examining the effects of pre and probiotics on gut...
TRANSCRIPT
Session: Reviewing key ingredients shaping nutrition for healthy ageing Tuesday 22nd November 2016
Examining the effects of pre and probiotics on
gut microbiota during the ageing process
Louise R Wilson RD PhD Assistant Science Manager, Yakult UK Ltd
[email protected] www.yakult.co.uk/hcp
Outline
New insights into how the gut microbiota changes with age
• Changes in diet
• Place of residence
Applications for probiotics (and prebiotics) in the elderly
• Well researched applications: risks associated with antibiotic treatment, common infectious illnesses and gut-related problems in older people
• Emerging potential applications: immunomodulation, depression, cognitive function
In later life..
The composition of the gut microbiota changes to one that seems to be less healthy and less protective: microbial diversity declines, Bifidobacteria decrease and Enterobacteriaceae (Gram-negative bacteria) increases.
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4
6
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Total anaer Bifid Lacto Bacteroides
Children (1.5-7y)
Adults (21-34 y)
Elderly (67-88 y)
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0 v
iab
le c
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nt
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Hopkins et al (2001) Gut 48: 198-205
Community Long-stay Young control
Unweighted UniFrac OTU PCoA
Claesson et al. (2012) Nature 488, 178-184
Where you live determines your microbiota
Habitual diet differences in long-stay-like and healthy community dwellers
LS-Like
Less Healthy
Healthy Diet
Jeffery et al. (2016) ISME J 10(1):170-182
Healthy Diet
Intermediate Healthy Diet
Intermediate LS-Like unclassified
Bacteroides
Alistipes
Parabacteroides
Faecalibacterium
Oscillospira
Clostridium
Coprococcus
Ruminococcus
Roseburia
Lachnospira
Blautia
Eubacterium
Prevotella
Other
Less Healthy
LS-Like
Genus Level Microbiota
Jeffery et al. (2016) ISME J 10(1):170-182
Probiotic Live microorganisms that, when administered in adequate amounts confer a health benefit on the host Joint FAO/WHO (2002); Hill et al (2014)
Prebiotic A selectively fermented ingredient that allows specific changes, both in the composition and/or activity of the gastrointestinal microbiota, thus conferring benefit(s) upon host health. Gibson GR et al (2010)
Synbiotic Probiotic + prebiotic
Definitions
Probiotic applications in the elderly
Applications in relevant risks associated with older age:
Antibiotic treatment (AAD & C diff)
Common infectious illness (norovirus, diarrhoea, fever, upper respiratory tract infections)
Common gut-related problems (bowel habits, constipation)
Emerging potential future applications:
Immunomodulation
Depression
Cognitive function
Effect of Probiotics on Microbiota, Bowel Habits & Illness (1)
Example of an LcS study in elderly care home patients Open-label study, n=42 elderly residential nursing home patients (82 y 10) Intervention: 6 months of probiotic (Lactobacillus casei Shirota) intake
Organism Before intake After intake P
C. difficile Log10 5.4 1.3 (31/42) Log10 4.0 1.0 (8/31) <0.05
MRSA Log10 8.0 (1/42) <Log10 4.0 (0/31)
Staphylococcus Log10 5.7 1.0 (26/42) Log10 4.6 0.6 (20/31) <0.01
Symptom Before intake After intake P
Fever (days per week) 1.36 2.18 0.95 1.58 <0.05
Constipation (times per week) 0.50 0.55 0.32 0.53 < 0.05
Diarrhoea (days per week) 0.31 0.52 0.16 0.44 <0.05
Bian et al (2011) Int J Probiotics Prebiotics 6:123-132
Nagata S et al. (2016) Ann Nutr Metab. 68:51-9
Effect of Probiotics on Microbiota, Bowel Habits & Illness (2)
Randomised placebo-controlled double-blind trial, n=72 elderly residents of facility for the elderly, aged 84-86 yrs
Intervention: 6 months of a probiotic (Lactobacillus casei Shirota) or placebo beverage
Nagata S et al. (2016) Ann Nutr Metab. 68:51-9
Effect of Probiotics on Microbiota, Bowel Habits & Illness (3)
In the probiotic group: Higher numbers of Bifidobacterium
and Lactobacillus Lower numbers of destructive
bacteria such as Clostridium difficile
Higher total acidity
Long-term consumption of LcS fermented milk may be useful for decreasing the daily risk of infection and improving the quality of life among the residents.
Immunomodulatory Effects of Probiotics
A randomised placebo-controlled, single-blind crossover study
4 wk intervention, 4 wk washout, 4 wk intervention
Probiotic intervention: Lactobacillus casei Shirota
n=30 healthy volunteers, aged 55-74 yrs
Consumption of probiotic drink improved NK cell activity in the elderly
Fig. 1 Effect of probiotic LcS consumption on NK cell activity. E/T = The ratios of effector/target cells
Dong et al (2013) Eur J Nutr 52(8): 1853-63
Probiotics Reported to Improve Mood/Ease Depression
Benton D et al. (2007) Eur J Clin Nutr. 61:355-61.
A double-blind placebo-controlled trial: 3-week intervention with either a probiotic (Lactobacillus casei Shirota) containing milk drink or a placebo
N=132 participants, mean age of 61.8 yrs
Consumption of probiotic-containing yoghurt improved the mood of those whose mood was initially poor.
Effects of Probiotics on Depression: Age Related
Huang R et al. (2016) Nutrients 8(8): 483.
Cognitive Function in Alzheimer’s Disease
Akbari E et al. (2016) Frontiers in Aging Neuroscience 10 Nov 2016. E-pub available ahead of print at http://journal.frontiersin.org/article/10.3389/fnagi.2016.00256/full
A 12-week RCT in 60 patients with Alzheimer’s disease (control vs probiotic, n=30 in each group)
Probiotic intervention: 200 ml/day probiotic milk containing Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium bifidum, and Lactobacillus fermentum (2 × 109 CFU/g for each)
Result: the probiotic treated patients showed a significant improvement in the mini-mental state examination (MMSE) score
Prebiotics
In prebiotic based studies, different combinations of prebiotics have been examined in elderly.
For example, use of inulin and its derivatives (FOS) has demonstrated an increment in abundance of Bifidobacteria, which led to reduction in markers of inflammation and increment in stool frequency. 1-5
However, eating foods that promote healthy species in the gut (eg. prebiotic-containing vegetables such as onions, leeks, asparagus, chicory and Jerusalem artichoke) can become difficult in old ager, particularly if there are dental problems or little appetite due to poor taste or smell.
1Macfarlane S et al 2006 Aliment Pharmacol Ther. 24: (5):701–714. 2Schiffrin EJ et al 2007 J Nutr Heal Aging. 11: (6):475–479. 3Bouhnik Y et al 2004 Am J Clin Nutr. 80: (6):1658–1664. 4Kleessen B et al 1997 Am J Clin Nutr. 65: 1397–1402. 5Fuller R & Gibson GR 1998. Clin Microbiol Infect 4: (2):477–480.
Is simply adding microbes enough?
Favourable conditions
Adding substrate Supplementing
missing microbes
Prebiotics (Personalised) diets
Probiotics (next generation) Therapeutic microbes
Dietary intake, drugs, ingredients impacting pH, inflammation, bile salts • Are the microbes not there because
conditions were unfavourable? • Does the next generation of
probiotics also need to consider optimising microbiome-host condition?
Thank you for listening!
Any questions?
Louise R Wilson RD PhD Assistant Science Manager, Yakult UK Ltd
[email protected] www.yakult.co.uk/hcp