Caroline Karlsson

The Microbiota of the Gut in Preschool Children With Normal and Excessive Body Weight

The aim of this study was to investigate the gut microbiota in preschool children with and without overweight and obesity. Twenty overweight or obese children and twenty children with BMI within the normal range (age: 4–5 years) were recruited from the south of Sweden. The gut microbiota was accessed by quantitative PCR (qPCR) and terminal restriction fragment length polymorphism and calprotectin was measured in feces. Liver enzymes were quantified in obese/overweight children. The concentration of the gram‐negative family Enterobacteriaceae was significantly higher in the obese/overweight children (P = 0.036), whereas levels of Desulfovibrio and Akkermansia muciniphila‐like bacteria were significantly lower in the obese/overweight children (P = 0.027 and P = 0.030, respectively). No significant differences were found in content of Lactobacillus, Bifidobacterium or the Bacteroides fragilis group. The diversity of the dominating bacterial community tended to be less diverse in the obese/overweight group, but the difference was not statistically significant. Concentration of Bifidobacterium was inversely correlated to alanine aminotransferase (ALT) in obese/overweight children. The fecal levels of calprotectin did not differ between the study groups. These findings indicate that the gut microbiota differed among preschool children with obesity/overweight compared with children with BMI within the normal range.

Exercise during growth and bone mineral density and fractures in old age

If exercise is to be recommended during growth, benefits in bone mineral density (BMD) must be maintained in old age and shown to prevent fractures. Our cross-sectional study of soccer players suggests that a high BMD is no longer recorded after retirement and fracture frequency is no less than predicted in old age.

Pregnancy and Lactation Confer Reversible Bone Loss in Humans

Abstract: The influence of pregnancy on bone mineral density (BMD) was evaluated by dual-energy X-ray absorptiometry (DXA) in 73 women (mean age 29 years, range 20–44 years) postpartum. Fifty-five age-matched women served as controls. The influence of lactation was evaluated in 65 of the delivered women who were followed with repeated measurements, a mean of 4.5 ± 0.1 and 11.5 ± 0.1 months after the delivery. The influence of multiple pregnancies was evaluated in 39 premenopausal women (mean age 38 years, range 31–54 years) with a minimum of four pregnancies (range 4–7). Fifty-eight age-matched healthy premenopausal women with a maximum of two pregnancies (range 0–2) served as controls. Data are presented as mean ± SEM. BMD data are adjusted for differences in total fat mass and total lean mass. Lumbar spine BMD was 7.6 ± 0.1% and total body BMD 3.9 ± 0.1% lower in women postpartum compared with controls (both p<0.001). BMD did not decrease significantly in non-breastfeeding mothers. Mothers breastfeeding for 1–6 months decreased femoral neck BMD by 2.0 ± 1.0% during the first 5 months postpartum (p<0.001). No further BMD loss was seen between 5 and 12 months postpartum. Femoral neck BMD 12 months after delivery was 1.3 ± 0.8% lower than after delivery in mothers breastfeeding for 1–6 months (p= 0.05). Mothers breastfeeding for more than 6 months decreased Ward’s triangle BMD by 8.5 ± 1.0% and lumbar spine BMD by 4.1 ± 0.8% during the first 5 months postpartum (both p<0.05). No further BMD loss was seen between 5 and 12 months postpartum. Femoral neck BMD 12 months after delivery was 4.0 ± 1.1% lower and Ward’s triangle BMD 5.3 ± 1.9% lower than after delivery in mothers breastfeeding for more than 6 months (both p<0.05). BMD loss was higher during the first 5 months following delivery in the lactating women compared with the non-lactating women (p< 0.05 comparing lumbar spine BMD loss in lactating mothers versus non-lactating mothers). However, in women with a minimum of four pregnancies the BMD was no lower than in age-matched women with fewer pregnancies. Total duration of lactation was not correlated with the present BMD. In summary, pregnancy seem to confer a low BMD with additional BMD loss during 5 months of lactation. Even if complete restoration in BMD was not reached within 5 months of weaning, women with four pregnancies or more had a BMD no lower than women with two pregnancies or fewer. We conclude that neither an extended lactation period nor multiple pregnancies could be used as a risk factor when predicting women at risk for future osteoporosis.

Prevention of falls in the elderly: a review.

The proportion of elderly in the society increases and fall frequency increases with advancing age. Many falls result in fractures and also soft tissue injuries, longstanding pain, functional impairment, reduced quality of life, increased mortality, and excess in healthcare costs. Due to the magnitude of these negative effects, a variety of single- and multicomponent fall-preventive intervention programs has been initiated.This review identifies programs that, in randomized controlled trials (RCTs), have been shown with fall-reductive effects.The most effective strategies in community-dwelling elderly include regular physical training with program that includes several different training modalities. Modification of the overall or patient-specific risk factor profile in home hazard modification program has been proven to decrease fall risk in community-living elderly. The elderly in the community benefit also from wearing antislip shoe devices when walking in icy conditions, from adjustment of psychotropic medication, and from structured modification of multipharmacy. If vitamin D levels in blood are low, supplementation is beneficial as is the first eye cataract surgery and pacemaker implantation in patients with cardioinhibitory carotid sinus hypersensitivity. In addition to modification of specific risk factors, generalized and individualized multifactorial preventive programs, all including some sort of physical training, have been found to decrease the fall risk. In summary, there is now strong evidence in the literature that structured fall-preventive programs in the elderly, especially in high-risk groups, are beneficial in reducing both the number of fallers and the number of falls in community.

Bone Loss and Fracture Risk After Reduced Physical Activity

Former male young athletes partially lost benefits in BMD (g/cm2) with cessation of exercise, but, despite this, had a higher BMD 4 years after cessation of career than a control group. A higher BMD might contribute to the lower incidence of fragility fractures found in former older athletes ⩾60 years of age compared with a control group.

Uncomplicated Mason type-II and III fractures of the radial head and neck in adults. A long-term follow-up study.

BACKGROUND The purpose of this study was to evaluate the incidence and the long-term results of closed uncomplicated Mason type-II and III fractures in a defined population of adults. METHODS Seventy women and thirty men who were a mean of forty-seven years old when they sustained a fracture of the radial head or neck (a Mason type-II fracture in seventy-six patients and a Mason type-III fracture in twenty-four) were reexamined after a mean of nineteen years. Radiographic signs of degenerative changes of the elbow were recorded. The fracture had been treated with an elastic bandage or a collar and cuff sling with mobilization for forty-four individuals, with cast immobilization for thirty-four, with resection of the radial head in nineteen, with open reduction of the radial head in two, and with a collateral ligament repair in one. Secondary excision of the radial head was performed because of residual pain in nine patients, and a neurolysis of the ulnar nerve was performed in one patient. RESULTS Seventy-seven individuals had no symptoms in the injured elbow at the time of follow-up, twenty-one had occasional pain, and two had daily pain. The injured elbows had a slight flexion deficit compared with the uninjured elbows (mean and standard deviation, 138 degrees +/- 8 degrees compared with 140 degrees +/- 7 degrees ) as well as a small extension deficit (mean and standard deviation, -4 degrees +/- 8 degrees compared with -1 degrees +/- 6 degrees ) (p < 0.001 for both). The prevalence of degenerative changes was higher in the injured elbows than in the uninjured ones (76% compared with 16%, p < 0.001). CONCLUSIONS The results following uncomplicated Mason type-II and III fractures are predominantly favorable. A secondary radial head resection is usually effective for patients with an unfavorable outcome (predominantly long-standing pain). LEVELS OF EVIDENCE Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

Maternity and bone mineral density

During pregnancy and lactation, changes occur in a variety of factors which have great potential to influence bone mineral density (BMD). Smoking habits, the level of alcohol consumption, the level of physical activity, body weight, soft tissue composition and hormone levels are all factors that change during the course of these conditions. Some of these factors are capable of increasing BMD, and some can reduce it. Due to these various changes, it is virtually impossible to predict the development in BMD that will occur during a pregnancy and lactation. However, longitudinal studies have suggested that both pregnancy and lactation are associated with a BMD loss of up to 5%, albeit that the BMD recovers after weaning. Cross-sectional studies have indicated that women with many children and a long total period of lactation have similar or higher BMD and similar or lower fracture risk than their peers who have not given birth. As the studies showing this trend have been observational and cross-sectional case-control studies, the conclusions can only be regarded as being suggestive, and no causality can be proven.

The duration of exercise as a regulator of bone mass

Exercise is associated with increased peak bone mineral density (BMD). To determine the relationship between the duration of exercise and BMD, we measured BMD of the axial and appendicular skeleton by dual-energy X-ray absorptiometry (DXA), and speed of sound (SOS), broadband attenuation (BUA), and stiffness index by quantitative ultrasound (QUS) of the calcaneus, in 67 active male national soccer players (mean age 23 years, range 17-35), which included 23 premier-league players exercising 12 h/week (range 8-18), 23 third-league players exercising 8 h/week (range 3-18), and 21 sixth-league players exercising 6 h/week (range 2-10). Results were compared with 24 sedentary age- and gender-matched controls and presented as mean +/- SEM. BMD was higher in all weight-bearing regions for the whole group relative to controls (BMD: total body 6.8 +/- 0.7%, leg 9.6 +/- 0.8%, lumbar spine 13.2 +/- 1.2%, femoral neck 12.7 +/- 1.2% [all p < 0.001]; calcaneus SOS 4.2 +/- 0.3%, BUA 8.7 +/- 1.5%, and stiffness index 24.2 +/- 2.0% [all p < 0.01]). No differences were found in head or arm BMD. There were no differences in BMD or QUS measurements when comparing soccer players exercising for different activity durations. Duration of activity correlated with BMD weight-loaded regions and with QUS, provided it was less <6 h/week (p < 0.01 respectively), but not when exercising more frequently. Femoral neck BMD increased by 3.3% across every hour increase in activity in those with 0-6 h of exercise/week and by 0.7% in those exercising more than this (p < 0.01). We conclude that, in national-league soccer, the BMD needed to attain a bone strength commensurate with that of duration of activity is achieved by 6 h of exercise per week. Beyond this, additional exercise confers no higher BMD. The skeleton adapts to the prevalent level of exercise intensity required and no further.

Physical activity increases bone mass during growth

Background The incidence of fragility fractures has increased during the last half of the 1990′s. One important determinant of fractures is the bone mineral content (BMC) or bone mineral density (BMD), the amount of mineralised bone. If we could increase peak bone mass (the highest value of BMC reached during life) and/or decrease the age-related bone loss, we could possibly improve the skeletal resistance to fracture. Objective This review evaluates the importance of exercise as a strategy to improve peak bone mass, including some aspects of nutrition. Design Publications within the field were searched through Medline (PubMed) using the search words: exercise, physical activity, bone mass, bone mineral content, bone mineral density, BMC, BMD, skeletal structure and nutrition. We included studies dealing with exercise during growth and young adolescence. We preferably based our inferences on randomised controlled trials (RCT), which provide the highest level of evidence. Results Exercise during growth increases peak bone mass. Moderate intensity exercise intervention programs are beneficial for the skeletal development during growth. Adequate nutrition must accompany the exercise to achieve the most beneficial skeletal effects by exercise. Conclusion Exercise during growth seems to enhance the building of a stronger skeleton through a higher peak bone mass and a larger bone size.

Immunological alteration and changes of gut microbiota after dextran sulfate sodium (DSS) administration in mice.

Ulcerative colitis (UC) is characterized by chronic inflammation of the colonic mucosa. Administration of dextran sulfate sodium (DSS) to animals is a frequently used model to mimic human colitis. Deregulation of the immune response to the enteric microflora or pathogens as well as increased intestinal permeability have been proposed as disease-driving mechanisms. To enlarge the understanding of the pathogenesis, we have studied the effect of DSS on the immune system and gut microbiota in mice. Intestinal inflammation was verified through histological evaluation and myeloperoxidase activity. Immunological changes were assessed by flow cytometry in spleen, Peyer′s patches and mesenteric lymph nodes and through multiplex cytokine profiling. In addition, quantification of the total amount of bacteria on colonic mucosa as well as the total amount of lactobacilli, Akkermansia, Desulfovibrio and Enterobacteriaceae was performed by the use of quantitative PCR. Diversity and community structure were analysed by terminal restriction fragment length polymorphism (T-RFLP) patterns, and principal component analysis was utilized on immunological and T-RFLP patterns. DSS-induced colitis show clinical and histological similarities to UC. The composition of the colonic microflora was profoundly changed and correlated with several alterations of the immune system. The results demonstrate a relationship between multiple immunological changes and alterations of the gut microbiota after DSS administration. These data highlight and improve the definition of the immunological basis of the disease and suggest a role for dysregulation of the gut microbiota in the pathogenesis of colitis.