Post-meal perceivable satiety and subsequent energy intake with intake of partially hydrolysed guar gum

Changes in Digestive Health, Satiety and Overall Well-Being after 14 Days of a Multi-Functional GI Primer Supplement

A recent review proposed a role for multi-functional food or supplement products in priming the gut to support both digestive and systemic health. Accordingly, we designed and eva-luated the effect of a multi-functional gastrointestinal (GI) primer supplement on participant-reported measures for digestive health, quality-of-life (e.g., energy/vitality and general health), and reasons for satiation (e.g., attitudes towards food and eating). In this single-arm clinical trial, 68 participants with mild digestive symptoms consumed the GI primer supplement daily for 14 days. Digestive symptoms were evaluated daily from baseline (Day 0) through Day 14. At baseline and Day 14, participants reported their stool consistency, reasons for satiation, and quality-of-life measures using validated questionnaires. At Day 14, participants reported significant improvements in all (13/13) digestive symptom parameters (p-values < 0.05) and an increase in % of stools with normal consistencies. There were significant improvements (p-values < 0.05) in energy/vitality and general health, and in specific attitudes towards food and eating (e.g., physical satisfaction, planned amount, decreased eating priority, decreased food appeal, and self-consciousness). Results suggest the GI primer supplement promotes digestive health, improves quality of life, and impacts attitudes towards food/eating. This study provides preliminary support for the gut priming hypothesis through which multi-functional digestive products may improve GI health.

A semi dynamic in vitro digestion study of milk protein concentrate dispersions structured with different polysaccharides

Hydrocolloids are often added as functional ingredients in foods, to better design the structure of the matrix and ensure food quality and optimal sensory properties. However, much less is known about their influence on the physical and chemical changes during gastric digestion. In this study, semi-continuous in vitro gastric digestion was applied on a model food system, prepared with milk protein concentrate (MPC) (3% w/v) and 1% alginate, pectin, guar gum, as well as a 1:1 mixture of alginate and pectin. The dynamics during simulated gastric digestion were observed by measuring particle size distributions, structuring at various length scales, as well as by evaluating differences in protein breakdown. Immediately after contact with the simulated gastric fluids, all samples showed extensive aggregation and formation of different structures. MPC control dispersions (no polysaccharide) and MPC containing alginate formed large inhomogeneous aggregates. The lack of structural homogeneity affected the simulated gastric emptying: there were marked differences in the type of aggregates present at various times of emptying depending on the hydrocolloid present in the mixture. MPC containing pectin or guar gum formed macroscopically homogeneous dispersion, with rather small protein aggregates showing a large population of particles between 60 and 100 ​μm of diameter, with marked differences in microstructure. Pectin created large coacervates, while guar microscopic phase separated systems. These dispersions showed a higher extent of protein digestion, due to the larger surface area created for enzyme activity compared to the macroscopically phase separated matrices. In all cases, there was a large undigested fraction at the end point of 140 ​min. SDS PAGE demonstrated differences in the casein peptides distribution depending on the type of polysaccharide present during simulated gastric emptying. This in spite of similarities in cumulative protein emptied. It was concluded that in this semi-continuous in vitro gastric digestion model, structuring with polysaccharides has a significant impact on gastric emptying and protein digestion kinetics.

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Protein-hydrocolloid interactions cause differences in structuring during gastrointestinal transit.

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Milk protein concentrates show different proteolysis kinetics during gastric digestion depending on aggregates formed.

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Milk protein concentrates with alginates show a delay in digestion.

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Pectin and guar form homogenous dispersions during gastric digestion.

Effect of Repeated Consumption of Partially Hydrolyzed Guar Gum on Fecal Characteristics and Gut Microbiota: A Randomized, Double-Blind, Placebo-Controlled, and Parallel-Group Clinical Trial

Partially hydrolyzed guar gum (PHGG) is a water-soluble dietary fiber and is used in solid and liquid food to regulate gut function. The aim of this study was to investigate effects of PHGG on bowel movements (stool form and frequency), plasma bile acids, quality of life, and gut microbiota of healthy volunteers with a tendency toward diarrhea, i.e., irritable bowel syndrome diarrhea (IBS-D)-like symptoms. A randomized, double-blind, placebo-controlled, and parallel trial was performed on 44 healthy volunteers (22 males, 22 females, 41.9 ± 6.3 years old (average ± SD)) with minimum 7 bowel movements every week, wherein above 50% of their stool was between the Bristol stool scale (BSS) value of 5 and 6. Intake of the PHGG for 3 months significantly improved stool form, evaluated using BSS, and had no effects on stool frequency. BSS was significantly normalized in the group consuming the PHGG compared with the placebo. Comprehensive fecal microbiome analysis by the 16S rRNA-sequence method detected significant changes in the ratio of some bacteria, such as an increase of Bifidobacterium (p < 0.05) in the PHGG group. Our results suggest that intake of PHGG improves human stool form via regulating intestinal microbiota.

Perspective: Physiologic Importance of Short-Chain Fatty Acids from Nondigestible Carbohydrate Fermentation

In recent years, it has become increasingly obvious that dietary fiber or nondigestible carbohydrate (NDC) consumption is critical for maintaining optimal health and managing symptoms of metabolic disease. In accordance with this, the US FDA released its first official definition of dietary fiber in 2016 for regulation of Nutrition and Supplement Facts labels. Included in this definition is the requirement of an isolated or synthetic NDC to produce an accepted physiologic health benefit, such as improved laxation or reduced fasting cholesterol concentrations, upon consumption. Even though NDC fermentation and production of short-chain fatty acids elicit many physiologic effects, including serving as a source of energy for colonocytes, curbing glycemic response and satiety, promoting weight loss, enhancing mineral absorption, reducing systemic inflammation, and improving intestinal health, the process of fermentation is not considered a physiologic endpoint. Instead, expensive and laborious clinical trials must be conducted and an accepted physiologic benefit observed. In this review, we discuss the physiologic importance of NDC fermentation through extensive examination of clinical evidence and propose that the degree of fermentability of an NDC, rather than the endpoints of a clinical trial, may be appropriate for classifying it as a dietary fiber.

Randomized controlled trial on efficacy of oligomeric formula (HINE E-GEL®) versus polymeric formula (MEIN®) enteral nutrition after esophagectomy for esophageal cancer with gastric tube reconstruction

The efficacy of early enteral nutrition after esophageal cancer surgery has been reported. However, the choice of formula and management of diarrhea are important to achieve the goal of enhanced recovery after surgery. The aim of this study is to assess the frequency of diarrhea/completion rate of enteral nutrition regimen as primary endpoints and the postoperative nutritional status/body composition analysis/operative morbidity as secondary endpoints was compared between the two nutrition groups. Among the 122 patients who underwent esophagectomy for esophageal cancer between December 2015 and September 2017, 67 patients who met the eligibility criteria were randomly assigned to receive enteral nutrition with either HINE E-GEL® (HINE group; n = 33) or MEIN® (MEIN group; n = 34). The incidence of diarrhea was significantly lower in the HINE group (18.2 % vs. 64.7 %, P < 0.001). The score of Bristol scale of POD 6/7 was significantly lower in the HINE group (P = 0.019/P = 0.006, respectively). The completion rate of enteral nutrition regimen was significantly higher in the HINE group (97.4 % vs. 86.6 %, P = 0.002). The Controlling Nutritional Status scores and total protein levels at 6 months after surgery were significantly better in the HINE group (P = 0.030 and P = 0.023, respectively), indicating improved tendency in nutritional status in the HINE group. However, there were no significant differences in Prognostic Nutritional Index values, blood test results, rapid turnover proteins, body mass index, or body composition between the two groups. HINE E-GEL compared with MEIN may reduce the frequency of diarrhea, enabling patients to adhere to the scheduled enteral nutrition plan. Also, maintenance of nutritional status with HINE E-GEL was comparable or potentially better in some nutrition components to that with MEIN, indicating that HINE E-GEL can be an option for enteral nutrition following esophageal surgery to achieve the goal of successful completion of scheduled enteral nutrition and smooth transition to the normal diet.

Unravelling the Effects of Soluble Dietary Fibre Supplementation on Energy Intake and Perceived Satiety in Healthy Adults: Evidence from Systematic Review and Meta-Analysis of Randomised-Controlled Trials

Consumption of soluble dietary fibre is recommended as part of a healthy diet. Evidence has shown that soluble dietary fibre slows gastric emptying, increases perceived satiety and plays a significant role in appetite regulation. This systematic review examined the effects of soluble dietary fibre using randomised-controlled trials (RCTs). Three different electronic databases were used, namely PubMed, Scopus® and the Cochrane Central Register of Controlled Trials (CENTRAL). Effect size (Cohen's d) was calculated based on the intergroup mean difference and standard deviation (SD) followed by Cochran's Q and I² determination. The effect size was statistically pooled in the meta-analyses and presented as a forest plot. The risk of bias was high for each study as assessed using the Jadad scale. Meta-analysis of statistically pooled data for guar gum showed a sizeable effect on post-meal energy intake, followed by β-glucan, alginate, polydextrose and pectin, with pooled effect sizes of -0.90, -0.44, -0.42, -0.36 and -0.26, respectively. Guar gum (5 g) effectively reduced energy intake when prepared in milk beverages compared with control milk (p < 0.001). Alginate, when prepared in liquid (5 g) or solid (9 g) meals, effectively reduced energy intake compared with control (p < 0.001). A high dose of polydextrose (25 g) prepared in liquid meal form significantly reduced energy intake (p = 0.01). This study suggests that soluble fibres are not all created equal. Further interventional studies are needed to determine whether combinations of these soluble fibres might have greater effects than individual fibres per se.

Systematic review of the evidence for sustained efficacy of dietary interventions for reducing appetite or energy intake

We assessed evidence for changes in efficacy of food-based interventions aimed at reducing appetite or energy intake (EI), and whether this could be used to provide guidance on trial design. A systematic search identified randomized controlled trials testing sustained efficacy of diets, foods, supplements or food ingredients on appetite and/or EI. Trials had to include sufficient exposure duration (≥3 days) with appetite and/or EI measured after both acute and repeated exposures. Twenty-six trials met the inclusion criteria and reported data allowing for assessment of the acute and chronic effects of interventions. Most (21/26) measured appetite outcomes and over half (14/26) had objective measures of EI. A significant acute effect of the intervention was retained in 10 of 12 trials for appetite outcomes, and six of nine studies for EI. Initial effects were most likely retained where these were more robust and studies adequately powered. Where the initial, acute effect was not statistically significant, a significant effect was later observed in only two of nine studies for appetite and none of five studies for EI. Maintenance of intervention effects on appetite or EI needs to be confirmed but seems likely where acute effects are robust and replicable in adequately powered studies.

In vitro analysis of partially hydrolyzed guar gum fermentation differences between six individuals

Partially hydrolyzed guar gum (PHGG) is a fermentable, soluble, non-gelling fiber consumed as both a supplement and ingredient. PHGG supports bifidogenic and lactogenic growth, and increases the concentration of short chain fatty acids (SCFAs) in the distal intestine due to its fermentability. Changes in SCFA development due to the fermentation of dietary fibers in the colon have been widely studied, but there are limited studies analyzing the differences in SCFA development across multiple individuals (ages 23-68) exposed to the same dietary fiber (PHGG). With the six donors analyzed in this study, gas production varied from 59-80 mL/0.5 g fiber at 12 h and 85-93 mL/0.5 g fiber at 24 h between the six donors. At 12 h butyrate concentrations varied from 6.99 μmol mL(-1) to 23.84 μmol mL(-1) and from 8.78 μmol mL(-1) to 22.84 μmol mL(-1) at 24 h. Total SCFA concentration at 24 h ranged from 42.85 μmol mL(-1) to 91.17 μmol mL(-1). The overall average SCFA ratio for the six fecal donors was 30 : 45 : 25 (acetate : propionate : butyrate), which is similar to other fermentable fibers analyzed using in vitro systems. SCFA development in the distal intestine increases the amount of metabolizable energy from the diet, but varies greatly among people based primarily on the composition and changes of their gut microflora. With over a 2-fold difference in SCFA production, significant differences were found among healthy individuals fecal microflora when exposed to PHGG. Donor 6 SCFA concentrations decreased at 24 h, indicating a quicker fermentation process than the other five donors. All SCFAs measured fluctuated greatly among the six individuals within 24 h of analysis. Results of in vitro fermentation analyses are limited by the wide variation found with fecal donor.