In vitro digestion of complex foods: How microstructure influences food disintegration and micronutrient bioaccessibility

Understanding of formation, gastrointestinal breakdown, and application of whey protein emulsion gels: Insights from intermolecular interactions

Whey protein emulsion gel is an ideal model food for revealing how the multilength scale food structures affect food digestion, as their structure and mechanical properties can be precisely manipulated by controlling the type and intensity of intermolecular interactions between protein molecules. However, there are still significant understanding gaps among intermolecular interactions, protein aggregation and gelation, emulsion gel formation, gel breakdown in the gastrointestinal tract (GIT), and the practical use of whey protein emulsion gels, which limits their GIT-targeted applications. In this regard, the relationship between the structure and digestion behavior of heat-set whey protein emulsion gels is reviewed and discussed mainly from the following aspects: (1) structural characteristics of whey protein molecules; (2) how different types of intermolecular interactions influence heat-induced aggregation and gelation of whey protein in the aqueous solutions and the oil-in-water emulsions, and the mechanical properties of the final gels; (3) functions of the mouth, the stomach, and the small intestine in processing of solid foods, and how different types of intermolecular interactions influence the breakdown properties of heat-set whey protein emulsion gels in GIT (i.e., their respective role in controlling gel digestion). Finally, the implications of knowledge derived from the formation and gastrointestinal breakdown of heat-set whey protein emulsion gels for developing controlled delivery vehicles, human satiety enhancers, and sensory modifiers are highlighted.

Effect of high pressure homogenization on in vitro digestibility and colon fermentability of pea protein-rich bread designed for elderly consumers

Enrichment of staple foods with proteins can be a solution to tackle protein-energy malnutrition in the elderly. For instance, bread can be enriched with pea proteins that are cheap, sustainable and easily digestible. Non-conventional technologies, such as high pressure homogenization (HPH), can improve the digestibility of plant proteins. To characterize the health functionality of pea-enriched bread, a functional bread tailored to elderly consumers was developed by substituting 5% wheat flour with untreated or HPH-treated pea protein concentrate. Protein digestibility and colon fermentability were assessed by mimicking elderly in vitro gastrointestinal and gut microbiota conditions and compared with adult conditions. Bread reformulation with pea proteins affected physical and chemical properties and produced an increase in hardness, which is one of the key features for the acceptability of bread by the elderly. The highest hardness value was observed for pea protein bread, followed by HPH-treated pea protein bread and wheat bread. In vitro protein digestibility and fermentability were affected by reformulation and by physiological digestive conditions, with lower digestibility under elderly conditions compared to adult ones. The obtained results may contribute to a better understanding of food digestibility under different gastrointestinal conditions and its dependence on physiological and formulation factors, and ultimately would help to design age-tailored foods.

Walnut protein isolate based emulsion as a promising delivery system enhanced lutein bioaccessibility

Lutein, a natural pigment with multiple beneficial bioactivities, faces limitations in food processing due to its instability. In this study, we constructed four modified walnut protein isolate (WNPI) based emulsions as emulsion-based delivery systems (EBDS) for lutein fortification. The modification treatments enhanced the encapsulation efficiency of the WNPI-based EBDS on lutein. The modified WNPI-based EBDS exhibited improved storage and digestive stability, as well as increased lutein delivery capability in simulated gastrointestinal conditions. After in vitro digestion, the lutein retention in the modified WNPI-based EBDS was higher than in the untreated WNPI-based EBDS, with a maximum retention of 49.67 ± 1.10 % achieved after ultrasonic modification. Furthermore, the modified WNPI-based EBDS exhibited an elevated lutein bioaccessibility, reaching a maximum value of 40.49 ± 1.29 % after ultrasonic modification, nearly twice as high as the untreated WNPI-based EBDS. Molecular docking analysis indicated a robust affinity between WNPI and lutein, involving hydrogen bonds and hydrophobic interactions. Collectively, this study broadens WNPI's application and provides a foundation for fortifying other fat-soluble bioactive substances.

Probabilistic Modelling of the Food Matrix Effects on Curcuminoid's In Vitro Oral Bioaccessibility

The bioaccessibility of bioactive compounds plays a major role in the nutritional value of foods, but there is a lack of systematic studies assessing the effect of the food matrix on bioaccessibility. Curcuminoids are phytochemicals extracted from Curcuma longa that have captured public attention due to claimed health benefits. The aim of this study is to develop a mathematical model to predict curcuminoid's bioaccessibility in biscuits and custard based on different fibre type formulations. Bioaccessibilities for curcumin-enriched custards and biscuits were obtained through in vitro digestion, and physicochemical food properties were characterised. A strong correlation between macronutrient concentration and bioaccessibility was observed (p = 0.89) and chosen as a main explanatory variable in a Bayesian hierarchical linear regression model. Additionally, the patterns of food matrix effects on bioaccessibility were not the same in custards as in biscuits; for example, the hemicellulose content had a moderately strong positive correlation to bioaccessibility in biscuits (p = 0.66) which was non-significant in custards (p = 0.12). Using a Bayesian hierarchical approach to model these interactions resulted in an optimisation performance of r2 = 0.97 and a leave-one-out cross-validation score (LOOCV) of r2 = 0.93. This decision-support system could assist the food industry in optimising the formulation of novel food products and enable consumers to make more informed choices.

Differential Digestive Stability of Food-Derived microRNAs: The Case of miR-30c-5p and miR-92a-3p in Polyfloral Honey

Dietary microRNAs (miRs) represent a new area in food science. Although they have been found in many foods, including honey, more research is needed about their stability and fate during digestion. Hence, this study aimed to analyze the digestive stability of two selected miRs in honey. We extracted miR-92a-3p and miR-30c-5p from pasteurized and unpasteurized forms of polyfloral honey using two different methods and kits: a column-based manual method and a phenol-free semi-automated magnetic-bead-based method. The latter option was used for the subsequent analysis of samples according to the INFOGEST static in vitro digestion protocol. Also, the honey samples were examined for exosome-like particles using dynamic light scattering. Although the expression levels of both miRs were significantly lower following intestinal digestion, we found a difference in the resilience of the miRs to gastrointestinal conditions, with miR-30c-5p being relatively stable compared to miR-92a-3p following digestion, regardless of the honey's pasteurization treatment. Moreover, there was marked heterogeneity in the extracellular vesicle profile of the pasteurized sample. We identified the presence of two broadly conserved miRs in honey: miR-92a-3p and miR-30c-5p. Despite honey exhibiting high digestibility, miR-92a-3p was less resilient than miR-30c-5p, demonstrating considerable resistance under gastrointestinal conditions. Although further research is needed, the results obtained from this study may represent a starting point for utilizing honey as a source of exogenous miRNAs for preventive strategies and more "natural" treatments.

In vitro gastric digestion of polysaccharides in mixed dispersions: Evaluating the contribution of human salivary α-amylase on starch molecular breakdown

The aim of this work was to investigate the impact of the addition of salivary α-amylase on starch hydrolysis in protein-containing dispersions during an in vitro digestion process. In vitro digestion provides useful insights on the fate of nutrients during gastro-intestinal transit in complex food matrices, an important aspect to consider when developing highly nutritious foods. Many foods contain polysaccharides, and as their disruption in the gastric stage is limited, salivary α-amylase is often neglected in in vitro studies. A reference study on the effect of salivary α-amylase using one of the most advanced and complex in vitro digestion models (INFOGEST) is, however, not available. Hence, this work reports the gastrointestinal breakdown of three mixed dispersions containing whey protein isolate with different polysaccharides: potato starch, pectin from citrus peel and maize starch. The latter was also studied after heating. No polysaccharide or salivary α-amylase-dependent effect on protein digestion was found, based on the free NH2 and SDS-PAGE. However, in the heat-treated samples, the addition of salivary α-amylase showed a significantly higher starch hydrolysis compared to the sample without α-amylase, due to the gelatinization of the starch granules, which improved the accessibility of the starch molecules to the enzyme. This work demonstrated that the presence of different types of polysaccharides does not affect protein digestion, but also it emphasizes the importance of considering the influence of processing on food structure and its digestibility, even in the simplest model systems.

How food matrices modulate folate bioaccessibility: A comprehensive overview of recent advances and challenges

The incomplete absorption of dietary folate makes it crucial to understand how food matrices affect folate bioaccessibility. Bioavailability encompasses bioaccessibility, which depicts the proportion that is liberated from the food matrix during digestion and becomes available for absorption. Bioavailability studies are expensive and difficult to control, whereas bioaccessibility studies utilize in vitro digestion models to parameterize the complex digestion, allowing the evaluation of the effect of food matrices on bioaccessibility. This review covers the folate contents in various food matrices, the methods used to determine and the factors affecting folate bioaccessibility, and the advances and challenges in understanding how food matrices affect folate bioaccessibility. The methods for determining bioaccessibility have been improved in the last decade. Current research shows that food matrices modulate folate bioaccessibility by affecting the liberation and stability of folate during digestion but do not provide enough information about folate and food component interactions at the molecular level. In addition, information on folate interconversion and degradation during digestion is scant, hindering our understanding of the impact of food matrices on folate stability. Moreover, the role of conjugase inhibitors should not be neglected when evaluating the nutritional value of food folates. Due to the complexity of food digestion, holistic methods should be applied to investigate bioaccessibility. By synthesizing the current state of knowledge on this topic, this review highlights the lack of in-depth understanding of the mechanisms of how food matrices modulate folate bioaccessibility and provides insights into potential strategies for accurate evaluation of the nutritional value of dietary folate.

Effects of Matrix Structure on Protein Digestibility and Antioxidant Property of Different Soybean Curds During In Vitro Digestion

This study compared the three most common types of tofu (soybean curd), which were prepared by using magnesium chloride (MgCl2 tofu), calcium sulfate (CaSO4 tofu), and glucono-δ-lactone (GDL tofu) coagulants. The results showed that GDL tofu had a higher water holding capacity than MgCl2 tofu and CaSO4 tofu, which was attributed to its high surface hydrophobicity and disulfide bond content. GDL tofu possessed the lowest firmness, gumminess, and chewiness, along with a uniform network structure and a thin protein matrix. In contrast, MgCl2 tofu exhibited an inhomogeneous network structure with a thick protein matrix. Combining the results of protein hydrolysis degree, SDS-PAGE, and free amino acids during in vitro digestion, it was indicated that the degree of protein digestion in GDL tofu was the highest. After intestinal digestion, GDL tofu had the highest total phenolic content, ferric reducing antioxidant power, and DPPH value. These results demonstrated the superior protein digestibility and antioxidant property of GDL tofu during in vitro digestion due to its structural characteristics that facilitate enzyme diffusion in the matrix. The findings offer insight into the protein digestibility and antioxidant properties of different types of tofu during digestion from structural characteristic perspective and valuable reference information for consumer dietary nutrition.

The role of food structure in gastric-emptying rate, absorption and metabolism

The high levels of non-communicable diseases such as CVD and type 2 diabetes mellitus are linked to obesity and poor diet. This continuing emphasis on health in relation to food is proving a powerful driver for the development of cheap but palatable and more functional foods. However, the efficacy of such foods is often hard to prove in human subjects. Thus, a suite of tools has been developed including in silico and in vitro simulations and animal models. Although animal models offer physiologically relevant platforms for research, their use for experimentation is problematic for consumers. Thus, in vitro methods such as Infogest protocols have been developed to provide digestion endpoints or even an indication of the kinetics of digestion. These protocols have been validated for a range of food systems but they still miss the final absorption step. This review discusses the use of such in vitro models and what further steps need to be included to make the bioaccessibility determination more relevant to bioavailability and human health.

A Novel Approach to Serving Plant-Based Confectionery-The Employment of Spray Drying in the Production of Carboxymethyl Cellulose-Based Delivery Systems Enriched with Teucrium montanum L. Extract

In this study, spray drying was used as a technological solution for the valorization of Teucrium montanum extract into carboxymethyl cellulose-based delivery systems (CMC), individually or in combination with collagen, guar gum, gum arabic, and kappa-carrageenan. The results showed that the process yield and morphological properties were positively influenced by the introduction of CMC binary blends. The employment of CMC resulted in a high encapsulation efficiency (77-96%) for all phenylethanoid glycosides (PGs) analyzed. Due to the low wettability of the microparticles, a relatively gradual in vitro release of the PGs was achieved. Infusion of the filling with hydrophilic T. montanum extract encapsulated in microparticles with high hydrophobic surface area proved to be a practical route for significant confectionery fortification (5-9 mg PGs per dw serving), ensuring prolonged interaction between the food matrix used and the extract under simulated gastrointestinal conditions. Based on sensory evaluation, the introduction of kudzu starch into the jelly matrix has shown a texture-modifying potential.

Adult and elderly in vitro digestibility patterns of proteins and carbohydrates as affected by different commercial bread types

Carbohydrate and protein digestibility were assessed in different commercial bread types, i.e., soft, durum, and whole wheat, by applying in vitro digestion protocols mimicking adult or elderly physiological conditions. Protein digestibility was measured after the gastric and intestinal phases by the o-phthalaldehyde spectrophotometric assay (OPA). Carbohydrate digestibility was assessed by determining the incremental area under glucose curve during the intestinal phase of digestion to estimate the glycaemic index (GI_e). Finally, the correlation between protein and carbohydrate digestibility was computed. Bread proteins presented a high gastric resistance, with a digestibility < 10% in all cases while after the intestinal phase, protein digestibility increased, ranging from 40 to 70%. Protein digestibility was affected both by formulation, with whole wheat bread presenting the lowest values, and by physiological conditions, with restrained digestibility under elderly conditions compared to adult ones. The GI_e decreased in the order durum > soft > whole, under both adult (119, 101, and 82, respectively) and elderly (107, 93, and 65, respectively) conditions. The extent of differences under different physiological settings varied depending on the bread type, without significant changes for soft wheat bread (ΔGI_e = 8), whereas elderly conditions significantly reduced GI_e both for durum (ΔGI_e = 12) and whole (ΔGI_e = 17) wheat bread. An almost strong positive correlation between protein digestibility and GI_e was observed (p = 0.69), indicating that concomitantly addressing sarcopenia and type 2 diabetes can only be pursued by a compromise solution or more desirably requires identifying technological strategies to maximize protein digestibility while restraining the glycaemic response.

Current trends and perspectives on bioaccessibility and bioavailability of food bioactive peptides: in vitro and ex vivo studies

The bioaccessibility and bioavailability of food-derived bioactive compounds are important issues when assessing their in vivo physiological health-promoting effects. Food components such as proteins and peptides are exposed to different proteases and peptidases during gastrointestinal digestion and absorption. Different in vitro approaches have therefore been developed to evaluate the bioaccessibility and stability of bioactive peptides. The static simulated gastrointestinal digestion model (SGD) was widely reported to assess the bioaccessibility of bioactive peptides. On the other hand, although the dynamic SGD model may better simulate human digestion, it has rarely been explored in bioaccessibility studies of food bioactive peptides due to its high cost and lack of standardization. For bioavailability studies, the Caco-2 cell monolayer model has been used extensively for the assessment of food bioactive peptides. In fact, very few reports using alternative methods for determining transepithelial transport of bioactive peptides have been employed. In this sense, ex vivo tissue-based models such as the Ussing chamber and the everted sac gut have been used. Current evidence supports the fact that using SGD with cell-based models for evaluating the bioaccessibility, absorption, and bioavailability of food-derived bioactive peptides, is the most commonly used approach. Nevertheless, SGD with ex vivo tissue-based models such as the everted sac, remains to be further explored because it seems to be the model that better mimics the physiological process - it is also fast and inexpensive, and several compounds may be tested simultaneously. In the present review, we discuss information available on the different in vitro approaches for the determination of bioaccessibility and bioavailability of food-derived bioactive peptides with special emphasis on ex vivo tissue-based models such as the everted sac and the Ussing chamber models. © 2022 Society of Chemical Industry.

Designing food for the elderly: the critical impact of food structure

Ageing is an unavoidable progressive process causing many changes of the individual life. However, if faced in an efficient way, living longer in a healthy status could be an opportunity for all. In this context, food consumption and dietary patterns are pivotal factors in promoting active and healthy ageing. The development of food products tailored for the specific needs of the elderly might favour the fulfilment of nutritionally balanced diets, while reducing the consequences of malnutrition. To this aim, the application of a food structure design approach could be particularly profitable, being food structure responsible to the final functionalities of food products. In this narrative review, the physiological changes associated to food consumption occurring during ageing were firstly discussed. Then, the focus shifted to the possible role of food structure in delivering target functionalities, considering food acceptability, digestion of the nutrients, bioactive molecules and probiotic bacteria.

Compositional, Structural, and Kinetic Aspects of Lipid Digestion and Bioavailability: In Vitro, In Vivo, and Modeling Approaches

Lipid digestion and bioavailability are usually investigated separately, using different approaches (in vitro, modeling, in vivo). However, a few inclusive studies show that their kinetics are closely linked. Lipid bioavailability kinetics is likely involved in the development and evolution of several diseases, so lipid digestion kinetics could be involved as well and can be modulated by food design or combination. To illustrate this possibility, the compositional and structural aspects of lipid digestion kinetics, as investigated using in vitro and modeling approaches, are presented first. Then, in vivo and mixed approaches enabling the study of both kinetics are reviewed and discussed. Finally, disparate modeling approaches are introduced, and a unifying modeling scheme is proposed, opening new perspectives for understanding the role and interactions of various factors (chemical, physical, and biological) involved in lipid metabolism.

Expected final online publication date for the Annual Review of Food Science and Technology, Volume 13 is March 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

The Bioaccessibility of Folate in Breads and the Stability of Folate Vitamers during in vitro Digestion

Both the liberation and stability of endogenous folate are relevant to the bioaccessibility of folate. Since folates are unstable, in addition to studying the natural folate content in foods, bioaccessibility...

Childhood lead exposure of Amerindian communities in French Guiana: an isotopic approach to tracing sources

In French Guiana were detected high lead (Pb) levels in blood of Amerindian people. Lead exposure is a serious hazard that can affect the cognitive and behavior development. People can be exposed to Pb through occupational and environmental sources. Fingerprinting based on stable Pb isotopes in environmental media is often used to trace natural and anthropogenic sources but is rarely paired with blood data. The objective of this study was to determine the main factors associated with high Blood Lead Levels (BLL). Soil, manioc tubers, food bowls, beverages, wild games, lead pellets and children blood were sampled in small villages along the Oyapock River. children BLL ranged between 5.7 and 35 µg dL^-1, all exceeding 5 µg dL^-1, the reference value proposed in epidemiologic studies for lead poisoning. Among the different dietary sources, manioc tubers and large game contained elevated Pb concentrations while manioc-based dishes were diluted. The isotopes ratios (²⁰⁷Pb/²⁰⁶Pb and ²⁰⁸Pb/²⁰⁶Pb) of children blood overlapped these of lead shots and meals. These first results confirm for the first time, the diary consumption of manioc-based food as the main contributor to Amerindian children's BLL in French Guiana, but don't exclude the occasional exposure to lead bullets by hunting activities. This is a specific health concern, since previous studies have shown that these same villagers present high levels of mercury (Hg). These communities are indeed subject to a double exposure to neurotoxic metals, Hg and Pb, both through their diet. The farming activity is based on manioc growing, and explaining that this ancestral practice can induce serious health risks for the child's development may seriously affect their food balance and cultural cohesion.

Advances in static in vitro digestion models after the COST action Infogest consensus protocol

In vitro digestion models are essential to predictively evaluate the bioaccessibility and bioactivity of food molecules or natural products. Dynamic models better simulate the gastrointestinal conditions as they reproduce similar physiological environments. Despite this, static methods, also known as biochemical methods, represent a simple and useful approach for the study of different types of molecules, with a broad applicability in the nutritional, pharmaceutical, and toxicological fields. In addition, static models can be validated, avoiding the disadvantage of a difficult reproducibility of dynamic in vitro systems and inter-individual variations of in vivo experiments. A crucial point in the standardization of static models was the COST Action Infogest in 2014, which elaborated an international consensus static digestion method to harmonize experimental conditions and has general guidelines, thus allowing the comparison of studies and data. The aim of our review is to underline the impact of the Infogest consensus method and the development and evolution of in vitro static methods in the following years, with a focus on food applications.

The Effect of Balsamic Vinegar Dressing on Protein and Carbohydrate Digestibility is Dependent on the Food Matrix

The balsamic vinegar of Modena (BVM), a food specialty under the European Protected Geographical Indication system, is made from grape must blended with wine vinegar exclusively in the Italian province of Modena or Reggio Emilia. Vinegar is associated to an improved digestive function and glycemic response to carbohydrate-rich meals, appetite stimulation, and reduction of hyperlipidemia and obesity. Although many of these effects are attributed to the high concentration of bioactive molecules, the modulation of digestive enzymes activity could have a role. The aim of this study was to investigate the effect of BVM on the digestibility and component release of three foods that are often seasoned with this dressing but have different composition: Parmigiano Reggiano cheese, Bresaola (cured meat), and boiled potatoes. BVM modulated the protein digestion of protein-rich foods (cheese and cured meat) in a matrix-dependent manner, and the BVM effect was mainly related to the inhibition of pepsin in the gastric phase. In the starch-rich food (boiled potatoes), the most impressive effect of BVM was the lower release of anomeric and total carbohydrates, which was consistent with the observed reduction of pancreatic amylase activity. The present investigation shed a new light on the impact of BVM on the digestion process.

Impact of in vitro gastrointestinal digestion on peptide profile and bioactivity of cooked and non-cooked oat protein concentrates

Oat (Avena sativa) is one of the most cultivated and consumed cereals worldwide. Recognized among cereals for its high protein content (12%-24%), it makes it an excellent source of bioactive peptides, which could be modified during processes such as heating and gastrointestinal digestion (GID). This work aims to evaluate the impact of heat treatment on the proteolysis of oat proteins and on the evolution of antioxidant peptide released during in vitro static GID, in terms of comparative analysis between cooked oat protein concentrate (COPC) and non-heated oat protein concentrate (OPC) samples. The protein extraction method and cooking procedure used showed no detrimental effects on protein quality. After GID, the proportion of free amino acids/dipeptides (<0.2 ​kDa) reached >40% for both samples (OPC and COPC), thus producing peptides with low molecular weight and enhanced bioactivity. Furthermore, during GID, the amino acid profile showed an increase in essential, positively-charged, hydrophobic and aromatic amino acids. At the end of GID, the reducing power of OPC and COPC increased >0.3 and 8-fold, respectively, in comparison to the non-digested samples; while ABTS•+ and DPPH• showed a >20-fold increase. Fe2+ chelating capacity of OPC and COPC was enhanced >4 times; similarly, Cu2+ chelation showed a >19-fold enhancement for OPC and >10 for COPC. β-carotene bleaching activity was improved 0.8 times in OPC and >9 times in COPC; the oxygen radical antioxidant capacity assay increased 2 times in OPC and >4.7 times in COPC, respectively. This study suggests that OPC after cooking and GID positively influenced the nutritional and bioactive properties of oat peptides. Thus, COPC could be used as a functional food ingredient with health-promoting effects, as hydrothermal treatment is frequently used for this type of cereals.

Bioaccessibility of folate in faba bean, oat, rye and wheat matrices

Cereals and legumes are rich in folate. However, due to the instability of folate, processing and digestion can induce significant folate loss. In this paper, folate bioaccessibility of faba bean, oat, rye and wheat flours and pastes was studied using a static in vitro digestion model. Folate bioaccessibility depended on food matrices, varying from 42% to 67% in flours and from 40% to 123% in pastes. Digestion was associated with the interconversion of formyl folates, as well as the increase of oxidised vitamers and decrease of reduced vitamers. Especially in faba bean, 5-methyltetrahydrofolate showed surprisingly good stability both in digestion and heat treatment, resulting in high bioaccessibility. The physiological concentration of ascorbic acid did not stabilise folate in digestion; however, a higher level helped to maintain reduced vitamers. Heat treatment (10-min paste making) could improve folate bioaccessibility by liberating folate from the food matrices and by altering folate vitamer distribution.

Clinical evaluation of an evidence-based method based on food characteristics to adjust pancreatic enzyme supplements dose in cystic fibrosis

BACKGROUND

Patients with cystic fibrosis (CF) and pancreatic insufficiency need pancreatic enzyme replacement therapy (PERT) for dietary lipids digestion. There is limited evidence for recommending the adequate PERT dose for every meal, and controlling steatorrhea remains a challenge. This study aimed to evaluate a new PERT dosing method supported by a self-management mobile-app.

METHODS

Children with CF recruited from 6 European centres were instructed to use the app, including an algorithm for optimal PERT dosing based on in vitro digestion studies for every type of food. At baseline, a 24h self-selected diet was registered in the app, and usual PERT doses were taken by the patient. After 1 month, the same diet was followed, but PERT doses were indicated by the app. Change in faecal fat and coefficient of fat absorption (CFA) were determined.

RESULTS

58 patients (median age 8.1 years) participated. Baseline fat absorption was high: median CFA 96.9%, median 2.4g faecal fat). After intervention CFA did not significantly change, but range of PERT doses was reduced: interquartile ranges narrowing from 1447-3070 at baseline to 1783-2495 LU/g fat when using the app. Patients with a low baseline fat absorption (CFA<90%, n=12) experienced significant improvement in CFA after adhering to the recommended PERT dose (from 86.3 to 94.0%, p=0.031).

CONCLUSION

the use of a novel evidence-based PERT dosing method, based on in vitro fat digestion studies incorporating food characteristics, was effective in increasing CFA in patients with poor baseline fat absorption and could safely be implemented in clinical practice.