Mediterranean Diet and Gut Health Mediteranska prehrana in zdravje prebavil

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1 World Food Day 2015 / Svetovnidan hrane2015 Mediterranean Diet and Gut Health Mediteranska prehrana in zdravje prebavil Alojz Ihan 1, Damijana Presečnik 2 1 Univerza v Ljubljani, Medicinska fakulteta Ljubljana, Slovenija EMG, d.d., Žalec, Slovenija

2 Different habitual diet result in different gut microbiota & health status? World Food Day / Svetovni dan hrane 2014

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4 BMI related changes in analysed markers in healthy individuals PLoS ONE 2012;7(1) e28761

5 Lactobacillus gasserik7 modulates the blood celltranscriptomeof conventional mice infected with Escherichia coli O157:H7 Journal of Applied Microbiology 116, The Society for Applied Microbiology

6 Gut Microbiota have a Role in Health and Disease

7 A dysbiosis of the gut microbiota can result from different mechanisms Healthy Anti Pro Balanced Excess bad bacteria Proinflammatory microbes Too few good bacteria Antiinflammatory microbes

8 Low diversity and imbalances in gut microbiota are associated with human disease states Health High biodiversity and richness Stable Primarily Bacteroides and Firmicutes Disease Low biodiversity Unstable Increased abundances of Proteobacteria, Fusobacteria, Verrucomicrobia C. Difficile colitis, IBD, IBS, obesity, metabolic syndrome, peripheral vascular disease, renal disease, diabetes

9 Proposed causes of dysbiosis of the microbiota Increased incidence of immune-mediated disorders in developed countries could be due to alterations in the microbiota

10 Interactions between diet, gut microbiota, microbial metabolites and host Different habitual diet may result in different health status by manipulating gut microbiota and their metabolites ARP: appetite-regulating peptides; SCFA: short chain fatty acid; GABA: g-aminobutyric acid; PSA: polysaccharide A; LPS: lipopolysaccharide. Current Opinion in Food Science 2015, 2:71 77 World Food Day / Svetovni dan hrane 2014

11 Vegetarian Diets and Blood Pressure AMeta-analysis Yokoyama et all. JAMA Intern Med. 2014;174(4): studies, participants; mean age 46.6, all participants older than20 years, vegetarian diets as an exposure or intervention consumption of vegetarian diets was associated with lower mean systolic BP ( 6.9mmHg; 95%CI, 9.1 to 4.7; P <.001) and diastolic BP ( 4.7mmHg; 95%CI, 6.3 to 3.1; P <.001) compared with the consumption of omnivorous diets. World Food Day / Svetovni dan hrane 2014

12 Mediterranean dietary patterns (MDPs) and the frequency of recommended intake Three meals, no snacks Freshfood-low sodium intake Whole Grains Fruits and Vegetables Beans and Legumes Olive Oil Very little meat World Food Day / Svetovnidanhrane 2015

13 The high adherence to MD&healtheffects Reductionof mortality and the incidence of major chronic diseases such as: cancer (Nutrients2014, 6, ; Br. J. Cancer2011, 104, ; Eur. Rev. Med. Pharmacol. Sci. 2012, 16, ) metabolic and cardiovascular syndrome (Arch. Intern. Med. 2007, 167, ; Hell. J. Cardiol. 2014, 55, ) neurodegenerative diseases (BioFactors 2013, 39, ) type 2 diabetes (Ann. Intern. Med. 2014, 160, 1 10; Food Sci. Nutr. 2014, 54, ,32) fatty liver diseases (World J. Gastroenterol. 2012, 18, ) allergy (Pediatr. Allergy Immunol. 2013, 24, ) World Food Day / Svetovni dan hrane 2014

14 Reduction in the Incidence of Type 2 Diabetes With the Mediterranean Diet 418 nondiabetic subjects aged years recruited in one center a-meddiet, suppl with olive oil (1 liter/week) b-meddiet, suppl with nuts (30 g/day). c-education on a low-fat diet (control) Diabetes Care 34:14 19, 2011 World Food Day / Svetovni dan hrane 2014

15 Primary Prevention of Cardiovascular Disease with a Mediterranean Diet N Engl J Med 2013;368: Amulticenter trial in Spain, 7447 part.(55 to 80 years), median follow-up of 4.8 years Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil (EVOD) or nuts reduced the incidence of major cardiovascular events. World Food Day / Svetovni dan hrane 2014

16 Hazard ratios within specific subgroups N Engl J Med 2013;368: World Food Day / Svetovni dan hrane 2014

17 MD-related positive effects on diseases World Food Day / Svetovni dan hrane 2014

18 How can you change your microbiota? Antibiotics Kill both good and bad bacteria Original microbiota usually return once drugs are removed Can allow for the growth of pathogens Probiotics Giving back live beneficial microorganisms Do not colonize Prebiotics Non-digestible food substances that provide substrate for existing beneficial microbes already present in the gut Mediterranean Diet? Changes activity of existing microbes Fecal transplants Changing complete gut ecosystem

19 Dietary Patterns Differently Associate with Inflammation and Gut Microbiota in Overweight and Obese Subjects Three clusters of dietary patterns were identified in overweight/obese subjects. Cluster 1 had the least healthyeating behavior (highest consumption of potatoes, confectionary and sugary drinks, and the lowest consumption of fruits, yogurt, and water). This dietary pattern was associated with the highestldl cholesterol, plasma soluble CD14 (p = 0.01) a marker of systemic inflammation but the lowest accumulation of CD163+macrophages with anti-inflammatory profile in adipose tissue. Cluster 3 had the healthiest eating behavior (lower consumption of confectionary and sugary drinks, and highest consumption of fruits but also yogurts and soups). The lowest inflammatory markers (scd14) and the highest anti-inflammatory adipose tissue CD163+ macrophages. Dietary intakes, insulin sensitivity and some inflammatory markers (plasma IL6) were close tothose of lean subjects. Cluster 2 was in-between clusters 1 and 3 in terms of healthfulness. PLoS ONE 2014;9(10): e World Food Day / Svetovni dan hrane 2014

20 MD dietary pattern associated with lower inflammatory markers as well as greater gut microbiotarichness in overweight and obese subjects World Food Day / Svetovni dan hrane 2014

21 1. DAY 90. DAY Value Ref. Value t-test Leuco 6,89 6,71 10^ ,612 Erythr 5,06 5,08 10^12 4,2-5,4 0,549 Hem 155,15 155,98 g/l ,331 Neutro 3,86 3,76 10^9/L ,280 Lymph 5,44 5,68 10^9/L ,349 Mono 0,63 0,64 10^9/L ,597 Glucose 4,73 4,51 mmol/l ,042 * CK 2,14 1,77 μkat/l do ,297 CRP 2,58 0,94 mg/l do 5 0,021 * Cholesterol 4,93 4,89 mmol/l ,292 HDL 1,51 1,43 mmol/l nad 1,4 0,292 LDL 3,15 2,91 mmol/l ,612 Tryglicerides 1,09 0,96 mmol/l ,391 TSH 2,82 2,34 mlu/l ,247 Cortisol 603,51 437,10 nmol/l 2,8-8,0 0,012 * Testosteron 4,87 5,42 μg/l ,423

22 A barrier exists between microbes and the immune system Microbial barrier (commensal bacteria) Chemical barrier (mucus layer) Physical barrier (the epithelium) Immunological barrier (immune cells of the lamina propria) Muscle layers (smooth muscle intestinal wall) Hooper LV (2009) Nat Rev Microbiol 7(5):367-74

23 A breakdown in gut barrier function has been linked with numerous diseases Inflammatory bowel disease Chronic kidney disease Sepsis Necrotizing pancreatitis Celiac disease Type 1 diabetes Food allergies Alcoholic liver disease

24 MDhelps improve health status by microbiota-related mechanisms? Polyphenols inwine, fruits, and vegetables may raise the proportions of Bifidobacterium, Enterococcus, Bacteroides, and Prevotella anddecreasethe abundance of pathogens like Clostridiumperfringens, adjustments which in general improved inflammatory condition caused by obesity Low-fat content in this diet may link to increased proportions of Bifidobacterium and Bacteroidetes Dietary therapies? Consumption of fermentable Oligosaccharides, Disaccharides, Monosaccharide and Polyols that are poorly absorbed by the human body but can be quickly metabolized by gut microbiota, can reduce the discomfort of Irritable Bowel Syndrome and relieve symptoms of inflammatory bowel disease superior to other diet patterns. J Gastroenterol Hepatol, 25 (2010), pp World Food Day / Svetovni dan hrane 2014

25 IL-6 predicts cognitive declines Highest tertile for plasma IL-6: Poorer baseline cognitive function (odds ratio [OR]) At 7 years of follow-up more likely to exhibit declines in cognition (OR = 1.90) At 2.5 years IL-6 predicted cognitive decline Second tertileof IL-6 (OR = 2.21) Third tertile(or = 2.03) Weaver JD et al Neurology Aug 13;59(3):371-8.

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27 Conclusion MDPs include low-glycemic index and lowglycemic load foods, derived from the whole grain and other fiber-rich product intake, which have been associated with a lower risk of diabetes, mainly type 2, coronary health diseases (CHD)and cancer, while refined grain has been linked to the risk of diabetes, obesity, CHD and other chronic diseases World Food Day / Svetovni dan hrane 2014

28 Thank you / Hvala Alojz Ihan, M.D. Professor of Medicine University Ljubljana Faculty of Medicine Institute of microbiology and immunology Ljubljana, Slovenia

29 Thankyou/ Hvala Univerza na Primorskem Fakulteta za vede o zdravju Polje Izola Slovenija World Food Day / Svetovnidanhrane 2015