EPA and DHA differentially coordinate the crosstalk between host and gut microbiota and block DSS-induced colitis in mice by a reinforced colonic mucus barrier.

Background: Ulcerative colitis (UC) is a chronic inflammatory disorder of the colon with a continuously remitting and relapsing course. Its etiology is closely related to abnormal interactions between host and gut microbiota. The mucus barrier lining the gastrointestinal tract is necessary to coordinate host and gut microbiota interaction by nourishing and modulating the microbiota. Differential effects of the anti-inflammatory fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) on UC progression in mice were firstly addressed by our previous work; here, the mechanism for their respective effects were further uncovered from host-microbiome crosstalk based on mucus barrier modulation to pave the way for UC therapy. Methods: Assessment of the disease activity index and histopathology score was conducted in mice with dextran sodium sulfate (DSS)-induced colitis pre-treated with different doses of EPA and DHA. Mucin generation, glycosylation and secretion were evaluated by a combination of electron microscopy, specific mucous staining, and qPCR. Western blotting was used to analyze the underlying molecular events. Fecal short chain fatty acids were detected using gas chromatography, and the gut microbial composition was analyzed using 16S rRNA sequencing. Results: Compared with DHA, the more potent inhibitory effect of high dose EPA on DSS-induced colitis was reconfirmed, which was underlain by a reinforced mucus layer as indicated by increased mucin granule release, mucus layer stratification and markedly upregulated expression of the key modulators involved in goblet cell differentiation. In turn a remarkably enhanced mucus barrier in the EPA group functioned to modulate the gut microbiome, as demonstrated by the enriched abundance of the phylum Bacteroidetes and mucin-degrading bacterium Akkermansia muciniphila producing acetic and propionic acids. Conclusions: EPA and DHA differentially coordinate the interaction between the host and the gut microbiota and relieve mucus barrier disruption in DSS-induced colitis. EPA may develop into a promising adjunctive therapy for UC.

Effects of fructose from apple and honey on serum uric acid in young Chinese: Randomized crossover trials.

BACKGROUND AND OBJECTIVES: Overconsumption of drinks containing fructose increases the risk for hyperuricemia and gout. Comparative analysis evaluating the indicators of serum uric acid (SUA) load caused by natural food-derived fructose and pure fructose in sweeteners is lacking. We aimed to uncover the effect of fructose from apple and honey and pure fructose powder on the SUA concentration of healthy young Chinese individuals. METHODS AND STUDY DESIGN: Two randomized crossover trials were performed. The participants were randomly assigned to consume apple or honey (test food) or pure fructose powder (reference food); one week later, the groups' dietary intervention was switched. Blood samples were collected at 0, 30, 60, and 120 min after meal to measure the SUA and blood glucose concentrations. RESULTS: At 30 and 60 min, the SUA concentration in participants consuming apple or honey was lower than in those consuming fructose powder. At 120 min, the SUA concentration of participants consuming apple returned to baseline. The areas under the curve (AUC) within 2 h (2h- AUCs) of SUA exhibited the trend of fructose >honey >apple. The 2h-AUC ratio between test food and reference food was determined using the uric acid index to assess the efficiency of food-derived fructose in increasing the SUA concentration. The uric acid index of honey was higher than that of apple. Men had higher postprandial SUA concentration than women. CONCLUSIONS: Food-derived fructose caused a lighter load on uric acid metabolism than pure fructose. Uric acid index can be useful for distinguishing fructose-containing foods.

Assessment of causal factors for Parkinson's disease in European populations: A phenome-wide Mendelian randomisation analysis.

BACKGROUND AND OBJECTIVES: To assess the causality of potentially modifiable factors, including lifestyle, nutrients, lipids, anthropometric traits, and inflammatory factors of Parkinson's disease (PD), genetic instruments for modifiable factors were identified from genome-wide association studies (GWAS). METHODS AND STUDY DESIGN: Genetic associations for PD (1,239 cases and 451,025 matched controls) were extracted from the UK Biobank GWAS summary statistics. The causal effects of modifiable factors on the risk of PD were estimated using the multiplicative random-effects inverse variance weighted method (IVW). RESULTS: In the IVW analysis, a decreased risk for PD was causally associated with genetically predicted smoking cessation (odds ratio 0.41, [95% confidence interval] 0.32-0.78; p<0.001), and higher bone mineral density (0.43, 0.38 -0.71; p<0.001), higher concentrations of vitamin B-12 (0.56, 0.43-0.91; p<0.001), docosahexenoic acid (0.52, 0.37-0.71; p<0.001), and sIL-6R (0.69, 0.58-0.75; p<0.001). Instead, analysis further supported the role of apolipoprotein (a) isoform size(1.67, 1.36-1.71; p<0.001), being a genetically morning person (2.18, 1.12-4.72; p<0.001), and number of cigarette smoking (1.05, 1.01-1.08; p<0.001) in contributing to the risk of developing PD. CONCLUSIONS: Our findings provide new evidence for the potential positive causal association of cigarette smoking number and apolipoprotein (a) isoform size and the inverse causal association of vitamin B-12, docosahexaenoic acid, smoking cessation, and soluble interleukin-6 receptor with PD, which contributes to the development of new interventions for PD.

PPARγ: The Central Mucus Barrier Coordinator in Ulcerative Colitis.

Ulcerative colitis (UC) is an idiopathic, long-term inflammatory disorder of the colon, characterized by a continuous remitting and relapsing course. The intestinal mucus barrier is the first line at the interface between the host and microbiota and acts to protect intestinal epithelial cells from invasion. Data from patients and animal studies have shown that an impaired mucus barrier is closely related to the severity of UC. Depletion of the mucus barrier is not just the strongest but is also the only independent risk factor predicting relapse in patients with UC. Peroxisome proliferator-activated receptor gamma (PPARγ), a nuclear transcription regulator, is involved in the regulation of inflammatory cytokine expression. It is also known to promote mucus secretion under pathological conditions to expel pathogenic bacteria or toxins. More important, PPARγ has been shown to affect host-microbiota interactions by modulating the energy metabolism of colonocytes and the oxygen availability of the intestinal microbiome. It is well known that gut microbiota homeostasis is essential for butyrate generation by the commensal bacteria to supply energy resources for colonocytes. Therefore, it can be speculated that PPARγ, as a central coordinator of the mucus barrier, may be a promising target for the development of effective agents to combat UC.

Self-Perceived Health and Sleep Quality of Community Older Adults after Acupunch Exercises.

OBJECTIVES: To test the long-term effects of the 12-month Healthy Beat Acupunch (HBA) exercise program on the self-perceived health and sleep quality of older adults in community care centers, and to compare the effects of two delivery methods: instructor-led HBA for the first 6 months and DVD-guided HBA for another 6 months. DESIGN: Cluster-randomized controlled trial. SETTING: Eight community care centers. PARTICIPANTS: In total, 232 participants were recruited from eight community care centers, and cluster-randomized to the experimental (4 centers, N = 113) and control (4 centers, N = 119) groups. INTERVENTION: The experimental group received the instructor-led HBA program 3 times weekly for the first 6 months, followed by the DVD-guided HBA program for another 6 months. MEASUREMENTS: Self-perceived health and sleep quality were assessed using the Short Form Health Survey and the Pittsburgh Sleep Quality Index, respectively, at baseline and every 3 months for 1 year. RESULTS: The experimental group reported more favorable self-perceived physical and mental health, higher subjective sleep quality, and less daytime dysfunction than did the control group. Effect sizes of physical health and sleep quality increased from the instructor-led stage to the DVD-guided stage; the effect size of physical health showed the most significant change, increasing from 0.38 in the instructor-led stage to 0.55 in the DVD-guided stage. CONCLUSIONS: The exercise program consisting of the instructor-led class, followed by the DVD-guided class, was an effective and feasible longitudinal program for older adults in community care centers.

Resistance Band Exercises Reduce Depression and Behavioral Problems of Wheelchair-Bound Older Adults with Dementia: A Cluster-Randomized Controlled Trial.

OBJECTIVES: To test the effects of a 15-month wheelchair-bound resistance band exercise program on depression and behavioral problems of wheelchair-bound older adults with dementia. DESIGN: Single-blind, cluster-randomized controlled trial with repeated measures. SETTING: Eight nursing homes in southern Taiwan. PARTICIPANTS: Wheelchair-bound nursing home older adults with dementia who participated voluntarily (N = 150) were cluster-randomized to two groups (experimental or control group); 127 completed the study (experimental: four nursing homes, n = 65; control: four nursing homes, n = 62). INTERVENTION: The resistance band exercises were conducted three times per week in 40-minute sessions in the following two sequences: volunteer-led sessions for the first 6 months (Stage I) followed by DVD-guided sessions for the next 9 months (Stage II). MEASUREMENTS: Depression, as measured using the Cornell Scale for Depression in Dementia, and behavioral problems, as measured using the Clifton Assessment Procedures for the Elderly-Behavior Rating Scale, of participants were observed at six time points at 3-month intervals: pretest, two posttests at Stage I, and three posttests at Stage II. RESULTS: By the sixth month of the study, experimental group participants were significantly less depressed and had fewer behavioral problems than control group participants (all P < .05). These small but statistically significant differences persisted throughout the 9 months of the DVD-guided sessions (all P < .05). CONCLUSION: Volunteer-led sessions followed by DVD-guided sessions of resistance band exercise is effective and practical in institutional settings.

Elastic Band Exercises Improved Activities of Daily Living and Functional Fitness of Wheelchair-bound Older Adults with Cognitive Impairment: A Cluster Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to test the effects of a 6-month Wheelchair-bound Senior Elastic Band (WSEB) exercise program on the activities of daily living (ADL) and functional fitness of wheelchair-bound older adults with cognitive impairment. DESIGN: Cluster randomized controlled trial was used. A convenience sample of 138 wheelchair-bound older adults with cognitive impairment were recruited from 8 nursing homes in southern Taiwan and were randomly assigned based on the nursing homes they lived to the experimental (4 nursing homes; n = 73) or the control group (4 nursing homes; n = 65). The experimental group performed WSEB exercises 3 times per week and 40 minutes per session for 6 months. The ADL and functional fitness (cardiopulmonary function, body flexibility, range of joint motion, and muscle strength and endurance) were examined at baseline, 3 months, and the end of 6-month study. RESULTS: The ADL and functional fitness indicators of participants in the experimental group showed significant improvements compared to the control group (all P < 0.05). CONCLUSIONS: The WSEB exercises have positive benefits for the ADL and functional fitness of wheelchair-bound older adults with cognitive impairment. It is suggested that WSEB exercises be included as a routine activity in nursing homes. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCMECME OBJECTIVES:: Upon completion of this article the reader should be able to: (1) Understand the risk factors for functional decline in older adults with dementia; (2) Articulate the benefits of structured activities and exercises in the older adult with dementia; and (3) Incorporate elastic band exercises into the treatment plan of wheelchair bound older adults with dementia. LEVEL: AdvancedACCREDITATION:: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Feasible modalities and long-term effects of elastic band exercises in nursing home older adults in wheelchairs: A cluster randomized controlled trial.

BACKGROUND: Physical activity holds promise for mobility-impaired older adults to prevent further disabilities and improve their health. However, staffing constraints have made it challenging to promote physical activity in long-term care facilities. OBJECTIVES: To test the feasibility and effects of 12 months Wheelchair-bound Senior Elastic Band (WSEB) group-exercises that were led by volunteers for the first six months followed by the DVD-guided for another six months on functional fitness, activities of daily living (ADL), and sleep quality of nursing home older adults in wheelchairs. DESIGN: Cluster randomized controlled trial with two groups, pre-test and post-tests. SETTINGS: Ten nursing homes, Taiwan. PARTICIPANTS: 127 participants participated voluntarily; 107 of them completed the study. INCLUSION CRITERIA: (1) aged 65 years and over, (2) using wheelchairs for mobility, (3) living in facility for at least three months, (4) cognitively intact, and (5) heavy or moderate dependency in ADL. Majority of participants were middle-old older adults (75-84 years old, 53.2%), female (51.4%), and had chronic illnesses (98.1%). METHODS: Participants were randomly assigned by facility to either the experimental (five nursing homes, n=56) or control group (five nursing homes, n=51). The WSEB program was conducted three times per week and 40 min per session in two stages: volunteer-led for the first six months (stage I) followed by the DVD-guided modality for another six months (stage II). The primary outcomes (functional fitness: lung capacity, body flexibility, range of joint motion, and muscle strength and endurance) and the secondary outcomes (ADL measured by the Barthel Index; sleep quality measured by the Pittsburgh Sleep Quality Index) of the participants were measured at three time points: pre-test, at the six-month interval, and at the end of 12 months of the study. No blinding was applied. RESULTS: All of the functional fitness indicators of the experimental group participants improved significantly (p<.05), and were all better than the control group at six-month and 12-month of the study (p<.05). No symptoms of discomfort occurred during interventions. CONCLUSIONS: Nursing home older adults in wheelchairs who received WSEB exercise training had better functional fitness, ADL, and sleep quality than those who did not. It was a feasible way of carrying out this exercise program by using the volunteer-led followed by the DVD-guided modalities. The program can be applied in institutional settings routinely.

An elastic band exercise program for older adults using wheelchairs in Taiwan nursing homes: a cluster randomized trial.

BACKGROUND: The number of older adults using wheelchairs in nursing homes is over 50% of that population, and many of them use wheelchairs due to muscle weakness in the lower extremities. Muscles of older adults are trainable, and progressive resistance exercises using elastic bands can increase muscle strength in older adults. OBJECTIVES: To test the effectiveness of six-month Wheelchair-bound Senior Elastic Band exercises on the functional fitness of older adults in nursing homes. DESIGN: Cluster randomized trial. SETTINGS: Ten nursing homes, southern Taiwan. PARTICIPANTS: 127 participants were recruited, and 114 of them completed the study. Inclusion criteria were: (1) aged 65 and over, (2) using wheelchairs for mobility, (3) living in the facility for at least three months, (4) cognitively intact, and (5) heavily or moderate dependency in their activities of daily living. The mean age of the participants was 79.15 (7.03) years, and 98.20% of them had chronic illnesses. METHODS: Participants were randomly assigned to the experimental (five nursing homes, n=59) or the control (five nursing homes, n=55) group based on the nursing homes where they stayed. A 40-min Wheelchair-bound Senior Elastic Band exercise program was implemented three times per week for six months for the experimental group participants. The functional fitness (activities of daily living, lung capacity, body flexibilities, muscle power and endurance) of the participants was examined at baseline, after three months, and at the end of the six months study. The mixed-design, two-way analysis of variance was used to detect the interaction effects, and one-way repeated measures analysis of variance and analysis of covariance were performed to analyze the within-group and between-group differences. RESULTS: At the end of the six-month study, the Wheelchair-bound Senior Elastic Band group had better performances in all of the functional fitness indicators than the control group (all p<0.05). CONCLUSIONS: The Wheelchair-bound Senior Elastic Band exercises significantly improved the functional fitness of the older adults in wheelchairs. It is suggested that the program be incorporated as a part of daily activities for nursing home older adults in wheelchairs.

Sleep quality and depression of nursing home older adults in wheelchairs after exercises.

BACKGROUND: Sleep disturbances and depression are costly and potentially disabling conditions that affect a considerable proportion of older adults. The purpose of this study was to test the effectiveness of 6 months of elastic band exercises on sleep quality and depression of wheelchair-bound older adults in nursing homes. METHODS: One hundred twenty-seven older adults from 10 nursing homes participated in this cluster randomized controlled trial, and 114 completed the study. Participants were randomly assigned to two groups: experimental group (five nursing homes, n = 59) and control group (five nursing homes, n = 55). A 40-minute wheelchair-bound senior elastic band exercise program was implemented 3 times per week for 6 months. Sleep quality and depression of the participants were examined at baseline, after 3 months, and at the end of the 6-month study. DISCUSSION: Participants in the experimental group had longer sleep durations, better habitual sleep efficiencies, and less depression than the control group at 3 months of the study and maintained them throughout the rest of the 6-month study. CONCLUSIONS: Nursing home directors could recruit volunteers to learn the program and lead the elderly residents in wheelchairs in practicing the wheelchair-bound senior elastic band exercises regularly in the facilities.