Low FODMAPs diet for functional abdominal pain disorders in children: critical review of current knowledge / Dieta com baixo teor de FODMAPs para distúrbios de dor abdominal funcional em crianças: revisão crítica do conhecimento atual

ABSTRACT Objective: This narrative review aimed to provide practitioners a synthesis of the current knowledge on the role of a low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols diet in reducing symptoms associated with functional abdominal pain disorders in children. This review is focused on the pathophysiology, efficacy and criticism of low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols diet in children. Sources: Cochrane Database, Pubmed and Embase were searched using specific terms for Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols diet interventions and functional abdominal pain disorders. Summary of the findings: In children, only one Randomized Control Trial and one open-label study reported positive results of low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols diet; one Randomized Control Trial showed exacerbation of symptoms with fructans in children with Irritable Bowel Syndrome; no effect was found for the lactose-free diet whilst fructose-restricted diets were effective in 5/6 studies. Conclusions: In children there are few trials evaluating low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols in functional abdominal pain disorders, with encouraging data on the therapeutic efficacy particularly of fructose-restricted diet. Additional efforts are still needed to fill this research gap and clarify the most efficient way for tailoring dietary restrictions based on the patient's tolerance and/or identification of potential biomarkers of low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols efficacy, to maintain nutritional adequacy and to simplify the adherence to diet by labeling Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols content in commercial products.

RESUMO Objetivo: Nos últimos anos, foram feitos esforços consideráveis para esclarecer o papel da dieta com baixo teor de oligossacarídeos fermentáveis, dissacarídeos, monossacarídeos e polióis (FODMAPs) para o tratamento de distúrbios gastrintestinais funcionais (DGIFs). Esta revisão narrativa teve como objetivo fornecer aos profissionais uma síntese do conhecimento atual sobre o papel de uma dieta com baixo teor de FODMAPs (BFM) na redução dos sintomas associados a distúrbios funcionais de dor abdominal (DFDA) em crianças. Esta revisão está focada na fisiopatologia, eficácia e crítica da dieta BFM em crianças. Fontes: O banco de dados Cochrane, Pubmed e Embase foram pesquisados com o uso dos termos específicos para intervenções na dieta FODMAP e DFDA. Resumo dos achados: Em crianças, apenas um estudo controlado randomizado e um estudo aberto relataram resultados positivos da dieta BFM; um estudo controlado randomizado mostrou exacerbação dos sintomas com frutanos em crianças com síndrome do intestino irritável; nenhum efeito foi encontrado para a dieta livre de lactose, enquanto dietas com restrição de frutose foram eficazes em 5/6 estudos. Conclusões: Existem poucos estudos que avaliam BFM em DFDA em crianças, com dados encorajadores sobre a eficácia terapêutica, particularmente de dietas com restrição de frutose. Esforços adicionais ainda são necessários para preencher essa lacuna de pesquisa e esclarecer a maneira mais eficiente de adaptar as restrições dietéticas com base na tolerância do paciente e/ou identificação de biomarcadores potenciais de eficácia da BFM, para manter a adequação nutricional e simplificar a adesão à dieta, ao incluir informações sobre conteúdo de FODMAPs em rótulos de produtos comerciais.

Current Issues on Irritable Bowel Syndrome: Diet and Irritable Bowel Syndrome / 대한소화기학회지

Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders. It is a multifactorial disorder with its pathogenesis attributed to abnormal gastrointestinal motility, low-grade inflammation, visceral hypersensitivity, communication in the gut-brain axis, and so on. Traditionally, IBS has been treated with diet and lifestyle modification, fiber supplementation, psychological therapy, and pharmacological treatment. Carbohydrates are intermingled with a wide range of regularly consumed food including grains such as rye and wheat, vegetables, fruits, and legumes. Short-chain carbohydrates that are poorly absorbed exert osmotic effects in the intestinal lumen increasing its water volume, and are rapidly fermented by bacteria with consequent gas production. These effects may be the basis for the induction of most of the gastrointestinal symptoms. This has led to the use of lactose-free diets in those with lactose intolerance and of fructose-reduced diets for fructose malabsorption. As all poorly absorbed short-chain carbohydrates have similar and additive effects in the intestine, a concept has been developed to regard them collectively as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) and to evaluate a dietary approach that restricts them all. Based on the observational and comparative studies, and randomized-controlled trials, FODMAPs have been shown to trigger gastrointestinal symptoms in patients with IBS. Food choice via the low FODMAPs and potentially other dietary strategies is now a realistic and efficacious therapeutic approach for managing symptoms of IBS.

Genotypic diversity of S. mutans in dental biofilm formed in situ under sugar stress exposure

In situ dental biofilm composition under sugar exposure is well known, but sugar effect on the genotypic diversity of S. mutans in dental biofilm has not been explored. This study evaluated S. mutans genotypic diversity in dental biofilm formed in situ under frequent exposure to sucrose and its monosaccharide constituents (glucose and fructose). Saliva of 7 volunteers was collected for isolation of S. mutans and the same volunteers wore intraoral palatal appliances, containing enamel slabs, which were submitted to the following treatments: distilled and deionized water (negative control), 10 percent glucose + 10 percent fructose (fermentable carbohydrates) solution or 20 percent sucrose (fermentable and EPS inductor) solution, 8x/day. After 3, 7 and 14 days, the biofilms were colleted and S. mutans colonies were isolated. Arbitrarily primed polymerase chain reaction (AP-PCR) of S. mutans showed that salivary genotypes were also detected in almost all biofilm samples, independently of the treatment, and seemed to reflect those genotypes present at higher proportion in biofilms. In addition to the salivary genotypes, others were found in biofilms but in lower proportions and were distinct among treatment. The data suggest that the in situ model seems to be useful to evaluate genotypic diversity of S. mutans, but, under the tested conditions, it was not possible to clearly show that specific genotypes were selected in the biofilm due to the stress induced by sucrose metabolism or simple fermentation of its monosaccharides.

A composição do biofilme dental in situ exposto a açúcares é bem conhecida, mas o efeito dos açúcares na diversidade genotípica de S. mutans no biofilme dental ainda não foi explorada. Este estudo avaliou a diversidade genotípica de S. mutans no biofilme dental formado in situ sob frequente exposição à sacarose e seus monossacarídeos constituintes (glicose e frutose). Primeiramente, saliva de voluntários foi coletada para isolamento de S. mutans e os mesmos voluntários usaram um dispositivo intraoral palatino, contendo blocos de esmalte, que foram submetidos 8x/dia aos seguintes tratamentos: água destilada e deionizada (controle negativo), solução de glicose 10 por cento + frutose 10 por cento (carboidratos fermentáveis) e solução de sacarose 20 por cento (fermentável e indutor de PEC). Após 3, 7 e 14 dias, os biofilmes foram coletados e colônias de S. mutans foram isoladas. A técnica de reação em cadeia de polimerase usando primers arbitrários (AP-PCR) demonstrou que o genótipo salivar foi detectado em quase todas as amostras de biofilme, independente do tratamento, e parece refletir aqueles genótipos presentes em maiores proporções no biofilme. Além do genótipo salivar, outros foram encontrados nos biofilmes, mas em uma menor proporção e foram distintos entre os tratamentos. Os dados sugerem que o modelo in situ é útil para a avaliação da diversidade genotípica de S. mutans. Porém, nas condições do presente estudo, não foi possível demonstrar que genótipos específicos foram detectados no biofilme devido ao estresse induzido pelo metabolismo da sacarose ou fermentação de seus monossacarídeos.

Malaysian mosquitocidal soil bacterium (Bacillus thuringiensis) strains with selective hemolytic and lectin activity against human and rat erythrocytes.

The objective of this study is to determine the role of carbohydrates on the toxic effect of parasporal inclusion proteins isolated from Malaysian mosquitocidal Bacillus thuringiensis (Bt) strains on erythrocytes (human and rat). Dose response analyses on the effect of these parasporal inclusions on human and rat erythrocytes suggest that toxin action is selective depending on bacterial strains and source of erythrocytes. Results from this study suggest Bt toxin is a lectin which recognizes specific plasma membrane glycoconjugate receptor(s) with a terminal residue of either D-mannose (Man), N-acetyl-D-galactosamine (GalNAc), N-acetyl-D-glucosamine (GlcNAc) or even a combination of these monosaccharides.

Effect of protein malnutrition on the intestinal absorption of monosaccharides in rats in vivo.

The present study was planned to elucidate the role of protein malnutrition on the intestinal absorption of monosaccharides particularly--glucose and xylose, in inbred female albino rats. The experimental rats were fed with protein deficient diet containing 3% protein, whereas the control rats were given a diet containing 18% protein. The study on intestinal absorption of monosaccharides was conducted on both the groups of rats after the 7th and 15th day of receiving respective diets. The results indicated no significant impairment of glucose absorption of experimental rats fed 3% diet for 7 days as compared to the controls. However a 42% decrease in glucose absorption was observed when the animals were fed with the same diet for 15 days. The impairment was significant in all segments of intestine suggesting diminution in the absorption capacity of small intestine in malnutrition perhaps as a result of some permanent injury to mucosal cells of small intestine. Regarding xylose absorption, in experimental rats an increase of intestinal uptake was noticed in most of the segments of small intestine as compared to control rats.

Chronic lactose intake modifies the gastric emptying of monosaccharides but not of disaccharides in weanling rats

Ninety-six weanling male Wistar rats were fed for four weeks one of two different chows: a normal rat chow containing 55.5 percent (w/w) starch (control group, N = 48) or a rat chow in which starch was partially replacced by lactose, in such a way that the experimental group (N = 48) received 35.3 per cent (w/w) starch and 20 percent (w/w) lactose. The gastric emptying of fluid was then studied by measuring the gastric retention of four test meals containing lactose (5 percent or 10 percent, w/v) or glucose + galactose (5 percent or 10 percent, w/v). Homogenates of the small intestine were assayed for lactase activity. The gastric retention values were obtained 15 min after orogastric infusion of the liquid meals. The median values for gastric retention of the 5 percent lactose solutions were 37.7 percent for the control group and 37.0 percent for the experimental group (P>0.02) For the 10 percent lactose solution the median values were 51.2 percent and 47.9 percent (P>0.02) for the control and experimental groups, respectively. However, for the 2.5 percent glucose + 2.5 percent galactose meal the median gastric retention was lower (P<0.02) in the group fed a lactose-enriched chow (38.5 percent) than in the control group (41.6 percent). For the 5 percent glucose + 5 percent galactose solution the median values were not statistically different between groups, 65.0 percent for the control group and 58.8 percent for the experimental group. The median values of the specific lactase activity in the small intestine homogenate was 0.74 U/g in the control group and 0.91 U/g in the experimental group. These values were not statistically different (P>0.05). These results suggest that the prolonged ingestion of lactose by young adult rats changes the gastric emptying of a solution containing 5 percent monosaccharides. This adaptation may reflect the desensitization of intestinal nutrient receptors, possibly by an osmotic effect of lactose present in the chow.

Fatty acid synthesis by isolated leucoplasts from developing Brassica seeds: role of glycolytic intermediates as the source of carbon and energy.

Fatty acid synthesis from Na [1-14C] acetate in leucoplasts isolated from developing seeds of Brassica campestris was completely dependent on exogenous supply of ATP. None of the intermediates of glycolysis or pentose phosphate pathway tested could replace ATP in the reaction mixture. In absence of exogenously supplied ATP, maximum activity was obtained with glu-6-P (68%) followed by fru-6-P (50%) and PEP (44%), respectively. With other intermediates as energy sources, the activity ranged from 1 to 38%. In complementary experiments (presence of ATP), none of the metabolites gave activity higher than the ATP control activity. Under optimum conditions for fatty acid synthesis from acetate, Brassica leucoplasts readily utilized labelled glucose as the substrate for fatty acid synthesis. Omission of NADH and NADPH individually from the reaction mixtures containing labelled glucose resulted only in 46 and 20% loss in activity, respectively, compared to the corresponding losses of 56 and 50%, when labelled acetate was used as the substrate. Similarly, deletion of ATP from the reaction mixture containing glucose as the substrate decreased the rate of fatty acid synthesis by about 65%, while the corresponding decrease with acetate as the substrate was 96%. Inclusion of 5 mM cold acetate, pyruvate, malate and glu-6-P in the reaction mixture containing glucose as the labelled substrate reduced label incorporation into fatty acids by 38 to 69%, maximum reduction being observed with pyruvate followed by glu-6-P, acetate and malate, respectively. With labelled acetate as the substrate, maximum reduction in label incorporation was obtained with cold glucose (5 mM) followed by glu-6-P, pyruvate and malate, respectively. The study demonstrated the operation of complete glycolytic pathway in Brassica leucoplasts, allowing the plastids to use glucose as a source of carbon, reducing power and energy for fatty acid synthesis.

Estudo comparativo do esvaziamento gástrico de dissacarídios e de seus respectivos monossacarídios em ratos com deficiência ontogênica de lactase / Comparative study of the gastric emptying of disaccharides and their respective monosaccharides in rats with ontogenic lactase deficiency

Com a finalidade de avaliar o esvaziamento gástrico de dissacarídios e monossacarídios, foram empregados no estudo 64 ratos Wistar, machos, pesando, em média, 180g. com idade de 8-10 semanas de vida, divididos em grupos de oito animais cada. Os grupos foram assim constituídos: grupo maltose, grupo sacarose, grupo lactose e grupo lactulose e os correspondentes grupos de monossacarídios: grupos glicose, grupo frutose + glicose, grupo galactose + glicose e grupo galactose + frutose. Cada animal de cada grupo recebeu, por via orogástrica, após jejum alimentar de 20h, refeiçäo de prova constituída de uma soluçäo a 10% (p/v) de açucar, acrescida de fenol vermelho na concentraçäo de 6mg/dl, como marcador. O volume empregado foi de 2ml/100g de peso do animal. A retençäo gástrica foi determinada aos 10 min após infusäo da refeiçäo de prova, e expressa em porcentagem. Os resultados (X ñ SE) das retençöes gástricas (%) da sacarose (35,0ñ 1,8), lactose (30,4 ñ 1,5) e lactulose (29,5 ñ 1,6 foram significativamente menores (teste t, alfa = 0,05) que os observados com os respectivos monossacarídios, ou seja, glicose + frutose (46,9 ñ 2,6), glicose + galactose (48,3 ñ 2,4), galactose + frutose (43,5 ñ 1,5). Näo foi observada diferença da retençäo gástrica de maltose (49,0 ñ 4,7), quando comparada com a glicose (53,0 ñ 3,0). Entre os dissacarídios, a análise estatístoca (análise de variância seguida do teste de Tukey, alfa = 0,05) dos resultados näo mostrou diferenças na retençäo gástrica de sacarose, lactose e lactulose. A retençäo gástrica da maltose foi significativamente maior em relaçäo aos outros dissacarídios. Näo foram observadas diferenças significativas na retençäo gástrica dos monossacarídios. Estas observaçöes indicam que a menor concentraçäo de dissacaridases (sacarase, lactase) ou aausência de uma enzima específica (lactulase), na mucosa do intestino delgado, induz um esvaziamento gástrico mais rápido dos respectivos dissacarídios. O fenômeno pode ser explicado pela falta de estímulo dos receptores que modulam o esvaziamento gástrico, lcoalizados mais profundamente em relaçäo às enzimas