Effect of ileal fat perfusion on satiety and hormone release in healthy volunteers. Int J Obes (Lond). 2008;32:1633-1639. [PMID: 18794896 DOI: 10.1038/ijo.2008.166]

An analysis of the "Effect of Olibra: a 12-week randomized control trial and a review of earlier studies"

Nutrients affect hunger and satiety. However, food structure, in particular that of emulsions, may also affect the body's satiety mechanisms. Olibra™ is a fat emulsion, a mixture of fractionated palm oil and fractionated oat oil manufactured by Lipid Technologies Provider AB, Sweden, which affects hunger sensation. However, up to now, no data have shown convincingly that reduced appetite or hunger sensations induced by Olibra lead, in the long run, to a significant and clinically relevant reduction in body mass. To clearly demonstrate a cause-and-effect relationship of Olibra to weight loss, it seems that longer studies with strict control of energy intake and nutrient composition, as well as control of energy expenditure by exercise, are needed.

Nutrient sensing and signalling by the gut

Recent advances highlight that nutrient receptors (such as T1R1/T1R3 heterodimer, Ca sensing receptor and GPR93 for amino acids and protein, GPR40, GPR41, GPR43 and GPR120 for fatty acids, T1R2/T1R3 heterodimer for monosaccharides) are expressed in the apical face of the gut and sense nutrients in the lumen. They transduce signals for the regulation of nutrient transporter expressions in the apical face. Interestingly, they are also localised in enteroendocrine cells (EEC) and mainly exert a direct control on the secretion in the lamina propria of gastro-intestinal peptides such as cholecystokinin, glucagon-like peptide-1 and peptide YY in response to energy nutrient transit and absorption in the gut. This informs central nuclei involved in the control of feeding such as the hypothalamus and nucleus of the solitary tract of the availability of these nutrients and thus triggers adaptive responses to maintain energy homoeostasis. These nutrient receptors then have a prominent position since they manage nutrient absorption and are principally the generator of the first signal of satiation mechanisms mainly transmitted to the brain by vagal afferents. Moreover, tastants are also able to elicit gut peptides secretion via chemosensory receptors expressed in EEC. Targeting these nutrient and tastant receptors in EEC may thus be helpful to promote satiation and so to fight overfeeding and its consequences.

Intraduodenal administration of intact pea protein effectively reduces food intake in both lean and obese male subjects

BACKGROUND

Human duodenal mucosa secretes increased levels of satiety signals upon exposure to intact protein. However, after oral protein ingestion, gastric digestion leaves little intact proteins to enter the duodenum. This study investigated whether bypassing the stomach, through intraduodenal administration, affects hormone release and food-intake to a larger extent than orally administered protein in both lean and obese subjects.

METHODS

Ten lean (BMI:23.0±0.7 kg/m²) and ten obese (BMI:33.4±1.4 kg/m²) healthy male subjects were included. All subjects randomly received either pea protein solutions (250 mg/kg bodyweight in 0.4 ml/kg bodyweight of water) or placebo (0.4 ml/kg bodyweight of water), either orally or intraduodenally via a naso-duodenal tube. Appetite-profile, plasma GLP-1, CCK, and PYY concentrations were determined over a 2 h period. After 2 h, subjects received an ad-libitum meal and food-intake was recorded.

RESULTS

CCK levels were increased at 10(p<0.02) and 20(p<0.01) minutes after intraduodenal protein administration (IPA), in obese subjects, compared to lean subjects, but also compared to oral protein administration (OPA)(p<0.04). GLP-1 levels increased after IPA in obese subjects after 90(p<0.02) to 120(p<0.01) minutes, compared to OPA. Food-intake was reduced after IPA both in lean and obese subjects (-168.9±40 kcal (p<0.01) and -298.2±44 kcal (p<0.01), respectively), compared to placebo. Also, in obese subjects, food-intake was decreased after IPA (-132.6±42 kcal; p<0.01), compared to OPA.

CONCLUSIONS

Prevention of gastric proteolysis through bypassing the stomach effectively reduces food intake, and seems to affect obese subjects to a greater extent than lean subjects. Enteric coating of intact protein supplements may provide an effective dietary strategy in the prevention/treatment of obesity.

Interfacial & colloidal aspects of lipid digestion

Amongst the main issues challenging the food manufacturing sector, health and nutrition are becoming increasingly important. Global concerns such as obesity, the ageing population and food security will have to be addressed. Food security is not just about assuring food supply, but is also about optimising nutritional delivery from the food that is available [1]. Therefore one challenge is to optimise the health benefits from the lipids and lipid soluble nutrients. Colloid scientists have an affinity for lipids because they are water insoluble, however this presents a challenge to the digestive system, which has to convert them to structures that are less insoluble so they are available for uptake. Despite this, the human digestive system is remarkably effective at digesting and absorbing most lipids. This is primarily driven through maximising energy intake, as lipids possess the highest calorific value, which was a survival trait to survive times of famine, but is now an underlying cause of obesity in developed countries with high food availability. The critical region here is the lipid-water interface, where the key reactions take place to solubilise lipids and lipid soluble nutrients. Digestive lipases have to adsorb to the oil water interface in order to hydrolyse triacylglycerols into fatty acids and mono glycerides, which accumulate at the interface [2], and inhibit lipase activity. Pancreatic lipase, which is responsible for the majority of lipid hydrolysis, also requires the action of bile salts and colipase to function effectively. Bile salts both aid the adsorption of co-lipase and lipase, and help solubilise the lipolysis products which have accumulated at the interface, into mixed micelles composing bile salts and a range of other lipids, to facilitate transport to the gut mucosal surface prior to uptake and absorption. The process can be affected by the lipid type, as shorter chain, fatty acids are more easily absorbed, whereas the uptake of longer chain fatty acids, particularly the very long chain n-3 fatty acids from fish oils are dependent on source and so may depend on food microstructure for optimal uptake [3]. The uptake of some poorly water soluble nutrients are enhanced by the presence of lipids, but the mechanisms are not clear. In addition, controlling the digestion of lipids can be beneficial as slower release of lipids into the bloodstream can reduce risk of cardiovascular disease, and can promote gut feedback processes that reduce appetite. This presents an opportunity to colloid and interfacial science, as there are many unanswered questions regarding the specific physicochemical mechanisms underlying the process of lipid digestion and uptake. I will review our current knowledge of lipid digestion and present examples of how fundamental research in colloidal and interface science is beginning to address these issues. These include the adsorption behaviour of physiological surfactants such as bile salts; interfacial processes by which different polar lipids can influence lipolysis; and the effect of emulsion based delivery systems on cellular uptake of lipid soluble nutrients. A fundamental understanding of these processes is required if we are to develop intelligent design strategies for foods that will deliver optimal nutrition and improved health benefits in order to address the global challenges facing the food sector in the future.

Length and site of the small intestine exposed to fat influences hunger and food intake

The site of intestinal fat delivery affects satiety and may affect food intake in humans. Animal data suggest that the length of the small intestine exposed to fat is also relevant. The aim of the present study was to investigate whether increasing the areas of intestinal fat exposure and the way it is exposed would affect satiety parameters and food intake. In the present single-blind, randomised, cross-over study, fifteen volunteers, each intubated with a naso-ileal tube, received four treatments on consecutive days. The oral control (control treatment) was a liquid meal (LM) containing 6 g fat ingested at t = 0 min, with saline infusion at t = 30-120 min. Experimental treatments were a fat-free LM at t = 0 min, with either 6 g oil delivered sequentially (2 g duodenal, t = 30-60 min; 2 g jejunal, t = 60-90 min; 2 g ileal, t = 90-120 min), simultaneously (2 g each to all sites, t = 30-120 min) or ileal only (6 g ileal, t = 30-120 min). Satiety parameters (hunger and fullness) and cholecystokinin (CCK), glucagon-like peptide-1 (GLP-1), peptide YY (PYY) secretion were measured until t = 180 min, when ad libitum food intake was assessed. Only the ileum treatment reduced food intake significantly over the control treatment. The ileum and simultaneous treatments significantly reduced hunger compared with the control treatment. Compared with control, no differences were observed for PYY, CCK and GLP-1 with regard to 180 min integrated secretion. Ileal fat infusion had the most pronounced effect on food intake and satiety. Increasing the areas of intestinal fat exposure only affected hunger when fat was delivered simultaneously, not sequentially, to the exposed areas. These results demonstrate that ileal brake activation offers an interesting target for the regulation of ingestive behaviour.

Gastrointestinal targets to modulate satiety and food intake

This review discusses the role of enteroendocrine cells in the gastrointestinal tract as chemoreceptors that sense intraluminal contents and induce changes in food intake through the release of signalling substances, such as satiety hormones. Recent evidence supports the concept that chemosensing in the gut involves G protein-coupled receptors (GPCRs) that are known to mediate gustatory signals in the oral cavity. GPCRs can be grouped into several families, depending on the stimuli to which they respond, e.g. proteins, amino acids, carbohydrates, fatty acids, or tastants. Sensing of these stimuli by GPCRs results in hormone secretions of enteroendocrine cells, which participate in the control of food intake. A better understanding of the stimuli that induce the strongest binding with these receptors, and thus induce a strong release of hormones, can be a very useful strategy for the development of novel foods in the treatment of obesity.

Characterization of the hyperphagic response to dietary fat in the MC4R knockout mouse

Defective melanocortin signaling causes hyperphagic obesity in humans and the melanocortin-4 receptor knockout mouse (MC4R(-/-)). The human disease most commonly presents, however, as haploinsufficiency of the MC4R. This study validates the MC4R(+/-) mouse as a model of the human disease in that, like the MC4R(-/-), the MC4R(+/-) mouse also exhibits a sustained hyperphagic response to dietary fat. Furthermore, both saturated and monounsaturated fats elicit this response. N-acylphosphatidylethanolamine (NAPE) is a signaling lipid induced after several hours of high-fat feeding, that, if dysregulated, might explain the feeding behavior in melanocortin obesity syndrome. Remarkably, however, MC4R(-/-) mice produce elevated levels of NAPE and are fully responsive to the anorexigenic activity of NAPE and oleoylethanolamide. Interestingly, additional differences in N-acylethanolamine (NAE) biochemistry were seen in MC4R(-/-) animals, including reduced plasma NAE levels and elevated hypothalamic levels of fatty acid amide hydrolase expression. Thus, while reduced expression of NAPE or NAE does not explain the high-fat hyperphagia in the melanocortin obesity syndrome, alterations in this family of signaling lipids are evident. Analysis of the microstructure of feeding behavior in response to dietary fat in the MC4R(-/-) and MC4R(+/-) mice indicates that the high-fat hyperphagia involves defective satiation and an increased rate of food intake, suggesting defective satiety signaling and enhanced reward value of dietary fat.

Gastrointestinal metabolism of a vegetable-oil emulsion in healthy subjects

BACKGROUND

Given the growing prevalence of overweight and obesity, weight-management strategies could be developed based on the effect of specific food ingredients on the gastrointestinal system to reduce food intake.

OBJECTIVE

The aim of this study was to investigate the mechanisms by which a vegetable-oil emulsion may exert its effect on satiety by applying a multilumen tube to investigate digestion and absorption of lipids in the stomach and proximal jejunum.

DESIGN

We gave 16 healthy, normal-weight subjects (in a double-blind, placebo-controlled crossover design) a test product (yogurt with a vegetable-oil emulsion) or an equal-calorie control by intragastric administration on 2 separate occasions. Gastric and intestinal samples were collected from the proximal jejunum during 180 min.

RESULTS

We observed almost double amounts (P < 0.05) of total lipids, mainly as free fatty acids, from the test product (450 +/- 119 mg) in the proximal jejunum compared with amounts of total lipids from the control product (230 +/- 50 mg), and an over-time difference of free fatty acid concentrations was observed between the products (P < 0.05). To our knowledge, a novel and unexpected finding was the appearance of needle-shaped crystals in the jejunal samples that originated from the vegetable-oil emulsion and consisted of saturated fatty acids. Crystals were only rarely seen in the control samples.

CONCLUSION

The higher amount of lipids in the proximal jejunum and the recovery of crystals in the intestinal samples after test-product infusion provide a plausible physiologic explanation for the ileal brake mechanism that leads to the increased satiety observed for this test product.

Effect of fat emulsion (Fabuless) on orocecal transit time in healthy men

BACKGROUND

Given the growing prevalence of overweight and related health consequences, there is increased interest in the search for novel dietary strategies for weight control. A food ingredient, an emulsion based on palm and oat oil (Fabuless, previously known as Olibra), has been associated with short-term reductions of food intake, induction of satiety, alternation in the satiety hormones, as well as long-term effects on weight control. The mechanism by which it can exert these effects is so far unclear, though it has been suggested that the "ileal break" may play a role in increasing gastrointestinal transit time. The aim of this study was to investigate the effects of this stable fat emulsion on orocecal transit time in healthy men.

MATERIAL AND METHODS

In a controlled, double-blind, cross-over-designed study, 15 healthy men (aged 20-59 years, body mass index (BMI) 22-28), randomly allocated to two treatments, consumed the stable fat emulsion or a milk fat in yoghurt during two days of investigation, with an interval of 1 week. Orocecal transit time was determined by following blood sulfapyridine levels, which is a metabolite of salazopyrine in the colon.

RESULTS

A statistically significant delay in the appearance of sulfapyridine in serum was obtained after active treatment versus control treatment, corresponding to a 45-min longer orocecal transit time due to fat emulsion consumption.

CONCLUSIONS

This study provides the first evidence to suggest that this stable fat emulsion may affect the ileal brake mechanism by slowing down the gastrointestinal transit time, which might explain the weight control and appetite suppression previously observed in association with this emulsion.

Effect of fat saturation on satiety, hormone release, and food intake

BACKGROUND

Ileal delivery of fat reduces hunger and food intake through activation of the ileal brake. Physicochemical properties of fat have been shown to affect satiety and food intake.

OBJECTIVE

The objective of this study was to assess the effect of ileal fat emulsions with differing degrees of fatty acid saturation on satiety, food intake, and gut peptides (cholecystokinin and peptide YY). We hypothesized that long-chain triacylglycerols with diunsaturated fatty acids would increase satiety and reduce energy intake compared with long-chain triacylglycerols with monounsaturated or saturated fatty acids.

DESIGN

We performed a double-blind, randomized, crossover study in which 15 healthy subjects [mean age: 24 y; mean body mass index (in kg/m(2)): 22] were intubated with a naso-ileal catheter and participated in 4 experiments performed in random order on 4 consecutive days. After consumption of a liquid meal, subjects received a fat or control infusion in the ileum. Fat emulsions consisted of 6 g of 18:0 (shea oil; mainly 18:0), 18:1 (canola oil; mainly 18:1), or 18:2 (safflower oil; mainly 18:2) oils. Food intake was measured during an ad libitum lunch. Satiety questionnaires (visual analog scale) and blood samples were collected at regular intervals.

RESULTS

Compared with the control, only 18:2 and 18:1 significantly increased fullness and reduced hunger. No effect on food intake was observed. 18:1 and 18:2 increased cholecystokinin secretion significantly compared with the control. Fatty acid saturation did not affect peptide YY secretion.

CONCLUSIONS

When infused into the ileum, triacylglycerols with unsaturated fatty acids increase satiety, whereas triacylglycerols with saturated fatty acids does not. This trial was registered with the Dutch Trial Register as: ISRCTN51742545.