“We are what we eat”, or to take up the words of Feuerbach in his work “Education of food” (1850), Man is what he eats. Human nature, as well as health, are deeply influenced by material conditions such as food; An empirical observation known for a long time.
To the question, what nutrients and bioactive molecules are contained in food? Added to another question for a few years, how do they impact the microbiota? The complex interaction between the microbiome and human health, with the growing importance of the microbiota-intestine-end axis, is a field of clinical research with large medical implications. The microbiota appears to be an increasing weight factor in human health, beyond purely digestive or physical, also contributing to mental health.
Many diseases include a risk of comorbidities, including mental health. This is the case with chronic kidney disease, which touche 10 % of the world’s population, or around 800 million people worldwide. One in seven suffer of this disease. The most common mental disorders in hemodialyseed patients are a high risk of anxiety and depression. Their prevalence is 38 to 32 % in terms of anxiety and 37 to 42 % in the event of depression. In addition, these patients often suffer from malnutrition.
General presentation of the study
It is in the previous context that a recent study fits published in the journal Nutrientsled by the Spanish researcher Gabriel Olveira (FIMABIS, CIBERDEM). He reported the effects of a nutritional and probiotic approach to the mental health of patients with chronic kidney disease under hemodialysis and suffering from malnutrition. This is a secondary study derived from Renacare Trialfocused on the biomarkers of inflammation and oxidation in these patients.
A randomized multicentric double-blind design was followed by three parallel groups, including a) a monitoring group followed and an individualized diet (control), b) another group to which nutritional, without probiotic (placebo), was also supplied, and c) a group receiving the above, with a probiotic supplementation (SU-PR group).
The nutritious supplement was a specific preparation for patients with under-effective hemodialysis with a high energy content, proteins and enriched in functional nutrients (virgin olive oil, omega-3 fatty acids, lactrum, antioxidant proteins, carbon water hydrates, fiber and carnitine and with or without adding Probiotics) and fibers, with a report of 70 to 30 % soluble fibers compared to insoluble fibers, including fruitoligosaccharides, acacia fibers and oat fibers.
Probiotic capsules, visually inseparable from placebo, contained living bacteria with Bifidobacterium Brief, Bifidobacterium animal milk et Lactobacillus paracasei.
B. animal has been selected for its oxidative stress reduction properties and its ability to modulate the metabolism of the tryptophan of the food (precursor of various neurotransmitters), while L. Paracasei 4 et B. brief have been selected for their immunomodulatory effects.
The follow -up lasted six months, with zero -time assessments and samples, three and six months. 31 patients finished the study, including 11 in the control group, 10 in the placebo group and 10 in the probiotic group. It has been shown that there was no statistically significant difference between the relevant characteristics (age, state of health, etc.) of zero -time study groups.
Impact of treatment
For the evaluation of the psycho-psychiatric impact of treatment, the scales Hospital Anxiety and Depression Scale (HADS) were used with their HADS-D sub-cheaks for depression and HADS-A for anxiety, as well as the Short Form Health Survey 12(SF12-MH).
The results have shown that in the SU-PR group, the HADS-D result has decreased significantly, indicating a decrease in depression levels. In fact, at the end of the study, 100 % of patients in the SU-PR group presented normal HADS-D values, against only 50 % at the start of the study. On the HADS-A scale, no statistically significant change has been detected, but a downward trend has been observed.
The composition of the fecal microbiota was studied by obtaining genomic banks from samples, with subsequent NGS sequencing. This made it possible to show variations in the composition of the microbiota. Overall, probiotic supplementation has reduced genres potentially harmful to this context, such as theAkkermansia (associated with inflammation and alterations of the intestinal barrier) or theAcidaminococcusand increased the abundance of other genres as Barnesiellaconsidered as protective by making colonization difficult by pathogenic bacteria.
Pertinence future
Probiotic treatment has had positive effects in depressive symptoms and the quality of life reported in patients studied. Although the underlying mechanisms, undoubtedly complex, remain to be determined, they could be associated with the taxonomic modulation of the intestinal microbiota.
Despite the reduced size of the sample, the statistical power was greater than 80 % for all the variables indicated as significant. Consequently, the study shows that the association of probiotics with nutritional supplementation can potentially treat the symptoms of depression in patients with chronic kidney disease with malnutrition.
In this regard, Professor Olveira said: “Our results show the promising potential of the association of nutritional supplements and probiotics as an effective therapeutic tool to improve quality of life and reduce depressive symptoms in undernourished hemodialysis patients. New research, with more patients, will be necessary to verify whether our conclusions can be generalized to other contexts. »»
Confirmation of these results would make it possible to expand the resources of the treatment of conditions such as depression, by associating approaches such as behavioral and cognitive therapy, pharmacological therapy or physical activity.
The conflicts of interest of the authors can be consulted in the original publication.
