15Objective: Breast cancer (BC) is the most diagnosed cancer in women. Increasing survival rates 16shifts attention to preventive strategies. Obesity and intestinal microbiota (IM) composition may be 17 associated with BC. Mediterranean Diet (MD) proved to be protective. The aim of this study was to 18 assess the efficacy of probiotics in addition to MD versus diet alone in influencing gut microbiota 19and metabolic profile in overweight BC survivors. 20Methods: 34 BC survivor were randomized to MD for 4 months plus 1 sachet/day of probiotics 21(Bifidobacterium longum BB536, Lactobacillus rhamnosus HN001) for the first 2 months 22(intervention group, n=16) or MD alone for 4 months (control group, n=18). Anthropometric and 23 nutritional assessments, adherence to MD, compliance to physical activity and metabolic 24 parameters dosage were performed at baseline (T0), at 2 (T2) and at 4-months (T4). IM analysis 25 was performed at T0 and T2. 26Results: After 2-months of probiotic administration the number of bacterial species (p=0.01) and 27 the bacterial diversity assessed with the Chao1 index (p=0.004) significantly increased, no 28 significant variations were detected after diet alone. The Bacteroidetes-/-Firmicutes ratio 29 significantly decreased in the intervention group and increased in controls (p=0.004). Significant 30 reductions of body weight, body mass index (BMI), fasting glucose and Homeostasis-Model 31Assessment Insulin-Resistance (HOMA-IR) were observed at T4 in both groups, in the intervention 32 group also waist circumference (p=0.012), waist/hip ratio (p=0.045) and fasting insulin (p=0.017) 33 significantly decreased. 34Conclusions: Probiotics in addition to MD positively influence the gut microbiota and improve 35 metabolic and anthropometric parameters respect to MD alone. 36 37

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Liraglutide, a glucagon-like peptide-1 agonist, has been shown to have beneficial effects on fecal output in short bowel syndrome (SBS) by small human studies. Its potential effects early after gut resection are not known. In this pilot observational study, we described the 1- and 6-month liraglutide effects in 19 adult patients with a new SBS diagnosis within 1 month after surgical resection. Stomal/fecal and urinary outcomes, serum/urinary electrolytes, and body composition were assessed. Both within-group differences and between-group comparisons with 20 SBS patients refusing liraglutide treatment were evaluated. The main liraglutide-related side effect was mild nausea, except in one patient, who experienced severe nausea/vomiting. The median ostomy/fecal output was significantly reduced by −550 mL/day after 6 months of treatment (vs. −200 mL/day in untreated, p = 0.04). The number of patients reaching a ≥20% output reduction was 10/19 (52.6%) treated vs. 3/20 (15.0%) untreated patients (p = 0.013) at 1 month and 12/19 (63.2%) vs. 6/20 (30.0%) (p = 0.038) at 6 months, respectively. Participants with a clinically relevant output reduction at 6 months had a significantly lower baseline weight and BMI. Energy parenteral supply significantly decreased, while infused volumes, oral energy, and fluid intakes slightly decreased, though not significantly. This pilot study supports liraglutide benefits in ostomy/fecal output early after surgical gut resection in SBS patients, particularly in those with lower baseline weight values.

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