max roser and hannah ritchie (2020) - burden of …...max roser and hannah ritchie (2020) -...

Max Roser and Hannah Ritchie (2020) - "Burden of Disease". Published online at OurWorldInData.org. 'https://ourworldindata.org/

Hannah Ritchie and Max Roser (2020) - "Causes of Death". Published online at OurWorldInData.org. 'https://ourworldindata.org/causes-of-death'

DEFECATIONRESIDUES IN DIET

MEALINGESTION

1000

mL

0POSTPRE

Colonic Biomass: Effect of Meals and Diet

MR imaging

•7

MR, magnetic resonance.

Bendezu R, et al. Neurogastroenterol Motil. 2016;28:849-854.

# of genes

Average gene set per individual 590,384

Common (>50% of individuals) 294,110

http://www.hmdb.ca

Fluid TotalMicrobial

origin% Microbial origin

Blood 3158 104 3,3

Saliva 1233 59 4,8

Urine 1976 102 5,2

CSF 450 36 8,0

Breast milk 120 10 8,3

Bile 18 5 27,8

Number of Metabolites Detected in Human Fluids

Rienks et al, Nutrients 2017

McDonald et al, mSystems 2018

Diversity of plants in diet associated with microbiome composition American Gut Project: Microbial sequence and data from 15,096 samples from 11,336 human participants

Gut microbes modulate response toimmunotherapy in melanoma patients

Gopalakrishnan et al, Science 2017

Exposure to antibiotics reduces survival in patients onimmunotherapy against epithelial tumors

Routy et al, Science 2017

Palleja et al, Nat Microbiol 2018

Loss of Bacterial Diversity in the Human Gut Microbiome afterAntibiotic Exposure

Oral vancomycin, gentamicin and meropenem from D0 to D4

Palleja et al, Nat Microbiol 2018

Different Recovery Capacities between Strains

Oral vancomycin, gentamicin and meropenem from D0 to D4

Disorders associated with loss of richness/diversity of the gut microbiota:

• Nutrition-related disorders (obesity, type 2 diabetes and the metabolic syndrome)

• Inflammatory bowel diseases (UC and CD)

• Caeliac disease

• Recurrent diarrhoea by C. diff

• Functional bowel disorders

• Systemic complications of decompensated liver disease

• Colo-rectal cancer

• Certain allergies

• Certain mental and neuro-developmental conditions, such as autism spectrum disorders

Loss of microbial richness is a common feature of chronic non-communicable

diseases of modern society

Dysbiosis in IBD

Pascal et al, Gut 2017

Le Chatellier et al, Nature 2013

Stewart et al, Nature 2018

Temporal development of the gut microbiome in early childhood

TEDDY study: The Environmental Determinants of Type 1 Diabetes in the YoungCohort: 8676 children with high-risk HLA-DR-DQ or first-degree relatives of persons with T1D enrolled at birth (from 2004 to 2010)Microbiome study: 12,005 gut microbiome samples from 903 children 3–46 months of age

Gut microbiome in early-onset type 1diabetes from the TEDDY study

Vatanen et al , Nature 2018

Zhao et al, Science 2018

Gut bacteria selectively promoted by dietary fibers alleviatetype 2 diabetes

•30 patients complaining of flatulence •20 healthy subjects

Manichanh et al, Gut 2014

Diet-induced Microbiota Changes


Bilophila wadsworthia was found positively correlated with volume of gas

evacuated in patients (r = 0.64; FDR = 0.12) but not in healthy subjects

Bilophila wadsworthia and gas volume

200 400 600

-2

0

2

4

6

8

Volume of gas evacuated

Rela

tive

ab

un

da

nce


Flatulence PatientsBilophila wadsworthia and gas volume

200 400 600

-2

0

2

4

6

8

Rela

tive

ab

un

da

nce

Volume of gas evacuated

Healthy subjects

A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome

Halmos et al, Gastroenterology 2014

• FODMAPs are poorly absorbed short-chain carbohydrates including fructose, lactose, polyols, fructans, and galacto-oligosaccharides.

• Vegetables, legumes, fruits, nuts, bread and cereals, dairy, honey, fruit juices, etc., may contain FODMAPS.

• Such dietary restrictions are difficult to maintain for long periods

A Diet Low in FODMAPs Alters the Colonic Luminal Microenvironment

Halmos et al, Gut 2015

Bimuno GOS versus low FODMAPs dietin patients with FGD complaining of excessive gas: experimental design

prebiotic GOS + balanced diet

placebo + low-FODMAPs diet

treatment period (4 wk)basal period follow-up (2 wk)

habitual diet habitual diet

Huaman et al, Gastroenterology 2018

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 5flatulence pain distension borborygmi bloating

10

0

PREBIOTIC GROUP

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 50

10

flatulence pain distension borborygmi bloating

LOW FODMAPs GROUP

Digestive symptoms

pre-treatment


0

1

2

3

4

5

6

7

8

9

10


***

10

0

PREBIOTIC GROUP

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 5

*

*

*

**

0

10

flatulence pain distension borboriymi bloating

LOW FODMAPs GROUP

Digestive symptomspre-treatment treatment


0

1

2

3

4

5

6

7

8

9

10


***

* * *

10

0

PREBIOTIC GROUP

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 5

*

*

*

**

+

++*

**

0

10

flatulence pain distension borboriymi bloating

LOW FODMAPs GROUP

Digestive symptomspre-treatment treatment post-treatment


Number of daytime anal gas evacuation

* p<0.05 vs pre-treatment

0

5

10

15

20

1 2 3

*

*

20

0pre treatment post

LOW FODMAPs GROUP

0

5

10

15

20

1 2 3pre treatment post

20

0

PREBIOTIC GROUPPREBIOTIC GROUP


Changes in luminal bacteria during treatment


Functional gut symptoms: treatment strategies

microbiota

RESTRICTED BENEFICIAL

INACTIVITY ADAPTATION

COMPETENCEDYSBIOSIS/ATROPHY

SUBSTRATES IN DIET

• Maintaining gut microbiota diversity is a novel clinical target for health promotion and disease prevention.

• Improving gut species diversity and increasing abundance of fermentative taxa are to be considered as hard endpoints for human trials.

• Probiotics with high anti-oxidant and anti-inflammatory potential, and prebiotics promoting activity and abundance of butyrate producers, are to be developed and tested for their capacity of recovering vulnerable gut microbiotas in industrialized countries.

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