HDHL MICA: Microbiota-Inflammation-Brain axis in heart failure ... (AMBROSIA)

Long-term limited dietary intake (undernutrition) in older adults can greatly increase the risk of ill-health and increase frailty. Undernutrition is a common issue in patients diagnosed with heart failure and atrial fibrillation (an issue which causes an irregular heartbeat). Improving dietary intake in this patient group could improve physical functionality and should also reduce risk of future heart issues. The aim of this EU collaboration (the AMBROSIA project) is to test whether dietary counselling and provision of a novel fortified food product can benefit this patient group. This collaboration researchers across four different countries (Italy, Republic of Ireland, Spain and the UK) and bring together industrial and academic expertise.
The first goal of this study will be to design the novel food product (the AMBROSIA bar), specifically enriched an ideal mix of protein, fibre and other factors. The impacts of dietary counselling, either alone or in tandem with AMBROSIA bar intake will be assessed in 120 heart failure and atrial fibrillation patients. Blood samples, dietary data, cognitive testing and measurements of body composition will be collected from patients to track the impact of these two treatments. Additional analysis of blood, urine and stool samples will also analyse wider changes in metabolites and gut microbiota that will support understanding of the relationship of these factors with disease management. Use of cutting-edge machine-learning approaches will also help to uncover new "signatures" of dietary intake, frailty and health status. Such findings would have wider benefit on the understanding of the impact of dietary intake on supporting positive ageing

This transnational project aims to tackle undernutrition in a well-defined "older" population (i.e. heart failure and atrial fibrillation patients). Undernutrition in this patient group is a key factor leading to chronic inflammation, loss of functionality, disability and reduced life expectancy. Undernourished heart failure and atrial fibrillation patients enter a vicious cycle of poor health that may exacerbate reduced dietary intake, resulting in loss of lean body mass and cognitive function. A multipronged approach to increase nutrient status would be expected to positively impact on disease progression and other health parameters. The current project will assess the impact of dietary counselling and provision of a novel fortified food on disease status in this patient group by running a monocentric, parallel, randomised controlled trial.
The first stages of this project will be to design a novel fortified food product (the AMBROSIA bar) aimed at benefiting energy, protein and targeted nutrient intake in this patient group. The primary outcome of interventions (either diet and lifestyle counselling alone or with the addition of the AMBROSIA bar) will be change in skeletal muscle mass. Improvements in dietary habit and markers of disease status, cognitive, emotional and functional status will also be measured. Finally, microbiomic, lipidomic and metabolomic analysis will be carried out on saliva, blood, urine and faecal samples collected during the randomised, controlled trial. Outcomes of these analyses will be screened via a novel, cutting-edge machine-learning platform to aid discovery of novel markers or correlates of disease, frailty, nutrient uptake and nutritional status. The UK arm of this EU-wide collaboration (which includes partners organisations across 4 countries) will focus on dietary data (using novel diet quality scoring methods) and metabolomic analyses (using high resolution mass spectrometry).