Effect of Unripe Banana Flour on Gut-Derived Uremic Toxins in Individuals Undergoing Peritoneal Dialysis: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial.

In chronic kidney disease (CKD), the accumulation of gut-derived metabolites, such as indoxyl sulfate (IS), p-cresyl sulfate (pCS), and indole 3-acetic acid (IAA), has been associated with the burden of the disease. In this context, prebiotics emerge as a strategy to mitigate the accumulation of such compounds, by modulating the gut microbiota and production of their metabolites. The aim of this study was to evaluate the effect of unripe banana flour (UBF-48% resistant starch, a prebiotic) on serum concentrations of IS, pCS, and IAA in individuals undergoing peritoneal dialysis (PD). A randomized, double-blind, placebo-controlled, crossover trial was conducted. Forty-three individuals on PD were randomized to sequential treatment with UBF (21 g/day) and placebo (waxy corn starch-12 g/day) for 4 weeks, or vice versa (4-week washout). The primary outcomes were total and free serum levels of IS, pCS, and IAA. Secondary outcomes were 24 h urine excretion and dialysis removal of IS, pCS, and IAA, serum inflammatory markers [high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-α (TNF-α)], serum lipopolysaccharide LPS, and dietary intake. Of the 43 individuals randomized, 26 completed the follow-up (age = 55 ± 12 years; 53.8% men). UBF did not promote changes in serum levels of IS (p = 0.70), pCS (p = 0.70), and IAA (p = 0.74). Total serum IS reduction was observed in a subgroup of participants (n = 11; placebo: median 79.5 µmol/L (31-142) versus UBF: 62.5 µmol/L (31-133), p = 0.009) who had a daily UBF intake closer to that proposed in the study. No changes were observed in other secondary outcomes. UBF did not promote changes in serum levels of IS or pCS and IAA; a decrease in IS was only found in the subgroup of participants who were able to take 21g/day of the UBF.

Effectiveness of carbohydrates as a functional ingredient in glycemic control

High postprandial glycemia in the non-diabetic population is one of the known universal mechanisms for the progression of noncommunicable diseases (NCDs), which have impacted the finances of both individuals and of health systems. In order to highlight the role of carbohydrates in glycemic control and its implications on health, the International Life Sciences Institute Brazil held an international workshop on "Carbohydrates, Glycemia and Health". Carbohydrate digestion rate is related to glycemic response, which mainly depends on the quality and amount of carbohydrate ingested, and thus it may be modulated by intrinsic and extrinsic factors. These effects can be verified by using different methods which evidence how physiology adapts in the uptake of glucose. Consumers can be aided with the knowledge/awareness of the benefits of high postprandial glycemia control in non-diabetic subjects. Multisectorial actions can contribute to decrease the onset and worsening of NCDs. A strategy indicated to the public in general to expand the availability of products that do not result in a sudden increase of postprandial plasma glucose and/or insulin would be to use alternative ingredients and/or technology in addition to making the legally allowed communication of benefits, which are supported by scientific studies.

Translation and validation of the brazilian portuguese version of the gastrointestinal symptom rating scale (gsrs) questionnaire / Tradução e validação da versão brasileira do questionário Gastrointestinal Symptom Rating Scale (GSRS)

ABSTRACT Background - Bowel function is a widely evaluated parameter in interventional and longitudinal studies since it is associated with good maintenance of health. The evaluation of intestinal function has been performed by many questionnaires, however, there are few options validated in Brazilian Portuguese. Objective - The aim of this work was to translate and validate into Brazilian Portuguese the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire. Methods - Translation and cultural adaptation were performed according to a previously established methodology followed by reliability calculations. Results - The final translated GSRS questionnaire showed an adequate value of overall reliability of Cronbach's alpha of 0.83, and its domains were classified from acceptable to adequate. The overall test-retest reliability by intraclass correlation coefficient (ICC) was 0.84, considered excellent. Conclusion - The GSRS was translated and validated into Brazilian Portuguese, with appropriate internal consistency and reliability and is available to be used in assessments of bowel function.

RESUMO Contexto - O funcionamento intestinal é um dos parâmetros amplamente avaliado em estudos intervencionais e longitudinais, pois está associado à manutenção da saúde. A avaliação do funcionamento intestinal tem sido realizada por diferentes questionários, mas são poucas as alternativas validadas em português. Objetivo - O objetivo deste trabalho foi traduzir e validar para a língua portuguesa (Brasil) o questionário Gastrointestinal Symptom Rating Scale (GSRS). Métodos - A tradução e adaptação cultural foram realizadas de acordo com metodologia previamente estabelecida, seguida dos cálculos de confiabilidade. Resultados - A aplicação do questionário GSRS traduzido apresentou valor de confiabilidade geral alfa de Cronbach de 0,83, classificado como adequado, e seus domínios foram classificados de aceitável a adequado; o teste-reteste geral apresentou coeficiente de correlação intraclasse de 0,84, considerado excelente. Conclusão - O GSRS foi traduzido e validado para Português (Brasil), apresentando confiabilidade e reprodutibilidade apropriadas, e está disponível para ser utilizado em avaliações de funcionamento intestinal.

Farinha de banana verde: efeitos fisiológicos do consumo regular sobre a fome/saciedade e microbiota intestinal em voluntários saudáveis / Unripe banana flour: physiological effects of regular consumption on hunger/satiety and intestinal microbiota in healthy volunteers

Estudos com farinha de banana verde (FBV), rica em amido resistente, mostram efeitos positivos sobre a saciedade, resposta glicêmica e melhora do funcionamento intestinal. Entretanto, pouco se sabe sobre a capacidade da FBV em estimular seletivamente o crescimento e/ou atividades de microbiota intestinal benéfica e os efeitos fisiológicos do consumo habitual. No presente trabalho foi investigado o efeito da ingestão regular e descontinuada de FBV sobre a microbiota intestinal em voluntários saudáveis, bem como as interações com hormônios relacionados à fome e saciedade, funcionamento intestinal e homeostase da glicose. Para tanto foi realizado estudo de intervenção, duplo cego paralelo controlado com placebo, no qual voluntários saudáveis consumiram FBV ou maltodextrina, veiculadas através de sopa prontas congeladas, três vezes por semana e durante seis semanas. Os resultados evidenciaram que a FBV pode aumentar a saciedade, promover redução no aporte energético de refeições subsequentes (14%) e melhorar o funcionamento intestinal. Ao mesmo tempo reduz a secreção plasmática de insulina no jejum e o Índice HOMA2-RI em 20%, sinalizando aumento na sensibilidade à insulina. A análise da microbiota intestinal utilizando o rDNA 16S mostrou que existem dois grupos distintos de indivíduos, os quais respondem diferentemente ao consumo de FBV. O consumo de FBV por voluntários, cujo microbioma era mais abundante no gênero Prevotella, apresentou aumento de genes envolvidos em vias metabólicas relacionadas à degradação anaeróbia de carboidratos (794 Kegg orthologs, FDR=0,05), como as vias do metabolismo de amido e glicose, do butirato, propionato. Paralelamente outros genes indicaram redução de algumas vias metabólicas, incluindo a biossíntese de lipopolissacarídeos. Este mesmo grupo de voluntários apresentou gêneros microbianos positivamente relacionados com conteúdo de ácidos graxos de cadeia curta (AGCC), em padrão distinto do outro grupo de voluntários que consumiu FBV e do grupo Controle. Foi possível demonstrar que o consumo de FBV pode promover a modulação do microbioma em indivíduos saudáveis com enterótipos distintos, trazendo efeitos benéficos para a saúde humana

Studies with Unripe Banana Flour, rich in resistant starch, shave shown positive effects on satiety, glycemic response and improved intestinal function. Nevertheless, little is known about its capacity to selectively stimulate the intestinal microbiota's activity, or the physiological effects of its habitual consumption. This study investigated the effects of the regular, discontinued ingestion of UBF on the intestinal microbiome in healthy volunteers, as well as effects on hormones related to satiety, intestinal function and glucose homeostasis. To achieve these goals, a double blind, parallel, placebo controlled study was designed, in which healthy volunteers ingested UBF or maltodextrin added to a standardized frozen soup meal, 3 times a week for 6 weeks. The results showed that UBF can improve satiety, promote a reduction in energy intake at subsequent meals (14%) and improve intestinal function. At the same time, it reduces plasmatic secretion of fasting insulin and e the HOMA2-RI index by 20%, signaling an increase in insulin sensitivity. The analysis of the microbiome using the 16S rDNA gene showed that there are two clusters of individuals, which respond differently to the dietary intervention. The UBF consumption by volunteers with a Prevotella dominant microbiome showed an increase in genes related to anaerobic carbohydrate degradation (794 Kegg orthologs, FDR=0,05), such as members of the starch and glucose metabolism, propanoate metabolism and butyrate metabolism. At the same time, other genes were reduced, including the biosynthesis of lipopolysaccharides. The same volunteers presented several microbial groups positively correlated with the short chain fatty acids (SCFA) present in the fecal samples analyzed. This was a distinct pattern to that observed for the remaining volunteers. We demonstrated that the consumption of UBF can promote the overall health of the human host as well as the modulation of the intestinal microbiome in healthy individuals and that this effect is dependent on the enterotype present