Defining Microbiome Readiness for Surgery: Dietary Prehabilitation and Stool Biomarkers as Predictive Tools to Improve Outcome

Abstract

Objectives: Determine whether preoperative dietary prehabilitation with a low-fat, high-fiber diet reverses the impact of Western diet (WD) on the intestinal microbiota and improves postoperative survival Background: We have previously demonstrated that WD fed mice subjected to an otherwise recoverable surgical injury (30% hepatectomy), antibiotics, and a short period of starvation demonstrate reduced survival (29%) compared to mice fed a low-fat, high-fiber standard chow (SD) (100%). Methods: Mice were subjected to 6 weeks of a WD and underwent dietary pre-habilitation (3 days vs 7 days) with a SD prior to exposure to antibiotics, starvation, and surgery. 16S rRNA gene sequencing was utilized to determine microbiota composition. Mass spectrometry measured short chain fatty acids and functional prediction from 16S gene amplicons were utilized to determine microbiota function. Results: As early as 24 hours, dietary prehabilitation of WD mice resulted in restoration of bacterial composition of the stool microbiota, transitioning from Firmicutes dominant to Bacteroidetes dominant. However, during this early pre-habilitation (ie, 3 days), stool butyrate per microbial biomass remained low and postoperative mortality remained unchanged from WD. Microbiota function demonstrated reduced butyrate contributing taxa as potentially responsible for failed recovery. In contrast, after 7 days of prehabilitation (7DP), there was greater restoration of butyrate producing taxa and survival after surgery improved (29% vs 79% vs 100%: WD vs 7DP vs SD, P < 0.001). Conclusions:The deleterious effects of WD on the gut microbiota can be restored after 7 days of dietary prehabilitation. Moreover, stool markers may define the readiness of the microbiome to withstand the process of surgery including exposure to antibiotics and short periods of starvation.

Emerging Paradigms in the Prevention of Surgical Site Infection: The Patient Microbiome and Antimicrobial Resistance

“…1A), and mice fed meals simulating the Western diet have greatly increased mortality after normally survivable abdominal surgery. 56 This effect can be reversed by “dietary prehabilitation” with a low-fat, high-fiber, plant-based diet over the course of 1 week, potentially consistent with the scheduling of a typical surgical procedure. Such microbiome-directed dietary interventions may be complementary to enhanced recovery and prehabilitation programs targeting physical frailty and age-associated vulnerability.…”

Influence of the bile acid/microbiota axis in ileal surgery: a systematic review

“…All the studies specifically examined patients with a clinical pathology and an associated intestinal resection. Therefore, it is difficult to make conclusions about the precise influence that ileal surgery has on the BA/microbiota axis alone since the pathology itself is likely to contribute to this as well [51][52][53][54][55]. Another limitation is that none of the articles specifically examined the effects of ileal resection by itself and instead included a wide range of intestinal resection types.…”

Examining the Role of Microbiota-Centered Interventions in Cancer Therapeutics: Applications for Urothelial Carcinoma

“…Keskey et al 31 studied the effects of a WD on gut microbiome profiles in the context of surgical outcomes. These investigators subjected mice to either 6 weeks of a WD or 6 weeks of a standard diet (SD).…”

“…Furthermore, single time point measurements did not reflect the dynamic changes that occur with dietary interventions. 31 Keskey et al's work implies that alterations in the gut microbiome can establish a readiness to withstand the process of surgery, and may be predictive of enhanced survival.…”

“…29 The majority of surgical patients in the United States consume a highly processed, low-fiber Western diet (WD), which results in obese body habitus and a decrease in SCFAs, both of which are linked to delayed recovery from injury. 30 Keskey et al 31 studied the effects of a WD on gut microbiome profiles in the context of surgical outcomes. These investigators subjected mice to either 6 weeks of a WD or 6 weeks of a standard diet (SD).…”