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Tina Peckmezian,1 Vanessa Garcia-Larsen,2 Kayla Wilkins,3 Rana H Mosli,4 Nasser F BinDhim,5– 7 George Kunnackal John,8 Muhammad Yasir,9,10 Esam Ibraheem Azhar,9,10 Gerard E Mullin,11 Saleh A Alqahtani11,12 1Independent Scholar, Sydney, NSW, Australia; 2Program in Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 3Environmental GeoScience Research Group, Trent University, Peterborough, ON, Canada; 4Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia; 5Sharik Association for Health Research, Riyadh, Saudi Arabia; 6College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; 7Saudi Food and Drug Authority, Riyadh, Saudi Arabia; 8Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Easton, MD, USA; 9Special Infectious Agents Unit – BSL3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; 10Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia; 11Liver Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; 12Division of Gastroenterology & Hepatology, John Hopkins University, Baltimore, MD, USACorrespondence: Saleh A Alqahtani, Liver Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia, Email salalqahtani@kfshrc.edu.saObjective: This study evaluated the effect of microbiome-targeted therapies (pre-, pro-, and synbiotics) on weight loss and other anthropometric outcomes when delivered as an adjunct to traditional weight loss interventions in overweight and obese adults.Methods: A systematic review of three databases (Medline [PubMed], Embase, and the Cochrane Central Register of Controlled Trials) was performed to identify randomized controlled trials published between January 1, 2010 and December 31, 2020, that evaluated anthropometric outcomes following microbiome-targeted supplements in combination with dietary or dietary and exercise interventions. The pooled mean difference (MD) between treatment and control groups was calculated using a random effects model.Results: Twenty-one trials with 1233 adult participants (76.4% female) with overweight or obesity were included. Separate meta-analyses were conducted for probiotics (n=11 trials) and synbiotics (n=10 trials) on each anthropometric outcome; prebiotics were excluded as only a single study was found. Patient characteristics and methodologies varied widely between studies. All studies incorporated some degree of caloric restriction, while only six studies included recommendations for adjunct exercise. Compared with dietary or dietary and exercise interventions only, probiotics resulted in reductions in body weight (MD: − 0.73 kg; 95% confidence interval [CI]: − 1.02 to − 0.44, p < 0.001), fat mass (MD: − 0.61 kg; 95% CI: − 0.77 to − 0.45; p< 0.001) and waist circumference (MD: − 0.53 cm; 95% CI: − 0.99 to − 0.07, p=0.024) while synbiotics resulted in reductions in fat mass (MD: − 1.53 kg; 95% CI: − 2.95 to − 0.12, p=0.034) and waist circumference (MD: − 1.31 cm; 95% CI: − 2.05 to − 0.57, p< 0.001).Conclusion: This analysis indicates that microbiome-targeted supplements may enhance weight loss and other obesity outcomes in adults when delivered as an adjunct to dietary or dietary and exercise interventions. Personalized therapy to include microbiome-targeted supplements may help to optimize weight loss in overweight and obese individuals.Keywords: microbiome, obesity, adjunctive therapy, weight loss

This study aimed (1) to systematically review controlled trials of solid food diets for the treatment of inflammatory bowel disease (IBD); and (2) to grade the overall quality of evidence.Systematic review of prospective controlled trials of solid food diets for the induction or maintenance of remission in IBD. Two authors independently performed study selection, data extraction, and assessment of certainty of evidence. Meta-analyses were performed on studies with quantitative data on response, remission, and relapse.There were 27 studies for meta-analysis. For induction of remission in Crohn's disease (CD), low refined carbohydrate diet and symptoms-guided diet outperformed controls, but studies had serious imprecision and very low certainty of evidence. The Mediterranean diet was similar to the Specific Carbohydrate Diet (SCD) (low certainty of evidence) and partial enteral nutrition (PEN) was similar to exclusive enteral nutrition (very low certainty of evidence). PEN reduced risk of relapse (very low certainty of evidence), while reduction of red meat or refined carbohydrates did not (low certainty of evidence). For ulcerative colitis (UC), diets were similar to controls (very low and low certainty of evidence).Among the most robust dietary trials in IBD currently available, certainty of evidence remains very low or low. Nonetheless, emerging data suggest potential benefit with partial enteral nutrition for induction and maintenance of remission in CD. Reduction of red meat and refined carbohydrates might not reduce risk of CD relapse. As more dietary studies become available, the certainty of evidence could improve, thus allowing for more meaningful recommendations for patients.

Background: Malnutrition has been linked to adverse health economic outcomes. There is a paucity of data on malnutrition in patients admitted with COVID-19. Methods: This is a retrospective cohort study consisting of 4311 COVID-19 adult (18 years and older) inpatients at 5 Johns Hopkins-affiliated hospitals between 1 March and 3 December 2020. Malnourishment was identified using the malnutrition universal screening tool (MUST), then confirmed by registered dietitians. Statistics were conducted with SAS v9.4 (Cary, NC, USA) software to examine the effect of malnutrition on mortality and hospital length of stay among COVID-19 inpatient encounters, while accounting for possible covariates in regression analysis predicting mortality or the log-transformed length of stay. Results: COVID-19 patients who were older, male, or had lower BMIs had a higher likelihood of mortality. Patients with malnutrition were 76% more likely to have mortality (p < 0.001) and to have a 105% longer hospital length of stay (p < 0.001). Overall, 12.9% (555/4311) of adult COVID-19 patients were diagnosed with malnutrition and were associated with an 87.9% increase in hospital length of stay (p < 0.001). Conclusions: In a cohort of COVID-19 adult inpatients, malnutrition was associated with a higher likelihood of mortality and increased hospital length of stay.