Changes in Gut Microbiome after Bariatric Surgery Versus Medical Weight Loss in a Pilot Randomized Trial Prebiotics Reduce Body Fat and Alter Intestinal Microbiota in Children Who Are Overweight or With Obesity. Roux-en-Y gastric bypass surgery of morbidly obese patients induces swift and persistent changes of the individual gut microbiota Gut Microbiota in the First 2 Years of Life and the Association with Body Mass Index at Age 12 in a Norwegian Birth Cohort Microbial ecology: Human gut microbes associated with obesity Dysbiosis Signatures of Gut Microbiota Along the Sequence from Healthy, Young Patients to Those with Overweight and Obesity. Gastrointestinal microbiome modulator improves glucose tolerance in overweight and obese subjects: A randomized controlled pilot trial. The Natural History of the Development of Obesity in a Cohort of Young U.S. Adults between 1981 and 1998 Early differences in fecal microbiota composition in children may predict overweight. Changes in Gut Microbiota Composition after Bariatric Surgery: a New Balance to Decode Roux-en-Y Gastric Bypass and Vertical Banded Gastroplasty Induce Long-Term Changes on the Human Gut Microbiome Contributing to Fat Mass Regulation The anti-obesity effect of Ephedra sinica through modulation of gut microbiota in obese Korean women. Effects of Surgical and Dietary Weight Loss Therapy for Obesity on Gut Microbiota Composition and Nutrient Absorption Dietary Modulation of Gut Microbiota Contributes to Alleviation of Both Genetic and Simple Obesity in Children☆ Translational research — Implementation of NHLBI obesity guidelines in a primary care community setting: the physician obesity awareness project Four-year follow-up of school-based intervention on overweight children: the KOPS study. Structural Alteration of Gut Microbiota during the Amelioration of Human Type 2 Diabetes with Hyperlipidemia by Metformin and a Traditional Chinese Herbal Formula: a Multicenter, Randomized, Open Label Clinical Trial
Gut microbiota likely impact obesity and metabolic diseases . We evaluated the changes in gut microbiota after surgical versus medical weight loss in adults with diabetes and obesity . We performed 16S rRNA amplicon sequencing to identify the gut microbial composition at baseline and at 10 % weight loss in adults with diabetes who were r and omized to medical weight loss ( MWL , n = 4 ) , adjustable gastric b and ing ( AGB , n = 4 ) , or Roux-en-Y gastric bypass ( RYGB , n = 4 ) . All participants were female , 75 % reported black race with mean age of 51 years . At similar weight loss amount and glycemic improvement , the RYGB group had the most number of bacterial species ( 10 increased , 1 decreased ) that significantly changed ( p < 0.05 ) in relative abundance . Alpha-diversity at follow-up was significantly lower in AGB group compared to MWL and RYGB ( observed species for AGB vs. MWL , p = 0.0093 ; AGB vs. RYGB , p = 0.0093 ) . The relative abundance of Faecalibacterium prausnitzii increased in 3 participants after RYGB , 1 after AGB , and 1 after MWL . At similar weight loss and glycemic improvement , the greatest alteration in gut microbiota occurred after RYGB with an increase in the potentially beneficial bacterium , F. prausnitzii . Gut microbial diversity tended to decrease after AGB and increase after RYGB and MWL . Future studies are needed to determine the impact and durability of gut microbial changes over time and their role in long-term metabolic improvement after bariatric surgery in adults with type 2 diabetes . NCTDK089557— Clinical BACKGROUND & AIMS It might be possible to manipulate the intestinal microbiota with prebiotics or other agents to prevent or treat obesity . However , little is known about the ability of prebiotics to specifically modify gut microbiota in children with overweight/obesity or reduce body weight . We performed a r and omized controlled trial to study the effects of prebiotics on body composition , markers of inflammation , bile acids in fecal sample s , and composition of the intestinal microbiota in children with overweight or obesity . METHODS We performed a single-center , double-blind , placebo-controlled trial of 2 separate cohorts ( March 2014 and August 2014 ) at the University of Calgary in Canada . Participants included children , 7 - 12 years old , with overweight or obesity ( > 85th percentile of body mass index ) but otherwise healthy . Participants were r and omly assigned to groups given either oligofructose-enriched inulin ( OI ; 8 g/day ; n=22 ) or maltodextrin placebo ( isocaloric dose , controls ; n=20 ) once daily for 16 weeks . Fat mass and lean mass were measured using dual-energy-x-ray absorptiometry . Height , weight , and waist circumference were measured at baseline and every 4 weeks thereafter . Blood sample s were collected at baseline and 16 weeks , and analyzed for lipids , cytokines , lipopolysaccharide , and insulin . Fecal sample s were collected at baseline and 16 weeks ; bile acids were profiled using high-performance liquid chromatography and the composition of the microbiota was analyzed by 16S rRNA sequencing and quantitative polymerase chain reaction . The primary outcome was change in percent body fat from baseline to 16 weeks . RESULTS After 16 weeks , children who consumed OI had significant decreases in body weight z-score ( decrease of 3.1 % ) , percent body fat ( decrease of 2.4 % ) , and percent trunk fat ( decrease of 3.8 % ) compared with children given placebo ( increase of 0.5 % , increase of 0.05 % , and decrease of 0.3 % , respectively ) . Children who consumed OI also had a significant reduction in level of interleukin 6 from baseline ( decrease of 15 % ) compared with the placebo group ( increase of 25 % ) . There was a significant decrease in serum triglycerides ( decrease of 19 % ) in the OI group . Quantitative polymerase chain reaction showed a significant increase in Bifidobacterium spp . in the OI group compared with controls . 16S rRNA sequencing revealed significant increases in species of the genus Bifidobacterium and decreases in Bacteroides vulgatus within the group who consumed OI . In fecal sample s , levels of primary bile acids increased in the placebo group but not in the OI group over the 16-week study period . CONCLUSIONS In a placebo-controlled , r and omized trial , we found a prebiotic ( OI ) to selectively alter the intestinal microbiota and significantly reduce body weight z-score , percent body fat , percent trunk fat , and serum level of interleukin 6 in children with overweight or obesity ( Clinical trials.gov no : NCT02125955 ) Background Roux-en-Y gastric bypass ( RYGB ) is an effective means to achieve sustained weight loss for morbidly obese individuals . Besides rapid weight reduction , patients achieve major improvements of insulin sensitivity and glucose homeostasis . Dysbiosis of gut microbiota has been associated with obesity and some of its co-morbidities , like type 2 diabetes , and major changes of gut microbial communities have been hypothesized to mediate part of the beneficial metabolic effects observed after RYGB . Here we describe changes in gut microbial taxonomic composition and functional potential following RYGB . Methods We recruited 13 morbidly obese patients who underwent RYGB  , carefully phenotyped them , and had their gut microbiomes quantified before ( n = 13 ) and 3 months ( n = 12 ) and 12 months ( n = 8) after RYGB . Following shotgun metagenomic sequencing of the fecal microbial DNA purified from stools , we characterized the gut microbial composition at species and gene levels followed by functional annotation . Results In parallel with the weight loss and metabolic improvements , gut microbial diversity increased within the first 3 months after RYGB and remained high 1 year later . RYGB led to altered relative abundances of 31 species ( P < 0.05 , q < 0.15 ) within the first 3 months , including those of Escherichia coli , Klebsiella pneumoniae , Veillonella spp . , Streptococcus spp . , Alistipes spp . , and Akkermansia muciniphila . Sixteen of these species maintained their altered relative abundances during the following 9 months . Interestingly , Faecalibacterium prausnitzii was the only species that decreased in relative abundance . Fifty-three microbial functional modules increased their relative abundance between baseline and 3 months ( P < 0.05 , q < 0.17 ) . These functional changes included increased potential ( i ) to assimilate multiple energy sources using transporters and phosphotransferase systems , ( ii ) to use aerobic respiration , ( iii ) to shift from protein degradation to putrefaction , and ( iv ) to use amino acids and fatty acids as energy sources . Conclusions Within 3 months after morbidly obese individuals had undergone RYGB , their gut microbiota featured an increased diversity , an altered composition , an increased potential for oxygen tolerance , and an increased potential for microbial utilization of macro- and micro-nutrients . These changes were maintained for the first year post-RYGB.Trial registration Current controlled trials ( ID NCT00810823 , NCT01579981 , and NCT01993511 ) Underst and ing the role of the early-life gut microbiota in obesity is important because there may be opportunities for preventive strategies . We examined the relationships between  infant gut microbiota at six times during the first two years of life and BMI at age 12 in a birth cohort of 165 children and their mothers . We found that the gut microbiota from early life to two years shows an increasingly strong association with childhood BMI . This study provides preliminary evidence that the gut microbiome at 2 years of age may offer useful information to help to identify youth who are at risk for obesity , which could facilitate more-targeted early prevention efforts . ABSTRACT Childhood obesity is a growing problem worldwide . Recent research suggests that the gut microbiota may play an important and potentially causal role in the development of obesity and may be one mechanism that explains the transgenerational transmission of obesity risk . Here we examine the early-life gut microbiota at days 4 , 10 , 30 , 120 , 365 , and 730 and the association with body mass index ( BMI ) z-scores at age 12 in a Norwegian prospect i ve cohort ( n = 165 ) , and evaluate how these BMI -associated taxa relate to maternal overweight/obesity ( Ow/Ob ) and excessive gestational weight gain ( GWG ) . We performed 16S rRNA gene sequencing on the gut microbiota sample s. Taxonomic phylogeny at days 10 and 730 was significantly associated with childhood BMI , and the gut microbiota taxa at two years of age explained over 50 % of the variation in childhood BMI in this cohort . The subset of the early-life taxa within the gut microbiota that best predicted later childhood BMI showed substantial overlap with the maternal taxa most strongly associated with maternal Ow/Ob and excessive GWG . Our results show an association between the infant gut microbiota and later BMI , and they offer preliminary evidence that the infant gut microbiota , particularly at 2 years of age , may have potential to help identify children at risk for obesity . IMPORTANCE Underst and ing the role of the early-life gut microbiota in obesity is important because there may be opportunities for preventive strategies . We examined the relationships between  infant gut microbiota at six times during the first two years of life and BMI at age 12 in a birth cohort of 165 children and their mothers . We found that the gut microbiota from early life to two years shows an increasingly strong association with childhood BMI . This study provides preliminary evidence that the gut microbiome at 2 years of age may offer useful information to help to identify youth who are at risk for obesity , which could facilitate more-targeted early prevention efforts Two groups of beneficial bacteria are dominant in the human gut , the Bacteroidetes and the Firmicutes . Here we show that the relative proportion of Bacteroidetes is decreased in obese people by comparison with lean people , and that this proportion increases with weight loss on two types of low-calorie diet . Our findings indicate that obesity has a microbial component , which might have potential therapeutic implication OBJECTIVE To investigate the gut microbiota in healthy volunteers ( HVs ) , patients with overweight ( OW ) , and patients with obesity ( OB ) , including those with acanthosis nigricans ( AN ) or without AN ( N-AN ) . METHODS Microbial 16S rRNA genes were examined by using pyrosequencing technology and analyzed by using bioinformatics methods . RESULTS Subjects in the OW and OB groups showed severe disturbances in glycemic control , lipid profile , and inflammatory markers ( all P < 0.05 ) ; patients with AN had worse metabolic status ( P < 0.001 ) and a lower diversity of microbiota ( P < 0.05 ) . The OB and HV groups showed totally different gut microbiota composition . In the OB group , beneficial microbiotas including Bifidobacterium ( 0.01 % vs. 0.05 % , false discovery rate [ FDR ] = 4.27 * 10 - 5 ) , anti-inflammatory Faecalibacterium ( 6.70 % vs. 13.82 % , FDR = 0.010 ) , and butyrate-producing Ruminococcaceae were significantly decreased , whereas Bacillus ( 0.58 % vs. 0.04 % , FDR = 0.013 ) and potential opportunistic pathogens such as Fusobacterium ( 1.44 % vs. 0.11 % , FDR < 0.01 ) and Escherichia-Shigella ( 6.01 % vs. 0.76 % , FDR = 0.041 ) had outgrown dramatically . Function prediction revealed a significant increase in lipopolysaccharide bio synthesis proteins and bacterial invasion of epithelial cell-associated genes and a significant decrease in glucose and essential amino acid-related genes . CONCLUSIONS Gut microbiotas and their functions were significantly changed in obesity . More prospect i ve studies on association and causality between microbiota and obesity are imperative and might contribute to the prevention , diagnosis , and treatment of obesity OBJECTIVE The objective of this study was to examine the effects of a gastrointestinal microbiome modulator ( GIMM ) containing inulin , β-glucan , blueberry anthocyanins , and blueberry polyphenols on metabolic parameters , fecal markers of gut microbiota , and satiety . DESIGN AND METHODS Thirty overweight or obese individuals aged 18 to 70years , were enrolled in a r and omized controlled trial . Participants consumed the test product or placebo daily for four weeks . Stool sample s were collected and blood was drawn at baseline and week four for assessment s of gut microbiota , satiety hormones , glucose control , and lipid measures . Subjective satiety was assessed weekly . Linear models were used to compare differences from baseline to week four . RESULTS GIMM consumption improved blood glucose tolerance ( p=0.008 ) , and increased satiety ( p=0.03 ) . There were no statistically significant differences in insulin sensitivity , fecal markers of gut microbiota , plasma satiety hormones , or serum lipid concentrations between the groups . However , plasma satiety hormones and fecal short chain fatty acid concentrations increased in the test group compared to the placebo . CONCLUSIONS GIMM consumption for four weeks , increases satiety , and improves glucose tolerance possibly through insulin-independent pathways Context Studies of the natural history of obesity have had limitations , such as cross-sectional design , short follow-up , or narrowly defined population s. Contribution Using data from a national study of Americans born between 1957 and 1964 and followed for nearly two decades , these investigators found that more than 25 % were obese by age 35 years . Obesity developed most quickly in black women , with moderate rapidity in Hispanic women , and most slowly in white women . Hispanic men developed obesity more quickly than other men . More recent birth cohorts became obese faster than earlier cohorts . Implication s Underst and ing ethnic differences in the age of onset and rate of progression of obesity may help efforts to prevent obesity . The Editors The proportion of Americans who are overweight or obese is increasing at an alarming rate . From 1960 to 1999 , the prevalence of excess weight ( body mass index [ BMI ] 25 kg/m2 ) increased from 44 % to 61 % of the adult population ( persons aged 20 to 74 years ) and the prevalence of obesity ( BMI 30 kg/m2 ) doubled from 13 % to 27 % ( 1 , 2 ) . Obesity has been linked to increased mortality and chronic morbidity from such diverse causes as hypertension , diabetes , sleep apnea , certain types of cancer , and depression . In the context of this rising prevalence , obesity is increasingly being recognized as an important medical and public health problem ( 3 - 6 ) . Treatment options are available for obesity . However , they can be expensive , often involve difficult lifestyle modifications , and pose adherence problems for many patients . In addition , weight loss , once achieved , is difficult to sustain . Because the health consequences are often long term , the costbenefit ratio of treatment may be more favorable if people who have recently become obese are targeted . Similarly , prevention should focus on those at immediate risk for becoming obese or overweight . Such approaches require a clear underst and ing of who is at highest risk for obesity , when this risk is greatest , and how excess weight develops over time . Although inactivity and high caloric intake are the primary risk factors for obesity , other risk factors have been established . Three of the most influential are age , sex , and race or ethnicity ( 1 , 7 - 9 ) . To better identify people at risk for obesity and those who might benefit from early intervention , we assessed the relationship between weight development and these influential factors . Despite the morbidity and mortality burden of obesity , its natural history has not been well characterized . Current knowledge is based largely on cross-sectional data . Although several large studies have examined weight development in adults , they have important limitations . Only a few tracked weight long enough to detect age-based trends . The first National Health and Nutrition Examination Survey ( NHANES I ) Epidemiologic Follow-up Study examined a representative group of U.S. residents but sample d only two time points , spaced 10 years apart , and had insufficient follow-up to track weight patterns in most minority groups ( 10 ) . The Coronary Artery Risk Development in Young Adults study followed weight development in a large cohort of young black and white Americans but did not provide data for other population s and was geographically restricted ( 8) . Other studies have been performed outside of the United States , but the results may not apply here ( 10 , 11 ) . We design ed our study to address the limitations described earlier . We examined data from the National Longitudinal Survey of Youth 1979 ( NLSY79 ) . This large , prospect i ve cohort study allowed longitudinal examination of weight trends over a time frame sufficient to capture the dynamics of such a slowly changing problem and of an age range during which obesity becomes prevalent . Because not all weight gain has been documented to be harmful , our analysis focused on obesity onset ( defined as the time at which a person reaches obesity ) rather than weight gain . We used the clinical definition of obesity ( BMI 30 kg/m2 ) as our end point because it reflects a point at which mortality risk increases substantially ( 12 ) . Underst and ing how obesity develops over time , who is at greatest risk , and when that risk is highest may be essential in reversing the population trend toward excess weight . Methods Study Group and Obesity Measurement We analyzed data from the NLSY79 , which was initiated by the U.S. Department of Labor , Bureau of Labor Statistics . This survey was design ed to gather information about the labor market activities and other life events of young U.S. citizens . It has been used extensively in economic and sociologic analyses , and the sample design is described elsewhere ( 13 - 16 ) . The cohort of men and women , born between 1957 and 1964 , has been followed for more than two decades . It consists of a nationally representative group , with supplemental sample s overrepresenting minority racial and ethnic groups and poor persons . We excluded a sample of military personnel because this population was removed from the study in 1985 and because physical activity requirements for these individuals could lead to atypical weight patterns . We included only persons who reported that the ethnicity with which they most closely identified was Hispanic , black , or white ( or European origin ) . Height and weight data were self-reported ; height was reported in 1981 and 1985 , and weight was reported 12 times between 1981 and 1998 . Examination of Age-Specific Body Mass Index Patterns Age-specific BMI was calculated for all participants . Height was assumed to remain constant after age 21 years . St and ard clinical definitions were used for overweight ( BMI 25 to 29.9 kg/m2 ) and obesity ( BMI 30 kg/m2 ) . Trends in age-specific BMI were examined by race or ethnicity and birth year . Cohort Differences We examined whether rates of obesity onset differed for people maturing at different times in our sample . Birth cohorts were grouped by 2-year increments . To st and ardize relative rates to age rather than calendar year , time was expressed as the number of years until a person reached obesity , starting from a st and ard age . In the cohort analysis , obesity onset was evaluated from age 24 years ( the baseline age of the oldest participants ) . The outcome of interest was obesity , and the time variable was years from age 24 years to obesity . People who were already obese at age 24 years were excluded . KaplanMeier plots visually demonstrated differences in rates of obesity onset . Cox proportional-hazards modeling estimated the ratio of rates ( hazard ratio ) between groups . For this method to be correct , the ratio of rates must be constant over time ( proportional ) . To assess this assumption , we used two methods : a statistical test of the scaled Schoenfeld residuals , with a P value greater than 0.05 implying that the rates were proportional and a visual method with parallel lines implying proportional rates . In all our analyses , results of proportional hazards testing were reported whenever the assumption was violated . Timing of Obesity Onset by Race or Ethnicity and Sex We evaluated relative rates of obesity onset in 17- and 18-year-old persons of different race or ethnicity who were not obese at the start of the study ; different models were used for men and women . Time was expressed as the number of years from age 17 years until reaching obesity . To control for birth cohort differences , models were adjusted for birth year . As before , KaplanMeier plots were examined and hazard ratios were estimated by using Cox proportional-hazards modeling . To determine relative importance of weight gain during childhood compared with adulthood in terms of the timing of obesity onset , we adjusted the models for baseline BMI at 17 or 18 years of age and examined the effect on hazard ratio estimation . Prevalence and Incidence of Obesity in Early Adulthood For this analysis , we defined early adulthood as the period from 20 to 22 years of age to 35 to 37 years of age . Persons born between 1959 and 1963 were queried about their weight one to two times during each of these age intervals . We calculated the prevalence and incidence of obesity across the early adulthood range . Logistic regression modeling predicted obesity status at age 35 to 37 years from an individual 's race or ethnicity , sex , and BMI at age 20 to 22 years . The model was adjusted in 2-year increments for year of birth . Its predictive ability was quantified by using receiver-operating characteristic ( ROC ) curves . This study was evaluated and exempted from review by the Institutional Review Board of the University of North Carolina at Chapel Hill . Role of the Funding Sources Primary funding was through the Robert Wood Johnson Clinical Scholars Program , with additional support from the National Institute of Child Health and Human Development . Neither entity had a role in the design , conduct , or reporting of this study . Results Description of the Study Sample The total sample included 9179 people : 19 % Hispanic , 31 % black , and 50 % white ( Table ) . People who did not report ethnicity ( n = 106 ) were not included . Age ( sample year minus birth year ) ranged from 17 to 24 years in 1981 to 34 to 41 years in 1998 , and participants were equally distributed across 8 years of birth . Baseline weight was 31.7 to 136.1 kg , and baseline BMI was 11.3 to 51.5 kg/m2 . Table . Sample Characteristics in 1981 Relationship of Body Mass Index to Time Mean age-specific BMI increased with time . This relationship between weight and time has two components , illustrated with data from the oldest and youngest birth cohorts of our sample ( Figure 1 ) . The first is the natural history of body weight : Average BMI increased with age throughout early adulthood . The second is a secular weight trend : Persons born in later calendar years tended to have larger age-specific BMI values . In every case in which the same age was sample d for both birth cohorts , the group born in 1957 had a lower mean BMI than the group born BACKGROUND Experimental studies suggest that gut microbiota deviations predispose toward energy storage and obesity . OBJECTIVE We wanted to establish whether early gut microbiota composition can guide weight development throughout early childhood . DESIGN Overweight and obese children ( n = 25 ) were selected from a prospect i ve follow-up study at the age of 7 y and identified according to the International Obesity Task Force criteria . Normal-weight children ( n = 24 ) were selected from the same cohort and matched for gestational age and body mass index at birth , mode of delivery , probiotic supplementation  , duration of breastfeeding , use of antibiotics during infancy , and frequencies of atopic diseases and atopic sensitization . Early fecal microbiota composition was analyzed by fluorescent in situ hybridization ( FISH ) with microscopic and flow cytometry detection and by quantitative real-time polymerase chain reaction ( qRT-PCR ) . RESULTS The bifidobacterial numbers in fecal sample s during infancy , as assessed by the FISH with flow cytometry , were higher in children remaining normal weight , [ median : 2.19 x 10(9 ) cells/g ( interquartile range : 1.10 - 5.28 x 10(9 ) cells/g ) ] than in children becoming overweight [ 1.20 x 10(9 ) cells/g ( 0.48 - 1.59x 10(9 ) cells/g ) ; P = 0.02 ] . A similar tendency was found by FISH with microscopic detection and qRT-PCR . The microbiota aberrancy during infancy in children becoming overweight was also associated with a greater number of Staphylococcus aureus [ 0.64 x 10(6 ) cells/g ( 0.33 - 1.00 x 10(6 ) cells/g ) ] than in children remaining normal weight [ 0.27 x 10(6 ) cells/g ( 0.17 - 0.50 x 10(6 ) cells/g ) ; P = 0.013 ] . CONCLUSION Aberrant compositional development of the gut microbiota precedes overweight , offering new possibilities for preventive and therapeutic applications in weight management Recently , the link between obesity and gut microbiota has become a focus for research . This study shed some light on the modification of postoperative gut microbial composition after  bariatric surgery .  A prospect i ve longitudinal study on healthy lean subjects and patients who underwent bariatric surgery ( Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy )  was carried out . Anthropometric and metabolic data , smoking , food preferences data , and stool sample s were collected from lean subjects and from obese patients before and 3 and 6 months after surgery ( T0 , T3 , and T6 , respectively ) . We collected stool sample s from 25 obese patients before surgery and 3 and 6 months thereafter and from 25 normal weight patients . After Roux-en-Y gastric bypass , Yokenella regensburgei ( p < 0.05 ) , Fusobacterium varium ( p < 0.05 ) , Veillonella dispar/atypica ( p < 0.05 ) , and Streptococcus australis/gordonii ( p < 0.05 ) were transiently identified in the gut at T3 . Roux-en-Y gastric bypass patients had a permanent increase in Akkermansia muciniphila ( p < 0.05 ) , which is associated with healthy metabolism , both at T3 and T6 . There were no significant changes in gut microbiota in laparoscopic sleeve gastrectomy patients . In our study , Roux-en-Y gastric bypass induced major microbial differences and greater weight loss compared with laparoscopic sleeve gastrectomy . Analyzing the microbiota composition , a proliferation of potential pathogens and the onset of beneficial bacteria was observed . The effects of these bacteria on human health are still far from clear . Underst and ing the mechanisms of action of these bacteria could be the keystone in developing new therapeutic strategies for obesity Summary Bariatric surgery is currently the most effective procedure for the treatment of obesity . Given the role of the gut microbiota in regulating host metabolism and adiposity , we investigated the long-term effects of bariatric surgery on the microbiome of patients r and omized to Roux-en-Y gastric bypass or vertical b and ed gastroplasty and matched for weight and fat mass loss . The two surgical procedures induced similar and durable changes on the gut microbiome that were not dependent on body mass index and result ed in altered levels of fecal and circulating metabolites compared with obese controls . By colonizing germ-free mice with stools from the patients , we demonstrated that the surgically altered microbiota promoted reduced fat deposition in recipient mice . These mice also had a lower respiratory quotient , indicating decreased utilization of carbohydrates as fuel . Our results suggest that the gut microbiota may play a direct role in the reduction of adiposity observed after bariatric surgery ETHNOPHARMACOLOGICAL RELEVANCE Ephedra sinica ( Ma Huang ) has been used in traditional Chinese medicine for more than 5000 years for treatment of various conditions , including modern-day obesity . Ephedra has been used as a supplement for weight loss and its effects have been reported . The current study investigated the influence of ephedra on the composition of gut microbiota , and its correlation with weight loss . MATERIAL S AND METHODS Clinical data of subjects were measured at pre- and post-intake of ephedra ( 4 g of water extract , roughly equivalent of 24 g of crude herb ) , and analysis of the alteration of gut microbiota was performed simultaneously using 16S rRNA gene based pyrosequencing . RESULTS Body weight ( BW ) , body mass index ( BMI ) , and body fat percentage of subjects were reduced after intake ( p<0.05 ) . In correlation analysis , Subdoligranulum , Oscillibacter , and Akkermansia showed an association with changes of BW and BMI ( p<0.05 ) . However , the alteration of gut microbiota varied by indigenous microbiota of each subject , and the dissimilarity between microbiota of subjects at pre- and post-intake were different . CONCLUSIONS The influences of gut microbiota are unique according to indigenous microbiota and differences in individual sensitivity to ephedra . Alteration of gut microbiota by ephedra intake showed correlation with loss of BW and BMI Evidence suggests a correlation between the gut microbiota composition and weight loss caused by caloric restriction . Laparoscopic sleeve gastrectomy ( LSG ) , a surgical intervention for obesity , is classified as predominantly restrictive procedure . In this study we investigated functional weight loss mechanisms with regard to gut microbial changes and energy harvest induced by LSG and a very low calorie diet in ten obese subjects ( n = 5 per group ) demonstrating identical weight loss during a follow-up period of six months . For gut microbiome analysis next generation sequencing was performed and faeces were analyzed for targeted metabolomics . The energy-reabsorbing potential of the gut microbiota decreased following LSG , indicated by the Bacteroidetes/Firmicutes ratio , but increased during diet . Changes in butyrate-producing bacterial species were responsible for the Firmicutes changes in both groups . No alteration of faecal butyrate was observed , but the microbial capacity for butyrate fermentation decreased following LSG and increased following dietetic intervention . LSG result ed in enhanced faecal excretion of nonesterified fatty acids and bile acids .  LSG , but not dietetic restriction , improved the obesity-associated gut microbiota composition towards a lean microbiome phenotype . Moreover , LSG increased malabsorption due to loss in energy-rich faecal substrates and impairment of bile acid circulation . This trial is registered with Clinical Trials.gov NCT01344525 Gut microbiota has been implicated as a pivotal contributing factor in diet-related obesity ; however , its role in development of disease phenotypes in human genetic obesity such as Prader – Willi syndrome ( PWS ) remains elusive . In this hospitalized intervention trial with PWS ( n = 17 ) and simple obesity ( n = 21 ) children , a diet rich in non-digestible carbohydrates induced significant weight loss and concomitant structural changes of the gut microbiota together with reduction of serum antigen load and alleviation of inflammation . Co-abundance network analysis of 161 prevalent bacterial draft genomes assembled directly from metagenomic data sets showed relative increase of functional genome groups for acetate production from carbohydrates fermentation . NMR-based metabolomic profiling of urine showed diet-induced overall changes of host metabotypes and identified significantly reduced trimethylamine N-oxide and indoxyl sulfate , host-bacteria co-metabolites known to induce metabolic deteriorations . Specific bacterial genomes that were correlated with urine levels of these detrimental co-metabolites were found to encode enzyme genes for production of their precursors by fermentation of choline or tryptophan in the gut . When transplanted into germ-free mice , the pre-intervention gut microbiota induced higher inflammation and larger adipocytes compared with the post-intervention microbiota from the same volunteer . Our multi-omics-based systems analysis indicates a significant etiological contribution of dysbiotic gut microbiota to both genetic and simple obesity in children , implicating a potentially effective target for alleviation . Research in context Poorly managed diet and genetic mutations are the two primary driving forces behind the devastating epidemic of obesity-related diseases . Lack of underst and ing of the molecular chain of causation between the driving forces and the disease endpoints retards progress in prevention and treatment of the diseases . We found that children genetically obese with Prader – Willi syndrome shared a similar dysbiosis in their gut microbiota with those having diet-related obesity . A diet rich in non-digestible but fermentable carbohydrates significantly promoted beneficial groups of bacteria and reduced toxin-producers , which contributes to the alleviation of metabolic deteriorations in obesity regardless of the primary driving forces Background : Greater than 65 percent of the United States ( US ) population is overweight , with 32 percent obese . It is a problem in both developed and developing nations . While guidelines exist , counseling by physicians about obesity and weight loss is inconsistent , and physician approaches to obesity management have limited success . This study attempted to increase involvement in translating proven research into practice to improve physician awareness and improve outcomes of overweight/obesity . Twenty-one physicians in a suburban , middle class population in the Midwestern United States participated . Methods : Physician obesity awareness , weight , height , BMI , blood pressure , lipids , and glycohemoglobin were measured from 641 patients at baseline and were compared to 631 at 12-month follow-up . All 21 physicians received academic detailing and were presented with their clinical outcomes . Ten physicians received an Enhanced Intervention . They were additionally asked to place a sticker in the chart of their overweight or obese patients . Results : Fifty-three percent of physicians were not comfortable discussing obesity with their patients at baseline , decreasing to 0 % at followup ( p=0.041 ) . Reference to obesity management by Intervention physicians increased from 2.4 % to 9.2 % ( p=0.001 ) while for Enhanced Intervention physicians documentation increased from 3.9 % to 15.6 % ( p=0.002 ) . Those patients in the Enhanced Intervention group lost an average of 6.19 lbs ( 3.3 % ) ( p=0.083 ) during the one year period versus 4.6 lbs ( 2.5 % ) ( p=0.20 ) in the Intervention group . The BMI dropped 1.2 in the Intervention group and 0.72 in the Enhanced Intervention group . The data from both groups was pooled at both baseline and follow-up . The average weight of patients decreased from 185.7 lbs to 180.3 lbs ( excluding outliers weighing > 311 lbs ) . This 5.4 pound loss was significant ( p=0.027 ) . The BMI decreased from 30.1 to 29.1 ( p=0.095 ) . Cardiovascular co-morbidities improved . Conclusion : Obesity and overweight have a very high prevalence in a primary care community based setting s. Clinicians are not comfortable diagnosing and managing obese and overweight patients . A combination of academic detailing and presentation of outcomes to physicians will improve their awareness and result in improved clinical outcomes including weight loss OBJECTIVE To evaluate the 4-year outcome of a school-based health promotion on weight status as part of the Kiel Obesity Prevention Study ( KOPS ) . RESEARCH METHODS AND PROCEDURES Within a cluster- sample d quasi-r and omized controlled trial , 1764 children at 6 and 10 years of age were assessed between 1996 and 2005 in 32 primary schools in Kiel , North Germany .  Six nutrition units followed by 20-minute running games were performed within the first year at school . Prevalence , incidence , and remission of overweight were main outcome measures . RESULTS The 4-year change in BMI was + 11.6 % , with increases in prevalence of overweight and obesity from 5.2 % to 11.1 % and 3.9 % to 5.1 % , respectively . Cumulative 4-year incidence of overweight and obesity was 9.2 % and 3.1 % , respectively . Intervention had no effect on mean BMI . The effect on prevalence was significant in children from families with high socioeconomic status [ odds ratio ( OR ) , 0.35 ; 95 % confidence interval ( CI ) , 0.14 to 0.91 ] and marginally significant in children of normal-weight mothers ( OR , 0.57 ; 95 % CI , 0.33 to 1.00 ) . Cumulative 4-year incidence of overweight was lower only in intervention children from families with high socioeconomic status ( OR , 0.26 ; 95 % CI , 0.07 to 0.87 ) . Remission of overweight was most pronounced in children of normal-weight mothers ( OR , 5.43 ; 95 % CI , 1.28 to 23.01 ) . Prevalence of underweight was unchanged . The intervention had minor but favorable effects on lifestyle . DISCUSSION A school-based health promotion has sustainable effects on remission and incidence of overweight ; it was most pronounced in children of normal-weight mothers and children from families with high socioeconomic status . There was no effect on obesity . The data argue in favor of additional measures of prevention ABSTRACT Accumulating evidence implicates gut microbiota as promising targets for the treatment of type 2 diabetes mellitus ( T2DM ) . With a r and omized clinical trial , we tested the hypothesis that alteration of gut microbiota may be involved in the alleviation of T2DM with hyperlipidemia by metformin and a specifically design ed herbal formula ( AMC ) .  Four hundred fifty patients with T2DM and hyperlipidemia were r and omly assigned to either the metformin- or AMC-treated group . After 12 weeks of treatment , 100 patients were r and omly selected from each group and assessed for clinical improvement . The effects of the two drugs on the intestinal microbiota were evaluated by analyzing the V3 and V4 regions of the 16S rRNA gene by Illumina sequencing and multivariate statistical methods . Both metformin and AMC significantly alleviated hyperglycemia and hyperlipidemia and shifted gut microbiota structure in diabetic patients . They significantly increased a coabundant group represented by Blautia spp . , which significantly correlated with the improvements in glucose and lipid homeostasis . However , AMC showed better efficacies in improving homeostasis model assessment of insulin resistance ( HOMA-IR ) and plasma triglyceride and also exerted a larger effect on gut microbiota . Furthermore , only AMC increased the coabundant group represented by Faecalibacterium spp . , which was previously reported to be associated with the alleviation of T2DM in a r and omized clinical trial . Metformin and the Chinese herbal formula may ameliorate type 2 diabetes with hyperlipidemia via enriching beneficial bacteria , such as Blautia and Faecalibacterium spp . IMPORTANCE Metabolic diseases such as T2DM and obesity have become a worldwide public health threat . Accumulating evidence indicates that gut microbiota can causatively arouse metabolic diseases , and thus the gut microbiota serves as a promising target for disease control . In this study , we evaluated the role of gut microbiota during improvements in hyperglycemia and hyperlipidemia by two drugs : metformin and a specifically design ed Chinese herbal formula ( AMC ) for diabetic patients with hyperlipidemia . Both drugs significantly ameliorated blood glucose and lipid levels and shifted the gut microbiota . Blautia spp . were identified as being associated with improvements in glucose and lipid homeostasis for both drugs . AMC exerted larger effects on the gut microbiota together with better efficacies in improving HOMA-IR and plasma triglyceride levels , which were associated with the enrichment of Faecalibacterium spp . In brief , these data suggest that gut microbiota might be involved in the alleviation of diabetes with hyperlipidemia by metformin and the AMC herbal formula . Metabolic diseases such as T2DM and obesity have become a worldwide public health threat . Accumulating evidence indicates that gut microbiota can causatively arouse metabolic diseases , and thus the gut microbiota serves as a promising target for disease control . In this study , we evaluated the role of gut microbiota during improvements in hyperglycemia and hyperlipidemia by two drugs : metformin and a specifically design ed Chinese herbal formula ( AMC ) for diabetic patients with hyperlipidemia . Both drugs significantly ameliorated blood glucose and lipid levels and shifted the gut microbiota . Blautia spp . were identified as being associated with improvements in glucose and lipid homeostasis for both drugs . AMC exerted larger effects on the gut microbiota together with better efficacies in improving HOMA-IR and plasma triglyceride levels , which were associated with the enrichment of Faecalibacterium spp . In brief , these data suggest that gut microbiota might be involved in the alleviation of diabetes with hyperlipidemia by metformin and the AMC herbal formula
Conclusion This study suggests that the probiotics supplementation could potentially reduce the weight gain and improve some of the associated metabolic parameters , which may become an effective strategy for the prevention and treatment of obesity in adult individuals
Background The prevalence of overweight/obesity in adults is raised to 39 % , which is nearly tripled more than 1975 .
The alteration of the gut microbiome has been widely accepted as one of the main causal factors .
To find an effective strategy for the prevention and treatment of overweight/obesity , a systematic review and meta- analysis were design ed .