Role of Fibre in Nutritional Management of Pancreatic Diseases

An Improved Assessment Method to Estimate (Poly)phenol Intake in Adults with Chronic Pancreatitis

BACKGROUND

Insights into (poly)phenol exposure represent a modifiable factor that may modulate inflammation in chronic pancreatitis (CP), yet intake is poorly characterized and methods for assessment are underdeveloped.

AIMS

The aims are to develop and test a method for estimating (poly)phenol intake from a 90-day food frequency questionnaire (FFQ) using the Phenol-Explorer database and determine associations with dietary patterns in CP patients versus controls via analysis of previously collected cross-sectional data.

METHODS

Fifty-two CP patients and 48 controls were recruited from an ambulatory clinic at a large, academic institution. To assess the feasibility of the proposed methodology for estimating dietary (poly)phenol exposure, a retrospective analysis of FFQ data was completed. Mann-Whitney U tests were used to compare (poly)phenol intake by group; Spearman correlations and multivariable-adjusted log-linear associations were used to compare (poly)phenol intakes with dietary scores within the sample.

RESULTS

Estimation of (poly)phenol intake from FFQs was feasible and produced estimates within a range of intake previously reported. Total (poly)phenol intake was significantly lower in CP vs controls (463 vs. 567mg/1000kcal; p = 0.041). In adjusted analyses, higher total (poly)phenol intake was associated with higher HEI-2015 (r = 0.34, p < 0.001), aMED (r = 0.22, p = 0.007), EDIH (r = 0.29, p < 0.001), and EDIP scores (r = 0.35, p < 0.001), representing higher overall diet quality and lower insulinemic and anti-inflammatory dietary potentials, respectively.

CONCLUSIONS

Using enhanced methods to derive total (poly)phenol intake from an FFQ is feasible. Those with CP have lower total (poly)phenol intake and less favorable dietary pattern indices, thus supporting future tailored dietary intervention studies in this population.

Dietary Fibre for the Prevention of Post-Pancreatitis Diabetes Mellitus: A Review of the Literature and Future Research Directions

Post-pancreatitis diabetes mellitus-the most common sequela of pancreatitis-leads to poorer glycaemic control compared with type 2 diabetes. Because post-pancreatitis diabetes mellitus is an exemplar of secondary diabetes (with a clear underlying cause), much post-pancreatitis diabetes mellitus is preventable or treatable early. Earlier literature established the important role of dietary fibre in reducing plasma glucose in individuals with type 2 diabetes. The present review benchmarks available evidence on the role of habitual dietary fibre intake in pancreatitis and post-pancreatitis diabetes mellitus. It also paves the way for future research on the use of dietary fibre in the post-pancreatitis setting.

Association between Dietary Habits and Pancreatitis among Individuals of European Ancestry: A Two-Sample Mendelian Randomization Study

Dietary factors are believed to potentially influence the risk of pancreatitis. Here, we systematically investigated the causal relationships between dietary habits and pancreatitis by using two-sample Mendelian randomization (MR). Large-scale genome-wide association study (GWAS) summary statistics for dietary habits were obtained from the UK Biobank. GWAS data for acute pancreatitis (AP), chronic pancreatitis (CP), alcohol-induced AP (AAP) and alcohol-induced CP (ACP) were from the FinnGen consortium. We performed univariable and multivariable MR analyses to evaluate the causal association between dietary habits and pancreatitis. Genetically driven alcohol drinking was associated with increased odds of AP, CP, AAP and ACP (all with p < 0.05). Genetic predisposition to higher dried fruit intake was associated with reduced risk of AP (OR = 0.280, p = 1.909 × 10^-5) and CP (OR = 0.361, p = 0.009), while genetic predisposition to fresh fruit intake was associated with reduced risk of AP (OR = 0.448, p = 0.034) and ACP (OR = 0.262, p = 0.045). Genetically predicted higher consumption of pork (OR = 5.618, p = 0.022) or processed meat (OR = 2.771, p = 0.007) had a significant causal association with AP, and genetically predicted higher processed meat intake increased the risk of CP (OR = 2.463, p = 0.043). Our MR study showed that fruit intake may be protective against pancreatitis, whereas dietary intake of processed meat has potential adverse impacts. These findings may inform prevention strategies and interventions directed toward dietary habits and pancreatitis.

The Effect of Oat Hay, Alfalfa Hay, and Their Combined Diets on the Morphology and Function of the Pancreas in Preweaning Yak Calves

In this study, we used a combination of animal nutrition and nontargeted metabolomics to investigate the effects of feeding different sources forages rations on the morphology and function of the pancreas in preweaning yak calves, providing theoretical guidance and important references for the healthy and high-quality rearing of yak calves. At 45 days old, 21 yak calf males were divided into OP, AP, and AOP groups, with seven animals in each group, which were fed with oat hay, alfalfa hay, and mixed oat and alfalfa hay, respectively. Five calves from each group were selected randomly to slaughter after a pretest period of 21 days and the official period of 120 days, when the average daily feed intake reached 1 kg. During the test, the growth and pancreas weight of yak calves were recorded, and the morphology and function of the pancreas tissues were determined using tissue sectioning methods, enzyme-linked immunosorbent assay (ELISA) tests, and nontargeted metabolomics strategies. The results showed that the body weight and pancreatic organ index of yak calves in the AOP group were significantly higher than those of the AP and OP groups. Compared to the AP and OP groups, the AOP group had considerably lower ratios of the area of the pancreatic endocrine component and overall percentage of that section of the organ, and the AOP group increased pancreatic amylase activity and a higher concentration of growth inhibitor. The AP group had significantly higher levels of the differential metabolites L-ascorbic acid, spermidine, spermine, and dopaquinone in the glutathione, β-alanine, and tyrosine metabolic pathways than the OP group. The AOP group had significantly lower levels of the differential metabolites spermine and phenylacetylglycine in the glutathione and phenylalanine metabolic pathways than the AP group. In summary, compared to feeding oat or alfalfa hay alone, combined feeding oat hay and alfalfa hay is more beneficial to promote the morphological and functional development of the pancreas in preweaning yak calves, so as to enhance the digestion and absorption of nutrients in the diet and maintain the positive regulation of blood glucose levels. This provides an important basis for the optimized forage supply of healthy and high-quality rearing in preweaning yak calves.

Early Enteral Nutrition in Paediatric Acute Pancreatitis-A Review of Published Studies

Nowadays, nutrition is said to be an integral aspect of acute pancreatitis (AP) treatment. Early enteral nutrition (EEN) is safe and beneficial for patients. This was confirmed by clinical experience and can be found in guidelines on managing adults with AP. Furthermore, paediatric recommendations encourage EEN use in AP. However, paediatric guidelines are based exclusively on studies in adults. Therefore, we present a review of published studies on the time of nutritional interventions in children with AP. A search was independently conducted in April 2022 by two of the authors. Only full-text papers published in English involving children between 0-21 were considered. Only four papers met our inclusion criteria: one randomised-control trial (RCT), one prospective study with retrospective chart review, and two retrospective chart reviews. All studies supported EEN and there was no recommendation of any delay in its initiation. The results of all four papers suggested EEN with a regular, normal-fat diet. EEN is safe in children with mild or moderately severe AP and may decrease the length of hospitalisation. Unfortunately, all the conclusions are based on a small amount of heterogeneous data that are mostly retrospective. Future prospective RCTs are needed.

A Review of the Potential Consequences of Pearl Millet (Pennisetum glaucum) for Diabetes Mellitus and Other Biomedical Applications

Diabetes mellitus has become a troublesome and increasingly widespread condition. Treatment strategies for diabetes prevention in high-risk as well as in affected individuals are largely attributed to improvements in lifestyle and dietary control. Therefore, it is important to understand the nutritional factors to be used in dietary intervention. A decreased risk of diabetes is associated with daily intake of millet-based foods. Pearl millet is a highly nutritious grain, nutritionally comparable and even superior in calories, protein, vitamins, and minerals to other large cereals, although its intake is confined to lower income segments of society. Pearl millet contains phenolic compounds which possess antidiabetic activity. Thus, it can be used to prepare a variety of food products for diabetes mellitus. Moreover, it also has many health benefits, including combating diabetes mellitus, cancer, cardiovascular conditions, decreasing tumour occurrence, lowering blood pressure, heart disease risk, cholesterol, and fat absorption rate. Therefore, the current review addresses the role of pearl millet in managing diabetes.

Diagnosis and treatment of exocrine pancreatic insufficiency in chronic pancreatitis: An international expert survey and case vignette study

INTRODUCTION

Despite evidence-based guidelines, exocrine pancreatic insufficiency is frequently underdiagnosed and undertreated in patients with chronic pancreatitis. Therefore, the aim of this study is to provide insight into the current opinion and clinical decision-making of international pancreatologists regarding the management of exocrine pancreatic insufficiency.

METHODS

An online survey and case vignette study was sent to experts in chronic pancreatitis and members of various pancreatic associations: EPC, E-AHPBA and DPSG. Experts were selected based on publication record from the past 5 years.

RESULTS

Overall, 252 pancreatologists participated of whom 44% had ≥ 15 years of experience and 35% treated ≥ 50 patients with chronic pancreatitis per year. Screening for exocrine pancreatic insufficiency as part of the diagnostic work-up for chronic pancreatitis is performed by 69% and repeated annually by 21%. About 74% considers nutritional assessment to be part of the standard work-up. Patients are most frequently screened for deficiencies of calcium (47%), iron (42%), vitamin D (61%) and albumin (59%). In case of clinically steatorrhea, 71% prescribes enzyme supplementation. Of all pancreatologists, 40% refers more than half of their patients to a dietician. Despite existing guidelines, 97% supports the need for more specific and tailored instructions regarding the management of exocrine pancreatic insufficiency.

CONCLUSION

This survey identified a lack of consensus and substantial practice variation among international pancreatologists regarding guidelines pertaining the management of exocrine pancreatic insufficiency. These results highlight the need for further adaptation of these guidelines according to current expert opinion and the level of available scientific evidence.

Impact of pectin with various esterification degrees on the profiles of gut microbiota and serum metabolites

Colitis is generally affected by multiple factors, including the dysbiosis of intestinal microbiota, and may affect organs outside colon through circulation. Pectin, which is an edible polysaccharide widely present in plant cell walls, has been proved in our previous study to possess preventive potentials against acute ulcerative colitis, especially when the esterification degree is less than 50%. This study aimed to clarify the underlying correlations of gut microbiome and serum metabolites with the preventive effects of pectin with different esterification degrees (H121, L13, and L102) against colitis in mice. MiSeq sequencing data showed that symbiotic bacteria especially beneficial Lactobacillus and Bifidobacterium were enriched by pectin intake. Fiber consumers such as Prevotella and Bacteroides actively responded to L13 pectin, particularly under high dosage (L13-H). In addition, the abnormal abundance of Akkermansia associated with colitis would not appear in mice who had been provided with any of the three pectins before dextran sulfate sodium (DSS) treatment. Furthermore, pre-treatment of H121 and L13 pectins could improve the serum glycerophospholipids such as phosphatidylcholine (PC) and phosphatidylethanolamine (PE). In contrast, lysophosphatidic acid (LPA) contributing to the glycerophospholipid metabolism pathway was enriched only in the L13-H group, which has been previously proved to be associated with the epithelial barrier and intestinal homeostasis. Positive relationships between the glycerophospholipids and the dominant candidates of intestinal bacteria such as Lactobacillus indicated the joint actions of intestinal microbes and serum metabolites as well as the underlying crosstalks among gut microbiome. Therefore, the results of this research suggested that the preventive effects of low-esterified pectin on DSS-induced colitis were likely to be initiated by the enrichment of probiotics in the gut and serum glycerophospholipids. KEY POINTS: • L13 pectin remarkably improved the diversity of the gut microbiome in healthy mice. • Probiotics were enriched and abnormal Akkermansia was restored by L13 and L102 pectins. • Glycerophospholipid metabolism was significantly enriched by H121 and L13 pectins.

Orange Pectin with Compact Conformation Effectively Alleviates Acute Colitis in Mice

A comprehensive understanding of the relationships between the structure and function is critical for the targeted preparation of functional pectins. In this study, we compared the alleviating effects of five orange pectins (200 mg/kg) extracted using acid (P2), alkali (P10), cellulase (C), acid + cellulase (P2 + C), and alkali + cellulase (P10 + C) on dextran sodium sulfate-induced acute colitis. The physiological and histopathological indicators revealed that the alleviating effects were most significant for P10 + C, followed by P10, P2 + C, P2, and C. P10 + C increased the diversity and relative abundance of Akkermansia, leading to increased generation of colonic short-chain fatty acids as well as mRNA and protein expressions of GPR43, GPR109A, claudin-1, ZO-1, and occludin. Therefore, proinflammatory cytokines were decreased, and anti-inflammatory cytokines were increased. A compact conformation of P10 + C contributed to the alleviation effects on acute colitis. Alkali + cellulase-extracted orange pectin with a compact conformation has potential as adjuvant treatment for intestinal inflammation.

Preventive effects of pectin with various degrees of esterification on ulcerative colitis in mice

Low esterified or amidated low esterified pectin displayed better preventive effects on acute colitis over high esterified pectin.