| 1. |
- Engelheart, Stina, 1976-
(författare)
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Nutritional status in a functional perspective : A study in a cohort of older people in home health care
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- High age is a risk factor for most acute and chronic diseases, injuries and function disabilities, and hence, an important risk factor for nutritional problems. A great deal of elderly health care in Sweden are performed in the patient’s home environment and home health care has been transformed to more advanced medical care the last decades.The aim of this thesis was to comprehensively describe the nutritional status and its change over time in a population of older people receiving home health care. The aim includes to propose a framework for investigating and analysing the nutritional status in older people.Nutritional status was studied at enrolment in home health care and regularly followed up for three years. Patients that were 65 years or older and needed home health care for at least three months between 2012 and 2017 were asked to join the study, resulting in 69 participants (64%women).Data collection and analysis of the nutritional status was based on the proposed model for assessing the nutritional status in a comprehensive functional perspective (paper 1). The model comprises four domains that affect the nutritional status and functional outcome in a bidirectional way. In paper 2 we concluded that malnutrition, sarcopenia, frailty and dehydration are highly prevalent in the population and the most important indicators were loss of appetite and dehydration. This was confirmed in paper 3, were nutritional status was analysed with a statistical approach. A total of 103 indicators of nutritional status were reduced to 19 that were suggested to be primary investigated. Also, the paper empirically confirmed the relationship within as well as between the domains suggested in paper 1. Finally, we studied meal pattern, being a part of one of the domains (paper 4). We found indications that presence of at least one large meal (high energy intake) per day had more impact on the total daily energy and protein intake than more eating occasions during the day.
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| 2. |
- Ganda Mall, John-Peter, 1988-
(författare)
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Non-digestible Polysaccharides and Intestinal Barrier Function : specific focus on its efficacy in elderly and patients with Crohn’s disease
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A large number of elderly suffer from gastrointestinal (GI) symptoms such as constipation and diarrhoea. The underlying mechanisms of age-acquired GI symptoms are not well studied but are necessary to clarify in order to recommend the right treatment. Non-digestible polysaccharides (NPS) are dietary fibres that could have beneficial effects on the intestinal immune system and barrier function, although their efficacy needs to be evaluated. Paper I showed that elderly with GI symptoms have significantly higher small intestinal permeability than a general elderly population, along with a stronger association to psychological distress. In Paper II we performed a randomised controlled trial with a general population of elderly that consumed either placebo, the NPS’s arabinoxylan or oat β-glucan for a period of 6 weeks. No protective effects were observed related to indomethacin-induced intestinal hyperpermeability, inflammatory markers, or self-reported health if compared to placebo. Paper III showed that stimulation with a yeast-derived β-glucan significantly attenuated Compound (C) 48/80-induced hyperpermeability in colonic biopsies from elderly with GI symptoms mounted in Ussing chambers, but not in young healthy adults. Arabinoxylan attenuated only C48/80-induced transcellular permeability in elderly but both paracellular and transcellular permeability in young healthy adults. Paper IV showed that the same yeast-derived β-glucan from paper III could cross the epithelium of ileal tissues from patients with Crohn’s disease (CD) and non-CD controls, mounted in Ussing chambers, and attenuate C48/80-induced hyperpermeability. In conclusion, we found that elderly with GI symptoms display a deteriorated barrier function and that administration of selective NPS can have beneficial effect on intestinal permeability in selective populations.
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| 3. |
- Karlsson, Mattias, 1981-
(författare)
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Modulation of cellular innate immune responses by lactobacilli
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Lactobacillus is a genus of lactic acid bacteria frequently used as healthpromoting probiotics. Using probiotics to treat or prevent infections is a novel experimental approach with vast impact on future therapy. Lactobacillus rhamnosus GR-1 is a probiotic investigated for its ability to reduce urogenital disease including urinary tract infections caused by pathogenic Escherichia coli. L. rhamnosus GR-1 has been shown to modulate immunity, thought to influence its probiotic effect. In this thesis, the aim was to study immunomodulation by L. rhamnosus GR-1 and other lactobacilli, with emphasis on elicited immune responses such as nuclear factor-kappaB (NF-κB) activation and cytokine release from human urothelial cells.Viable, heat-killed, and isolated released products from L. rhamnosus GR-1 augmented NF-κB activation in E. coli-challenged urothelial cells. Blocking of lipopolysaccharide binding to toll-like receptor 4 completely quelled this augmentation. Size-fractionation, urothelial cell challenge, and two-dimensional gel electrophoresis of L. rhamnosus GR-1 released products presented several candidate proteins with NF-κB modulatory actions including chaperonin GroEL, elongation factur Tu, and a protein from the NLP/P60 protein family. While tumor necrosis factor was correspondingly augmented by L. rhamnosus GR-1, the release of two other cytokines, interleukin (IL)-6 and CXCL8, was reduced. Similar effects were observed in macrophage-like cells stimulated with L. rhamnosus GR-1.Many immunomodulatory effects of lactobacilli are believed to be species and strain dependent. Therefore, twelve Lactobacillus strains were used to screen for their effects on CXCL8 release from urothelial cells. A majority of these strains were able to influence CXCL8 release from the cells. Phylogenetic analysis revealed close evolutionary linkage between lactobacilli with similar actions on CXCL8. Increased knowledge on probiotic bacterial products and the mechanism(s) of action could lead to improved future treatments for infections.
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| 4. |
- Rajan, Sukithar K, 1978-
(författare)
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Metagenomic Characterization of the Gut Microbiome in Cohorts of Elderly
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Human gut microbiota plays a vital role in maintaining host health. This thesis aims to investigate the gut microbial population and function using next generation sequencing (NGS) data from faecal samples. Paper I examines the influence of sequencing depth and analysis methods in microbiota profiling using NGS whole genome sequencing (WGS) data. By subsampling the metagenomic data, the influence of varying sequencing depths on different phylogenetic classification methods is investigated. This suggests that necessary sequencing depth would be dependent on the individual research plan. This paper recommends the need for a consensus approach and an informed choice of NGS analysis method selection for a reliable prediction. Paper II relates the gut microbiota to general health, nutrient intake, physical activity, medications, and psychological distress in community-dwelling older adults and senior orienteers. A higher abundance of F. prausnitzi in the faecal microbiota of senior orienteers confirms the hypothesis that senior orienteers can be seen as a model for healthy ageing in the perspective of the microbiota. Paper III focuses on assessing the validity of function prediction using LC-MS at multiple annotation levels. Predicted and quantified protein-pathway profiles were subjected to correlation analyses, which showed statistically significant association between predicted and quantified proteins as well as predicted and quantified pathways. This study also showed a direct relation between protein abundance and correlation for predicted and quantified proteins at higher function levels. Paper IV investigates the effects of faecal microbiota transfer (FMT) on functional microbiota profiles. This study showed that allogenic FMT did not alter the metabolite profiles, but it seems to disturb the gut microbiota-metabolite interactions when compared to autologous FMT.This thesis reiterates the need for carefully selecting prediction tools and methods for microbiome analysis. The findings of this thesis could stimulate more focused studies using NGS in medicine and aid in better understanding of host-microbe interactions.
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| 5. |
- Rode, Julia, 1992-
(författare)
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Gut microbiota, its modifications and the gut-brain axis
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The human intestinal microbiota has a major impact on host physiology and might play an important role in several diseases. Therapeutic interventions aimed at modifying the gut microbiota might exert their effects locally as well as systemically, for example via the gut-brain axis, a bidirectional communication system.The overall aim of this thesis was to investigate potential modes of action via which modifications of the gut microbiota might influence health and disease. Paper I shows that faecal microbiota transfer could improve gastrointestinal symptoms in a subset of patients with collagenous colitis– a chronic low-grade inflammation of the large intestine. Papers II – IV describe the effects of an oral probiotic intervention on different aspects of the gut-brain axis in young, healthy adults. Paper II shows that brainactivity and functional connectivity during negative emotional stimuli were altered after probiotic intervention without major effects on the gut microbiota composition itself. Paper III shows that brain response patterns to an acute stressor were altered, whereas cortisol stress response, autonomic nervous system function and cognitive performance were not affected by the probiotic intervention. Paper IV describes the effect of the probiotic intervention on mental health in daily life. Amongst others, altered resting state brain function, slight improvements in depression symptoms and sleep quality were observed. Furthermore, serum levels of serotonin were slightly altered, indicating a potential mechanism of how probiotics might affect brain function. Paper V is an in vitro study that aimed to further elucidate a potential mechanism behind the microbiota-gut-brain axis. The short-chain fatty acid butyrate, an important microbial metabolite, rescued the disturbed uptake of the serotonin precursor tryptophan into fibroblasts mimicking cells of the nervous system.This thesis provides insights into whether and how gut microbiota modifications could improve health by affecting the gut-brain axis. Uncovering the underlying mechanisms might facilitate the development of personalised medicine.
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| 6. |
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| 7. |
- Östlund-Lagerström, Lina, 1984-
(författare)
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"The gut matters" : an interdisciplinary approach to health and gut function in older adults
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Improved life expectancy is a triumph of modern medicine. However, today’s senior citizens are predicted to soon consume 75% of the available health-care resources. Identifying new strategies to promote a healthy ageing process has thus become a priority. In contribution to the research field of healthy ageing this thesis is focused on the health and gut function of older adults. Paper I explored ‘optimal functionality’; a new approach to put the older adult’s own perspectives on health in focus. According to the results a plethora of factors related to the body, the self and the external environment needs to be considered in order to create a comprehensive understanding of the health experience in old age. Paper II characterised senior orienteering athletes as a new model of healthy ageing, due to their significantly better percived health as compared to other free-living older adults; in particular they report better gut health. As the gut is important to health maintenance and immune function paper III explored inflammation and oxidative stress in senior orienteering athletes, and older adults with gut problems, generally finding low levels in both groups. Subsequently, Paper IV investigated the health status of free-living older adults in Örebro County and also reports the results from a randomised controlled trial evaluating the effect of a probiotic supplement on self-reported health and gut symptoms. Two-thirds of the included older adults reported gut problems, however, the probiotic intervention failed to show any effects.This thesis provides additional perspectives on older adults health and gut function, by concluding that 1) optimal functionality may be a useful concept to map areas of importance to the older adult’s health experience, 2) senior orienteers may be regarded as a suitable model to study healthy ageing, 3) the prevalence of gut problems among the general population of Swedish older adults is high, but was not improved by probiotic supplementation with Lactobacillus reuteri.
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| 8. |
- Edebol-Carlman, Hanna, 1984-, et al.
(författare)
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Cognitive behavioral therapy for irritable bowel syndrome : the effects on state and trait anxiety and the autonomic nervous system during induced rectal distensions - An uncontrolled trial
- 2018
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 18, s. 81-91
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: Irritable bowel syndrome (IBS), is a common multifactorial gastrointestinal disorder linked to disturbances in the microbe gut-brain axis. Cognitive behavioral therapy (CBT), in face-to-face format has showed promising results on IBS and its associated psychological symptoms. The present study explored for the first time if CBT for IBS affects the autonomic nervous system (ANS) during experimentally induced visceral pain and cognitive stress, respectively. The levels of state and trait anxiety, current and perceived stress were also evaluated.Methods: In this uncontrolled trial, individual CBT was performed in face-to-face format for 12 weeks in 18 subjects with IBS. Heart rate variability and skin conductance were measured during experimentally induced visceral pain and during a cognitive task (Stroop color-word test), before and after intervention. The levels of state and trait anxiety as well as self-rated current and perceived stress were also measured before and after the intervention.Results: CBT did not affect ANS activity during experimentally induced visceral pain and cognitive stress. The sympathetic activity was high, typical for IBS and triggered during both visceral pain and cognitive stress. The levels of state and trait anxiety significantly decreased after the intervention. No significant changes in self-rated current or perceived stress were found.Conclusions: Results suggest that face-to-face CBT for IBS improved anxiety- a key psychological mechanism for the IBS pathophysiology, rather than the autonomic stress response to experimentally induced visceral pain and cognitive stress, respectively.
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| 9. |
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| 10. |
- Engelheart, Stina, 1976-, et al.
(författare)
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Nutritional status in older people - An explorative analysis
- 2021
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Ingår i: Clinical Nutrition ESPEN. - : Elsevier BV. - 2405-4577. ; 46, s. 424-433
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Tidskriftsartikel (refereegranskat)abstract
- Background & aims: The nutritional status is seldom defined in general, but is considered to be important throughout life span, especially in times of diseases and disabilities. We previously proposed a theoretical model of the nutritional status from a functional perspective [1], however without proposing a definition of the nutritional status. The model comprises four domains that might affect the nutritional and functional status in a bidirectional way. These four domains are: Food and nutrition; Health and somatic disorders; Physical function and capacity; and Cognitive, affective, and sensory function. This study contributes to the existing literature and knowledge by empirically analysing patterns and relationships of possible nutritional status indicators within and between the four domains. Methods: This study is based on a sample of 69 men and women; older than 65 years, receiving home health care. They were followed up for three years. A broad set of nutritional status indicators in the participants were assessed in their home yearly. Given the small sample size and large number of variables, we used both correlation and factor analysis to explore patterns of nutritional status indicators within the four domains and relationships between the four domains suggested by the theoretical model of nutritional status which we proposed earlier. Results: At baseline, between 4 and 18 components were extracted from the four domains, separately, using factor analysis. The first three components of each domain (called main components) were correlated (p < 0.05) with at least one of the main components of each of the other three domains (r = -0.34-0.79 at baseline, 0.38-0.74 at year 1, 0.40-0.77 at year 2 and 0.47-0.71 at year 3). At baseline, these main components explained, respectively, 31%, 52%, 57% and 63% of the sample variation in the four domains. This remained stable throughout all three years of follow up. In all four domains, there were statistically significant differences in prevalence of malnutrition, frailty, sarcopenia, and dehydration (all different inadequate nutritional status) between individuals' individual component scores. Conclusions: This study provides empirical evidence for the relationship between nutritional status indicators within and between the four domains suggested by our theoretical model of nutritional status. Components in all four domains were associated with inadequate nutritional status, highlighting that a wide perspective of the nutritional status assessment is necessary to be applied in clinical practice. (C) 2021 The Authors. Published by Elsevier Ltd on behalf of European Society for Clinical Nutrition and Metabolism.
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