A combined 13CO2/H2 breath test can be used to assess starch digestion and fermentation in humans

Unraveling the gut health puzzle: exploring the mechanisms of butyrate and the potential of High-Amylose Maize Starch Butyrate (HAMSB) in alleviating colorectal disturbances

Colorectal disturbances encompass a variety of disorders that impact the colon and rectum, such as colitis and colon cancer. Butyrate, a short-chain fatty acid, plays a pivotal role in supporting gut health by nourishing colonocytes, promoting barrier function, modulating inflammation, and fostering a balanced microbiome. Increasing colorectal butyrate concentration may serve as a critical strategy to improve colon function and reduce the risk of colorectal disturbances. Butyrylated high-amylose maize starch (HAMSB) is an edible ingredient that efficiently delivers butyrate to the colon. HAMSB is developed by esterifying a high-amylose starch backbone with butyric anhydride. With a degree of substitution of 0.25, each hydroxy group of HAMSB is substituted by a butyryl group in every four D-glucopyranosyl units. In humans, the digestibility of HAMSB is 68% (w/w), and 60% butyrate molecules attached to the starch backbone is absorbed by the colon. One clinical trial yielded two publications, which showed that HAMSB significantly reduced rectal O6-methyl-guanine adducts and epithelial proliferation induced by the high protein diet. Fecal microbial profiles were assessed in three clinical trials, showing that HAMSB supplementation was consistently linked to increased abundance of Parabacteroides distasonis. In animal studies, HAMSB was effective in reducing the risk of diet- or AOM-induced colon cancer by reducing genetic damage, but the mechanisms differed. HAMSB functioned through affecting cecal ammonia levels by modulating colon pH in diet-induced cancer, while it ameliorated chemical-induced colon cancer through downregulating miR19b and miR92a expressions and subsequently activating the caspase-dependent apoptosis. Furthermore, animal studies showed that HAMSB improved colitis via regulating the gut immune modulation by inhibiting histone deacetylase and activating G protein-coupled receptors, but its role in bacteria-induced colon colitis requires further investigation. In conclusion, HAMSB is a food ingredient that may deliver butyrate to the colon to support colon health. Further clinical trials are warranted to validate earlier findings and determine the minimum effective dose of HAMSB.

A Lowly Digestible-Starch Diet after Weaning Enhances Exogenous Glucose Oxidation Rate in Female, but Not in Male, Mice

Starches of low digestibility are associated with improved glucose metabolism. We hypothesise that a lowly digestible-starch diet (LDD) versus a highly digestible-starch diet (HDD) improves the capacity to oxidise starch, and that this is sex-dependent. Mice were fed a LDD or a HDD for 3 weeks directly after weaning. Body weight (BW), body composition (BC), and digestible energy intake (dEI) were determined weekly. At the end of the intervention period, whole-body energy expenditure (EE), respiratory exchange ratio (RER), hydrogen production, and the oxidation of an oral ¹³C-labelled starch bolus were measured by extended indirect calorimetry. Pancreatic amylase activity and total ¹³C hepatic enrichment were determined in females immediately before and 4 h after administration of the starch bolus. For both sexes, BW, BC, and basal EE and RER were not affected by the type of starch, but dEI and hydrogen production were increased by the LDD. Only in females, total carbohydrate oxidation and starch-derived glucose oxidation in response to the starch bolus were higher in LDD versus HDD mice; this was not accompanied by differences in amylase activity or hepatic partitioning of the ¹³C label. These results show that starch digestibility impacts glucose metabolism differently in females versus males.

Non-invasive continuous real-time in vivo analysis of microbial hydrogen production shows adaptation to fermentable carbohydrates in mice

Real time in vivo methods are needed to better understand the interplay between diet and the gastrointestinal microbiota. Therefore, a rodent indirect calorimetry system was equipped with hydrogen (H2) and methane (CH4) sensors. H2 production was readily detected in C57BL/6J mice and followed a circadian rhythm. H2 production was increased within 12 hours after first exposure to a lowly-digestible starch diet (LDD) compared to a highly-digestible starch diet (HDD). Marked differences were observed in the faecal microbiota of animals fed the LDD and HDD diets. H2 was identified as a key variable explaining the variation in microbial communities, with specific taxa (including Bacteroides and Parasutterella) correlating with H2 production upon LDD-feeding. CH4 production was undetectable which was in line with absence of CH4 producers in the gut. We conclude that real-time in vivo monitoring of gases provides a non-invasive time-resolved system to explore the interplay between nutrition and gut microbes in a mouse model, and demonstrates potential for translation to other animal models and human studies.

The physiologic and phenotypic significance of variation in human amylase gene copy number

Background

Salivary α-amylase gene (AMY1) copy number (CN) correlates with the amount of salivary α-amylase, but beyond this, the physiologic significance is uncertain.

Objective

We hypothesized that individuals with higher AMY1 CN would digest starchy foods faster and show higher postprandial responses and lower breath hydrogen excretion compared with those with low CN.

Design

Four linked studies were conducted. In Study 1, we genotyped 201 healthy subjects with the use of real-time quantitative polymerase chain reaction and determined glucose tolerance, insulin sensitivity, salivary α-amylase activity, body mass index (BMI), and macronutrient intake. In Study 2, a pool of 114 subjects tested 6 starchy foods, 3 sugary foods, 1 mixed meal, and 2 reference glucose solutions, containing either 50 or 25 g of available carbohydrate. In Study 3, we compared glycemic and insulin responses to starchy foods with responses to glucose in 40 individuals at extremes of high and low CN. In Study 4, we compared breath hydrogen and methane responses over 8 h in 30 individuals at extremes of CN.

Results

AMY1 CN correlated positively with salivary α-amylase activity (r = 0.62, P < 0.0001, n = 201) but not with BMI, glucose tolerance, or insulin sensitivity. However, CN was strongly correlated with normalized glycemic responses to all starchy foods (explaining 26-61% of interindividual variation), but not to sucrose or fruit. Individuals in the highest compared with the lowest decile of CN produced modestly higher glycemia (+15%, P = 0.018), but not insulinemia, after consuming 2 starchy foods. Low-CN individuals displayed >6-fold higher breath methane levels in the fasting state and after starch ingestion than high-CN individuals (P = 0.001), whereas hydrogen excretion was similar.

Conclusions

Starchy foods are digested faster and produce higher postprandial glycemia in individuals with high AMY1 CN. In contrast, having low CN is associated with colonic methane production. This trial was registered at www.anzctr.org.au as ACTRN12617000670370.

13C-Labeled-Starch Breath Test in Congenital Sucrase-isomaltase Deficiency

BACKGROUND AND HYPOTHESES

Human starch digestion is a multienzyme process involving 6 different enzymes: salivary and pancreatic α-amylase; sucrase and isomaltase (from sucrose-isomaltase [SI]), and maltase and glucoamylase (from maltase-glucoamylase [MGAM]). Together these enzymes cleave starch to smaller molecules ultimately resulting in the absorbable monosaccharide glucose. Approximately 80% of all mucosal maltase activity is accounted for by SI and the reminder by MGAM. Clinical studies suggest that starch may be poorly digested in those with congenital sucrase-isomaltase deficiency (CSID). Poor starch digestion occurs in individuals with CSID and can be documented using a noninvasive C-breath test (BT).

METHODS

C-Labled starch was used as a test BT substrate in children with CSID. Sucrase deficiency was previously documented in study subjects by both duodenal biopsy enzyme assays and C-sucrose BT. Breath CO2 was quantitated at intervals before and after serial C-substrate loads (glucose followed 75 minutes later by starch). Variations in metabolism were normalized against C-glucose BT (coefficient of glucose absorption). Control subjects consisted of healthy family members and a group of children with functional abdominal pain with biopsy-proven sucrase sufficiency.

RESULTS

Children with CSID had a significant reduction of C-starch digestion mirroring that of their duodenal sucrase and maltase activity and C-sucrase BT.

CONCLUSIONS

In children with CSID, starch digestion may be impaired. In children with CSID, starch digestion correlates well with measures of sucrase activity.

Conjugated linoleic acid does not affect digestion and absorption of fat and starch-a randomized, double-blinded, placebo-controlled parallel study

OBJECTIVE

Conjugated linoleic acid (CLA) is known as a potent agent for altering body weight and composition. However, its effect on the process of digestion is still unknown. The aim of this study has been to elucidate the effect of a 3-month supplementation with CLA on starch and fat digestion and absorption in humans.

APPROACH

The study included 74 obese and overweight adults who were randomized to receive 3.0 g of CLA or sunflower oil as placebo daily for 3 months. Digestion and absorption of fat and starch was assessed using non-invasive breath tests with a stable ¹³C isotope (cumulative percentage dose recovery, CPDR) before and after the supplementation period. To exclude the effect of oxidation, in addition total energy expenditure (TTE) was measured by a ¹³C bicarbonate breath test.

RESULTS

The changes in CPDR values (∆CPDR median 〈interquartile range〉) were no different between subjects from the CLA group and the placebo group (fat: -0.2 〈-9.1-4.1〉 versus 0.6 〈-7.0-8.0〉, p < 0.4796; starch: -1.3 〈-9.5-2.4〉 versus -1.0 〈-5.1-1.7〉, p < 0.5520, respectively). The incidence of negative and positive values of ∆CPDR was no different between groups [for fat: 53.1% versus 46.7%, RR 1.138, (95% CI 0.689-1.882) and for starch: 67.7% versus 56.7%, RR 1.195, (95% CI 0.804-1.777)]. The changes in TTE did not differ between the CLA and the placebo group (respectively 1 〈48; 267〉 versus -8 〈-120;93〉 kcal; p < 0.2728).

CONCLUSION

Supplementation with CLA for 3 months did not affect fat and starch digestion assessed by ¹³C mixed triglyceride breath test and ¹³C starch breath test.

Mulberry leaf extract decreases digestion and absorption of starch in healthy subjects-A randomized, placebo-controlled, crossover study

PURPOSE

Mulberry (Morus alba L.) leaf tea has recently received much attention as a dietary supplement due to the wide range of putative health benefits, such as antidiabetic effects. Nevertheless, data evaluating its influence on carbohydrate metabolism in humans are scarce. The present study aims to investigate the effect of mulberry leaf extract supplementation on starch digestion and absorption in humans.

MATERIALS AND METHODS

The study comprised of 25 healthy subjects, aged 19-27 years. In all subjects, a starch ¹³C breath test was performed twice in a crossover and single blind design. Subjects were initially randomized to ingest naturally ¹³C-abundant cornflakes (50g cornflakes+100ml low fat milk) either with the mulberry leaf extract (36mg of active component-1-deoxynojirimycin) or the placebo and each subject received the opposite preparation one week later.

RESULTS

The cumulative percentage dose recovery was lower for the mulberry leaf extract test than for the placebo test (median [quartile distribution]: 13.9% [9.9-17.4] vs. 17.2% [13.3-20.6]; p=0.015). A significant decrease was detectable from minute 120 after the ingestion.

CONCLUSIONS

A single dose of mulberry leaf extract taken with a test meal decreases starch digestion and absorption. These findings could possibly be translated into everyday practice for improvement of postprandial glycemic control.

Impact of a resistant dextrin with a prolonged oxidation pattern on day-long ghrelin profile

OBJECTIVES

The effects of a new resistant dextrin ingested at breakfast on day-long metabolic parameters and ghrelin profile at subsequent lunch were investigated.

METHODS

In this randomized, single-blinded, crossover study, 12 healthy men ingested a standardized breakfast with 50 g of NUTRIOSE 10, a resistant dextrin (RD), or of maltodextrin (Malto) and a standardized lunch 5 hours later. Both products (RD and Malto) were derived from corn naturally rich in (13)C to follow their metabolic fate (by using stable isotope analysis). Oxidation and fermentation patterns were assessed by simultaneous (13)CO(2)/H(2) breath testing. The appearance of exogenous (13)C-glucose in plasma, glycemia, insulinemia, nonesterified fatty acids (NEFAs), and ghrelin concentrations were measured for 10 hours following breakfast ingestion.

RESULTS

With RD, H(2) excretion (fermentation) was significantly enhanced compared with Malto, whereas the appearance of (13)CO(2) (oxidation) was significantly prolonged (p < 0.0001). Following breakfast, ghrelin secretion was significantly less inhibited and NEFA concentration was higher with RD (p < 0.05), but unexpectedly, both remained lower after lunch and up to T600 minutes. According to the reduced bioavailability of RD compared with Malto, the appearance of (13)C-glucose in plasma (p < 0.0001) and glycemic and insulinemic responses to breakfast (p < 0.05) were significantly reduced.

CONCLUSIONS

Ingestion of this new resistant dextrin at breakfast decreased ghrelin concentrations in response to the subsequent lunch, even if the caloric load ingested at breakfast was lower. This effect may be linked to the prolonged fermentation/oxidation pattern seen in the late postprandial phase (up to 10 hours after ingestion at breakfast), and thus prolonged energy release with the resistant dextrin.

Butyrate delivered by butyrylated starch increases distal colonic epithelial apoptosis in carcinogen-treated rats

Animal studies show that increasing large bowel butyrate concentration through ingestion of butyrylated or resistant starches opposes carcinogen-induced tumorigenesis, which is consistent with population data linking greater fiber consumption with lowered colorectal cancer (CRC) risk. Butyrate has been shown to regulate the apoptotic response to DNA damage. This study examined the impact of increasing large bowel butyrate concentration by dietary butyrylated starch on the colonic epithelium of rats treated with the genotoxic carcinogen azoxymethane (AOM). Four groups of 10 male rats were fed AIN-93G based-diets containing either low amylose maize starch (LAMS), LAMS with 3% tributyrin, 10% high amylose maize starch (HAMS) or 10% butyrylated HAMS (HAMSB). HAMS and HAMSB starches were cooked by heating in water. After 4 weeks, rats were injected once with AOM and killed 6 h later. Rates of apoptosis and proliferation were measured in colonic epithelium. Short-chain fatty acid concentrations in large bowel digesta and hepatic portal venous plasma were higher in HAMSB than all other groups. Apoptotic rates in the distal colon were increased by HAMSB and correlated with luminal butyrate concentrations but cellular proliferation rates were unaffected by diet. The increase in apoptosis was most marked in the base and proliferative zone of the crypt. Regulation of luminal butyrate using HAMSB increases the rates of apoptotic deletion of DNA-damaged colonocytes. We propose this pro-apoptotic function of butyrate plays a major role reducing tumour formation in the AOM-treated rat and that these data support a potential protective role of butyrate in CRC.

Butyrate esterified to starch is released in the human gastrointestinal tract

BACKGROUND

Short-chain fatty acids (SCFAs) maintain human colonic function and may help prevent colonic disease. A study with ileostomists showed that starches acylated with specific SCFAs largely survive passage through the small intestine, but the percentage released in the colon has not been established.

OBJECTIVE

The objective was to determine the percentage of ingested esterified butyrate released in the human gastrointestinal tract.

DESIGN

The study was a randomized, crossover, controlled trial consisting of baseline and four 2-wk periods during which 16 volunteers consumed diets low in resistant starch plus 20 and 40 g cooked high-amylose maize starch (HAMS: HAMS20 or HAMS40) or butyrylated HAMS (HAMSB20 or HAMSB40) daily. HAMSB20 contained 31.8 mmol esterified butyrate. Complete 48-h fecal collections were made on days 2-3 and 12-13 of each period.

RESULTS

Free fecal butyrate concentrations were higher after HAMSB40 than after HAMSB20 (P < 0.005) and HAMS (P < 0.0001) and higher than baseline data (P < 0.0001). Fecal esterified butyrate concentrations were highest in the HAMSB40 (days 12-13; P < 0.0001) group, and concentrations in the HAMSB40 (days 2-3) and HAMSB20 groups were higher than those in the HAMS groups and those at baseline (P < 0.0001). Ingestion of HAMSB20 and HAMSB40 resulted in the release of 26.8 ± 1.0 and 50.2 ± 2.4 mmol butyrate/d (days 12-13) (84.2 ± 3.0% and 79.0 ± 3.1% of total ingested esterified butyrate), respectively, in the gastrointestinal tract. By calculation, ∼57.2% of ingested esterified butyrate was released in the colon. Microbial analysis showed that this release was probably facilitated mainly by Parabacteroides distasonis, which increased in abundance with HAMSB40 (days 12-13) (P < 0.001).

CONCLUSIONS

This study shows that cooked butyrylated starch delivers esterified butyrate to the human colon effectively and has the potential to improve human bowel health. This trial is registered in the Australian Clinical Trials Registry as ACTRN012606000398505.

Prediction of in vivo short-chain fatty acid production in hindgut fermenting mammals: problems and pitfalls

Short-chain fatty acids (SCFA) are considered to have important physiological functions. However, to prove this, SCFA must be determined, which is rather difficult as a lot of factors interfere with their production. This review focuses on the factors that influence the prediction of short-chain fatty acid formation in the large intestine of monogastric mammals. To mimic the in vivo situation, when predicting the amount of short-chain fatty acids produced from a certain substrate based on in vitro models, one has to estimate the amount of this substrate entering the large intestine, the retention time in the different parts of the large intestine, and the substrate fermentability. Instead of in vitro models, direct and indirect techniques may be used to measure short-chain fatty acid production in vivo. Direct techniques include the measurement of input and output or measuring differences in SCFA between portal and venous blood whereas indirect techniques measure the end products of fermentation. In this case, other factors have to be taken into account, including technical limitations and ethical considerations. In this review it is concluded that the choice for a method will rely on the purpose of the study taking into account the (dis)advantages of every method.

Changes in starch physical characteristics following digestion of foods in the human small intestine

Factors controlling the concentration of resistant starch (RS) in foods are of considerable interest on account of the potential for this type of fibre to deliver health benefits to consumers. The present study was aimed at establishing changes in starch granule morphology as a result of human small-intestinal digestion. Volunteers with ileostomy consumed six selected foods: breakfast cereal (muesli), white bread, oven-baked French fries, canned mixed beans and a custard containing either a low-amylose maize starch (LAMS) or a high-amylose maize starch (HAMS). Analysis showed that digesta total RS (as a fraction of ingested starch) was: muesli, 8.9 %; bread, 4.8 %; fries, 4.2 %; bean mix, 35.9 %; LAMS custard, 4.0 %; HAMS custard, 29.1 %. Chromatographic analysis showed that undigested food contained three major starch fractions. These had average molecular weights (MW) of 43,500 kDa, 420 kDa and 8.5 kDa and were rich in amylopectin, higher-MW amylose and low-MW amylose, respectively. The low-MW amylose fraction became enriched preferentially in the stomal effluent while the medium-MW starch fraction showed the greatest loss. Fourier transform IR spectroscopy showed that absorbance at 1022 per cm decreased after digestion while the absorbance band at 1047 per cm became greater. Such changes have been suggested to indicate shifts from less ordered to more ordered granule structures. Further analysis of amylose composition by scanning iodine spectra indicated that the MW of amylose in ileal digesta was lower than that of undigested amylose. It appears that high-MW amylose is preferentially digested and that MW, rather than amylose content alone, is associated with resistance of starch to digestion in the upper gut of humans.

Postprandial glycaemic and insulinaemic responses to GM-resistant starch-enriched rice and the production of fermentation-related H2in healthy Chinese adults

Consumption of resistant starch (RS)-enriched foods is associated with decrease in the postprandial glycaemic and insulinaemic responses, accompanied by the production of fermentation-related gases in the large bowel. The present study aimed to determine the postprandial glycaemic and insulinaemic responses to the GM RS-enriched rice and the fermentation-related production of H2in young and healthy Chinese adults. A total of sixteen young adults (nine men and seven women) were recruited and divided into three groups. Their postprandial glycaemic and insulinaemic responses to 40 g glucose, carbohydrates of RS or wild-type (WT) rice were tested by a crossover model with a washout period of 7 d. The concentrations of blood glucose and insulin as well as breath H2were measured before and after food intake. Although the mean concentrations of fasting blood glucose, insulin and breath H2were similar, consumption of the RS rice significantly decreased the values of glycaemic index (GI) and insulin index (II), as compared with the intake of WT rice (48·4 (sem21·8)v.77·4 (sem34·9) for GI, 34·2 (sem18·9)v.54·4 (sem22·4) for II,P < 0·05), respectively. Conversely, intake of the RS rice meal significantly elevated the concentrations of breath H2, as compared with WT rice (38·9 (sem17·6)v.10·5 (sem3·7) parts per million for peak levels of breath H2,P < 0·05) through a period of 16-h tests. Consumption of the GM RS-enriched rice meal decreased the postprandial glycaemic and insulinaemic responses and promoted RS fermentation-related production of H2in the large bowel of young and healthy Chinese adults.

13C-breath tests for sucrose digestion in congenital sucrase isomaltase-deficient and sacrosidase-supplemented patients

BACKGROUND

Congenital sucrase-isomaltase deficiency (CSID) is characterized by absence or deficiency of the mucosal sucrase-isomaltase enzyme. Specific diagnosis requires upper gastrointestinal biopsy with evidence of low to absent sucrase enzyme activity and normal histology. The hydrogen breath test (BT) is useful, but is not specific for confirmation of CSID. We investigated a more specific 13C-sucrose labeled BT.

OBJECTIVES

Determine whether CSID can be detected with the 13C-sucrose BT without duodenal biopsy sucrase assay, and if the 13C-sucrose BT can document restoration of sucrose digestion by CSID patients after oral supplementation with sacrosidase (Sucraid).

METHODS

Ten CSID patients were diagnosed by low biopsy sucrase activity. Ten controls were children who underwent endoscopy and biopsy because of dyspepsia or chronic diarrhea with normal mucosal enzymes activity and histology. Uniformly labeled 13C-glucose and 13C-sucrose loads were orally administered. 13CO2 breath enrichments were assayed using an infrared spectrophotometer. In CSID patients, the 13C-sucrose load was repeated adding Sucraid. Sucrose digestion and oxidation were calculated as a mean percent coefficient of glucose oxidation averaged between 30 and 90 minutes.

RESULTS

Classification of patients by 13C-sucrose BT percent coefficient of glucose oxidation agreed with biopsy sucrase activity. The breath test also documented the return to normal of sucrose digestion and oxidation after supplementation of CSID patients with Sucraid.

CONCLUSIONS

13C-sucrose BT is an accurate and specific noninvasive confirmatory test for CSID and for enzyme replacement management.

A curve fitting approach to estimate the extent of fermentation of indigestible carbohydrates

BACKGROUND

Information about the extent of carbohydrate digestion and fermentation is critical to our ability to explore the metabolic effects of carbohydrate fermentation in vivo. We used cooked (13)C-labelled barley kernels, which are rich in indigestible carbohydrates, to develop a method which makes it possible to distinguish between and to assess carbohydrate digestion and fermentation.

MATERIALS AND METHODS

Seventeen volunteers ingested 86 g (dry weight) of cooked naturally (13)C enriched barley kernels after an overnight fast. (13)CO(2) and H(2) in breath samples were measured every half hour for 12 h. The data of (13)CO(2) in breath before the start of the fermentation were used to fit the curve representing the digestion phase. The difference between the area under curve (AUC) of the fitted digestion curve and the AUC of the observed curve was regarded to represent the fermentation part. Different approaches were applied to determine the proportion of the (13)C-dose available for digestion and fermentation.

RESULTS

Four hours after intake of barley, H(2)-excretion in breath started to rise. Within 12 h, 24-48% of the (13)C-dose was recovered as (13)CO(2), of which 18-19% was derived from colonic fermentation and the rest from digestion. By extrapolating the curve to baseline, it was estimated that eventually 24-25% of the total available (13)C in barley would be derived from colon fermentation.

CONCLUSION

Curve fitting, using (13)CO(2)- and H(2)-breath data, is a feasible and non-invasive method to assess carbohydrate digestion and fermentation after consumption of (13)C enriched starchy food.

A method for collecting breath samples from individual chickens for analysis of 13CO(2), H(2), and CH(4)

This study describes experiments using simple helmets to collect breath samples from individual birds for measurement of (13)CO(2), H(2), and CH(4), which form the basis for various diagnostic tests for intestinal dysfunction in humans. Peak enrichment in (13)C in breath CO(2) occurred between 5 and 30 min postingestion by 18-d-old chickens administered a gelatin capsule containing approximately 3.6 mg of (13)C-octanoic acid dissolved in vegetable oil. For 25-d-old chickens given 10 mL of homogenized cooked corn by oral gavage, peak enrichment occurred 60 to 90 min postingestion. In fully fed 25-d-old chickens, H(2) and CH(4) concentrations in breath ranged from 7 to 115 ppm and from 0 to 5.5 ppm, respectively. Following an overnight fast, H(2) and CH(4) concentrations in breath ranged from 0.5 to 7.5 ppm and 0 to 3.0 ppm, respectively, in the same chickens. Ranges in H(2) (1.0 to 56.5 ppm) and CH(4) (0 to 8.0 ppm) concentrations widened considerably 3 h after oral gavage with approximately 130 mg of lactulose (an indigestible disaccharide) dissolved in 5 mL of water. The results from these investigations indicate that collection of re-breathed air samples from chickens is plausible, which opens the way for development of noninvasive methods for evaluating gastrointestinal functions in chickens.

Butyrylated starch protects colonocyte DNA against dietary protein-induced damage in rats

Dietary resistant starch (RS), as a high amylose maize starch (HAMS), prevents dietary protein-induced colonocyte genetic damage in rats, possibly through the short-chain fatty acid (SCFA) butyrate produced by large bowel bacterial RS fermentation. Increasing butyrate availability may improve colonic health and dietary high amylose maize butyrylated starch (HAMSB) is an effective method of achieving this goal. In this study, rats (n = 8 per group) were fed diets containing high levels (25%) of dietary protein as casein with 10 or 20% dietary HAMSB and HAMS. Colonocyte genetic damage was measured by the comet assay and was 2-fold higher in rats fed 25% protein than those fed 15% protein (P < 0.001). Concurrent feeding of 25% protein and either HAMS or HAMSB lowered genetic damage significantly relative to a low-RS high-protein control diet. The 20% HAMSB diet was twice as effective as 20% HAMS in opposing genetic damage. Large bowel digesta butyrate was significantly increased in rats fed 20% compared with 10% HAMS and in rats fed 20% compared with 10% HAMSB. The levels were significantly higher in the HAMSB groups relative to the HAMS groups. Hepatic portal venous SCFA were higher in rats fed HAMS and highest in those fed HAMSB. Caecal digesta ammonia was increased by HAMSB and correlated negatively with digesta pH. Ammonia is cytotoxic and lower digesta pH could lower its absorption, possibly contributing to lower genetic damage. Delivery of butyrate to the large bowel by HAMSB could reduce colorectal cancer risk by preventing diet-induced colonocyte genetic damage.

Excretion of starch and esterified short-chain fatty acids by ileostomy subjects after the ingestion of acylated starches

BACKGROUND

Short-chain fatty acids (SCFAs) have a role in maintaining bowel health and can assist in the prevention and treatment of colonic disease. The ability of acylated starches to deliver SCFAs to the large bowel has been shown in animal studies but has not been established in humans.

OBJECTIVE

The aim was to determine whether cooked, highly acylated starches were resistant to small intestinal digestion in ileostomy volunteers.

DESIGN

Volunteers consumed single doses of custards containing 20 g cooked acetylated, propionylated, or butyrylated high-amylose maize starches (HAMSA, HAMSP, and HAMSB, respectively) on each collection day. The amounts of starch and of esterified SCFAs ingested and subsequently excreted in the stoma effluent were measured. Custards containing unacylated high-amylose maize starch (Hylon VII, HAMS) and low-amylose maize starch (3401C, LAMS) were consumed as controls.

RESULTS

Between 73% and 76% of the esterified SCFAs survived small intestinal digestion, which showed the potential of acylated starches to deliver specific SCFAs to the large bowel. The resistance of starches to small intestinal digestion as measured by ileal excretion was significantly greater for HAMSA, HAMSP, HAMSB, and HAMS than for LAMS (P < 0.001). The concentration of acetate in stoma digesta was higher than expected in all groups; this additional acid may have been derived from endogenous sources.

CONCLUSIONS

Acylated starches are a potentially effective method of delivering significant quantities of specific SCFAs to the colon in humans. These products have potential application in the treatment and prevention of bowel disorders amenable to modulation by SCFAs.

Butyrylated starch is less susceptible to enzymic hydrolysis and increases large-bowel butyrate more than high-amylose maize starch in the rat

Large-bowel fermentation of resistant starch produces SCFA that are believed to be important in maintaining visceral function. High-amylose maize starch (HAMS) and acylated starches are sources of resistant starch and are an effective means of increasing colonic SCFA. Cooking increases digestibility of starches but its effects on the capacity of these starches to raise large-bowel SCFA are unknown. We have examined the effects of cooking of HAMS and butyrylated HAMS (HAMSB) on amylolysis in vitro and their capacity to raise caeco-colonic SCFA in rats. The starches were boiled in excess water and microwaved, followed by drying at 100°C. Cooking increased in vitro glucose release for both starches but significantly less from HAMSB. Rat growth rates were unaffected when fed cooked resistant starch. Digesta pH was increased in the caecum and proximal colon of rats fed cooked HAMS. Distal colonic pH was highest in rats fed cooked HAMSB. Factorial analyses (2×2) of caecal SCFA pools showed significant differences between HAMS and HAMSB, and that cooking significantly lowered caecal butyrate pools. Portal venous butyrate concentrations were higher in both HAMSB groups than those fed HAMS. The data suggest that HAMSB is less susceptible to in vitro amylolysis than HAMS following cooking and delivers more butyrate to rat caecum than HAMS. This attribute may be useful in food applications for specific delivery of SCFA to the colon. Preparation of carbohydrates to simulate human food in animal experiments may be important to assess nutritional and physiological effects accurately.

Disaccharide digestion: clinical and molecular aspects

Sugars normally are absorbed in the small intestine. When carbohydrates are malabsorbed, the osmotic load produced by the high amount of low molecular weight sugars and partially digested starches in the small intestine can cause symptoms of intestinal distention, rapid peristalsis, and diarrhea. Colonic bacteria normally metabolize proximally malabsorbed dietary carbohydrate through fermentation to small fatty acids and gases (ie, hydrogen, methane, and carbon dioxide). When present in large amounts, the malabsorbed sugars and starches can be excreted in the stool. Sugar intolerance is the presence of abdominal symptoms related to the proximal or distal malabsorption of dietary carbohydrates. The symptoms consist of meal-related abdominal cramps and distention, increased flatulence, borborygmus, and diarrhea. Infants and young children with carbohydrate malabsorption show more intense symptoms than adults; the passage of undigested carbohydrates through the colon is more rapid and is associated with detectable carbohydrates in copious watery acid stools. Dehydration often follows feeding of the offending sugar. In this review we present the clinical and current molecular aspects of disaccharidase digestion.