A Symbiotic Meal Containing Extruded Sorghum and Probiotic (Bifidobacterium longum) Ameliorated Intestinal Health Markers in Individuals with Chronic Kidney Disease: A Secondary Analysis of a Subsample from a Previous Randomized and Controlled Clinical Trial.

BACKGROUND: Chronic kidney disease increases uremic toxins concentrations, which have been associated with intestinal dysbiosis. Sorghum bicolor L. Moench has dietary fiber and bioactive compounds, while Bifidobacterium longum can promote beneficial health effects. METHODS: It is a controlled, randomized, and single-blind clinical trial. Thirty-nine subjects were randomly separated into two groups: symbiotic group (SG), which received 100 mL of unfermented probiotic milk with Bifidobacterium longum strain and 40 g of extruded sorghum flakes; and the control group (CG), which received 100 mL of pasteurized milk and 40 g of extruded corn flakes for seven weeks. RESULTS: The uremic toxins decreased, and gastrointestinal symptoms improved intragroup in the SG group. The acetic, propionic, and butyric acid production increased intragroup in the SG group. Regarding α-diversity, the Chao1 index was enhanced in the SG intragroup. The KEGG analysis revealed that symbiotic meal increased the intragroup energy and amino sugar metabolism, in addition to enabling essential amino acid production and metabolism, sucrose degradation, and the biosynthesis of ribonucleotide metabolic pathways. CONCLUSIONS: The consumption of symbiotic meal reduced BMI, improved short-chain fatty acid (SCFA) synthesis and gastrointestinal symptoms, increased diversity according to the Chao1 index, and reduced uremic toxins in chronic kidney disease patients.

Synbiotic meal decreases uremic toxins in hemodialysis individuals: A placebo-controlled trial.

Generation of uremic toxins p-cresylsulfate (p-CS), indoxyl sulfate (IS) and indole 3-acetic acid (IAA) in hemodialysis (HD) individuals may be associated with the gut flora and recognized markers of disease progression. This study investigated the effect of synbiotic meal on uremic toxins in HD individuals. We conducted randomized singleblind and placebo-controlled intervention study with 58 HD subjects (20F/38M, 63.1 ±â€¯10.9-old) who were randomly allocated in synbiotic group (SG, 40 g of extruded sorghum plus 100 mL of unfermented probiotic milk) or control group (CG, 40 g of extruded corn plus 100 mL of pasteurized milk), during 7-wk Metabolic markers and uremic toxins, fecal concentration of short chain fatty acid and pH value was determined. The SG group had decreased serum p-CS and IS, as well as decreased urea concentration (p < .05) compared to CG. SG showed higher fecal butyric acid and lower pH compared to baseline and SC (p < .05). In addition, serum p-CS and fecal pH were positively correlated to urea concentration in SG participants at the endpoint. The consumption of the synbiotic meal during 7-wk reduced colonic pH, and reduced serum uremic (p-CS and IS) toxins and urea in HD subjects.

Modulation of intestinal microbiota, control of nitrogen products and inflammation by pre/probiotics in chronic kidney disease: a systematic review.

Dysbiosis may favor the occurrence of inflammation and oxidative stress in chronic kidney disease (CKD). It has been suggested that the intake of pre/probiotics may control the progression of chronic kidney disease. Thus, the objective of this study was to systematically review the literature on the effects of pre/probiotic intake on the intestinal microbiota, control of nitrogen products, oxidative stress, and inflammation in CKD patients.The literature search was conducted on MEDLINE, LILACS, Cochrane Library of Clinical Trials, and Science Direct. After careful evaluation by the reviewers, ten potentially relevant articles were selected for this study. Based on previous studies, intake of prebiotics appears to have the following effects: increased bifidobacteria and lactobacillus counts; reduced formation of uremic toxin, p-cresol, and its serum concentrations; improved lipid profiles; reduced systemic inflammatory state and concentrations of oxidative stress markers. Similarly, consumption of probiotics can reduce blood urea and serum phosphate concentrations. Furthermore, an increase in fecal volume and intestinal Bifidobacteriumand a reduction in p-cresol serum and blood urea concentrations were observed in response to symbiotic intake. These results suggest that consumption of pre/probiotics may modulate the intestinal microbiota, and promote the growth and metabolism of anaerobic bacteria by decreasing the production of uremic solutes, further causing oxidative stress and systemic inflammation in CKD patients.

Modulation of intestinal microbiota, control of nitrogen products and inflammation by pre/probiotics in chronic kidney disease: a systematic review / Modulación de microbiota intestinal, control de productos de nitrógeno e inflamación por pre/probióticos en la enfermedad renal crónica: una revisión sistemática

Dysbiosis may favor the occurrence of inflammation and oxidative stress in chronic kidney disease (CKD). It has been suggested that the intake of pre/probiotics may control the progression of chronic kidney disease. Thus, the objective of this study was to systematically review the literature on the effects of pre/probiotic intake on the intestinal microbiota, control of nitrogen products, oxidative stress, and inflammation in CKD patients.The literature search was conducted on MEDLINE, LILACS, Cochrane Library of Clinical Trials, and Science Direct. After careful evaluation by the reviewers, ten potentially relevant articles were selected for this study. Based on previous studies, intake of prebiotics appears to have the following effects: increased bifidobacteria and lactobacillus counts; reduced formation of uremic toxin, p-cresol, and its serum concentrations; improved lipid profiles; reduced systemic inflammatory state and concentrations of oxidative stress markers. Similarly, consumption of probiotics can reduce blood urea and serum phosphate concentrations. Furthermore, an increase in fecal volume and intestinal Bifidobacteriumand a reduction in p-cresol serum and blood urea concentrations were observed in response to symbiotic intake. These results suggest that consumption of pre/probiotics may modulate the intestinal microbiota, and promote the growth and metabolism of anaerobic bacteria by decreasing the production of uremic solutes, further causing oxidative stress and systemic inflammation in CKD patients

La disbiosis puede favorecer la incidencia de inflamación y de estrés oxidativo en enfermedades renales crónicas. Se ha sugerido que el consumo de prebióticos y probióticos puede controlar la progresión de enfermedades renales crónicas. De este modo, el objetivo de este estudio es revisar sistemáticamente la literatura sobre los efectos del consumo de prebióticos y probióticos en la microbiota intestinal, el control de los productos de nitrógeno, el estrés oxidativo y la inflamación en enfermedades renales crónicas. La búsqueda bibliográfica fue realizada por medio de MEDLINE, LILACS, Cochrane Library of Clinical Trials y Science Direct. Diez artículos fueron incluidos en este estudio. Los prebióticos parecen aumentar las bifidobacterias y el recuento de lactobacillus, reducir la formación de toxina urémica, p-cresol y su concentración sérica; mejorar los perfiles lipídicos y reducir el estado de inflamación sistémica y la concentración de indicadores de estrés oxidativo. El consumo de probióticos puede reducir la urea en sangre y la concentración de fosfato sérico. Se verificó el aumento del volumen fecal y de las bifidobacterias intestinales y la reducción de la concentración sérica de p-cresol y de urea en sangre en respuesta a la ingesta de simbióticos. Estos resultados indican que los prebióticos y probióticos modulan la microbiota intestinal y promueven el crecimiento del metabolismo de bacterias anaerobias, disminuyendo la producción de solutos urémicos y la incidencia de estrés oxidativo e inflamación sistémica en pacientes portadores de enfermedades renales crónicas

Evaluation of the health benefits of consumption of extruded tannin sorghum with unfermented probiotic milk in individuals with chronic kidney disease.

This study investigated the chemical and nutritional composition of breakfast cereal based on whole sorghum, and the effect of its association with unfermented probiotic milk on the inflammation and oxidative stress of individuals with chronic kidney disease. Extruded sorghum breakfast meal presented higher carbohydrate concentration (approximately 71%), followed by protein (approximately 11%) and lipid (approximately 0.4%). When compared to extruded maize breakfast meal, it presented higher percentage of dietary fiber (p < 0.05), and higher content of phenolic compounds and tannin, consequently higher antioxidant activity (p < 0.05). Extruded sorghum breakfast cereal combined with unfermented probiotic milk decreased the C-reactive protein (p < 0.05) and malondialdehyde (p < 0.05) serum levels and increased the total antioxidant capacity and superoxide dismutase (p < 0.05) in patients with chronic kidney disease. Therefore, the extruded sorghum, source of tannin, anthocyanin, and dietary fiber, when consumed with unfermented probiotic milk alleviates the inflammation and oxidative stress in patients with chronic kidney disease.