Suppressive effect of cellulose on osmotic diarrhea caused by maltitol in healthy female subjects

Recommendations for the management of gastrointestinal comorbidities with or without trofinetide use in Rett syndrome

INTRODUCTION

Although gastrointestinal (GI) comorbidities are experienced by over 90% of individuals with Rett syndrome (RTT), a neurodevelopmental disorder associated with mutations in the MECP2 gene, many neurologists and pediatricians do not rank the management of these comorbidities among the most important treatment goals for RTT. Trofinetide, the first approved pharmacologic treatment for RTT, confers improvements in RTT symptoms but is associated with adverse GI events, primarily diarrhea and vomiting. Treatment strategies for GI comorbidities and drug-associated symptoms in RTT represent an unmet clinical need.

AREAS COVERED

This perspective covers GI comorbidities experienced by those with RTT, either with or without trofinetide treatment. PubMed literature searches were undertaken on treatment recommendations for the following conditions: constipation, diarrhea, vomiting, aspiration, dysphagia, gastroesophageal reflux, nausea, gastroparesis, gastritis, and abdominal bloating.

EXPERT OPINION

The authors recommend a proactive approach to management of symptomatic GI comorbidities and drug-associated symptoms in RTT to enhance drug tolerance and improve the quality of life of affected individuals. Management strategies for common GI comorbidities associated with RTT are reviewed based on authors' clinical experience and augmented by recommendations from the literature.

Use of fiber-containing enteral formula in pediatric clinical practice: an expert opinion review

INTRODUCTION

Children who require enteral nutrition often report gastrointestinal symptoms. There is a growing interest in nutrition formulas that meet nutritional requirements and also maintain gut ecology and function. Fiber-containing enteral formulas can improve bowel function, promote the growth of healthy gut microbiota, and improve immune homeostasis. Nonetheless, guidance in clinical practice is lacking.

AREAS COVERED

This expert opinion article summarizes the available literature and collects the opinion of eight experts on the importance and use of fiber-containing enteral formulas in pediatrics. The present review was supported by a bibliographical literature search on Medline via PubMed to collect the most relevant articles.

EXPERT OPINION

The current evidence supports using fibers in enteral formulas as first-line nutrition therapy. Dietary fibers should be considered for all patients receiving enteral nutrition and can be slowly introduced from six months of age. Fiber properties that define the functional/physiological properties of the fiber must be considered. Clinicians should balance the dose of fiber with tolerability and feasibility. Introducing fiber-containing enteral formulas should be considered when initiating tube feeding. Dietary fiber should be introduced gradually, especially in fiber-naïve children, with an individualized symptom-based approach. Patients should continue with the fiber-containing enteral formulas they tolerate best.

Trial of Available Energy Evaluation of Highly Cross-linked Starch and Modified Cellulose Based on Breath H2 Excretion

Background:

The energy value of a substance is essential in nutritional labeling. However, the available energy of newly developed highly cross-linked phosphate starch (HCPS-N) and modified cellulose (MC) are unknown.

Objective:

To evaluate the available energy of HCPS-N and MC, an indirect and simple method which was applied as an indicator of the fermentability based on the breath hydrogen excretion, was used.

Methods:

HCPS-N was made from tapioca starch by polymerization in the presence of 0.5% phosphoric acid. MC was made from microcrystalline cellulose, maltodextrin, and karaya gum to attain a highly stable suspension. The present study was carried out using a within-subject, repeatedmeasures design. Blood was collected at 30 min intervals for 3 h after the ingestion of 30 g of a test substance. The end-respiratory gas was collected for 14 h after ingestion of 5 g of a test substance to evaluate the available energy.

Results and Discussion:

Plasma glucose and insulin levels did not elevate after the ingestion of HCPS-N, although they increased significantly after glucose ingestion. In the experiments to evaluate the available energy, breath hydrogen excretion after ingesting HCPS-N did not increase distinctly during the experiment. Breath hydrogen excretion after preceding HCPS-P (0 kcal) ingestion was also markedly smaller compared with the peak value at 4 h after FOS ingestion. For the ingestion of MC, breath hydrogen excretion increased scarcely, and the basal level remained until the end of the experiment.

Conclusion:

The available energies were evaluated to be 0 kcal/g for HCPS-N and 1 kcal/g for MC in healthy humans.

Highly Cross-linked Starch and Modified Cellulose as Dietary Fibers, and their Acclimation Effect on Hydrogen Excretion in Rats

Background:

Highly cross-linked phosphate starch (HCPS) and modified cellulose (MC) were newly developed and modified dietary fiber materials to prevent lifestyle-related diseases.

Objective:

We investigated the physiological property of HCPS and MC to be a dietary fiber.

Methods:

HCPS was made from tapioca starch by polymerization in the presence of 0.5% phosphoric acid, and MC was made from cellulose, maltodextrin and karaya gum by high-speed mixing. In the present study, rats were raised on a diet containing 10% or 15% HCPS, or 10% MC for four weeks, and physical effects such as growth, organ weights, blood biomedical parameters, fecal weight, and hydrogen excretion were recorded.

Results:

Growth was normal among all groups, and there was no significant difference in total body weight gain. Some organ weights including the adipose tissues differed slightly among groups, but no difference based on diet composition was observed. Blood biomedical parameters were normal and not significantly different among groups. Cecum tissue and content weights were significantly greater in the 15% HCPS, 10% MC, and 10% fructooligosaccharide (FOS) groups than in the control group, and fecal weight was significantly increased in the 10% and 15% HCPS, and 10% MC groups compared with the control group. Hydrogen excretion over 24 h was negligible when HCPS was administered orally to rats non-acclimatized to HCPS but increased significantly in rats acclimatized to 10% HCPS diet for one week.

Conclusion:

We conclude that both HCPS and MC could be suitable for use as low energy bulking materials.

The safety of green tea extract supplementation in postmenopausal women at risk for breast cancer: results of the Minnesota Green Tea Trial

Green tea is thought to provide health benefits, though adverse reactions to green tea extract (GTE) have been reported. We conducted a randomized, double-blind, placebo-controlled study of GTE on breast cancer biomarkers, including mammographic density, in which 1075 postmenopausal women were randomly assigned to consume GTE containing 843 mg (-)-epigallocatechin-3-gallate (EGCG) or placebo daily for one year. There were no significant differences in % of women with adverse events (AEs, 75.6% and 72.8% of the GTE group and placebo group, respectively) or serious AEs (2.2 % and 1.5% of GTE and placebo groups, respectively). Women on GTE reported significantly higher incidence of nausea (P < 0.001) and dermatologic AEs (P = 0.05) and significantly lower diarrhea incidence (P = 0.02). More women in the GTE group experienced an alanine aminotransferase (ALT) elevation compared with placebo group (n = 36, (6.7%) vs. n = 4, (0.7%); P < 0.001). There were no statistically significant differences between groups in frequencies of other AEs. Overall, AEs were mainly mild and transient, indicating that daily consumption of GTE containing 843 mg EGCG is generally well tolerated by a group of predominantly Caucasian postmenopausal women. However, 6.7% of GTE consumers experienced ALT elevations, with 1.3% experiencing ALT-related serious AEs.

Digestive tolerance and postprandial glycaemic and insulinaemic responses after consumption of dairy desserts containing maltitol and fructo-oligosaccharides in adults

BACKGROUND/OBJECTIVES

To evaluate the short-term digestive tolerance and glycaemic response of several associations of maltitol and short-chain fructo-oligosaccharides (scFOS) used to replace sugars (for example, dextrose) in foods.

SUBJECTS/METHODS

Thirty-six healthy subjects aged 18-60 years were recruited for the study and 32 completed it. The subjects consumed six different mixtures of dextrose, maltitol and scFOS added in a chocolate dairy dessert at a dosage of 35 g. The test days were separated by 2-week washout periods. The subjects reported the intensity of four individual gastrointestinal (GI) symptoms, number of bowel movements and stool frequency for the 48 h following consumption of the dessert. A subgroup of 18 subjects also provided blood samples 2 h after intake to evaluate the postprandial glycaemic and insulinaemic responses.

RESULTS

The composite score calculated from the intensity of flatulence, borborygmi, bloating and discomfort was significantly higher (P<0.0001) for all the desserts containing maltitol and/or scFOS than for the control dessert containing dextrose, but remains at the level of mild effects. The number of bowel movements was also slightly increased (P=0.0006) and the stools were softer (P=0.0045) for the first 24 h but not after (P=0.1373 and 0.5420, respectively). Blood glycaemic and insulinaemic responses were lower for all the sugar-free recipes containing maltitol and scFOS in comparison to the control one (P<0.0001).

CONCLUSIONS

This study has shown that maltitol and scFOS can be used jointly when formulating sugar-free foods with the benefit to lower postprandial glycaemic response with only a small and transient increase in non-serious GI symptoms.

Insoluble fiber in young barley leaf suppresses the increment of postprandial blood glucose level by increasing the digesta viscosity

Barley (Hordeum vulgare L.) is a well-known cereal plant. Young barley leaf is consumed as a popular green-colored drink, which is named “Aojiru” in Japan. We examined the effects of barley leaf powder (BLP) and insoluble fibers derived from BLP on postprandial blood glucose in rats and healthy Japanese volunteers. BLP and insoluble fibers derived from BLP suppressed the increment of postprandial blood glucose levels in rats (P < 0.01), and increased the viscosity of their digesta. The insoluble fibers present in BLP might play a role in controlling blood glucose level by increasing digesta viscosity. In human, BLP suppressed the increment of postprandial blood glucose level only in those which exhibited higher blood glucose levels after meals (P < 0.01). BLP might suppress the increment of postprandial blood glucose level by increasing digesta viscosity in both of rats and humans who require blood glucose monitoring.

Evaluation of canned therapeutic diets for the management of cats with naturally occurring chronic diarrhea

Dietary therapy plays an important role in the management of most gastrointestinal disorders. This study was designed to test the efficacy of a new therapeutic diet for cats with diarrhea, compared to the top selling brand. Sixteen adult cats with chronic diarrhea were grouped and assigned to diet X (Hill's Prescription Diet i/d Feline) or diet Y (Purina Veterinary Diets EN Gastroenteric Feline Formula). Following baseline evaluations, cats were fed their assigned test diet for 4 weeks. Fecal scores (FS; 7=very watery; 1=extremely dry and firm) were recorded daily during the last week on each diet. Each cat was then switched to the alternate test diet and the procedure was repeated. Fifteen cats completed the study. Both therapeutic diets resulted in a significant improvement in average FS and diet Y also resulted in significantly better results compared with diet X. Average FS improved at least one unit in 40% of the cats while fed diet X and in 67% of the cats while fed diet Y, resulting in normal stools (average FS≤3) in 13.3% of cats fed diet X and 46.7% of cats fed diet Y. This study confirms the value of dietary change in the management of chronic diarrhea in cats.

Short-term digestive tolerance of chocolate formulated with maltitol in children

INTRODUCTION

Polyols are molecules of interest for food industries because of their technological and nutritional properties. Maltitol is known for its non-acidogenic and low-energetic properties. Our primary objective was to evaluate the digestive tolerance of maltitol in children. The secondary objective was to compare the organoleptic properties of maltitol and sucrose in chocolate.

METHOD

Healthy children were included in a double-blind, randomized parallel study versus placebo. The subjects received one dose of either maltitol or sucrose chocolate per week. Increasing doses were tested from 5 to 15 g maltitol in chocolate. Abdominal pain, rumbling, bloating and flatulence scores were evaluated using visual analog scales.

RESULTS

Some statistical differences on intestinal parameters were observed in the maltitol group compared with placebo, mainly concerning flatulence scores. Nevertheless, these scores remained low and could be considered minor.

CONCLUSION

Our results suggest that maltitol was well tolerated in children at 15 g in one intake.