Christian Lodberg Hvas

Background: Clostridioides difficile infection (CDI) is a major cause of hospital-acquired infections. Faecal microbiota transplantation (FMT) is a safe and effective treatment to prevent CDI recurrence, but treatment efficiency depends on patient and donor characteristics. To investigate how donor microbiome and metabolite profiles are associated with FMT treatment efficiency in patients with CDI, data from a Danish cohort where faeces samples were collected from 47 donors and 102 patients with CDI before FMT, and one and eight weeks after FMT, were analysed. Analyses included microbiome composition analysis, alpha diversity, beta dispersion, and bile acid concentrations. Based on the weighted balance of four bile acids, a predictive model was created to predict variance in treatment efficiency using coda4microbiome . Results: CDI resolution in patients increased with higher abundances of Clostridia and Clostridiales in donor faeces, was positively associated with glycocholic acid, and negatively associated with 3-oxo-chenodeoxycholic acid in donor faeces. Using our predictive model, a linear regression was found where the predicted value explained 86% of the variance in efficiency score. When applying our model to the dataset with alternative filtering, it predicted a donor efficiency score (S _e ) with an average treatment efficiency of 73% for all donors, 83% for high-S _e donors and 67% for low-S _e donors. Conclusions: Donor-specific microbiome and metabolite compositions were linked to higher FMT success rates in the treatment of CDI, suggesting that predictive modelling can help select FMT donors. Our findings highlight a potential method for donor selection or optimization in FMT treatment of CDI.

Background: Intestinal failure patients receiving home parenteral nutrition are at risk of catheter‐related bloodstream infection. Metastatic infections include infective endocarditis and vertebral osteomyelitis. We aimed to investigate the incidences of catheter‐related bloodstream infection, infective endocarditis, and vertebral osteomyelitis in type 3 intestinal failure patients. Methods: This was a cohort study conducted in a Danish referral intestinal failure center. All data on catheter‐related bloodstream infections, infective endocarditis, and vertebral osteomyelitis were retrieved from medical records on patients receiving home parenteral nutrition through tunneled cuffed central venous access devices or peripherally inserted central catheters from 01 January 2019 to 31 December 2023. Results: A total of 323 patients (209 females) were included, totaling 913 catheters and 293,650 catheter days. The catheter‐related bloodstream infection incidence was 0.93 per 1,000 catheter days (95% CI: 0.82–1.03) over the 5‐year period, with a statistically significantly higher incidence for tunneled cuffed central venous access devices than for peripherally inserted central catheters (1.10 [95% CI: 0.95–1.26] vs. 0.66 [95% CI: 0.52–0.81] per 1,000 catheter days, respectively). Thirteen cases of infective endocarditis (0.04 per 1,000 catheter days [95% CI: 0.02–0.07]) and ten cases of vertebral osteomyelitis (0.03 per 1000 [95% CI: 0.01–0.06]) were identified. Conclusion: The catheter‐related bloodstream infection incidence is within the acceptable range recommended by current guidelines. The incidence of infective endocarditis is higher, and that of vertebral osteomyelitis is similar to those in other studies. Catheter‐related bloodstream infection is a serious complication that may lead to infective endocarditis or vertebral osteomyelitis, underscoring the need for timely detection and management.

BACKGROUND Alterations in gut microbiota composition have been implicated in the pathogenesis of type 2 diabetes (T2DM), and faecal microbiota transplantation (FMT) has emerged as a microbiota-targeted intervention with potential metabolic effects. Randomised controlled trials evaluating the effects of FMT on insulin sensitivity in individuals with T2DM are limited. OBJECTIVE This study aims to investigate the effects of FMT on insulin sensitivity and glycaemic control in individuals with T2DM. METHODS This is a single-center, randomised, double-blind, placebo-controlled trial. Sixteen participants with T2DM have been randomised in a 1:1 ratio to receive FMT from two healthy donors or a placebo intervention, administered in two predefined procedures using capsules. Assessments were performed at baseline and after the intervention period. The primary outcome is insulin sensitivity, assessed using the Matsuda index derived from a standardised oral glucose tolerance test (OGTT) after six weeks. Secondary outcomes include dynamic insulin sensitivity assessed by the oral glucose insulin sensitivity index and detailed glycaemic profiling using continuous glucose monitoring (time-in-range, glycaemic variability), alongside anthropometry, circulating metabolic and inflammatory biomarkers, and gut microbiota composition and functional capacity. Outcomes will be analysed using analysis of covariance, adjusting for baseline values, and will follow the intention-to-treat principle. RESULTS As of June 2026, all 16 participants have been enrolled and completed all patient visits. Laboratory analyses for the primary outcomes are in progress and therefore no results are currently available. CONCLUSIONS This randomised controlled trial will evaluate whether repeated FMT can improve insulin sensitivity in individuals with T2DM. The integration of dynamic OGTT-derived insulin sensitivity indices and continuous glucose monitoring–based glycaemic profiling enables a comprehensive assessment of glucose metabolism following microbiota modulation. CLINICALTRIAL ClinicalTrials.gov, study identifier NCT07375797, registered on 12 January 2026

Aims: Higher dietary spermidine intake has been associated with lower cardiovascular mortality. Spermidine and spermine support cellular homeostasis and mitochondrial function across species, but their relevance to physical and mitochondrial function in humans remains unclear. We examined associations of dietary spermidine and circulating and skeletal muscle spermidine and spermine with physical performance, body composition, and mitochondrial respiratory capacity in older patients with coronary artery disease. Methods and results: We included 187 patients with coronary artery disease [median age 72 (68–76) years; 80% men; 95% with prior coronary revascularization]. The primary outcomes were peak oxygen uptake and appendicular lean mass. Each doubling of dietary spermidine intake was associated with higher peak oxygen uptake (β 2.6 mL·kg−1·min−1, 95% CI 0.9–4.4; P = 0.003). This association remained after adjustment for age, sex, and physical activity. Dietary spermidine intake was also associated with higher appendicular lean mass, but this association was attenuated after adjustment. Among secondary outcomes, higher spermidine intake was associated with higher appendicular lean mass/body mass index and lower body fat percentage. In a subgroup, higher spermidine intake was associated with greater mitochondrial respiration. In exploratory analyses, a higher skeletal muscle spermine-to-spermidine ratio showed similar associations (all P ≤ 0.035). Conclusion: These observational findings warrant randomized trials to determine whether dietary spermidine interventions may influence physical and mitochondrial function in older patients with coronary artery disease.

Bioelectrical impedance analysis (BIA) is a widely used technique in clinical and research settings because it provides non-invasive estimates of body composition. However, the quality of a measurement depends on more than the perceived accuracy and precision of numbers produced by a BIA device. This review considers BIA through the lens of metrology, defined as the science of measurement. It highlights several key factors that affect measurement quality. These include accuracy, precision, calibration, standardisation, and uncertainty quantification, all of which are essential for meaningful, clinically feasible BIA measurements. Applying prediction equations generated by the device outside their intended context, poor electrode placement, or uncalibrated devices can introduce bias, whereas biological variability can complicate the interpretation of bioimpedance results. The traditional emphasis on using a reference method for validation is considered along with clinical relevance, which is argued to be an equally important benchmark for evaluating measurement utility. We also present best practices and practical guidelines for improving measurement quality, interpretation, and integration into clinical workflows. By adopting a metrological mindset in clinical practice and treating BIA with the same rigour as other diagnostic tools, its utility in areas such as fluid management, nutrition, and preventive health can be further enhanced. Trustworthy decisions depend not only on the data itself but also on how it is measured, interpreted, and used.

Background : Body composition measurement is an integral part of estimating nutritional status according to the Global Leadership Initiative on Malnutrition (GLIM). Bioelectrical impedance analysis (BIA) is suggested for measuring body composition. This study mimicked the BIA potential use in the everyday clinic. In the practical clinical setting, there is not always the possibility to adopt a strict protocol such as drinking a glass of water or voiding immediately before measurement for all patients. Aim : To investigate the effect of oral fluid intake and voiding on body composition measurements using a multi-frequency BIA device. Methods : This was a single-centre intervention crossover study. Body composition was measured four times in healthy adults: one prior to oral fluid intake and urinary voiding, twice immediately after voiding, and once 15 minutes after drinking 500 ml tap water. The main parameters were body weight, whole-body resistance (R, ohm), capacitive reactance (X _C ), and phase angle (PhA, ^o ). Results : We examined 31 healthy adults with a mean age of 34 (SD = 12) years; height, 173 (SD = 9) cm; body weight, 76.8 (SD = 18) kg; the baseline mean BIA outcomes were R 597 (SD = 88) ohm, X _C 59 (SD = 8) ohm and PhA 5.7 (SD = 0.7) . Oral fluid intake increased all BIA outcomes compared to baseline, i.e., with R 4.71 (SD = 7.17) ohm, p = 0.001; X _C with 0.73 (SD = 1.07) ohm, p = 0.001; PhA with 0.12 (SD = 0,52), p == 0.199, fat mass (FM) with 0.26 (SD = 0.57) kg, p = 0.008 and fat-free-mass (FFM) 0.08 (SD = 0.42) kg, p = 0.423. After urinary voiding the BIA outcomes decreased with R 3.52 (SD= 3.94) ohm, p = 0.000; X _C 0.38 (SD = 0.91) ohm, p = 0.029, and PhA 0.03 (SD = 0.17) . Conclusions : Oral fluid intake and urinary voiding have detectable effects on BIA outcomes but that the magnitude of these effects is small, and hence, in most cases, may be ignored in routine clinical practice.

Bioelectrical impedance analysis (BIA) is a widely used technique in clinical and research settings because it provides non-invasive estimates of body composition. However, the quality of a measurement depends on more than the perceived accuracy and precision of numbers produced by a BIA device. This review considers BIA through the lens of metrology, defined as the science of measurement. It highlights several key factors that affect measurement quality. These include accuracy, precision, calibration, standardisation, and uncertainty quantification, all of which are essential for meaningful, clinically feasible BIA measurements. Applying prediction equations generated by the device outside their intended context, poor electrode placement, or uncalibrated devices can introduce bias, whereas biological variability can complicate the interpretation of bioimpedance results. The traditional emphasis on using a reference method for validation is considered along with clinical relevance, which is argued to be an equally important benchmark for evaluating measurement utility. We also present best practices and practical guidelines for improving measurement quality, interpretation, and integration into clinical workflows. By adopting a metrological mindset in clinical practice and treating BIA with the same rigour as other diagnostic tools, its utility in areas such as fluid management, nutrition, and preventive health can be further enhanced. Trustworthy decisions depend not only on the data itself but also on how it is measured, interpreted, and used.

INTRODUCTION: Fecal microbiota transplantation (FMT) is effective for recurrent Clostridioides difficile infection (rCDI). Adverse reactions to FMT occur early, and cellular immune responses after FMT may contribute to effects and reactions. We compared early changes in peripheral immune cell subsets and clinical outcomes in patients with rCDI who received either FMT and antibiotics or antibiotics alone in a randomized trial. METHODS: Thirty-five patients with rCDI were randomized to vancomycin and FMT (n = 20) or vancomycin alone (n = 15). Blood samples were drawn before (wk0) and 1 week (wk1) after treatment. In 3 additional patients, blood samples were drawn before and 24 hours and wk1 after FMT. Adaptive and innate immune cell subsets and gut-homing memory (CD45RO ⁺ integrinβ7 ⁺ ) and effector (CD45RO ^- integrinβ7 ⁺ ) T cells were analyzed by flow cytometry. RESULTS: FMT induced subtle changes in immune cell subsets with no clear pattern from wk0 to wk1. The Treg fraction tended to decrease after FMT, and a similar decrease at 24 hours indicated rapid T regulatory cells dynamics. Natural killer T (NKT) cells increased during the first 24 hours and returned to baseline level at wk1. Regardless of FMT, patients with clinical resolution from rCDI had a decrease in nonclassical monocytes and a shift in gut-homing memory to effector cells at wk1. DISCUSSION: In rCDI, FMT induced subtle and transient dynamics in peripheral immune cell subsets. T regulatory cells and NKT cells seemed responsive and should be further studied. Cure of Clostridioides difficile infection may be associated with an increase in circulating gut-homing T cells.