Crommen Silke, Rheinwalt Karl Peter, Plamper Andreas, Simon Marie-Christine, Rösler Daniela, Fimmers Rolf, Egert Sarah, Metzner Christine
Department of Nutrition and Food Science, Nutritional Physiology, University of Bonn, Bonn, Germany.
Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus Hospital, Cologne, Germany.
J Nutr. 2022 Feb 8;152(2):408-418. doi: 10.1093/jn/nxab392.
Nonalcoholic fatty liver disease (NAFLD) is frequent among patients undergoing bariatric surgery. Beyond weight reduction, dietary supplements like micronutrients or probiotics that modify insulin resistance and lipotoxicity can be used to prevent or delay the progression of liver disease.
We evaluated the effect of a dietary approach with a specifically tailored multistrain probiotic and micronutrient mixture compared with a basic care micronutrient supplement on serum alanine aminotransferase (ALAT) in obese patients after mini gastric bypass (MGB) surgery.
This randomized, double-blind, controlled trial included 60 obese patients (age: 40 ± 10 y; BMI: 44 ± 3 kg/m²). Patients received a combination of specifically tailored multistrain probiotic powder and a specific micronutrient mixture (Pro+SM) or a control treatment consisting of a placebo and a basic care micronutrient mixture (Con+BM), with some micronutrients in lower doses than SM, for 12 wk after hospital discharge. Primary (serum ALAT) and secondary outcomes [serum aspartate aminotransferase (ASAT), fatty liver index, NAFLD fibrosis score, glucose metabolism, blood pressure (BP), heart rate] were assessed at week 0 and week 12. Data were analyzed using unpaired Student's t-tests or Mann-Whitney U tests to compare the changes due to each treatment to one another.
A total of 48 patients were included in the analyses. Changes in serum ALAT concentrations did not differ between groups. Compared with Con+BM, Pro+SM improved serum ASAT (difference: -8.0 U/L, 95% CI: -17.0, -4.0; P = 0.043), NAFLD fibrosis score (difference: -0.39; 95% CI: -0.78, 0; P = 0.048), serum triglycerides (difference: -22.8 mg/dL; 95% CI: -45.6, -0.1; P = 0.049) and the visceral adiposity index (difference: -0.70; 95% CI: -1.31, -0.08; P = 0.027).
Supplementation with a specifically tailored probiotic and micronutrient mixture improved NAFLD-related markers more than a basic micronutrient mixture in obese patients following MGB surgery. The trial was registered under clinicaltrials.gov as NCT03585413.
非酒精性脂肪性肝病（NAFLD）在接受减肥手术的患者中很常见。除了减轻体重外，可使用能改善胰岛素抵抗和脂毒性的膳食补充剂，如微量营养素或益生菌，来预防或延缓肝病进展。
我们评估了一种采用专门定制的多菌株益生菌和微量营养素混合物的饮食方法，与基础护理微量营养素补充剂相比，对小型胃旁路（MGB）手术后肥胖患者血清丙氨酸氨基转移酶（ALAT）的影响。
这项随机、双盲、对照试验纳入了60名肥胖患者（年龄：40±10岁；BMI：44±3kg/m²）。患者在出院后12周接受专门定制的多菌株益生菌粉和特定微量营养素混合物的组合（Pro+SM），或由安慰剂和基础护理微量营养素混合物组成的对照治疗（Con+BM），其中一些微量营养素的剂量低于SM。在第0周和第12周评估主要结局（血清ALAT）和次要结局[血清天冬氨酸氨基转移酶（ASAT）、脂肪肝指数、NAFLD纤维化评分、糖代谢、血压（BP）、心率]。使用非配对学生t检验或曼-惠特尼U检验分析数据，以比较每种治疗引起的变化。
共有48名患者纳入分析。两组之间血清ALAT浓度的变化没有差异。与Con+BM相比，Pro+SM改善了血清ASAT（差异：-8.0U/L，95%CI：-17.0，-4.0；P=0.043）、NAFLD纤维化评分（差异：-0.39；95%CI：-0.78，0；P=0.048）、血清甘油三酯（差异：-22.8mg/dL；95%CI：-45.6，-0.1；P=0.049）和内脏脂肪指数（差异：-0.70；95%CI：-1.31，-0.08；P=0.027）。
在MGB手术后的肥胖患者中，补充专门定制的益生菌和微量营养素混合物比基础微量营养素混合物更能改善与NAFLD相关的指标。该试验已在clinicaltrials.gov上注册，注册号为NCT03585413。
