住院老年营养不良患者的肠道微生物群紊乱与临床结局。

Gut microbiota disturbances in hospitalized older adults with malnutrition and clinical outcomes.

机构信息

Nutrition Department, School of Public Health, University of São Paulo, São Paulo, Sao Paulo, Brazil.

Laboratorio de Investigacao Medica em Envelhecimento (LIM 66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Sao Paulo, Brazil; Departamento de Medicina, Hospital Universitario, Universidade Federal de Sergipe, Aracaju, Sergipe, Brazil.

出版信息

Nutrition. 2024 Jun;122:112369. doi: 10.1016/j.nut.2024.112369. Epub 2024 Feb 1.

DOI:10.1016/j.nut.2024.112369

PMID:38422755

Abstract

OBJECTIVE

Malnutrition is one of the most threatening conditions in geriatric populations. The gut microbiota has an important role in the host's metabolic and muscular health: however, its interplay with disease-related malnutrition is not well understood. We aimed to identify the association of malnutrition with the gut microbiota and predict clinical outcomes in hospitalized acutely ill older adults.

METHODS

We performed a secondary longitudinal analysis in 108 geriatric patients from a prospective cohort evaluated at admission and 72 h of hospitalization. We collected clinical, demographic, nutritional, and 16S rRNA gene-sequenced gut microbiota data. Microbiota diversity, overall composition, and differential abundance were calculated and compared between patients with and without malnutrition. Microbiota features associated with malnutrition were used to predict clinical outcomes.

RESULTS

Patients with malnutrition (51%) had a different microbiota composition compared to those who were well-nourished during hospitalization (ANOSIM R = 0.079, P = 0.003). Patients with severe malnutrition showed poorer α-diversity at admission (Shannon P = 0.012, Simpson P = 0.018) and follow-up (Shannon P = 0.023, Chao1 P = 0.008). Differential abundance of Lachnospiraceae NK4A136 group, Subdoligranulum, and Faecalibacterium prausnitzii were significantly lower and inversely associated with malnutrition, while Corynebacterium, Ruminococcaceae Incertae Sedis, and Fusobacterium were significantly increased and positively associated with malnutrition. Corynebacterium, Ruminococcaceae Incertae Sedis, and the overall composition were important predictors of critical care in patients with malnutrition during hospitalization.

CONCLUSION

Older adults with malnutrition, especially in a severe stage, may be subject to substantial gut microbial disturbances during hospitalization. The gut microbiota profile of patients with malnutrition might help us to predict worse clinical outcomes.

摘要

目的

营养不良是老年人群体中最具威胁性的状况之一。肠道微生物群在宿主的代谢和肌肉健康中起着重要作用：然而，其与与疾病相关的营养不良的相互作用尚不清楚。我们旨在确定营养不良与肠道微生物群的关联，并预测住院急性老年患者的临床结局。

方法

我们对前瞻性队列中 108 名老年患者进行了二次纵向分析，这些患者在入院时和住院 72 小时时接受了评估。我们收集了临床、人口统计学、营养和 16S rRNA 基因测序肠道微生物群数据。计算并比较了营养不良患者和营养良好患者之间的微生物多样性、总体组成和差异丰度。将与营养不良相关的微生物群特征用于预测临床结局。

结果

营养不良患者（51%）在住院期间的微生物群组成与营养良好的患者不同（ANOSIM R = 0.079，P = 0.003）。入院时（Shannon P = 0.012，Simpson P = 0.018）和随访时（Shannon P = 0.023，Chao1 P = 0.008）严重营养不良患者的α多样性较差。Lachnospiraceae NK4A136 组、Subdoligranulum 和 Faecalibacterium prausnitzii 的差异丰度明显较低，与营养不良呈负相关，而 Corynebacterium、Ruminococcaceae Incertae Sedis 和 Fusobacterium 的差异丰度明显增加，与营养不良呈正相关。Corynebacterium、Ruminococcaceae Incertae Sedis 和总体组成是营养不良患者住院期间发生重症监护的重要预测因子。