Randomized controlled trials (RCTs) of fecal microbiota transplantation (FMT) in patients with irritable bowel syndrome (IBS) have produced outcomes varying from no effect at all to high efficacy and durable effects over time. This review analyzed differences in the protocols used in FMT RCTs for IBS in the recently published literature with the aim of identifying the factors responsible for the success or failure of these RCTs. The results of this analysis might be useful in formulating an effective standard protocol for FMT in IBS. A systematic search was conducted in the PubMed database of the literature published in English from January 2015 to December 2023 using several search phrases comprising MeSH expressions. Those RCTs that carefully selected donors based on environmental factors that are known to affect the gut microbiota positively and ensured bacterial diversity before and during FMT produced successful outcomes. Furthermore, direct freezing of the donor’s fecal transplant, storing it at −80°C until the FMT is performed, and then thawing it at 4°C and mixing it manually appear to be factors associated with the success of FMT in IBS. Administering the donor’s fecal transplant into the small intestine results in durable effects of FMT and long-term colonization of beneficial bacteria. A standard protocol for FMT with large and durable effects should include (1) careful donor selection, (2) handling the donor’s fecal transplant in a way that preserves its microbiota contents, and (3) administering the transplant into the small intestine.

BACKGROUND AND OBJECTIVES: Insulin resistance is associated with hyperlipidemia. Recently, visceral fat adiposity is reported to be associated with insulin resistance and hyperlipidemia. We investigated insulin resistance and visceral fat adiposity in hyperlipidemic patients. MATERIALS AND METHOD: Hyperlipidemic group included 14 hyperlipidemic patients (total cholesterol > or = 220 mg/dl and triglyceride < or = 400 mg/dl) without hypertension, angina, impaired glucose tolerance and diabetes mellitus (DM). Control group included age, sex and body mass index (BMI) matched 25 healthy volunteers. We measured plasma lipid profiles and the insulin and glucose during the oral glucose tolerance test. We measured visceral fat area and abdominal subcutaneous fat area with computed tomography (CT). RESULTS: There were no differences of age, sex and BMI in both group. Total cholesterol, LDL cholesterol and triglyceride increased significantly in hyperlipidemic group. Fasting plasma glucose, insulin, area under curve (AUC) of the glucose and insulin and the Insulin / Glucose (IG) ratio increased significantly in hyperlipidemic group. Significant positive correlations were demonstrated between visceral fat area and the fasting plasma glucose, AUC of glucose and insulin at 120 minutes after glucose load. However, there was no difference in visceral fat area between both groups. After adjustment of visceral fat area, fasting plasma glucose, insulin, area under curve (AUC) of the glucose and insulin and the Insulin / Glucose (IG) ratio still remained increased significantly in hyperlipidemic group. CONCLUSION: We observed significantly increased insulin resistance in hyperlipidemic group. There was partial relationship between visceral fat area and the glucose and insulin profile. However, we did not find increased visceral fat area in hyperlipidemic group.
Adiposity ; Area Under Curve ; Blood Glucose ; Body Mass Index ; Cholesterol ; Cholesterol, LDL ; Diabetes Mellitus ; Fasting ; Glucose ; Glucose Tolerance Test ; Healthy Volunteers ; Humans ; Hyperlipidemias* ; Hypertension ; Insulin Resistance* ; Insulin* ; Intra-Abdominal Fat* ; Obesity* ; Plasma ; Subcutaneous Fat, Abdominal ; Triglycerides

BACKGROUND: The visceral fat accumulation, an important factor to increase the insulin resistance is known to be associated with coronary artery disease. We investigated the relation between visceral fat accumulation and the coronary artery disease. METHODS: The coronary artery disease (CAD) group included 14 patients (9 men and 5 women) with angina pectoris. All patients had typical chest pain, diagnosed as coronary artery disease with coronary angiogram or treadmill test. The patients with hypertension, hyperlipidemia, non-insulin dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT) and taking any medication known to affect the insulin sensitivity were excluded. The control group included 24 healthy volunteers (11 men and 13 women) who were not taking any medication. We measured the visceral fat area, abdominal subcutaneous fat area, thigh muscle area and the thigh fat area with computed tomography (CT) in both groups. We measured the plasma lipid profile, plasma insulin and glucose level during the oral glucose tolerance test in both groups. RESULTS: There were no differences in the age, sex ratio, body mass index (BMI) and the waist to hip ratio (WHR) between both groups. The total cholesterol and LDL cholesterol were significantly higher in CAD group (p<0.001). The HDL cholesterol was significantly lower in CAD group (p<0.05). The fasting insulin, fasting glucose, area under curve (AUC) of the insulin and glucose, and the insulin to glucose (IG) ratio were significant higher in CAD group (p<0.001). There were significant differences between CAD group and the control group in the visceral fat area (94.2+/-19.1 cm2 vs. 76.5+/-34.3 cm2, p<0.05), thigh fat area (60.2+/-24.8 cm2 vs. 92.6+/-41.0 cm2, p<0.01) and the visceral fat to thigh fat area ratio (VSFTF ratio : 1.74+/-0.61 vs. 1.07+/-0.80, p<0.01). The visceral fat area was independently associated with fasting insulin (r=0.661, p<0.01), fasting glucose (r=0.490, p<0.05), the AUC of glucose (r=0.605, p<0.01), HDL cholesterol (r= -0.528, p<0.01) and triglyceride (r=0.483, p<0.05) in control group. After adjustment for visceral fat area, there were still significant differences in the fasting insulin, fasting glucose, AUC of insulin, AUC of glucose and the IG ratio between both groups. CONCLUSION: We observed significant increase in the visceral fat area and VSFTF ratio and decrease in thigh fat area in CAD group compared with age, BMI, WHR matched control group. The insulin resistance was observed in the CAD group. The visceral fat area and VSFTF ratio was associated with cardiovascular risk factors such as low HDL cholesterol and the insulin resistance in control group.
Angina Pectoris ; Area Under Curve ; Body Mass Index ; Chest Pain ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Coronary Artery Disease* ; Coronary Vessels* ; Diabetes Mellitus ; Exercise Test ; Fasting ; Glucose ; Glucose Tolerance Test ; Healthy Volunteers ; Humans ; Hyperlipidemias ; Hypertension ; Insulin ; Insulin Resistance ; Intra-Abdominal Fat* ; Male ; Plasma ; Risk Factors ; Sex Ratio ; Subcutaneous Fat, Abdominal ; Thigh ; Triglycerides ; Waist-Hip Ratio

BACKGROUND: The visceral fat accumulation, an important factor to increase the insulin resistance is known to be associated with coronary artery disease. We investigated the relation between visceral fat accumulation and the coronary artery disease. METHODS: The coronary artery disease (CAD) group included 14 patients (9 men and 5 women) with angina pectoris. All patients had typical chest pain, diagnosed as coronary artery disease with coronary angiogram or treadmill test. The patients with hypertension, hyperlipidemia, non-insulin dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT) and taking any medication known to affect the insulin sensitivity were excluded. The control group included 24 healthy volunteers (11 men and 13 women) who were not taking any medication. We measured the visceral fat area, abdominal subcutaneous fat area, thigh muscle area and the thigh fat area with computed tomography (CT) in both groups. We measured the plasma lipid profile, plasma insulin and glucose level during the oral glucose tolerance test in both groups. RESULTS: There were no differences in the age, sex ratio, body mass index (BMI) and the waist to hip ratio (WHR) between both groups. The total cholesterol and LDL cholesterol were significantly higher in CAD group (p<0.001). The HDL cholesterol was significantly lower in CAD group (p<0.05). The fasting insulin, fasting glucose, area under curve (AUC) of the insulin and glucose, and the insulin to glucose (IG) ratio were significant higher in CAD group (p<0.001). There were significant differences between CAD group and the control group in the visceral fat area (94.2+/-19.1 cm2 vs. 76.5+/-34.3 cm2, p<0.05), thigh fat area (60.2+/-24.8 cm2 vs. 92.6+/-41.0 cm2, p<0.01) and the visceral fat to thigh fat area ratio (VSFTF ratio : 1.74+/-0.61 vs. 1.07+/-0.80, p<0.01). The visceral fat area was independently associated with fasting insulin (r=0.661, p<0.01), fasting glucose (r=0.490, p<0.05), the AUC of glucose (r=0.605, p<0.01), HDL cholesterol (r= -0.528, p<0.01) and triglyceride (r=0.483, p<0.05) in control group. After adjustment for visceral fat area, there were still significant differences in the fasting insulin, fasting glucose, AUC of insulin, AUC of glucose and the IG ratio between both groups. CONCLUSION: We observed significant increase in the visceral fat area and VSFTF ratio and decrease in thigh fat area in CAD group compared with age, BMI, WHR matched control group. The insulin resistance was observed in the CAD group. The visceral fat area and VSFTF ratio was associated with cardiovascular risk factors such as low HDL cholesterol and the insulin resistance in control group.
Angina Pectoris ; Area Under Curve ; Body Mass Index ; Chest Pain ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Coronary Artery Disease* ; Coronary Vessels* ; Diabetes Mellitus ; Exercise Test ; Fasting ; Glucose ; Glucose Tolerance Test ; Healthy Volunteers ; Humans ; Hyperlipidemias ; Hypertension ; Insulin ; Insulin Resistance ; Intra-Abdominal Fat* ; Male ; Plasma ; Risk Factors ; Sex Ratio ; Subcutaneous Fat, Abdominal ; Thigh ; Triglycerides ; Waist-Hip Ratio

BACKGROUND: The insulin resistance is common in the patients with essential hypertension, even in the absence of non-insulin-dependent diabetes mellitus(NIDDM) or hyperlipidemia. It is well known that the offspring of patients with NIDDM have shown less insulin sensitivity compared with that of normal parents. But it is not yet known whether the insulin resistance is common in the offspring of patients with essential hypertension in Korea, who have no hypertension, NIDDM and hyperlipidemia. The aims of this study were to find out whether the insulin resistance exist in the middle aged normal offspring of the patients with essential hypertension and whether the insulin resistance is dependent on the metabolic abnormalities such as the body mass index(BMI), obesity and hyperlipidemia. METHODS: The serum lipid profiles and oral glucose tolerance test were performed. The anthropometrical measurement was done. The abdominal CT scan at umbilicus level and thigh CT was performed in the 11 offspring of parents with essential hypertension(group I;male : 7, female : 4)and 24 offspring of parents without essential hypertension, NIDDM, ischemic heart disease and hyperlipidemia(group II; male : 9, female : 15). RESULTS: The average age of group I was 44.1+/-6.9 years, and that of the group II was 47.5+/-9.5 years. There were no significant differences in the blood pressure, weight, BMI, waist to hip ratio, waist to thigh ratio. And there were no significant differences in the serum cholesterol, triglyceride, HDL-cholesterol, serum Na, and plasma renin activities between both groups. Fasting plasma insulin and 2 hour insulin after 75gm glucose ingestion were significantly higher in group I than in group II(8.5+/-3.0mU/mL versus 5.0+/-1.8mU/mL, 61.6+/-31.7mU/mL versus 33.3+/-16.8mU/mL, p<0.05). The insulin sensitivity index was significantly lower in group I than in group II(355.1+/-92.6 versus 451.8+/-88.1, p<0.05). The visceral fat area was wider in group I than in group II(102.0+/-30.7cm2 versus 64.5+/-28.5cm2, p<0.05). The multiple regression analysis with the fasting plasma insulin and insulin sensitivity index as the dependent variables and family history of essential hypertension, visceral fat area and BMI as the predictor variables revealed that only the family history was associated with the fasting plasma insulin and insulin sensitivity index. CONCLUSIONS: The offspring of the parents with essential hypertension showed the insulin resistance with increased visceral fat area in comparison with the offspring of the parents without essential hypertension.
Blood Pressure ; Cholesterol ; Diabetes Mellitus, Type 2 ; Eating ; Fasting ; Female ; Glucose ; Glucose Tolerance Test ; Humans ; Hyperlipidemias ; Hypertension ; Insulin Resistance* ; Insulin* ; Intra-Abdominal Fat ; Korea* ; Male ; Middle Aged* ; Myocardial Ischemia ; Obesity ; Parents* ; Plasma ; Renin ; Thigh ; Tomography, X-Ray Computed ; Triglycerides ; Umbilicus ; Waist-Hip Ratio