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Can Psychobiotics Intake Modulate Psychological Profile and Body De Lorenzo et al. J Transl Med (2017) 15:135 DOI 10.1186/s12967-017-1236-2 Journal of Translational Medicine RESEARCH Open Access Can psychobiotics intake modulate psychological profle and body composition of women afected by normal weight obese syndrome and obesity? A double blind randomized clinical trial Antonino De Lorenzo1,8*, Micaela Costacurta2, Giuseppe Merra3, Paola Gualtieri4, Giorgia Cioccoloni4, Massimiliano Marchetti5,6, Dimitrios Varvaras7, Rafaella Docimo2 and Laura Di Renzo1 Abstract Background: Evidence of probiotics efects on gut function, brain activity and emotional behaviour were provided. Probiotics can have dramatic efects on behaviour through the microbiome–gut–brain axis, through vagus nerve. We investigated whether chronic probiotic intake could modulate psychological state, eating behaviour and body composi- tion of normal weight obese (NWO) and preobese–obese (PreOB/OB) compared to normal weight lean women (NWL). Methods: 60 women were enrolled. At baseline and after a 3-week probiotic oral suspension (POS) intake, all subjects underwent evaluation of body composition by anthropometry and dual X-ray absorptiometry, and psycho- logical profle assessment by self-report questionnaires (i.e. EDI-2, SCL90R and BUT). Statistical analysis was carried out using paired t test or a non-parametric Wilcoxon test to evaluate diferences between baseline and after POS intake, one-way ANOVA to compare all three groups and, where applicable, Chi square or t test were used to assess symptoms. Results: Of the 48 women that concluded the study, 24% were NWO, 26% were NWL and 50% were PreOB/OB. Sig- nifcant diferences in body composition were highlighted among groups both at baseline and after a POS (p < 0.05). After POS intake, a signifcant reduction of BMI, resistance, FM (kg and %) (p < 0.05), and a signifcant increase of FFM (kg and %) (p < 0.05) were observed in all subjects in NOW and PreOB/OB. After POS intake, reduction of bacterial overgrowth syndrome (p < 0.05) and lower psychopathological scores (p < 0.05) were observed in NWO and PreOB/ OB women. At baseline and after POS intake, all subjects tested were negative to SCL90R_GSI scale, but after treat- ment subjects positive to BUT_GSI scale were signifcantly reduced (8.33%) (p < 0.05) compared to the baseline (33.30%). In NWO and PreOB/OB groups signifcant diferences (p < 0.05) in response to the subscales of the EDI-2 were observed. Signifcant improvement of the orocecal transit time was observed (p < 0.05) after POS intake. Fur- thermore, signifcant diferences were observed for meteorism (p < 0.05) and defecation frequency (p < 0.05). Conclusions: A 3-week intake of selected psychobiotics modulated body composition, bacterial contamination, psychopathological scores of NWO and PreOB/OB women. Further research is needed on a larger population and for a longer period of treatment before defnitive conclusions can be made. *Correspondence: [email protected] 8 Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00136 Rome, Italy Full list of author information is available at the end of the article © The Author(s) 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. De Lorenzo et al. J Transl Med (2017) 15:135 Page 2 of 12 Trial registration ClinicalTrials.gov Id: NCT01890070 Keywords: NWO syndrome, Probiotic, Psychobiotic, Psychological profle, Body composition Background depression like behaviors, HPA axis hyperactivity and Te human gut hosts a dynamic and complex microbial abnormal neurochemical changes [9]. ecosystem. It is represented by approximately 1 kg of bac- Gut microbiota seems to have an impact on the sero- teria in the average adult, about the weight of the human tonergic system. In fact, treatment with Lactobacillus brain. It is composed by microorganisms belonging to 14 helveticus in hyperammonemia-treated rats led to an families, 45 genera and 400–500 distinct species, vari- anxiolytic efect and improved cognitive function pos- ously distributed along the entire intestinal tract. Two sibly through a reduction in hippocampal 5-Hydroxy bacterial phylotypes Firmicutes and Bacteroidetes are the Tryptamine (5HT) levels [10]. most abundant bacteria species in the gut [1]. Moreover, a combined treatment with Lactobacillus Te microbiota–gut brain axis, recently termed “psy- helveticus and rhamnosus prevented intestinal perme- chobiota” [2], plays an important role in host physiology, ability alteration caused by stress [11]. as in the regulation of neuroinfammation, neuroendo- Anxiety-like behavior associated with chronic colitis in crine stress response, neurodevelopment and modulation mice was attenuated by B. longum administration, asso- of mood and behavior [3–5], which implicates it in psy- ciated with decreased hippocampal brain-derived neuro- chiatric disorders, such as stress, anxiety and depression. trophic factor (BDNF) mRNA [12, 13]. Nowadays, several studies identify the relationship Although less evidence exists for probiotic actions between gut microbiota and the onset of various dis- on human population, it has been demonstrated that eases, demonstrating the ability of probiotics in control- patients who received a probiotic formulation containing ling infammatory processes, attenuation of metabolic Lactobacillus acidophilus, Lactobacillus casei and Bifdo- dysfunctions, normalization of stress-induced abnormal bacterium bifdum, signifcantly decreased Beck Depres- behaviors, regulation of the hypothalamus–pituitary– sion Inventory (BDI) scores [14]. Moreover, a probiotic adrenal axis (HPA axis) and neuropsychiatric disorders mixture of Lactobacillus helveticus and Bifdobacterium [6–8]. longum and a probiotic-containing milk drink of Lacto- Te evidence of the infammatory state alteration, high- bacillus casei showed positive efects on psychological lighted in schizophrenia, major depressive disorder and distress [15, 16]. bipolar disorder, strongly recalls the microbiota altera- Furthermore, a growing body of scientifc evidence tion, suggesting an important role of the alteration of the supports the notion that the crosstalk between the gut gastrointestinal (GI) system also in neuropsychiatric dis- microbiota, diet and immune system activates mediators orders [8]. and signalling pathways, which infuence the whole body Probiotics can have dramatic efects on behaviour, metabolism and disease [17–19]. Te metabolic activi- through their action on the vagus nerve and on the ties of the gut microbiota play a decisive part in obesity microbiome–gut–brain axis, which constitutes a bidi- because of its role in the improvement of calorie extrac- rectional communication network. Probiotics produce a tion from food, the accumulation of substrates in adipose variety of neurochemicals, analogues of mammalian hor- tissue, like fatty acids, and the utilization of energy and mones, involved in mood and behaviour. Terefore, the nutrients for its growth [20]. visceral messages from the gut can afect brain function Obesity is characterized by a peculiar microbiota and and, vice versa, signals from the brain may afect the sen- the microbiota itself, together with the host genotype sory system and the gut secretion mode. and lifestyle, could contribute to the development of this Te bacteria most commonly exploited as probiotics metabolic dysfunction. Also, a bidirectional association with psychotropic efects in animal models and human between obesity and self-reported or clinical measures of clinical trials have been classifed as “psychobiotics” [2], depression were observed, and body dissatisfaction was and they belong to the Bifdobacterium and Lactobacillus robustly associated as a risk factor for obesity and eating families. disorders [9]. In the last few years, in vivo experiments demonstrated Diferent obese phenotypes have been described based that administration of Bifdobacterium longum 1714 and on body fat composition and distribution, rather than Bifdobacterium breve 1205, Lactobacillus helveticus and the simple increase of body weight, body mass index Lactobacillus plantarum strain PS128 reduce anxiety and (BMI) and genetics [21]: (1) metabolically obese normal weight [22]; (2) metabolically healthy obese [23]; and (3) De Lorenzo et al. J Transl Med (2017) 15:135 Page 3 of 12 metabolically unhealthy obese or “at risk” obese [24]; (4) and General Hospital Foundation, Catholic University of normal weight obese (NWO) [25]. Sacred Heart, Rome, Italy. Subjects afected by NWO syndrome usually have a Sixty women were enrolled. Subjects were screened for BMI value within the normal range (<25 kg/m2) and, eligibility at frst medical visit and underwent body com- at the same time, high total body fat percentage (TBFat position analysis, psychological profle and eating behav- >30%) and total body lean mass (TBLean) defciency iour assessment by symptom checklist 90 (SCL90R), based on a genetic predisposition. Tey also have high [31] for the evaluation
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