Oral butyrate, a better adjunct for managing pediatric obesity: JAMA

Italy: A JAMA study has concluded that oral butyrate supplementation reduces BMI in children with obesity. It also exerts beneficial effects on glucose metabolism and inflammation.

The study data support the importance of butyrate as a protective factor against obesity.

Pediatric obesity is a growing concern worldwide and requires effective therapeutic strategies to reduce and limit the disease burden.

The gut microbiome (GM) plays a role in obesity. GM ferments plant foods and produce butyrate. A fibre-rich diet maintains GM.

Butyrate may play a potential role in obesity management because evidence suggests that reduced consumption of dietary substrates for butyrate production and decreased butyrate-producing bacteria lead to obesity.

The Butyrate Against Pediatric Obesity (BAPO) trial evaluated if butyrate supplementation could effectively manage pediatric obesity.

Emerging data suggest that butyrate is a health-promoting molecule and its deficiency has been linked to harmful effects on human metabolism and has been reported in individuals with obesity.

The question here is,

Is oral butyrate supplementation an effective adjunct to standard care for managing pediatric obesity?

To answer this and add more data, a study was conducted by researchers team led by Dr Coppola from the Department of Translational Medical Science and ImmunoNutritionLab, CEINGE-Advanced Biotechnologies at the University of Naples "Federico II," Naples, Italy.

The summary of key points are:

· The RCT was designed to determine the therapeutic effects of Butyrate on Pediatric Obesity.

· The study location was a university tertiary centre for pediatric nutrition in Italy.

· The study included pediatric patients with obesity of mean age of 11 years.

· There were 23 male and 31 female participants.

· Total of 54 children with obesity were randomized.

· 27 participants were in the Butyrate group and 27 in the placebo group.

· In the Butyrate group, the intervention was standard care for pediatric obesity plus 20 mg/kg of body weight/d of sodium butyrate orally.

· The intervention in the placebo group was standard care for pediatric obesity plus obesity.

· The primary outcome measured in the study was a BMI (Body mass index) decrease of ≥ 0.25 BMI SD score (SDS) after six months of intervention.

· Two patients experienced mild adverse effects like transient nausea and headache during the first month of butyrate intervention. (Intention-to-treat analysis).

· The butyrate group (n=48) showed the following changes as waist circumference (−5.07 cm), insulin level (−5.41 μU/mL ), HOMA-IR (−1.14), ghrelin level (−47.89 μg/mL); microRNA221 relative expression, (−2.17)and IL-6 level, (−4.81 pg/mL)

· The butyrate and placebo group proportion with primary outcomes was 0.96 and 0.56, respectively.

· The absolute benefit increase was 40 %.

The researchers concluded that Oral butyrate supplementation effectively treats pediatric obesity.

Waist circumference is a marker of abdominal obesity. We found that butyrate significantly decreases waist circumference in obese children, which aligns with the previous data.

To our knowledge, the BAPO trial first evaluated the effects of butyrate supplementation.

We warrant further RCTs to confirm our findings. The unpleasant organoleptic features may limit the clinical application of the compound, so new butyrate-based compounds should be developed free of undesirable characteristics.

Further reading:

Coppola S, Nocerino R, Paparo L, et al. Therapeutic Effects of Butyrate on Pediatric Obesity: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(12):e2244912. doi:10.1001/jamanetworkopen.2022.44912