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Abstract

Technological progress in high-throughput sequencing and advanced bioinformatic techniques, have facilitated a deeper understanding of the gut microbial influence on human health. Collectively known as the gut microbiota, the trillions of microbes including bacteria, viruses and fungi, which reside within the gut, are now recognised as significant contributors to human (host) health. Patients with non-communicable diseases such as metabolic syndrome, obesity and inflammatory bowel disease, demonstrate distinct microbial alterations. This has prompted vigorous pursuit of the mechanisms by which this microbial ‘organ’ influences host health. This branch of medicine has already revealed exciting avenues for disease treatment, from the discovery of novel antibiotics to the treatment of recurrent Clostridium difficile infection.1 The scale and spectrum of microbial influence is substantial and elegant studies have linked the presence or absence of specific microbes with immunity,2 neurodevelopment and even behavioural disturbances.3 The potential impact of microbiome science extends to the specialties of Sports Medicine and particularly to Exercise Medicine. The development of a mature enteric microbiota is subject to modifiable and non-modifiable factors, including diet and host genetics.4 The gut microbiota is perturbed by …

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... Numerous reviews have been published highlighting the effect of exercise on the gut microbiota (39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56). However, the primary focus of these reviews has been the implications for aspects of host health, such as the immune system and risk of chronic diseases. ...
... However, the primary focus of these reviews has been the implications for aspects of host health, such as the immune system and risk of chronic diseases. Only a few have discussed the implications for athletic performance (41,48,52). This review aims to provide a more in-depth discussion of the interactive effect between the gut microbiota and diet on athletic performance and highlight the need for further research in this area. ...
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The gut microbiome is a key factor in determining inter-individual variability in response to diet. Thus, far, research in this area has focused on metabolic health outcomes such as obesity and type 2 diabetes. However, understanding the role of the gut microbiome in determining response to diet may also lead to improved personalization of sports nutrition for athletic performance. The gut microbiome has been shown to modify the effect of both diet and exercise, making it relevant to the athlete's pursuit of optimal performance. This area of research can benefit from recent developments in the general field of personalized nutrition and has the potential to expand our knowledge of the nexus between the gut microbiome, lifestyle, and individual physiology.
... Pre-clinical studies with Veillonella show a 13% increase in endurance performance [30]. It is likely that the diverse, metabolically favorable intestinal microbiome evident in the elite athlete is the cumulative manifestation of many years of high nutrient intake and high degrees of physical activity and training throughout youth, adolescence and during adult participation in professional sports [31]. ...
... Partitioning of individuals into enterotypes appears to be driven by whether their primary dietary patterns include high complex carbohydrate (Prevotella) or high fat/protein (Bacteroides) consumption [33]. Protein intake appears to be a strong modulator of the microbiota [20,32,34], with whey protein showing some potential benefits that need further study in humans [31,35]. Carbohydrates are well known for their profound effect on the gut microbiota, with increased intake of dietary fiber associated with microbial richness and/or diversity [36,37]. ...
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Position statement: The International Society of Sports Nutrition (ISSN) provides an objective and critical review of the mechanisms and use of probiotic supplementation to optimize the health, performance, and recovery of athletes. Based on the current available literature, the conclusions of the ISSN are as follows: Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host (FAO/WHO). Probiotic administration has been linked to a multitude of health benefits, with gut and immune health being the most researched applications. Despite the existence of shared, core mechanisms for probiotic function, health benefits of probiotics are strain- and dose-dependent. Athletes have varying gut microbiota compositions that appear to reflect the activity level of the host in comparison to sedentary people, with the differences linked primarily to the volume of exercise and amount of protein consumption. Whether differences in gut microbiota composition affect probiotic efficacy is unknown. The main function of the gut is to digest food and absorb nutrients. In athletic populations, certain probiotics strains can increase absorption of key nutrients such as amino acids from protein, and affect the pharmacology and physiological properties of multiple food components. Immune depression in athletes worsens with excessive training load, psychological stress, disturbed sleep, and environmental extremes, all of which can contribute to an increased risk of respiratory tract infections. In certain situations, including exposure to crowds, foreign travel and poor hygiene at home, and training or competition venues, athletes’ exposure to pathogens may be elevated leading to increased rates of infections. Approximately 70% of the immune system is located in the gut and probiotic supplementation has been shown to promote a healthy immune response. In an athletic population, specific probiotic strains can reduce the number of episodes, severity and duration of upper respiratory tract infections. Intense, prolonged exercise, especially in the heat, has been shown to increase gut permeability which potentially can result in systemic toxemia. Specific probiotic strains can improve the integrity of the gut-barrier function in athletes. Administration of selected anti-inflammatory probiotic strains have been linked to improved recovery from muscle-damaging exercise. The minimal effective dose and method of administration (potency per serving, single vs. split dose, delivery form) of a specific probiotic strain depends on validation studies for this particular strain. Products that contain probiotics must include the genus, species, and strain of each live microorganism on its label as well as the total estimated quantity of each probiotic strain at the end of the product’s shelf life, as measured by colony forming units (CFU) or live cells. Preclinical and early human research has shown potential probiotic benefits relevant to an athletic population that include improved body composition and lean body mass, normalizing age-related declines in testosterone levels, reductions in cortisol levels indicating improved responses to a physical or mental stressor, reduction of exercise-induced lactate, and increased neurotransmitter synthesis, cognition and mood. However, these potential benefits require validation in more rigorous human studies and in an athletic population.
... More recently, it has been suggested that a correlation between intestinal microbiota and exercise, including strong competitive sport activities, may help to explain the advantages of physical activity on overall body health. On the other hand, irregular or excessive physical activity as well as inappropriate endurance training may induce unfavorable changes in gut microbial composition with repercussions on athletic performance [3]. ...
Article
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Gut microbiota refers to those microorganisms in the human digestive tract that display activities fundamental in human life. With at least 4 million different bacterial types, the gut microbiota is composed of bacteria that are present at levels sixfold greater than the total number of cells in the entire human body. Among its multiple functions, the microbiota helps promote the bioavailability of some nutrients and the metabolization of food, and protects the intestinal mucosa from the aggression of pathogenic microorganisms. Moreover, by stimulating the production of intestinal mediators able to reach the central nervous system (gut/brain axis), the gut microbiota participates in the modulation of human moods and behaviors. Several endogenous and exogenous factors can cause dysbiosis with important consequences on the composition and functions of the microbiota. Recent research underlines the importance of appropriate physical activity (such as sports), nutrition, and a healthy lifestyle to ensure the presence of a functional physiological microbiota working to maintain the health of the whole human organism. Indeed, in addition to bowel disturbances, variations in the qualitative and quantitative microbial composition of the gastrointestinal tract might have systemic negative effects. Here, we review recent studies on the effects of physical activity on gut microbiota with the aim of identifying potential mechanisms by which exercise could affect gut microbiota composition and function. Whether physical exercise of variable work intensity might reflect changes in intestinal health is analyzed.
... In fact, their gut microbiota may reflect years of optimized nutrition and high degrees of physical conditioning from an early age. 39 Besides, stability, resistance, and resilience are generally associated with a health-associated gut microbiota. 40 Thirdly, while the recruitment of a women's national football team enabled to investigate the impact of an official football tournament in the gut microbiota of a football team, avoid geographic bias and reduce the confounding effect of players' competitive level, it also conditioned the sample size. ...
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The current study aimed to investigate if the gut microbiota composition of elite female football players changes during an official international tournament. The study was conducted throughout ten consecutive days, encompassing seven training sessions and three official matches. The matches were separated by 48-72 hours. Seventeen elite female football players from the Portuguese women’s national football team participated in the study. Faecal samples were collected at two time points: at the beginning and end of the tournament. Faecal microbiota was analysed by sequencing the 16S rRNA gene. Throughout the study, the duration and rating of perceived exertion (RPE) were recorded after training sessions and matches. The internal load was determined by the session-RPE. The gut microbiota of players was predominantly composed of bacteria from the phyla Firmicutes (50% of relative abundance) and Bacteroidetes (20%); the genera Faecalibacterium (29%) and Collinsella (16%); the species Faecalibacterium prausnitzii (30%) and Collinsella aerofaciens (17%). Overall, no significant changes were observed between time points (p ≥ 0.05). Also, no relationship was found between any exercise parameter and the gut microbiota composition (p ≥ 0.05). These findings demonstrate that the physical and physiological demands of training and matches of an official international tournament did not change the gut microbiota composition of elite female football players. Furthermore, it supports that the gut microbiota of athletes appears resilient to the physical and physiological demands of training and match play.
... 23 Buna ek olarak düzenli egzersizin bağırsak mikrobiyotasına, bağırsak mikrobiyotasının da spor performansına etkisi olduğu iddia edilmektedir. 64,65 Ayrıca sporcuların beraber seyahat etme, konaklama, yemek yeme ve soyunma odası gibi ortak kullanım alanlarında bulunmaları nedeniyle gastrointestinal sistem enfeksiyonlarının sık olduğu ve sporcularda hızlı yayılabileceği bilinmektedir. Bu nedenle sporcuların periyodik muayenesinde gaita testleri yapılmalı ve patolojik mikroorganizma varlığında tedavi başlanmalıdır. ...
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Sporcuların periyodik sağlık ve performans değerlendirmeleri spor hekimliğinin ve sporcu sağlığı ekibinin önemli görevlerindendir. Genel sağlığın, kas-iskelet sisteminin ve spor performansının değerlendirilmesi olarak üç farklı basamakta gerçekleştirilir. Bu değerlendirmeler sırasında amaç sporcu sağlığını, performansını kötü etkileyecek problemleri ve kas-iskelet sistemi yaralanmalarına neden olabilecek risk faktörlerini tespit etmektir. Genel sağlık değerlendirmesi ayrıntılı bir anamnez, aile öyküsü ve sistemik muayene ile başlar. Bu değerlendirmeler sırasında tespit edilen anormalliklere göre ileri tetkik ve konsültasyon planlanır. Sporcu sağlığının takibi multidisipliner bir ekip çalışması gerektirir, spor hekimliği uzmanı bu ekibin koordinasyonundan sorumludur. Bu bölümde periyodik sağlık muayenesinin genel sağlık değerlendirmelerinden ve temel kas-iskelet sistemi muayenesinden bahsedilecektir. ABSTRACT Periodic health and performance evaluations of athletes are among the important duties of sports medicine and athlete health teams. It is carried out in three different steps as evaluation of general health, musculoskeletal system, and sports performance. During these evaluations, the aim is to identify problems that will adversely affect the health and performance of the athlete and risk factors that may cause musculoskeletal injuries. General health evaluation begins with a detailed anamnesis, family history, and systemic examination. Further examination and consultation are planned according to the abnormalities detected during these evaluations. Screening the health of athletes requires multidisciplinary teamwork, the sports medicine specialist is responsible for the coordination of this team. In this section, the general health evaluations of the periodic health examination and the basic musculoskeletal examination will be mentioned.
... Diet is 1 tool that athletes use to optimize their fitness, performance, and recovery (1). Dietary strategies for sport seek to optimize training, performance, and recovery via supplementation of specific nutrients (e.g., protein, carbohydrate loading, iron), restriction of energy or certain food categories (e.g., low-FODMAP diet, gluten-free), and adequate hydration; however, the effects of these dietary strategies on the gut microbiota are not well understood (17,53,54). Alternatively, increasing research indicates that dietary strategies for improving gastrointestinal health (e.g., probiotics, prebiotics, and synbiotics) represent promising opportunities to optimize the interaction between the gut and sport, with the potential to enhance athletes' health and performance. ...
Article
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The athlete's goal is to optimize their performance. Towards this end, nutrition has been used to improve the health of athletes' brains, bones, muscles, and cardiovascular system. However, recent research suggests that the gut and its resident microbiota may also play a role in athlete health and performance. Therefore, athletes should consider dietary strategies in the context of their potential effects on the gut microbiota, including the impact of sports-centric dietary strategies (e.g., protein supplements, carbohydrate loading) on the gut microbiota as well as the effects of gut-centric dietary strategies (e.g., probiotics, prebiotics) on performance. This review provides an overview of the interaction between diet, exercise, and the gut microbiota, focusing on dietary strategies that may impact both the gut microbiota and athletic performance. Current evidence suggests that the gut microbiota could, in theory, contribute to the effects of dietary intake on athletic performance by influencing microbial metabolite production, gastrointestinal physiology, and immune modulation. Common dietary strategies such as high protein and simple carbohydrate intake, low fiber intake, and food avoidance may adversely impact the gut microbiota and, in turn, performance. Conversely, intake of adequate dietary fiber, a variety of protein sources, and emphasis on unsaturated fats, especially omega-3 (ɷ-3) fatty acids, in addition to consumption of prebiotics, probiotics, and synbiotics, have shown promising results in optimizing athlete health and performance. Ultimately, while this is an emerging and promising area of research, more studies are needed that incorporate, control, and manipulate all 3 of these elements (i.e., diet, exercise, and gut microbiome) to provide recommendations for athletes on how to "fuel their microbes."
... It is hypothesized that approximately 3.3 million microbial genes are encoded in the entire genetic repertoire of the gut microbiota [1]. In humans, one of the major influences on the microbial signatures of individuals is diet [2,3], while antibiotic use [4], exercise [5] and age [6] also have significant effects. Furthermore, the gut microbiota profiles of humans are altered in metabolic disease states such as obesity [7], type II diabetes mellitus (T2DM) [8] and cardiovascular disease (CVD) [9]. ...
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Dietary fibre has long been established as a nutritionally important, health-promoting food ingredient. Modern dietary practices have seen a significant reduction in fibre consumption compared with ancestral habits. This is related to the emergence of low-fibre “Western diets” associated with industrialised nations, and is linked to an increased prevalence of gut diseases such as inflammatory bowel disease, obesity, type II diabetes mellitus and metabolic syndrome. The characteristic metabolic parameters of these individuals include insulin resistance, high fasting and postprandial glucose, as well as high plasma cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Gut microbial signatures are also altered significantly in these cohorts, suggesting a causative link between diet, microbes and disease. Dietary fibre consumption has been hypothesised to reverse these changes through microbial fermentation and the subsequent production of short-chain fatty acids (SCFA), which improves glucose and lipid parameters in individuals who harbour diseases associated with dysfunctional metabolism. This review article examines how different types of dietary fibre can differentially alter glucose and lipid metabolism through changes in gut microbiota composition and function.
... This is unfavourable within the context of oxidative stress increasing the demand for antioxidants (Yavari, Javadi, Mirmiran, Bahadoran, 2015), as well as increased demand for vitamins regulating metabolic intensities (group B) and minerals important in muscle contraction processes (Volpe, 2007). Low consumption of dairy products increases the risk of calcium deficiency, which is involved in the regulation of neuromuscular excitability and acid-base balance (Volpe, 2007), while low consumption of fermented dairy products reduces the consumption of probiotics that affect the maintenance of diverse and rich intestinal microflora, with numerous health-promoting properties (Cronin et al., 2017). Low consumption of fish and nuts may reduce the supply of omega-3 polyunsaturated fatty acids (PUFA) optimising blood lipid profile (Gillingham, Harris-Janz, Jones, 2011). ...
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The aim of the study was to assess the frequency of consuming particular food groups among regional-level football referees depending on age, refereeing experience and sense of generalised self-efficacy. The study was conducted among a group of 138 male football referees from the Małopolska and Podkarpacie regions, using the authors’ own questionnaire on food consumption frequency and the Generalised Self-Efficacy Scale (GSES). It was shown that along with the age of the referees, the frequency of consuming fruit (p < 0.001), milk and dairy products with reduced fat content (p < 0.001), poultry and cold-cuts (p < 0.01) as well as nuts (p < 0.001) increased, while the frequency of consuming white cereal products (p < 0.001) and sea fish (p < 0.05) decreased. Along with refereeing experience, the frequency of eating fruit (p < 0.001), milk and dairy products with reduced fat content (p < 0.01), poultry meat and cold-cuts (p = 0.001), nuts (p < 0.001) and alcoholic beverages (p < 0.001) increased, while the frequency of consuming white cereal products (p < 0.001), sea fish (p < 0.05) and sweet carbonated drinks (p < 0.01) decreased. A positive correlation was found between the intensity of generalised self-efficacy and the frequency of consuming milk and dairy products with reduced fat content (p < 0.01), fermented dairy products (p < 0.01), eggs (p < 0.001) and mineral water (p < 0.001) as well as dry red wine (p < 0.05), and a negative correlation was noted with the frequency of consuming pork (p < 0.05), fast food products (p = 0.001) and sweetened carbonated beverages (p < 0.001). In the examined group of regional-level football referees, there was a tendency towards more rational nutrition choices along with age and refereeing experience as well as a sense of self-efficacy, while the most explicit trends regarded relationships with the sense of self-efficacy.
... Some human interventional studies have examined the effects of PA on gut microbiota, demonstrating that exercise both qualitatively and quantitatively changes gut microbial composition and function, with several benefits for the host, including enriching microbiota diversity towards more "health-associated" microbes. These bacteria are able to modulate mucosal immunity, improving barrier functions and stimulate the production of substances (SCFAs) that protect against gastrointestinal disorders and improve performance [291][292][293][294][295][296][297]. ...
Article
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Non-communicable diseases (NCDs) (mainly cardiovascular diseases, cancers, chronic respiratory diseases and type 2 diabetes) are the main causes of death worldwide. Their burden is expected to rise in the future, especially in less developed economies and among the poor spread across middle- and high-income countries. Indeed, the treatment and prevention of these pathologies constitute a crucial challenge for public health. The major non-communicable diseases share four modifiable behavioral risk factors: unhealthy diet, physical inactivity, tobacco usage and excess of alcohol consumption. Therefore, the adoption of healthy lifestyles, which include not excessive alcohol intake, no smoking, a healthy diet and regular physical activity, represents a crucial and economical strategy to counteract the global NCDs burden. This review summarizes the latest evidence demonstrating that Mediterranean-type dietary pattern and physical activity are, alone and in combination, key interventions to both prevent and control the rise of NCDs.
... We have theorized that the structure of the athlete microbiome is, in part, the result of adaptations to long-term engagement in rigorous physical activity and associated lifestyle (eg, optimized diet). 40 This is consistent with the observation that the gut microbiome of adults has been shown to be resistant to dramatic alteration and, thus, may not rapidly adapt to the systemic influences of exercise. 41 Here however, we investigated whether the gut microbiome is altered by exercise over an extended period of time. ...
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The athlete gut microbiome differs from that of non‐athletes in its composition and metabolic function. Short‐term fitness improvement in sedentary adults does not replicate the microbiome characteristics of athletes. The objective of this study was to investigate whether sustained fitness improvement leads to pronounced alterations in the gut microbiome. This was achieved using a repeated‐measures, case‐study approach that examined the gut microbiome of two initially unfit volunteers undertaking progressive exercise training over a 6‐month period. Samples were collected every two weeks, and microbiome, metabolome, diet, body composition, and cardiorespiratory fitness data were recorded. Training culminated in both participants completing their respective goals (a marathon or Olympic‐distance triathlon) with improved body composition and fitness parameters. Increases in gut microbiota α‐diversity occurred with sustained training and fluctuations occurred in response to training events (eg, injury, illness, and training peaks). Participants’ BMI reduced during the study and was significantly associated with increased urinary measurements of N‐methyl nicotinate and hippurate, and decreased phenylacetylglutamine. These results suggest that sustained fitness improvements support alterations to gut microbiota and physiologically‐relevant metabolites. This study provides longitudinal analysis of the gut microbiome response to real‐world events during progressive fitness training, including intercurrent illness and injury.
... These results are contrary to what had been observed in active subjects, suggesting that the intensity of the exercise impacts the gut microbiota in a different way. Indeed, elite athletes seem to have a metabolically favorable intestinal microbiome as a manifestation of many years of optimized nutrition and a high degree of physical condition throughout the years [197]. The mechanisms by which moderate exercise might affect gut communities involve the association of moderate exercise with a lesser degree of IP, the preservation of mucous thickness, lower rates of bacterial translocation, and the upregulation of the production of antimicrobial proteins, such as defensins [198]. ...
Article
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It is widely known that a good balance and healthy function for bacteria groups in the colon are necessary to maintain homeostasis and preserve health. However, the lack of consensus on what defines a healthy gut microbiota and the multitude of factors that influence human gut microbiota composition complicate the development of appropriate dietary recommendations for our gut microbiota. Furthermore, the varied response to the intake of probiotics and prebiotics observed in healthy adults suggests the existence of potential inter- and intra-individual factors, which might account for gut microbiota changes to a greater extent than diet. The changing dietary habits worldwide involving consumption of processed foods containing artificial ingredients, such as sweeteners; the coincident rise in emotional disorders; and the worsening of other lifestyle habits, such as smoking habits, drug consumption, and sleep, can together contribute to gut dysbiosis and health impairment, as well as the development of chronic diseases. This review summarizes the current literature on the effects of specific dietary ingredients (probiotics, prebiotics, alcohol, refined sugars and sweeteners, fats) in the gut microbiota of healthy adults and the potential inter- and intra-individual factors involved, as well as the influence of other potential lifestyle factors that are dramatically increasing nowadays.
... In addition, higher diversity of microbiota composition was associated with lean phenotypes compared to that of obese individuals. It is likely that the diverse, metabolically favorable intestinal microbiota evident in the elite athlete is the cumulative manifestation of many years of high nutrient intake and high degrees of physical activity and training throughout youth, adolescence, and during adult participation in high-level sports [133]. Future areas of gut microbiota research in relation to athletes and exercise is presented in Table 3. ...
Article
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The microorganisms in the gastrointestinal tract play a significant role in nutrient uptake, vitamin synthesis, energy harvest, inflammatory modulation, and host immune response, collectively contributing to human health. Important factors such as age, birth method, antibiotic use, and diet have been established as formative factors that shape the gut microbiota. Yet, less described is the role that exercise plays, particularly how associated factors and stressors, such as sport/exercise-specific diet, environment, and their interactions, may influence the gut microbiota. In particular, high-level athletes offer remarkable physiology and metabolism (including muscular strength/power, aerobic capacity, energy expenditure, and heat production) compared to sedentary individuals, and provide unique insight in gut microbiota research. In addition, the gut microbiota with its ability to harvest energy, modulate the immune system, and influence gastrointestinal health, likely plays an important role in athlete health, wellbeing, and sports performance. Therefore, understanding the mechanisms in which the gut microbiota could play in the role of influencing athletic performance is of considerable interest to athletes who work to improve their results in competition as well as reduce recovery time during training. Ultimately this research is expected to extend beyond athletics as understanding optimal fitness has applications for overall health and wellness in larger communities. Therefore, the purpose of this narrative review is to summarize current knowledge of the athletic gut microbiota and the factors that shape it. Exercise, associated dietary factors, and the athletic classification promote a more "health-associated" gut microbiota. Such features include a higher abundance of health-promoting bacterial species, increased microbial diversity, functional metabolic capacity, and microbial-associated metabolites, stimulation of bacterial abundance that can modulate mucosal immunity, and improved gastrointestinal barrier function.
... The proper supply of calcium among athletes is particularly important because of its participation in regulating neuromuscular excitability and the acid-base balance of the body [48]. Low consumption of fermented dairy products reduces the consumption of probiotics that affect the maintenance of a diverse and rich intestinal microflora with numerous health-promoting properties [7,9]. Low consumption of sea fish may reduce the supply of omega 3 PUFAs with lipid-lowering properties, optimizing blood lipid profile [21]. ...
Article
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Background: Mistakes in dietary choices and an unbalanced diet reduce the exercise capacity of athletes. Nutritional behaviours are conditioned by environmental and individual factors. Objective: The aim of the study was to assess the scale of improper eating behaviours among high-performance Polish athletes depending on gender, sports level and type of discipline. Material and methods: The study was conducted among 610 athletes (391 men and 219 women). The group consisted of 289 athletes of individual disciplines and 321 team sports athletes representing the championship sports class (282 individuals) as well as the first and second classes (328 subjects). The authors’ validated nutritional behaviour questionnaire was used, referring to the recommendation of the Swiss nutrition pyramid for athletes. In statistical analysis, the Chi2 test was applied (α=0.05). Results: Athletes most often demonstrated improper behaviours regarding: insufficient frequency of consuming vegetable fats (61.78%), fruits (59.89%), wholegrain products (59.90%), vegetables (53.62%) and dairy products (52.09%), and not limiting the intake of energy drinks (59.89%). Compared to women, men, to a larger extent, did not include the following in their daily diet: raw vegetables (p<0.001), wholegrain products (p<0.05) and vegetable fats (p<0.01). Significantly more often, they also did not limit the consumption of: animal fats (p<0.001), sweetened carbonated beverages (p<0.001), energy drinks (p<0.05) or fast food products (p<0.001). Women consumed meals less regularly (p<0.01), rarely ate fish (p<0.01), and were more likely to be inadequately hydrated (p<0.05). Athletes training individual sports disciplines compared to those training team sports consumed hydrating beverages (p<0.001) less often, but included fruit in their daily diet more frequently (p<0.05). Athletes from the master class consumed meals irregularly (p<0.01) in a smaller percentage than athletes with a lower sports class, not limiting animal fats (p<0.05) and implementing inadequate hydration (p<0.05). Conclusions: The scale of incorrect nutrition choices among athletes indicated variations depending on gender, sports level and type of sport practiced, with incorrect behaviours more often presented by men than women and competitors with a lower sports level (non-master class). The nature of the performed discipline was a factor less differentiating the nutritional choices of athletes.
... The effect of exercise on microbiota has been extensively studied, and has been a focus of several recent reviews (Campbell et al., 2016;Cerdá et al., 2016;Cronin et al., 2017;Hamasaki, 2017;Mitchell et al., 2018;Monda et al., 2017). In general, positive effects have been reported, mainly in order to enhance colon health, increasing the C. Gubert, et al. ...
Article
The last decade has witnessed an exponentially growing interest in gut microbiota and the gut-brain axis in health and disease. Accumulating evidence from preclinical and clinical research indicate that gut microbiota, and their associated microbiomes, may influence pathogenic processes and thus the onset and progression of various diseases, including neurological and psychiatric disorders. In fact, gut dysbiosis (microbiota dysregulation) has been associated with a range of neurodegenerative diseases, including Alzheimer's, Parkinson's, Huntington's and motor neuron disease, as well as multiple sclerosis. The gut microbiota constitutes a dynamic microbial system constantly challenged by many biological variables, including environmental factors. Since the gut microbiota constitute a changeable and experience-dependent ecosystem, they provide potential therapeutic targets that can be modulated as new interventions for dysbiosis-related disorders, including neurodegenerative diseases. This article reviews the evidence for environmental modulation of gut microbiota and its relevance to brain disorders, exploring in particular the implications for neurodegenerative diseases. We will focus on three major environmental factors that are known to influence the onset and progression of those diseases, namely exercise, diet and stress. Further exploration of environmental modulation, acting via both peripheral (e.g. gut microbiota and associated metabolic dysfunction or 'metabolopathy') and central (e.g. direct effects on CNS neurons and glia) mechanisms, may lead to the development of novel therapeutic approaches, such as enviromimetics, for a wide range of neurological and psychiatric disorders.
... In humans, the effect is less established and the current evidence is based on a few cross-sectional studies [27][28][29][30] and three uncontrolled short-term exercise trials [31][32][33]. These studies do indicate some effects of physical activity on the gut microbiota; still randomized controlled interventions are needed to assess causality [34]. ...
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Objectives: Studies suggest that exercise affects the composition and function of the human gut microbiota, yet this has not been investigated in a randomized controlled trial. The primary aim of this study was to assess if exercise alters the diversity, composition and functional potential of the gut microbiota in free-living humans. A secondary aim was to test whether alpha diversity was associated with phenotypical outcomes. Methods: Eighty eight participants with overweight or obesity completed a 6-month randomized controlled trial with 4 arms; habitual living (CON), active commuting by bike (BIKE) and leisure-time exercise of moderate (MOD) or vigorous intensity (VIG). Faecal samples for 16 s rRNA gene amplicon sequencing were collected prior to randomization and again after 3 and 6 months, with simultaneous registration of phenotypical outcomes and diet. Results: Shannon's diversity index increased by 5% in VIG (CI95 1-9%, P = 0.012) at 3 months compared with CON. No associations were observed between alpha diversity and phenotypical outcomes. Beta diversity changed in all exercise groups compared with CON, particularly the participants in VIG showed decreased heterogeneity. No genera changed significantly. The inferred functional potential of the microbiota in the exercise groups was increased, primarily at 3 months and in MOD. Conclusion: Structured exercise induced subtle changes to the human gut microbiota. Cardiorespiratory fitness and fat mass were not associated with alpha diversity.
... In our study, the extreme amount of adipose tissue in Zucker rats could mask the changes in gut microbiota composition induced by regular exercise [23,52,53]. Nevertheless, Lamoureux et al. observed minor effects of spontaneous exercise on gut microbiota composition also in normal-weight C57BL/6 mice [24]. ...
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Aims Increased visceral adipose tissue and dysbiosis in the overweight and obese promote chronic inflammation. The aim of this study was to compare the effects of moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) on the gut-adipose tissue cross-talk in obese Zucker rats. Methods Obese male Zucker rats (n = 36) were divided in three groups: MICT (12m.min⁻¹ for 51min), HIIT (6 sets at 18 m.min⁻¹ for 4min followed by 3min at 10m.min⁻¹) and controls (CONT; no exercise). The animals ran on a treadmill 5 days/week for 10 weeks. Body composition, glycaemic control, lipid profile, inflammation, lipolysis signalling in subcutaneous and visceral adipose tissue, intestinal permeability (tight junctions and plasma lipopolysaccharide binding protein; LBP), and gut microbiota composition were assessed in the three groups. Results After 10 weeks of exercise, total and epididymal fat mass decreased only in the HIIT group. The α/β adrenergic receptor RNA ratio in subcutaneous adipose tissue increased only in the HIIT group. The expression level of phosphorylated hormone-sensitive lipase was not modified by training. Both HIIT and MICT decreased inflammation (plasma myeloperoxidase and keratinocyte-derived chemokine secretion in adipose tissue) and improved glucose metabolism. Zonula occludens-1 and occludin were upregulated in the HIIT group. Plasma LBP was similarly reduced in both training groups. HIIT and MICT did not affect gut microbiota composition. Conclusion In obese Zucker rats, HIIT and MICT improved inflammation and glucose metabolism. In contrast, only HIIT decreased total and visceral fat mass. These adaptations were not associated with modifications in gut microbiota composition.
... The long-term habitual diet seems to be the primary factor influencing gut microbiota, with regular diet having the most significant effect on microbiome composition and correlated release of microbial metabolites [217,218]. The fact that regular exercise can be one of the drivers of a specific microbiome composition and related functions has recently gained remarkable interest [219,220]. Recent literature describes a higher level of microbial diversity, usually associated with a healthy gut, in elite athletes compared to sedentary cohorts [221]. Exploring the metabolic functions by metagenomics, the same authors recently found an enrichment of Akkermansia in athletes and increased the abundance of pathways such as the biosynthesis of organic cofactors and antibiotics, as well as carbohydrate degradation and secondary metabolite metabolism, which could be relevant to health benefits [222]. ...
Article
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The need to evaluate the health status of an athlete represents a crucial aim in preventive and protective sports science in order to identify the best diagnostic strategy to improve performance and reduce risks related to physical exercise. In the present review we aim to define the main biochemical and haematological markers that vary significantly during and after sports training to identify risk factors, at competitive and professional levels and to highlight the set up of a specific parameter's panel for elite athletes. Moreover, we also intend to consider additional biomarkers, still under investigation, which could further contribute to laboratory sports medicine and provide reliable data that can be used by athlete's competent staff in order to establish personal attitudes and prevent sports injuries.
... A modality of vigorous physical activity, high-intensity interval training, improved the microbiota of obese mice, countering the changes following a high-fat diet [162]. High-degree of physical conditioning, as seen in elite athletes, results in a distinctive microbiota, and more metabolic and inflammatory profiles [163]. Especially in endurance athletes, mitochondrial oxidative capacity is increased as mediated by mitochondrial regulation of inflammasomes; however, the effects of overtraining on the intestinal tract results in a major production of stressors, which facilitates the entrance of pathogens [164]. ...
... It should be acknowledged that the unperturbed adult intestinal microbiome is resilient (29) and may not be subject to significant alteration following an 8-week intervention period. It is likely that the diverse, metabolically favorable intestinal microbiome evident in the elite athlete is the cumulative manifestation of many years of optimized nutrition and of high degrees of physical condition throughout youth and adolescence and during adult participation in professional sports (30). Initial examination of the acute effects of extreme and prolonged endurance exercise, such as in trained military regiments, suggests that prolonged physical stress negatively impacts intestinal permeability and gut microbiota composition (31). ...
... It should be acknowledged that the unperturbed adult intestinal microbiome is resilient (29) and may not be subject to significant alteration following an 8-week intervention period. It is likely that the diverse, metabolically favorable intestinal microbiome evident in the elite athlete is the cumulative manifestation of many years of optimized nutrition and of high degrees of physical condition throughout youth and adolescence and during adult participation in professional sports (30). Initial examination of the acute effects of extreme and prolonged endurance exercise, such as in trained military regiments, suggests that prolonged physical stress negatively impacts intestinal permeability and gut microbiota composition (31). ...
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The gut microbiota of humans is a critical component of functional development and subsequent health. It is important to understand the lifestyle and dietary factors that affect the gut microbiome and what impact these factors may have. Animal studies suggest that exercise can directly affect the gut microbiota, and elite athletes demonstrate unique beneficial and diverse gut microbiome characteristics. These characteristics are associated with levels of protein consumption and levels of physical activity. The results of this study show that increasing the fitness levels of physically inactive humans leads to modest but detectable changes in gut microbiota characteristics. For the first time, we show that regular whey protein intake leads to significant alterations to the composition of the gut virome.
... interest. [24][25][26][27][28][29] Previously, using 16S rRNA amplicon sequencing, we demonstrated taxonomic differences in gut microbiota between an elite athlete cohort of international-level rugby players and a group of age-matched high (>28 kg/m 2 ) and low (<25 kg/m 2 ) body mass index (BMI) controls. 26 This analysis illustrated a significantly greater intestinal microbial diversity among the athletes compared with both control groups. ...
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Objective: It is evident that the gut microbiota and factors that influence its composition and activity effect human metabolic, immunological and developmental processes. We previously reported that extreme physical activity with associated dietary adaptations, such as that pursued by professional athletes, is associated with changes in faecal microbial diversity and composition relative to that of individuals with a more sedentary lifestyle. Here we address the impact of these factors on the functionality/metabolic activity of the microbiota which reveals even greater separation between exercise and a more sedentary state. Design: Metabolic phenotyping and functional metagenomic analysis of the gut microbiome of professional international rugby union players (n=40) and controls (n=46) was carried out and results were correlated with lifestyle parameters and clinical measurements (eg, dietary habit and serum creatine kinase, respectively). Results: Athletes had relative increases in pathways (eg, amino acid and antibiotic biosynthesis and carbohydrate metabolism) and faecal metabolites (eg, microbial produced short-chain fatty acids (SCFAs) acetate, propionate and butyrate) associated with enhanced muscle turnover (fitness) and overall health when compared with control groups. Conclusions: Differences in faecal microbiota between athletes and sedentary controls show even greater separation at the metagenomic and metabolomic than at compositional levels and provide added insight into the diet-exercise-gut microbiota paradigm.
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Purpose of the study: the study of the intestinal microbiome of high-class athletes and the effect of restoring the balance of intestinal microflora on indicators of their physical and psychophysiological state. Materials and methods: A single-center prospective study was performed on professional athletes in the conditions of training camps. Fifty-one high-class athletes (women - 37, men - 14) aged from 18 to 32 years took part. Athletes were divided into 3 groups: Group 1 (basketball) - 16 female athletes, Group 2 (biathlon, ski racing) - 19 athletes (14 men and 5 women), Group 3 (water polo) - 16 female athletes. Stool was analyzed for the composition of microflora. Depending on the results of the analysis, the sportsmen were recommended to use one of the programs, including prebiotic, probiotic, metabiotic, or their combination. Results and conclusions: gut dysbacteriosis and gastrointestinal dysfunctions are frequent in highly qualified athletes. A combined use of prebiotic and probiotic or prebiotic and metabiotic has an effective effect on restoring the gut microbiome and the functional state of the gastrointestinal tract. This normalization has a direct positive effect on the gut-microbiota-brain axis, thereby improving the functional and psychoemotional state of high-class athletes in general
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Physical exercise affects the human gut microbiota that, in turn, influences athletes’ performance. The current understanding of how the microbiota of professional athletes changes along with different phases of training is sparse. We aim to characterize the fecal microbiota in elite soccer players along with different phases of a competitive season using 16S rRNA gene sequencing. Fecal samples were collected after the summer off-season period, the pre-season retreat, the first half of the competitive season, and the 8 weeks COVID-19 lockdown that interrupted the season 2019-2020. According to our results, the gut microbiota of professional athletes changes along with the phases of the season, characterized by different training, diet, nutritional surveillance, and environment sharing. Pre-season retreat, during which nutritional surveillance and exercise intensity were at their peak, caused a decrease in bacterial groups related to unhealthy lifestyle and an increase in health-promoting symbionts. The competitive season and forced interruption affected other features of the athletes’ microbiota, i.e. bacterial groups that respond to dietary fibers load and stress levels. Our longitudinal study, focusing on one of the most followed sports worldwide, provides baseline data for future comparisons and microbiome-targeting interventions aimed at developing personalized training and nutrition plans for performances maximization.
Chapter
Physical inactivity is associated with an increased risk of morbidity and the development of chronic non-communicable diseases such as obesity and hypertension. Adverse changes in the gut microbiota composition affect the intestinal lumen's integrity and permeability, stimulating endotoxemia and low-grade systemic inflammation, contributing factors in the pathogenesis of metabolic diseases. However, exercise, a non-pharmacologic agent, promotes positive microbial changes in the gut and reduces low-grade systemic inflammation, and it can be used to treat chronic diseases. Besides exercise, dietary supplementation is a promising strategy for improving microbial composition in the gut and boosting training recovery and sports performance.
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Exercise mimetics are a proposed class of therapeutics that specifically mimic or enhance the therapeutic effects of exercise. Increased physical activity has demonstrated positive effects in preventing and ameliorating a wide range of diseases, including brain disorders such as Alzheimer disease and dementia, cancer, diabetes and cardiovascular disease. This article discusses the molecular mechanisms and signalling pathways associated with the beneficial effects of physical activity, focusing on effects on brain function and cognitive enhancement. Emerging therapeutic targets and strategies for the development of exercise mimetics, particularly in the field of central nervous system disorders, as well as the associated opportunities and challenges, are discussed. Physical activity has demonstrated positive effects in preventing and ameliorating a broad range of diseases, particularly central nervous system disorders. Accordingly, strategies to therapeutically mimic the effects of exercise are gaining interest. Here, Gubert and Hannan focus on the molecular and cellular effects of physical activity in the central nervous system, assessing opportunities for the development of therapeutic exercise mimetics.
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Objective: The composition and metabolic function of the gut microbiome in the elite athlete differs from that of non-athletes. However, short-term fitness improvement in the sedentary adult does not replicate the microbiome characteristics seen in the athlete. Whether sustained fitness improvement over a prolonged period can lead to pronounced and beneficial alteration in the gut microbiome is unknown. The objective was to explore this possibility. Methods: This study used a repeated-measures, case-study approach to explore changes in the gut microbiome of two unfit volunteers undertaking progressive exercise training over a 6-month period. Training was to culminate in the completion of a marathon or Olympic-distance triathlon. The volunteers were sampled every two weeks for six months and microbiome, metabolome, diet, body composition, and cardiorespiratory fitness data were recorded. Results: Both participants completed their respective goals with improved body composition and fitness parameters over the training period. Increases in α-diversity of the gut microbiota occurred with sustained training and fluctuations occurred in response to training events (e.g., injury, illness and training peaks). Participants' fat mass and BMI reduced during the study and was significantly associated with increased urinary measurements of N-methyl nicotinate (P value < 0.001) and hippurate (P value < 0.05), and decreased phenylacetylglutamine (P value < 0.05). Conclusion: These results suggest that sustained fitness improvements result in alterations to gut microbiota and physiologically-relevant metabolites. This study provides longitudinal analysis of the response of the gut microbiome to real-world events during progressive fitness training, including intercurrent illness and injury.
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Inrtroduction: Intestinal metabolism and microbiota profiles are impaired in obesity and insulin resistance. Moreover, dysbiotic gut microbiota has been suggested to promote systemic low-grade inflammation and insulin resistance through the release of endotoxins particularly lipopolysaccharides. We have previously shown that exercise training improves intestinal metabolism in healthy men. To understand whether changes in intestinal metabolism interact with gut microbiota and its release of inflammatory markers, we studied the effects of sprint interval (SIT) and moderate intensity continuous training (MICT) on intestinal metabolism and microbiota in insulin resistance. Methods: Twenty-six, sedentary subjects (prediabetic n=9, T2D n=17; age 49[SD 4] years; BMI 30.5[SD 3]) were randomized into SIT or MICT. Intestinal insulin-stimulated glucose uptake (GU) and fatty acid uptake (FAU) from circulation were measured using PET. Gut microbiota composition was analysed by 16S rRNA gene sequencing and serum inflammatory markers with multiplex assays and enzyme-linked immunoassay kit. Results: VO2peak improved only after SIT (p=0.01). Both training modes reduced systematic and intestinal inflammatory markers (TNF α, LBP) (time p<0.05). Training modified microbiota profile by increasing Bacteroidetes phylum (time p=0.03) and decreasing Firmicutes/Bacteroidetes ratio (time p=0.04). Moreover, there was a decrease in Clostridium genus (time p=0.04) and Blautia (time p=0.051). Only MICT decreased jejunal FAU (p=0.02). Training had no significant effect on intestinal GU. Colonic GU associated positively with Bacteroidetes and inversely with Firmicutes phylum, ratio Firmicutes/Bacteroidetes and Blautia genus. Conclusion: Intestinal substrate uptake associates with gut microbiota composition and activity and whole-body insulin sensitivity. Exercise training improves gut microbiota profiles and reduces endotoxemia.
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The gut microbiome is a community of microbes residing within the gastrointestinal tract with the potential to significantly influence host health. This infographic summarises the key features of a healthy gut microbiome, highlights its role in athlete health and performance, and identifies its positive and negative influences. This information will be of interest to health professionals involved in sport and can be used as a guide to inform athletes on optimising the health of their gut microbiome.
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Many factors affect the microbiomes of humans, mice, and other mammals, but substantial challenges remain in determining which of these factors are of practical importance. Considering the relative effect sizes of both biological and technical covariates can help improve study design and the quality of biological conclusions. Care must be taken to avoid technical bias that can lead to incorrect biological conclusions. The presentation of quantitative effect sizes in addition to P values will improve our ability to perform meta-analysis and to evaluate potentially relevant biological effects. A better consideration of effect size and statistical power will lead to more robust biological conclusions in microbiome studies.
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Background Reduced microbial diversity in human intestines has been implicated in various conditions such as diabetes, colorectal cancer, and inflammatory bowel disease. The role of physical fitness in the context of human intestinal microbiota is currently not known. We used high-throughput sequencing to analyze fecal microbiota of 39 healthy participants with similar age, BMI, and diets but with varying cardiorespiratory fitness levels. Fecal short-chain fatty acids were analyzed using gas chromatography. ResultsWe showed that peak oxygen uptake (VO2peak), the gold standard measure of cardiorespiratory fitness, can account for more than 20 % of the variation in taxonomic richness, after accounting for all other factors, including diet. While VO2peak did not explain variation in beta diversity, it did play a significant role in explaining variation in the microbiomes’ predicted metagenomic functions, aligning positively with genes related to bacterial chemotaxis, motility, and fatty acid biosynthesis. These predicted functions were supported by measured increases in production of fecal butyrate, a short-chain fatty acid associated with improved gut health, amongst physically fit participants. We also identified increased abundances of key butyrate-producing taxa (Clostridiales, Roseburia, Lachnospiraceae, and Erysipelotrichaceae) amongst these individuals, which likely contributed to the observed increases in butyrate levels. Conclusions Results from this study show that cardiorespiratory fitness is correlated with increased microbial diversity in healthy humans and that the associated changes are anchored around a set of functional cores rather than specific taxa. The microbial profiles of fit individuals favor the production of butyrate. As increased microbiota diversity and butyrate production is associated with overall host health, our findings warrant the use of exercise prescription as an adjuvant therapy in combating dysbiosis-associated diseases.
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The 100 trillion microorganisms residing within our intestines contribute roughly 5 million additional genes to our genetic gestalt, thus posing the potential to influence many aspects of our physiology. Microbial colonization of the gut shortly after birth is vital for the proper development of immune, neural and metabolic systems, while sustaining a balanced, diverse gut flora populated with beneficial bacteria is necessary for maintaining optimal function of these systems. Although symbiotic host-microbial interactions are important throughout the lifespan, these interactions can have greater and longer lasting impacts during certain critical developmental periods. A better understanding of these sensitive periods is necessary to improve the impact and effectiveness of health promoting interventions that target the microbial ecosystem. We have recently reported that exercise initiated in early life increases gut bacterial species involved in promoting psychological and metabolic health. In this review, we emphasize the ability of exercise during this developmentally receptive time to promote optimal brain and metabolic function across the lifespan through microbial signals.Immunology and Cell Biology accepted article preview online, 09 December 2015. doi:10.1038/icb.2015.113.
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Objective: Pneumonia accounts for more deaths than any other infectious disease worldwide. The intestinal microbiota supports local mucosal immunity and is increasingly recognised as an important modulator of the systemic immune system. The precise role of the gut microbiota in bacterial pneumonia, however, is unknown. Here, we investigate the function of the gut microbiota in the host defence against Streptococcus pneumoniae infections. Design: We depleted the gut microbiota in C57BL/6 mice and subsequently infected them intranasally with S. pneumoniae. We then performed survival and faecal microbiota transplantation (FMT) experiments and measured parameters of inflammation and alveolar macrophage whole-genome responses. Results: We found that the gut microbiota protects the host during pneumococcal pneumonia, as reflected by increased bacterial dissemination, inflammation, organ damage and mortality in microbiota-depleted mice compared with controls. FMT in gut microbiota-depleted mice led to a normalisation of pulmonary bacterial counts and tumour necrosis factor-α and interleukin-10 levels 6 h after pneumococcal infection. Whole-genome mapping of alveolar macrophages showed upregulation of metabolic pathways in the absence of a healthy gut microbiota. This upregulation correlated with an altered cellular responsiveness, reflected by a reduced responsiveness to lipopolysaccharide and lipoteichoic acid. Compared with controls, alveolar macrophages derived from gut microbiota-depleted mice showed a diminished capacity to phagocytose S. pneumoniae. Conclusions: This study identifies the intestinal microbiota as a protective mediator during pneumococcal pneumonia. The gut microbiota enhances primary alveolar macrophage function. Novel therapeutic strategies could exploit the gut-lung axis in bacterial infections.
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The gut microbiome is affected by multiple factors, including genetics. In this study, we assessed the influence of host genetics on microbial species, pathways and gene ontology categories, on the basis of metagenomic sequencing in 1,514 subjects. In a genome-wide analysis, we identified associations of 9 loci with microbial taxonomies and 33 loci with microbial pathways and gene ontology terms at P < 5 × 10⁻⁸. Additionally, in a targeted analysis of regions involved in complex diseases, innate and adaptive immunity, or food preferences, 32 loci were identified at the suggestive level of P < 5 × 10⁻⁶. Most of our reported associations are new, including genome-wide significance for the C-type lectin molecules CLEC4F–CD207 at 2p13.3 and CLEC4A–FAM90A1 at 12p13. We also identified association of a functional LCT SNP with the Bifidobacterium genus (P = 3.45 × 10⁻⁸) and provide evidence of a gene–diet interaction in the regulation of Bifidobacterium abundance. Our results demonstrate the importance of understanding host–microbe interactions to gain better insight into human health. © 2016 Nature Publishing Group, a division of Macmillan Publishers Limited. All Rights Reserved.
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Gut microbiota colonization is a key event for host physiology that occurs early in life. Disruption of this process leads to altered brain development which ultimately manifests as changes in brain function and behaviour in adulthood. Studies using germ-free mice highlight the extreme impact on brain health that results from life without commensal microbes, however the impact of microbiota disturbances occurring in adulthood is less studied. To this end, we depleted the gut microbiota of 10-week-old male Sprague Dawley rats via chronic antibiotic treatment. Following this marked, sustained depletion of the gut bacteria, we investigated behavioural and molecular hallmarks of gut-brain communication. Our results reveal that depletion of the gut microbiota during adulthood results in deficits in spatial memory as tested by Morris water maze, increased visceral sensitivity and a greater display of depressive-like behaviours in the forced swim test. In tandem with these clear behavioural alterations we found changes in altered CNS serotonin concentration along with changes in the mRNA levels of corticotrophin releasing hormone receptor 1 and glucocorticoid receptor. Additionally, we found changes in the expression of BDNF, a hallmark of altered microbiota-gut-brain axis signaling. In summary, this model of antibiotic-induced depletion of the gut microbiota can be used for future studies interested in the impact of the gut microbiota on host health without the confounding developmental influence of early-life microbial alterations.
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The role of fecal microbiota transplantation (FMT) for Clostridium difficile infection (CDI) is not well-known. To assess the efficacy, comparative effectiveness, and harms of FMT for CDI. MEDLINE (1980 to January 2015), Cochrane Library, and ClinicalTrials.gov, followed by hand-searching references from systematic reviews and identified studies. Any study of FMT to treat adult patients with CDI; case reports were only used to report harms. Data were extracted by 1 author and verified by another; 2 authors independently assessed risk of bias and strength of evidence. Two randomized, controlled trials (RCTs); 28 case-series studies; and 5 case reports were included. Two RCTs and 21 case-series studies (516 patients receiving FMT) reported using FMT for patients with recurrent CDI. A high proportion of treated patients had symptom resolution; however, the role of previous antimicrobials is unclear. One RCT comparing FMT with 2 control groups (n = 43) reported resolution of symptoms in 81%, 31%, and 23% of the FMT, vancomycin, or vancomycin-plus-bowel lavage groups, respectively (P < 0.001 for both control groups vs. FMT). An RCT comparing FMT route (n = 20) reported no difference between groups (60% in the nasogastric tube group and 80% in the colonoscopy group; P = 0.63). Across all studies for recurrent CDI, symptom resolution was seen in 85% of cases. In 7 case-series studies of patients with refractory CDI, symptom resolution ranged from 0% to 100%. Among 7 patients treated with FMT for initial CDI, results were mixed. Most studies were uncontrolled case-series studies; only 2 RCTs were available for analysis. Fecal microbiota transplantation may have a substantial effect with few short-term adverse events for recurrent CDI. Evidence is insufficient on FMT for refractory or initial CDI treatment and on whether effects vary by donor, preparation, or delivery method. U.S. Department of Veterans Affairs.
Article
Objective The commensal microbiota, host immunity and metabolism participate in a signalling network, with diet influencing each component of this triad. In addition to diet, many elements of a modern lifestyle influence the gut microbiota but the degree to which exercise affects this population is unclear. Therefore, we explored exercise and diet for their impact on the gut microbiota. Design Since extremes of exercise often accompany extremes of diet, we addressed the issue by studying professional athletes from an international rugby union squad. Two groups were included to control for physical size, age and gender. Compositional analysis of the microbiota was explored by 16S rRNA amplicon sequencing. Each participant completed a detailed food frequency questionnaire. Results As expected, athletes and controls differed significantly with respect to plasma creatine kinase (a marker of extreme exercise), and inflammatory and metabolic markers. More importantly, athletes had a higher diversity of gut micro-organisms, representing 22 distinct phyla, which in turn positively correlated with protein consumption and creatine kinase. Conclusions The results provide evidence for a beneficial impact of exercise on gut microbiota diversity but also indicate that the relationship is complex and is related to accompanying dietary extremes.