Fasting alters the gut microbiome with sustained blood pressure and body weight reduction in metabolic syndrome patients

AbstractPeriods of fasting and refeeding may reduce cardiometabolic risk elevated by Western diet. We show that in hypertensive metabolic syndrome (MetS) patients (n=35), a 5-day fast followed by a modified DASH diet (Dietary Approach to Stop Hypertension) reduced systolic blood pressure (SBP), antihypertensive medication need, and body-mass index (BMI) at three months post intervention compared to a modified DASH diet alone (n=36). Fasting altered the gut microbiome, impacting bacterial taxa and gene modules associated with short-chain fatty acid production. Cross-system analyses revealed a positive correlation of circulating mucosa-associated invariant T (MAIT) cells, non-classical monocytes and CD4+ effector T cells with SBP. Furthermore, regulatory T cells (Tregs) positively correlated with BMI and weight. Machine learning could predict sustained SBP-responsiveness within the fasting group from baseline immunome data, identifying CD8+ effector T cells, Th17 cells and Tregs as important contributors to the model. The high-resolution multi-omics data highlights fasting as a promising non-pharmacological intervention in MetS.

Download Full-text

Fasting alters the gut microbiome reducing blood pressure and body weight in metabolic syndrome patients

Nature Communications ◽

10.1038/s41467-021-22097-0 ◽

2021 ◽

Vol 12 (1) ◽

Cited By ~ 1

Author(s):

András Maifeld ◽

Hendrik Bartolomaeus ◽

Ulrike Löber ◽

Ellen G. Avery ◽

Nico Steckhan ◽

...

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Body Mass Index ◽

T Cells ◽

Regulatory T Cells ◽

Systolic Blood Pressure ◽

Body Mass ◽

Gut Microbiome ◽

Effector T Cells ◽

Pharmacological Intervention

AbstractPeriods of fasting and refeeding may reduce cardiometabolic risk elevated by Western diet. Here we show in the substudy of NCT02099968, investigating the clinical parameters, the immunome and gut microbiome exploratory endpoints, that in hypertensive metabolic syndrome patients, a 5-day fast followed by a modified Dietary Approach to Stop Hypertension diet reduces systolic blood pressure, need for antihypertensive medications, body-mass index at three months post intervention compared to a modified Dietary Approach to Stop Hypertension diet alone. Fasting alters the gut microbiome, impacting bacterial taxa and gene modules associated with short-chain fatty acid production. Cross-system analyses reveal a positive correlation of circulating mucosa-associated invariant T cells, non-classical monocytes and CD4+ effector T cells with systolic blood pressure. Furthermore, regulatory T cells positively correlate with body-mass index and weight. Machine learning analysis of baseline immunome or microbiome data predicts sustained systolic blood pressure response within the fasting group, identifying CD8+ effector T cells, Th17 cells and regulatory T cells or Desulfovibrionaceae, Hydrogenoanaerobacterium, Akkermansia, and Ruminococcaceae as important contributors to the model. Here we report that the high-resolution multi-omics data highlight fasting as a promising non-pharmacological intervention for the treatment of high blood pressure in metabolic syndrome patients.

Download Full-text

Effects of the DASH diet on blood pressure in patients with and without metabolic syndrome: results from the DASH trial

Journal of Human Hypertension ◽

10.1038/jhh.2013.52 ◽

2013 ◽

Vol 28 (3) ◽

pp. 170-175 ◽

Cited By ~ 14

Author(s):

Fadi Hikmat ◽

L J Appel

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Dash Diet

Download Full-text

Abstract 002: Adoptive Transfer of CD8 T Cells With Constitutively Active Pi3kγ Induces Hypertension in Mice

Hypertension ◽

10.1161/hyp.68.suppl_1.002 ◽

2016 ◽

Vol 68 (suppl_1) ◽

Author(s):

Daniela Carnevale ◽

Maria Piacenti ◽

Giuseppe Cifelli ◽

Roberta Iacobucci ◽

Giuseppe Lembo

Keyword(s):

Blood Pressure ◽

T Cells ◽

Renal Function ◽

Cd8 T Cells ◽

Adoptive Transfer ◽

Intracellular Signaling ◽

Effector T Cells ◽

Naive T Cells ◽

Naïve T Cells ◽

Constitutively Active

In the field of research exploring the connection existing between hypertension and immune system, CD8 effector T cells emerge as the possible mediators of target organ colonization. In the absence of overt inflammation or pathogen response, naïve T cells circulate from the blood into secondary lymphoid organs, where, upon challenge, become activated. Then, they differentiate into effector T cells, which display typical activation patterns. However, less is known about the intracellular signaling pathways that are responsible for the acquisition of effectors functions in T cells. The p110γ isoform of the PI3K family has unique features, being crucially involved in the immune and cardiovascular systems. On this issue, we have described that PI3Kγ has a crucial role in blood pressure regulation, being KO mice protected from AngII-induced hypertension. Moreover, we found that mice with a constitutively active PI3Kγ isoform (CAAX mice) were spontaneously hypertensive (SBP: CAAX 135 ± 3 vs WT 105 ± 4 mmHg, p<0.001). Interestingly, PI3Kγ is known to play a selective role in regulating the migration of effector CD8 T cells, even though there was no effect of PI3Kγ in naïve T cells. Thus we explored the possible involvement of PI3Kγ in the crosstalk between hypertension and immunity. CAAX mice displayed a significant infiltration of activated CD8 + CD69 + T cells in kidney, as compared to WT mice (10.2 ± 2.1 vs 2.8 ± 0.6 *10 4 cells/kidney, p<0.01). At the functional level, this phenotype was associated with enlarged Bowman’s spaces and fibrosis in the kidney of CAAX mice, leading to disruption of renal function, as shown by later development of proteinuria. In the end, to demonstrate whether the CAAX hypertensive phenotype, associated to renal damage after CD8 colonization, could be ascribed to the overactivation of PI3Kγ signaling in this immune cell type, we performed an adoptive transfer of CD8 T cells isolated from CAAX mice in WT mice. Strikingly we found that CD8 T cells with constitutively active PI3Kγ were effective to induce hypertension in naïve mice. These data suggest that in the development of hypertension, PI3Kγ signaling in CD8 T cells is crucial for their accumulation in the kidney, likely contributing to increase in blood pressure by altering renal function.

Download Full-text

Abstract 14854: A Primary Care Digital Therapeutic for Diabesity

Circulation ◽

10.1161/circ.142.suppl_3.14854 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Gitte Wieneke ◽

Niall S Colwell ◽

Jack Egan ◽

Mícheál O'Croinín ◽

Andrew Sheppard

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Metabolic Syndrome ◽

Care Practice ◽

Health Coach ◽

Post Intervention ◽

Medication Costs ◽

Type 2 Diabetic

Introduction: While lifestyle change is a Class I Recommendation for Metabolic Syndrome components and Type II Diabetes, implementation of such change is often not achieved in primary care. Hypothesis: Test RediCare ControlDTx, a digital therapeutic which is designed to scale the delivery of lifestyle therapy, in Obese and Type 2 Diabetic subjects. Methods: 43 subjects, 32 (75%) female and 11 (25%) male were enrolled within a primary care practice. Weight, BMI, Blood Pressure, HbA1c and lipids were analyzed pre and post intervention using a student t-test. The 16-week program combines personalized condition specific video-based health education, health coach support via unlimited one to one online consultations, peer to peer support and asynchronous messaging to optimize compliance. A prescribed dietary protocol based on consuming whole foods while emphasizing the reduction of refined carbohydrates and sugar intake, while exercising resulted in significant reductions in HbA1c, Weight, BMI, Systolic Blood Pressure and Triglycerides. Results: are presented in Fig 1 with standard deviations shown in brackets. In type 2 diabetic subjects, mean triglycerides were 216.4 mg/dL at baseline and 105.0 mg/dL at follow up, a reduction of -111.3 mg/dL (51.56%). Prediabetic subjects mean triglycerides were 137.6 mg/dL at baseline and 99.5 mg/dL at follow up, a reduction of -38.2 mg/dL (-27.72%). The average number of health coach consultations was 1.3 per participant. Conclusion: A prescribed primary care digital therapeutic confers statistically and clinically significant reductions in metabolic syndrome and diabetic parameters and is seamlessly integrated into the primary care setting. The digital intervention at <$75 per participant was cost effective in both the health benefits and savings achieved in reduced medication costs.

Download Full-text

Dietary Approaches to Stop Hypertension (DASH): potential mechanisms of action against risk factors of the metabolic syndrome

Nutrition Research Reviews ◽

10.1017/s0954422419000155 ◽

2019 ◽

Vol 33 (1) ◽

pp. 1-18 ◽

Cited By ~ 9

Author(s):

Masoumeh Akhlaghi

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Metabolic Syndrome ◽

Saturated Fat ◽

Hdl Cholesterol ◽

Reduce Blood Pressure ◽

Overweight And Obesity ◽

Cross Sectional ◽

Dash Diet ◽

The Metabolic Syndrome

AbstractThe metabolic syndrome is a cluster of disorders dominated by abdominal obesity, hypertriacylglycerolaemia, low HDL-cholesterol, high blood pressure and high fasting glucose. Diet modification is a safe and effective way to treat the metabolic syndrome. Dietary Approaches to Stop Hypertension (DASH) is a dietary pattern rich in fruits, vegetables and low-fat dairy products, and low in meats and sweets. DASH provides good amounts of fibre, K, Ca and Mg, and limited quantities of total fat, saturated fat, cholesterol and Na. Although DASH was initially designed for the prevention or control of hypertension, using a DASH diet has other metabolic benefits. In the present review, the effect of each dietary component of DASH on the risk factors of the metabolic syndrome is discussed. Due to limited fat and high fibre and Ca content, individuals on the DASH diet are less prone to overweight and obesity and possess lower concentrations of total and LDL-cholesterol although changes in TAG and HDL-cholesterol have been less significant and available evidence in this regard is still inconclusive. Moreover, high amounts of fruit and vegetables in DASH provide great quantities of K, Mg and fibre, all of which have been shown to reduce blood pressure. K, Mg, fibre and antioxidants have also been effective in correcting glucose and insulin abnormalities. Evidence is provided from cross-sectional investigations, cohort studies and randomised controlled trials, and, where available, from published meta-analyses. Mechanisms are described according to human studies and, in the case of a lack of evidence, from animal and cell culture investigations.

Download Full-text

The Effect of n-3 Polyunsaturated Fatty Acids on the Components of Metabolic Syndrome, a Systematic Review and Meta-Analysis of Randomized Controlled Trials (P08-037-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz044.p08-037-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Tianyao Huo ◽

Changjun Yang ◽

Michelle Cardel ◽

Andrew Brown ◽

Matthew Gurka

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Body Mass Index ◽

Fatty Acids ◽

High Density Lipoprotein ◽

Randomized Trials ◽

Density Lipoprotein ◽

P Value ◽

Post Intervention ◽

Pufa Intake

Abstract Objectives Intake of n-3 polyunsaturated fatty acids (PUFAs) has been reported to provide various benefits for patients with metabolic syndrome (MetS), such as reducing blood pressure and improving blood lipids, but results are inconsistent. This study aimed to investigate the effect of n-3 PUFA intake on components of MetS. Methods We searched PubMed, Scopus, Web of Sciences, and Cochrane databases up to June 2018 for randomized trials at least 30 days long comparing n-3 PUFAs with a control in patients diagnosed with MetS (PROSPERO registration ID: CRD42017072332). The outcomes include body mass index, systolic and diastolic blood pressure, triglyceride, high-density lipoprotein cholesterol, and fasting blood glucose. Mean differences post-intervention or mean change from baseline were combined using random-effects models; confirmation of within-study effect sizes is ongoing. Results A total of 14 trials were identified. The pooled results showed n-3 PUFA intake reduced systolic blood pressure by 3.92 mmHg (95%CI: –6.89, –0.96, P-value = 0.009, I2 = 34%, 9 trials) and diastolic blood pressure by 2.81 mmHg (95%CI: –4.26, –1.36, P-value = 0.0001, I2 = 15%, 8 trials). Body mass index was lower in the n-3 PUFA group by 3.19 kg/m2 (95%CI: –6.16, –0.22, P-value = 0.04, I2 = 97%, 7 trials) compared to the control group. Triglyceride levels in n-3 PUFA groups were significantly lower than the control when pooling trials with post intervention data only (–33.13 mg/dL, 95%CI: –49.44, –16.81, P-value < 0.0001, I2 = 71%, 6 trials), but the overall effect was non-significant when including studies with pre-post data (P-value = 0.08). The n-3 PUFA intake did not significantly alter high-density lipoprotein cholesterol (P-value = 0.71) or fasting glucose (P-value = 0.36). Conclusions Our preliminary results provide evidence for beneficial effects of n-3 PUFAs on reducing blood pressure and improving weight control in patients with MetS, with less certain results for triglycerides. Sensitivity and confirmatory analyses are in progress to test the robustness of results under different effect-size assumptions and to investigate sources of heterogeneity. Most of the included trials had small sample sizes. Randomized trials with higher quality and larger scale are needed to confirm the findings. Funding Sources The authors received no funding for this specific work. Other funding support includes: AWB: NIH R25DK099080, R25HL124208. Supporting Tables, Images and/or Graphs

Download Full-text

Effects of recommendations to follow the Dietary Approaches to Stop Hypertension (DASH) diet v. usual dietary advice on childhood metabolic syndrome: a randomised cross-over clinical trial

British Journal Of Nutrition ◽

10.1017/s0007114513001724 ◽

2013 ◽

Vol 110 (12) ◽

pp. 2250-2259 ◽

Cited By ~ 43

Author(s):

Parvane Saneei ◽

Mahin Hashemipour ◽

Roya Kelishadi ◽

Somayeh Rajaei ◽

Ahmad Esmaillzadeh

Keyword(s):

Insulin Resistance ◽

Blood Pressure ◽

Metabolic Syndrome ◽

Clinical Trial ◽

Waist Circumference ◽

Vitamin C ◽

High Blood Pressure ◽

Adolescent Girls ◽

Dietary Advice ◽

Dash Diet

The effects of the Dietary Approaches to Stop Hypertension (DASH) eating plan on childhood metabolic syndrome (MetS) and insulin resistance remain to be determined. The present study aimed to assess the effects of recommendations to follow the DASH diet v. usual dietary advice (UDA) on the MetS and its features in adolescents. In this randomised cross-over clinical trial, sixty post-pubescent adolescent girls with the MetS were randomly assigned to receive either the recommendations to follow the DASH diet or UDA for 6 weeks. After a 4-week washout period, the participants were crossed over to the alternate arm. The DASH group was recommended to consume a diet rich in fruits, vegetables and low-fat dairy products and low in saturated fats, total fats and cholesterol. UDA consisted of general oral advice and written information about healthy food choices based on healthy MyPlate. Compliance was assessed through the quantification of plasma vitamin C levels. In both the groups, fasting venous blood samples were obtained at baseline and at the end of each phase of the intervention. The mean age and weight of the participants were 14·2 (sd 1·7) years and 69 (sd 14·5) kg, respectively. Their mean BMI and waist circumference were 27·3 kg/m2 and 85·6 cm, respectively. Serum vitamin C levels tended to be higher in the DASH phase than in the UDA phase (860 (se 104) v. 663 (se 76) ng/l, respectively, P= 0·06). Changes in weight, waist circumference and BMI were not significantly different between the two intervention phases. Although changes in systolic blood pressure were not statistically significant between the two groups (P= 0·13), recommendations to follow the DASH diet prevented the increase in diastolic blood pressure compared with UDA (P= 0·01). We found a significant within-group decrease in serum insulin levels (101·4 (se 6·2) v. 90·0 (se 5·5) pmol/l, respectively, P= 0·04) and a non-significant reduction in the homeostasis model assessment for insulin resistance score (P= 0·12) in the DASH group. Compared with the UDA group, the DASH group experienced a significant reduction in the prevalence of the MetS and high blood pressure. Recommendations to follow the DASH eating pattern for 6 weeks among adolescent girls with the MetS led to reduced prevalence of high blood pressure and the MetS and improved diet quality compared with UDA. This type of healthy diet can be considered as a treatment modality for the MetS and its components in children.

Download Full-text

Effectiveness of Mindfulness-based Stress Reduction on Hypertension among Patients with Metabolic Syndrome

10.32592/ajnpp.2021.8.4.104 ◽

2021 ◽

pp. 192-198

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Stress Reduction ◽

Density Lipoprotein ◽

Analysis Of Covariance ◽

Pharmacological Intervention ◽

Control Group ◽

Control Group Design ◽

Cardiovascular Patients ◽

Mindfulness Based Stress Reduction

Background and Objective: Marital Reducing stressors is an effective way to decrease blood pressure and its other associated symptoms. The present study aimed to investigate the effectiveness of mindfulness-based stress reduction (MBSR) on metabolic syndrome among patients with hypertension. Materials and Methods: This experimental research was conducted based on a pretest-posttest control group design. A total number of 50 cardiovascular patients referring to Shahrekord Cohort Study, Shahrekord, Iran, in 2019 were selected using the convenience sampling method and randomly divided into experimental and control groups (n=25 each). Metabolic syndrome indices, including blood pressure, blood sugar, glucose triglyceride, high-density lipoprotein, and low-density lipoprotein, were used to collect the required data. All groups received the same standard medications under the supervision of an interventional cardiologist. In addition to the standard medical treatment, the experimental group received the intervention of MBSR (eight 90-minute sessions). The control group did not receive any non-pharmacological intervention. Data were analyzed using multivariate analysis of covariance. Results: The results showed that MBSR was effective in improving metabolic syndrome symptoms in cardiovascular patients with hypertension (P<0.05). Conclusions: The employment of MBSR along with medical and pharmacological treatments could help cardiovascular disease patients to improve the symptoms of metabolic syndrome.

Download Full-text