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Role of Small Intestinal Bacterial Overgrowth (SIBO) and Inflammation in Obese Children
Susanna Esposito1, Anna Biscarini2, Barbara Federici3
1Pediatric Clinic, Department of Medicine and Surgery, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy.
Insights
Small intestinal bacterial overgrowth (SIBO) is highly prevalent in overweight and obese children, affecting over 70%. While an inflammatory state is common, SIBO does not appear to drive obesity development in this population.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Microbiology
Background:
- Small intestinal bacterial overgrowth (SIBO) is increasingly recognized, but its prevalence and role in pediatric obesity require further investigation.
- Understanding SIBO's impact on childhood obesity is crucial for developing effective treatment strategies.
Purpose of the Study:
- To determine the incidence of SIBO in overweight and obese children.
- To explore the relationship between SIBO, inflammatory markers, and obesity severity in pediatric patients.
Main Methods:
- A prospective, single-blind study involving 36 overweight/obese children.
- Diagnosis of SIBO was confirmed using the lactulose breath test (LBT).
- Cytokine profiles were analyzed from blood samples to assess inflammatory status.
Main Results:
- SIBO was diagnosed in 72.2% of the study population (12/16 overweight, 14/20 obese).
- Elevated pro-inflammatory cytokines (IL-1, IL-6, TNF-α) and low anti-inflammatory cytokines (IL-4, IL-10) were observed, but without significant differences between SIBO+ and SIBO- groups.
- A significant relationship was found between SIBO severity and specific growth factors (EGF, IFN-α2) and breath hydrogen/methane levels.
Conclusions:
- SIBO is extremely common in overweight and obese children, extending beyond severely obese individuals.
- The observed inflammatory state appears to precede obesity, and SIBO itself may not be a primary driver of obesity development.
- Further research is needed to fully elucidate the complex interplay between SIBO, inflammation, and pediatric obesity.
Abstract:
Knowledge of the real incidence of small intestinal bacterial overgrowth (SIBO) in obese children and its role in obesity development seems essential for a more effective approach to the treatment of this condition. In this prospective, single-blind study, presence of SIBO was evaluated in a group of children with overweight/obesity. A blood sample for evaluation of cytokine profile was collected to establish the potential relationship with inflammatory condition and lactulose breath test (LBT) to diagnose SIBO was performed. A total of 36 patients with excess of adipose tissue were recruited. Among them, 16 (44.4%) were overweight and 20 (45.6%) were obese. Overall, 26 (72.2%) children had a positive LBT and were considered suffering from SIBO, 12 (75.0%) among those overweight and 14 (70.0%) among those obese. Measurement of cytokines (IL-1α, IL-1β, IL-4, IL-6, IL-7, IL-8, IL-10, IL-12p40, IL-12p70, IL-17, IFN-α2, IFN-γ, TNF-α), cytokine antagonists (IL-1ra), chemokines (IP10, MCP-1, MIP1α, MIP1β), and growth factors (EGF, G-CSF, GM-CSF, and VEGF) secreted in culture supernatants by PHA activated-PBMCs revealed that in the study population proinflammatory cytokines IL-1, IL-6, IL-8, IL-12, IFN-γ, IL-18, and TNF-α were high, whereas anti-inflammatory mediators IL-4 and IL-10 were low. However, no significance difference between children with SIBO and those without were evidenced. Evaluation of relationship of severity of SIBO showed a significant positive relationship between EGF or IFN-α2 and H2 but not CH4 levels and an inverse significant relationship with CH4 but not H2. Despite its limitations and further studies are needed, this study seems to indicate that SIBO is extremely common in overweight and obese children and can be demonstrated not only in severely obese subjects but also in moderately overweight patients. The inflammatory state seems to precede obesity development and SIBO does not seem to have relevance in obesity development, with no relationship found between severity of SIBO and inflammatory state.
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