a za procjenu svjesnosti o unosu soli korišten je upitnik. Analiza 24-satnog prisjećanja pokazuje da je unos proteina u skladu s preporukama (15,17 % kJ/dan), a unos ukupnih masti (44,38 % kJ/dan) i ugljikohidrata (40,22 % kJ/dan) neadekvatan. Iako su svi ispitanici svjesni da puno soli u prehrani može povisiti krvni tlak, samo 55 % ispitanika pokušava smanjiti unos soli prehranom. Prosječan dnevni unos natrija kod ispitanika iznosi 3048,06 ± 1814,87 mg/dan što je više od preporučenih 2000 mg/dan, a značajan izvor natrija u prehrani su suhomesnati proizvodi i mesne prerađevine te pekarski proizvodi.The World Health Organization estimates that one in three people in the world aged 25 and over have high blood pressure. The aim of this work was to evaluate the diet quality in people with high blood pressure and to determine their awareness of dietary salt sources and the consequences of high salt intake. The study included 12 people with high blood pressure, average age of 55,17 ± 8,26 . Diet quality assessment was determined with 24-hour recall, and the awareness of dietary sodium sources was estimated by questionnaire. The 24-hour recall results showed that the intake of protein (15,17 % kJ/day) is in accordance with the DRI recommendations, while the intake of fat (44,38 % kJ/day) and carbohydrate (40,22 % kJ/day) is not. Although all participants are aware that a lot of salt in the diet can raise blood pressure, only 55 % of them are trying to reduce salt intake in their diet. The average sodium intake is 3048,06 ± 1814,87 mg/day which is higher than recommended 2000 mg/day and the significant source of sodium in diet comes from dry meat products and processed meat and from bakery products