To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Two well-known architectural types of enclosure in early modern Venice – the Jewish Ghetto and the plague hospitals or lazaretti – are examined within the spatial dynamics of quarantine and the larger geographic sphere of the Mediterranean. Architectural and urbanistic mechanisms for maintaining purity against influences the Christian Venetians understood as harmful, the ghetto and the lazaretto worked to visually recognize, bureaucratically identify, and physically seclude ‘dangerous’ individuals. Both were also porous: the ghetto was open to all during daytime hours, when Jews were also allowed to exit into the city, and the lazaretto's population grew and shrank as new people sickened and patients recovered or died. This ‘leakage’ broke through any ideal of containment, and could be productive, benign or malign.
The ordinary practitioners of the city live ‘down below,’ below the thresholds at which visibility begins. They walk – an elementary form of this experience of the city; they are walkers, Wandermanner, whose bodies follow the thicks and thins of an urban ‘text’ they write about without being able to read it.
The French philosopher Michel de Certeau was an astute observer of cities and their inhabitants. His image is a compelling one: a city's walkers writing a urban text – or better still from my perspective as an art historian, painting a picture, step by step, stroke by stroke – of a city they cannot see. Yet, as even the most casual visitor to Venice knows, tracing out the thicks and thins of the Venetian urban landscape is a difficult task. The narrowest streets are sometimes major thoroughfares through the city; and, often one's path terminates in a dead-end or a watery canal. In Venice, walking in the city is always a fraught task. Indeed, this was purposefully so: Venice was, as the eleventh-century chronicler Giovanni Diacono put it, ‘not founded by shepherds as Rome was, but by rich and powerful people,’ who were fleeing rampaging Visigoths, Huns, Ostrogoths, and Longobards. The inhospitable swampy site had been expressly chosen over any placid open pasture for the very fact that it was difficult to reach and difficult to inhabit. Early modern writers on Venice such as Marco Antonio Sabellico and Giovanni Botero punctuated their descriptions of the urban fabric with repeated mention of the many bridges that might connect two islands – or could be blocked off.
This article discusses the role of employers and their organizations in promoting or hindering social insurance schemes and, ultimately, the welfare state. Unlike most studies that center on countries in periods of democracy, this research focuses on the role of employers, and specifically employers’ mutuals, in the development of the industrial accident scheme during the Franco dictatorship in Spain. The institutional elimination of the class struggle, by repressing the working class and prohibiting class-based unions, led to an evolution of the industrial accident scheme and employers’ liabilities that revolved around the interrelationship between employers and the state. While employers tried to keep control of the management and low cost of the insurance, the state maintained significant bureaucratic intervention and increased auditing and control. The democratic period that began in 1977 prolonged the structure fostered during the Franco regime and enhanced the power of the mutuals in managing this insurance.
TOMBS AND BURIALS in medieval religious buildings could appropriate these spaces for the memory of the dead and their families. This chapter aims to identify an internal topography of the cathedral of Mallorca using a unique document created to organize the religious services for the eternal care and memory of the dead there.
Until now, research on the medieval cathedral of Mallorca has focused on its construction, especially the work of Joan Domenge using fabric records of the fourteenth century, and others on later stages in its building. A broad consensus exists on the cathedral and the structures of the main mosque, which were taken over by Christians after the reconquest of Mallorca, and became a Gothic cathedral in the early fourteenth century. From an initially austere structure the cathedral of Mallorca took on its current form with three naves, part of a major promotional campaign by the crown involving prestigious architectural structures across its territory, both insular and continental, trying to legitimize a kingdom that could hardly be considered independent of the Crown of Aragon.
To date we have few studies on funerary documentation or the socio-economic reasons prestigious families began to choose the Mallorcan cathedral as a place of eternal rest, instead of the prestigious cloisters or chapels of the nearby Franciscan and Dominican friaries. Fortunately, the cathedral archive conserves a number of wills that allow us to analyze how the deceased buried in the building managed their commemoration.
From the early fourteenth century different areas of the cathedral began to form a hierarchical funerary complex where celebrations dedicated to the memory of the deceased were carried out: countless anniversary masses, absolutions associated with these masses, or the ritual of sharing bread at the grave. The records of the anniversaries are detailed and identify the place where each tomb is located, so we can see how the thousands of burials were distributed around the cloister or the chapels of the cathedral by social origin or the size of their perpetual rents, turning the building into a monumental stone necrologium and mirror of Mallorcan medieval society.
A few privileged individuals secured their memories with ornate monumental tombs, linking a definite lineage to a particular liturgical space.
Glucose transporter type 1 (GLUT1) deficiency syndrome (GLUT1 DS) (OMIM 606777) is a disorder of brain energy metabolism caused by insufficient transport of glucose from the blood to the brain. The first patients were reported by De Vivo et al. in 1991 (hence the disorder is also referred to as De Vivo syndrome). The original patients presented with an early infantile-onset developmental encephalopathy associated with seizures, acquired microcephaly, low cerebrospinal fluid (CSF) glucose and lactate concentrations, and a decreased uptake of glucose by isolated erythrocytes in vitro .
This paper analyses the mechanisms through which capital flows produced financial instability in Spain over a 165-year period. We study why and how capital bonanzas make crises more likely and severe, and whether their incidence varies depending on types of crises (currency, banking and debt crises). We conclude that most of them occurred in different monetary policy regimes, but they were associated with capital bonanzas in a liberal regulatory framework, both of which contributed to a higher likelihood and greater severity of crises. The analysis of the different monetary policy regimes, financial structures and the types of crises allows us to draw some policy implications that emphasise the need for sound financial regulation and supervision.
To utilise a community-based participatory approach in the design and implementation of an intervention targeting diet-related health problems on Navajo Nation.
A dual strategy approach of community needs/assets assessment and engagement of cross-sectorial partners in programme design with systematic cyclical feedback for programme modifications.
Navajo Nation, USA.
Navajo families with individuals meeting criteria for programme enrolment. Participant enrolment increased with iterative cycles.
The Navajo Fruit and Vegetable Prescription (FVRx) Programme.
A broad, community-driven and culturally relevant programme design has resulted in a programme able to maintain core programmatic principles, while also allowing for flexible adaptation to changing needs.
The Olrog’s Gull Larus atlanticus is an endemic and threatened species of the south-western Atlantic. Little is known about its movements during the non-breeding period. The objective of this study was to analyse the migration of the species by tracking adults from Bahía San Blas (Buenos Aires province, Argentina) with geolocators and using information of sightings of ringed gulls. Differences between males and females were evaluated using tracking data and ringed data were used to determine age differences. A single core area (kernel 50%) from 21 tracked birds was identified. This area included the study colony and also other breeding colonies located up to 300 km to the north. The range area (kernel 95%) included coastal areas up to 1,000 km from the colony. All sightings of ringed gulls (n = 41) occurred north of the breeding colony, however 12 adult individuals were sighted during the winter in its breeding grounds. Our results suggest the occurrence of partial migration behavior in Olrog’s Gull. The migration pattern reported here implies than during the non-breeding season, breeding and wintering areas away from the nesting grounds should be considered as one system in the design of conservation strategies for this regionally threatened gull.
Ruddy-headed Goose Chloephaga rubidiceps is the smallest of the five South American sheldgeese and has two separate populations: one sedentary, which resides in the Malvinas/Falkland Islands and one migratory that overwinters mainly in the Pampas region, Argentina and breeds in Southern Patagonia. The Ruddy-headed Goose’s continental population has decreased considerably, and recent estimates indicated that the population size is less than 800 individuals. In Argentina and Chile, this population is categorised as endangered. Understanding migration across vast landscapes is essential for the identification of factors affecting the survival of this endangered population and for the application of effective conservation measures. We aim to provide the first documentation of the complete migration cycle of Ruddy-headed Goose, and to analyse their annual migration in detail, including identification of stop-over, breeding and wintering sites, and to compare migration timing during spring and autumn migration. Adults were captured in the southern Pampas and equipped with solar satellite transmitters in 2015 and 2016. We analysed the influence of season (spring vs autumn migration) on the number and duration of stop-overs, distance travelled and overall migration speed using Generalized Linear Mixed Models. Our results showed that tracked geese used the eastern Patagonian route to reach their breeding grounds and take the same route after breeding. Spring migration was significantly faster than autumn migration, at least based on the number of days spent in their stop-overs. Stop-overs were closer to the final destination, either during spring and autumn migrations, though some of them were not used during subsequent migrations. Our migration cartography for Ruddy-headed Geese, together with the timing and location data, should be used to improve conservation efforts directed at this species and might contribute to the modification of the current status of ‘Least Concern’ under the IUCN criteria.
Concomitant antipsychotic prescription is common in clinical psychiatry, although it is not an evidence-based practice. The aim of the study was to describe the prescription of antipsychotics in inpatients with schizophrenia and identify which are the factors associated with this tendency.
We reviewed retrospectively the psychotropic drugs prescribed at the time of discharge of 177 inpatients who met criteria for schizophrenia [DSM-IV-TR] on an acute psychiatry unit from 2007 to 2008.
One hundred and two patients (57.6%) were male. Mean age (SD) was 38.1 (14.6) years. The percentage of patients discharged on treatment with two or more antipsychotics was 43.5%. Although in the strict sense we should not consider it as polipharmacy, the most frequent combination was long acting injectable risperidone with oral risperidone (21.5%), followed by long acting injectable typical antipsychotic with oral risperidone (3.4%). There was a significant association between the number of prescribed antipsychotics and the total number of previous hospitalizations and the number of hospitalizations during the previous year (ANOVA p=0.001 and p< 0.001 respectively). No correlation was found between polypharmacy and age. There was a significant association between the number of antipsychotics prescribed and the use of anticholinergic treatment (t-test p=0.005).
Our polypharmacy rates are comparable with prior European data (30-76%). Despite of the clinical guidelines, antipsychotic polipharmacy is an extended therapeutic strategy not necessarily related with resistant schizophrenia. Most of the antipsychotic associations identified are not evidenced-based practice. More clinical trials are needed to determine the efficacy of different combinations.
Cardiovascular side effects of antipsychotics are been studied both in typical and atypical antipsychotics but, in particular, with clozapine few systematic studies of these effects have been performed. In this study, we reviewed electrocardiographic (ECG) data from patients treated with clozapine.
Observational, retrospective study in our Clozapine Day Clinic from 2000 to 2008. We recluted 197 patients (70% men) with mean age 31,75 ± 9,0 years who began treatment with clozapine. All of them had an electrocardiogram taken before starting treatment and after 18 weeks of follow-up. None suffered from heart diseases. QTc was evaluated by Bazett formula (QT/ (R-R’)1/2). Treatment prescribed was taken down and drug serum levels were detected. Statistical analysis was executed by SPSS 17.0.
There was significant correlation between doses prescribed and levels of clozapine and norclozapine (r=.304, p=.023; r=.354 p=.007), between levels of clozapine, norclozapine and QTc enlargement (r=.348, p=.008; r=.268 p=.046) and between levels of clozapine, norclozapine and heart rate (r=.390, p=.003; r=.326 p=.014). There were no differences between QTc and treatment with clozapine or other antipsychotic (p=0.902), between sex or if polypharmacy existed. ECG alterations were a case of supraventricular extrasystoles, another of Wolf-Parkinson -White Syndrome and other inespecific alterations like repolarizations or left hypertrophy.
We did not find either major incidence on cardiological effects or significative QTc enlargement during treatment with clozapine in contrast to other antipsychotic previously prescribed. Therefore clozapine may be in the same cardiologic safety rank than other antipsychotics.
Due to our fear of extinction or annihilation, there is a great deal of preoccupation with the subject of death, through which we attempt to learn to feel more at ease with the concept, and allowing us to cope with our fear of death.
The study assumptions seek to emphasize the correlations between:
A. Demographic characteristics and anxiety of death and dying;
B. Inner - personality characteristics and death and dying anxiety variable; and
C. Intrapersonal characteristics and death and dying anxiety.
The connections between all of those variables were examined before and after the second Lebanon war. The study sample comprised 217 participants as the "before" group and, 151 participants as the "after" group. The study's data was collected via face-to-face interviews. All of the "after" group participant were at the "before" group.
Findings indicate that the war increased the death and dying anxieties especially among those elderly women and those who live within nursing homes. In general elderly people with a high level of self-evaluation and sense of mastery will experience lower levels of death and dying anxieties.
In spite of age, experience and knowledge, war has a powerful influence on elderly people. The phenomena in which innocent citizens became more and more involved in politics violence must be in front of policy makers.
Improving adherence in the early stages of illness by means of long-acting antipsychotics can lead to reduced number of readmissions and enhanced remission rates, which could lead to improved performance in the medium-long term.
Assessing clinical remission, number of admissions and personal and social performance in recent-onset schizophrenic patients undergoing LAIR.
Longitudinal retrospective study of a cohort of thirty-one recent-onset schizophrenic patients ( ≤ 2 years) who started LAIR treatment between 2004–2008. Twenty-six (83.9%) were treated for two years. PANSS scale was assessed at baseline; PANSS, Personal and Social Performance scale (PSP) and remission criteria after two years.
Twenty-six patients (83.9%), 61.5% male aged between 16–44 years old, completed two years of treatment. All patients met criteria for schizophrenia (DSM-IV) with an average duration of 0.8 year since diagnosis. The main reason to using LAIR was poor adherence (76.9%). The PANSS total and all its subscale scores improved significantly (p < 0.005) with 80.8% of patients showing a ≥ 50% improvement on the PANSS total. Seventeen patients (65.4%) achieved remission criteria. Five patients (19.2%) were admitted during the follow-up. The average on global functioning (PSP) was 72.4 (IC 95%, 66.4-78.4). LAIR doses at baseline were 25 mg (46.2%), 37.5 mg (30.8%) or 50 mg (23.1%); after two years, 25 mg (34.6%), 37.5 mg (34.6%), 50 mg (23.1%) or 75 mg (7.7%).
Despite the limitation of retrospective observational studies, our data, including the good adherence rate (83.9%), suggest that LAIR could be effective in the treatment of recent-onset schizophrenia.
Epidemiological studies on delusional disorder (DD) have shown that it is more frequent in women than in men. Women become ill later and the majority of them have lower social functioning at admission and more duration of the hospitalization.
Describe a sample of 78 inpatients on DD and performance in follow-up.
To perform a description and analysis of gender-related features in DD.
We included all consecutive cases of DD inpatients, fulfilling the DSM-IV-TR criteria, at the Department of Psychiatry (Hospital Clinic-Barcelona), from 2000 to 2011. We recorded sociodemographic data, clinical features at index admission, pharmacological treatment use and adherence to follow-up after discharge for the first year. for comparison purposes, Mann-Whitney U and Chi-square tests were used.
Seventy four per cent were women, mean age (SD) 61.27 years (13.08). the most common delusional ideas were persecutory delusions (74.4%). Women were admitted more frequently due to behavioral and thought disorders (p = 0.011). Women became ill later than men (50.05 vs 46.45 years; p=ns). Age at first admission was higher in women (56.71 vs 51.55), not significantly. Duration of hospitalization was longer in women (p=0.045), they received more antidepressants (p = 0.029) and showed less compliance during the first six months (38% vs 17.6% dropped-outs). There were no differences in the mean period between the first and the second admission.
There are gender differences in DD in age at onset, at first admission and duration of hospitalization. Women need more pharmacological treatments but show less compliance at follow-up.
ECT remains as one of the most effective and secure psychiatric treatments for a wide variety of disorders, like depression, bipolar disorder or schizophrenia. Although not fully known, several theories hypothesize about its mechanism of action. To be effective, it has to induce a generalized convulsion of at least 15 seconds.
To analyze and compare convulsion times regarding diagnosis and treatment phase (acute, continuation or maintenance) to discern whether these factors influence convulsion time.
1675 ECT sessions were performed on 117 patients during a year at a universitary hospital. Convulsion times were analyzed comparing them according to main diagnosis (bipolar disorder, major depressive disorder, schizophrenia, schizoaffective disorder), as well as according to treatment phase (acute, continuation, maintenance).
Schizophrenia mean convulsion time was 40,77 seconds (CI95% 39,25-42.28), for schizoaffective disorder it was 34,59 seconds (CI95% 32,74-36,44), for bipolar disorder 35,13 seconds (CI95% 33,83-36,43) and for major depressive disorder 34,90 seconds (CI95% 32,72- 37,07), with a statistical significance between groups of p < 0.001.
According to treatment phase, mean convulsion time in the acute phase was 34,94 seconds (CI95% 33,81-36,19), in the continuation phase it was 39,61 seconds (ICI95% 37,28-42,29), and in the maintenance phase it was 39,00 seconds (CI95% 37,92-40,18), with a statistical significance between groups of p < 0.001.
Although there exist statistically significant differences between groups according to diagnosis and treatment phase, they are not clinically relevant, thus concluding that neither diagnosis nor treatment phase seem to influence convulsion time to a relevant degree.
Delusional disorder is traditionally considered a treatment resistant disorder. Antipsychotics are considered to be the treatment of choice despite information in this area is limited.
Describe a sample of DD inpatients, which received routine treatment.
To perform indirectly an efficacy analysis of long-acting injectable risperidone (RLAI) compared to oral risperidone and to others atypical antipsychotics.
Prospective observational study including 80 inpatients on DD, according to DSM-IV-TR, consecutively admitted over a period of 10 years, and who were treated with atypical antipsychotics. The sample was divided into three groups according to which antipsychotic received: RLAI, oral risperidone and other oral atypical antipsychotics (OAP). Sociodemographic data and clinical features at the first admission and indirect efficacy variables at follow-up were registered. For comparison purposes, ANOVA, Chi-square and Mann-Whitney test were used.
Twenty-four patients received RLAI (30%), 30 oral risperidone (37.5%) and 26 (32.5%) OAP. No statistically significant differences were found among the three treatment groups regarding demographic data, reason for hospitalization and psychopathology at admission. RLAI group showed a greater adherence to follow-up (15/24 with> 75% of visits) and percentage of maintenance at the end of the period. In addition, the RLAI group required less frequently treatment with antidepressants (n = 5/24, 20.8%) and benzodiazepines (54.2% vs 65.4% in other oral atypical antipsychotics).
Treatment with RLAI in delusional disorder improves adherence to follow-up in these patients. On the other hand, patients treated with RLAI require less frequently use of other psychoactive drugs.
Poor insight has been associated to positive and negative symptoms in schizophrenia. However, the impact of antipsychotic treatment on insight in delusional disorder (DD) has not well defined.
Our purpose was to investigate the impact of long-acting atypical antipsychotics (PPLAI, RLAI) on insight in DD patients.
We conducted a prospective and observational study by including 60 consecutive cases of DD outpatients, which were followed up for at least 6 months. Outcome variables: Scores in the first three items of the SUMD for Insight, PANSS for psychopathology, HRSD-17 for depression and PSP for functionality. The sample was divided into two groups according to the treatment received: oral or long-acting atypical antipsychotics (RLAI or PPLAI). T and Chi-square tests were used. Insight differences between both groups were investigated by applying Analysis of Covariance.
At baseline, DD patients treated with long-acting injectable antipsychotics had higher scores in awareness of social consequences. Although no statistically significant differences were found, after 6 months of treatment, patients receiving long-acting injectable antipsychotics showed a tendency of improvement of awareness of illness, awareness of the effects of medication and awareness of social consequences. Statistically significant treatment group*PANSS total score interactions were found for awareness for social consequences. After controlling for SUMD baseline and PANSS total scores, DD patients treated with long-acting antipsychotics showed an improvement of awareness of the effects of medications and social consequences.
Patients receiving long-acting injectable antipsychotics showed an improvement in psychotic symptoms and insight dimensions.
SPECT DaTSCAN is used in clinical practice for differential diagnosis between Parkinson disease and other movement disorders, dementias and drug induced parkinsonism (Park 2012, Scherfler 2007). Nevertheless, its rational indication in patients with psychiatric comorbidity has not been clearly identified.
To assess the rationale for the indication of SPECT DaTSCAN in psychiatric population, explore the therapeutic consequences and clinical outcomes.
A prospective case series of DaTSCAN applications requested from the department of psychiatry of a general hospital (2008–2012). Reason of request, sociodemographic and clinical data, side effects (UKU Rating Scale), diagnostic (DSM-IV-R) and outcome after one-year follow-up were recorded.
18 cases were included (13 hospitalized, 55.5% women, 65±13 years old). Baseline UKU showed: 89.5% bradikinesia, 68% rigidity and 31.5% tremor. The indications for DaTSCAN were: 1) Atypical extrapiramidal syndrome (AES; 55.5%) and 2) Parkinsonism presumably induced by drugs (PPID; 44,4%).
AES group (N=10): 80% of patients had an affective disorder and 20% a psychotic disorder; DaTSCAN identified three cases of Parkinson disease (30%), two non-parkinson dementia (20%) and one Huntington disease (10%).
PPID group (N=8): 50% of patients had an affective disorder and 50% a psychotic disorder; DaTSCAN identified one case of Parkinson disease (12.5%) and five of drug-induced parkinsonism (62,5%).
After one year follow-up, AES group showed a worse outcome and an important functional decline, while most of patients of PPID group experienced complete remission
The results of this study enable to establish the profile of psychiatric patients that would beneficiate most from DaTSCAN.
Long-acting injectable antipsychotics in early-onset schizophrenia improve treatment adherence, and this may lead to decreased rates of hospital admission, better rates of clinical remission and better psychosocial adjustment.
To compare clinical remission rates, number of hospital readmissions and personal and social functioning after two years between patients with early-onset schizophrenia (EOS;≤ 2 years), either in treatment with long-acting injectable risperidone (LAIR) or oral antipsychotics (OA).
This is a case-control study comparing patients with EOS who initiated LAIR between 2004–2008 (n = 26 cases) with a control group with EOS matched for age and sex (n = 26 controls) treated with OA. The PANSS was administered at baseline; after two years the PANSS, the Personal and Social Functioning Scale (PSP) and the Andreasen remission criteria were administered.
The PANSS score comparison at baseline showed no significant differences between LAIR and OA groups (79.9 vs. 88.5, respectively; CI 95%: −21.6, 4.3; p = 0.185). There were statistical significant differences after two years of treatment in the PANSS scores (47.7 vs. 66.2, respectively; CI 95%: −27.2, −9.8; p < 0.001), the PSP scores (72.4 vs. 59.7, respectively; CI 95%: 4.9, 20.7; p = 0.002) and the clinical remission rates (65.4% vs. 38.5, respectively; p = 0.05). Although no statistically significant, there were differences between hospital readmission rates (19,5% vs. 42.3%, respectively).
Despite case-control studies limitations, data suggest that treatment with LAIR instead of OA in EOS might improve clinical, remission and social functioning rates. This improved effectiveness might be due to a greater treatment adherence achieved with LAIR.
Species of Anisakis typically infect the stomach of cetaceans worldwide, often causing ulcerative lesions that may compromise the host's health. These nematodes also cause anisakiasis or allergic reactions in humans. To assess the risks of this emerging zoonosis, data on long-term changes in Anisakis infections in cetaceans are necessary. Here, we compare the prevalence and severity of ulcerative lesions caused by Anisakis spp. in five cetacean species stranded along the north-west Spanish coast in 2017–2018 with published data from 1991–1996. Open ulcers were found in 32/43 short-beaked common dolphins, Delphinus delphis; 3/5 striped dolphins, Stenella coeruleoalba; 1/7 bottlenose dolphins, Tursiops truncatus; and 1/3 harbour porpoises, Phocoena phocoena meridionalis; a single individual of long-finned pilot whale, Globicephala melas, was found uninfected. In common dolphins, the mean abundance of open ulcers per host was 1.1 (95% confidence interval: 0.8–1.3), with a maximum diameter (mean ± standard deviation) of 25.4 ± 16.9 mm. Stomachs with scars or extensive fibrosis putatively associated with Anisakis were detected in 14 and five animals, respectively. A molecular analysis based on the mitochondrial cytochrome c oxidase II gene using 18 worms from three cetacean species revealed single or mixed infections of Anisakis simplex sensu stricto and Anisakis pegreffii. Compared with the period 1991–1996, we found a strong increase of prevalence, abundance and extension of ulcerative lesions in most cetacean species. Anisakis populations could have increased in the study area over the last decades, although we cannot rule out that a higher environmental stress has also boosted the pathological effects of these parasites.
Increased adiposity, dyslipidemia and insulin resistance are associated with increased risk of developing cardiometabolic diseases (CM). Such deleterious phenotypes have been shown to be associated with a low gene-richness microbiota that can partly be restored by a short-term dietary intervention (energy-restricted high-protein diet, low glycemic index, enrichment with fibers) in parallel to an improvement of CM profile. In this study, we aimed at increasing fiber intake in quantity and diversity through a two-month consumption of bread enriched with a mix of selected fibers and evaluated the impact of this dietary intervention on gut microbiota gene richness and CM risk profile in subjects at risk of developing CM.
Materials and methods
In a randomized double blind cross-over design, thirty-nine subjects with CM risk profile (18–70 years old, BMI: 25–35 kg/m2, waist circumference > 80 cm for women and > 96 cm for men, fiber intake < 20g/day, low fiber diversity) consumed daily for 8 weeks 150 g of standard bread vs. 150 g of bread enriched with a 7-selected fibers mix (5.55 g vs. 16.35 g of fiber respectively; 4-week washout). Gut microbiota and CM risk factors’ analyzes were conducted before and after intervention. Stool samples were analyzed by shotgun metagenomics; microbial genes and metagenomics species (MSP) profiles were generated by mapping reads on a reference genes catalog (1529 MSP).
The included dyslipidemic subjects with CM risk profile presented a lower microbiota gene richness compared to reference healthy cohorts. The two-month consumption of fiber-rich bread did not alter microbiota gene richness but modified microbiota composition with a significant decrease of Bacteroides vulgatus (q = 1.7e-4) and a significant increase of Parabacteroides distasonis (q = 2.8e-6), Fusicatenibacter saccharivorans (q = 5e-5) and Clostridiales (q = 3.8e-2). We observed in parallel a significant decrease in total cholesterol (- 0.26 mmol/L; - 5%; p = 0.021), LDL-cholesterol (- 0.2 mmol/L; - 6%, p = 0.0061) and an improvement of insulin sensibility estimated by HOMA index (3.23–2.54 mUI/L; - 21%; p = 0.0079).These effects were even significantly more pronounced for subjects presenting the higher waist circumference. Anthropometric parameters were not altered.
The enrichment of the diet with a mix of selected fibers for 2 months altered microbiota composition by modifying the relative abundance of specific gut bacterial species, in parallel to a significant improvement of cholesterol and insulin sensitivity parameters. Increasing the quantity and diversity of dietary fiber intake could be used as an efficient tool to favorably impact CM profile.