The effects of inulin-type fructans on cardiovascular disease risk factors: systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Inulin-type fructans (ITF) are the leading prebiotics in the market. Available evidence provides conflicting results regarding the beneficial effects of ITF on cardiovascular disease risk factors. OBJECTIVES: This study aimed to evaluate the effects of ITF supplementation on cardiovascular disease risk factors in adults. METHODS: We searched MEDLINE, EMBASE, Emcare, AMED, CINAHL, and the Cochrane Library databases from inception through May 15, 2022. Eligible randomized controlled trials (RCTs) administered ITF or placebo (for example, control, foods, diets) to adults for ≥2 weeks and reported one or more of the following: low, very-low, or high-density lipoprotein cholesterol (LDL-C, VLDL-C, HDL-C); total cholesterol; apolipoprotein A1 or B; triglycerides; fasting blood glucose; body mass index; body weight; waist circumference; waist-to-hip ratio; systolic or diastolic blood pressure; or hemoglobin A1c. Two reviewers independently and in duplicate screened studies, extracted data, and assessed risk of bias. We pooled data using random-effects model, and assessed the certainty of evidence (CoE) using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS: We identified 1767 studies and included 55 RCTs with 2518 participants in meta-analyses. The pooled estimate showed that ITF supplementation reduced LDL-C [mean difference (MD) -0.14 mmol/L, 95% confidence interval (95% CI: -0.24, -0.05), 38 RCTs, 1879 participants, very low CoE], triglycerides (MD -0.06 mmol/L, 95% CI: -0.12, -0.01, 40 RCTs, 1732 participants, low CoE), and body weight (MD -0.97 kg, 95% CI: -1.28, -0.66, 36 RCTs, 1672 participants, low CoE) but little to no significant effect on other cardiovascular disease risk factors. The effects were larger when study duration was ≥6 weeks and in pre-obese and obese participants. CONCLUSION: ITF may reduce low-density lipoprotein, triglycerides, and body weight. However, due to low to very low CoE, further well-designed and executed trials are needed to confirm these effects. PROSPERO REGISTRATION NUMBER: CRD42019136745.

Effects of inulin-type fructans supplementation on cardiovascular disease risk factors: a protocol for a systematic review and meta-analysis of randomised controlled trials.

INTRODUCTION: This review aims to assess the effects of dietary supplementation with inulin-type fructans (ITF) compared with no supplementation on cardiovascular disease risk factors in adults and assess the quality of trial reporting using the Consolidated Standards of Reporting Trials (CONSORT) and CONSORT for abstract (CONSORT-A) checklists. METHODS AND ANALYSIS: We will search randomised controlled trials (RCTs) in MEDLINE, EMBASE, CINAHL, Emcare, AMED and the Cochrane Database of Systematic Reviews from inception to 31 March 2022, without any language restrictions. The RCTs need to administer ITF in adults for at least 2 weeks and assess effects on at least one cardiovascular risk factor. We will exclude RCTs that (1) assessed the postprandial effects of ITF; (2) included pregnant or lactating participants; (3) enrolled participants undergoing treatment that might affect the response to ITF. We will assess the study risk of bias (RoB) using V.2 of the Cochrane RoB tool for RCTs (RoB 2) and the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We will pool data using a random-effects model. We will use the χ2 test to compare compliance of CONSORT and CONSORT-A checklists and Poisson regression to identify factors associated with better reporting. ETHICS AND DISSEMINATION: Ethics approval is not required for secondary analysis of already published data. We will publish the reviews in a peer-review journal. PROSPERO REGISTRATION NUMBER: CRD42019136745.

Evaluation of Nutritional, Inflammatory, and Fatty Acid Status in Patients with Gastric and Colorectal Cancer Receiving Chemotherapy.

Malnutrition is prevalent in gastrointestinal (GI) cancer patients, possibly due to inflammation and altered fatty acids (FA). There is a lack of research describing nutritional decline in these patients during chemotherapy. We described changes in nutritional, inflammatory, and FA status over time and factors relating to change in nutritional status according to tumor presence in 41 GI cancer patients undergoing first-line treatment over four chemotherapy visits, using linear mixed effects models. At baseline, 53% of patients were malnourished. Over time, there was a decrease in the proportion of malnourished vs. well-nourished individuals (ß= -0.564, p < 0.01). Median concentrations of plasma linoleic acid, arachidonic acid, eicosapentaenoic acid, docosahexaenoic acid, total n-3, total n-6 and total plasma phospholipid FA increased over time. Changes over time in nutritional status based on weight (p < 0.001), fat free mass (FFM) measured by bioelectrical impedance analysis (BIA, p = 0.02), and skinfold anthropometry (FSA, p = 0.04) were significantly dependent on tumor presence. There were positive associations between weight and total n-3 (ß = 0.02, p < 0.01), FFM and IL-6 (BIA, ß = 0.028, p = 0.02; FSA, ß = 0.03, p = 0.02), and FFM and total n-6 (BIA, ß = 0.003, p = 0.01). Changes in nutritional status during chemotherapy were negatively impacted by tumor presence, and were associated with increasing concentrations of cytokines and FA.

Sodium-Reduced Meat and Poultry Products Contain a Significant Amount of Potassium from Food Additives.

BACKGROUND: Sodium-reduced packaged food products are increasingly available to consumers; however, it is not clear whether they are suitable for inclusion in a potassium-reduced diet. For individuals with impaired renal potassium excretion caused by chronic kidney disease and for those taking certain medications that interfere with the rennin-angiotensin aldosterone axis, the need to limit dietary potassium is important in view of the risk for development of hyperkalemia and fatal cardiac arrhythmias. OBJECTIVE: The primary objective of this study was to determine the impact of the reduction of sodium in packaged meat and poultry products (MPPs) on the content of potassium and phosphorus from food additives. DESIGN: This was a cross-sectional study comparing chemically analyzed MPPs (n=38, n=19 original, n=19 sodium-reduced), selected from the top three grocery chains in Canada, based on market share sales. All MPPs with a package label containing a reduced sodium content claim together with their non-sodium-reduced packaged MPP counterparts were selected for analysis. The protein, sodium, phosphorus, and potassium contents of sodium-reduced MPPs and the non-sodium-reduced (original) MPP counterparts were chemically analyzed according to the Association of Analytical Communities official methods 992.15 and 984.27 and compared by using a paired t test. The frequency of phosphorus and potassium additives appearing on the product labels' ingredient lists were compared between groups by using McNemar's test. RESULTS: Sodium-reduced MPPs (n=19) contained 44% more potassium (mg/100 g) than their non-sodium-reduced counterparts (n=19) (mean difference [95% CI): 184 [90-279]; P=0.001). The potassium content of sodium-reduced MPPs varied widely and ranged from 210 to 1,500 mg/100 g. Potassium-containing additives were found on the ingredient list in 63% of the sodium-reduced products and 26% of the non-sodium-reduced products (P=0.02). Sodium-reduced MPPs contained 38% less sodium (mg/100 g) than their non-sodium-reduced counterparts (mean difference [95% CI]: 486 [334-638]; P<0.001). The amounts of phosphorus and protein, as well as the frequency of phosphorus additives appearing on the product label ingredient list, did not significantly differ between the two groups. CONCLUSIONS: Potassium additives are frequently added to sodium-reduced MPPs in amounts that significantly contribute to the potassium load for patients with impaired renal handling of potassium caused by chronic kidney disease and certain medications. Patients requiring potassium restriction should be counseled to be cautious regarding the potassium content of sodium-reduced MPPs and encouraged to make food choices accordingly.

The Impact of Additives on the Phosphorus, Potassium, and Sodium Content of Commonly Consumed Meat, Poultry, and Fish Products Among Patients With Chronic Kidney Disease.

OBJECTIVE: Patients with chronic kidney disease (CKD) are advised to limit their dietary intake of phosphorus and potassium as hyperphosphatemia and hyperkalemia are both associated with an increased risk of mortality. There is uncertainty concerning the actual content of these minerals in the Canadian food supply, as phosphorus and potassium are increasingly being used as food additives. This study aimed to determine the impact of food additives on the chemically analyzed content of phosphorus, potassium, sodium, and protein in commonly consumed meat, poultry, and fish products (MPFs). DESIGN: Foods representing commonly consumed MPF identified by a food frequency questionnaire in dialysis patients were purchased from three major grocery store chains in Canada. MPF with and without phosphorus and potassium additives listed on their ingredient list (n = 76) as well as reference MPF that was additive free (n = 15) were chemically analyzed for phosphorus, potassium, sodium, and protein content according to Association of Analytical Community official methods. RESULTS: Phosphorus, potassium, and sodium additives were present on the ingredient list in 37%, 9%, and 72% of MPF, respectively. Among MPF categories that contained a phosphorus additive, phosphorus content was significantly (P < .05) higher in MPF with phosphorus additives versus MPF without phosphorus additives and MPF reference foods (median [min, max]): (270 [140, 500] mg/100 g) versus (200 [130, 510] mg/100 g) versus (210 [100, 260] mg/100 g), respectively. Among MPF categories containing a potassium additive, foods listing a potassium additive had significantly more (P < .05) potassium than foods that did not list potassium additives and reference foods (900 [750, 1100] mg/100 g) versus (325 [260, 470] mg/100 g) versus (420 [270, 450] mg/100 g). CONCLUSIONS: The use of additives in packaged MPF products as indicated by the ingredient list can significantly contribute to the dietary phosphorus and potassium loads in patients with CKD. Patients with CKD should be educated to avoid MPF foods listing phosphorus and/or potassium additives on the ingredient list, which may lead to improved dietary adherence.

Evaluating the accuracy of a geographic closed-ended approach to ethnicity measurement, a practical alternative.

PURPOSE: Measuring ethnicity accurately is important for identifying ethnicity variations in disease risk. We evaluated the degree of agreement and accuracy of maternal ethnicity measured using the new standardized closed-ended geographically based ethnicity question and geographic reclassification of open-ended ethnicity questions from the Canadian census. METHODS: A prospectively designed study of respondent agreement of mothers of healthy children aged 1-5 years recruited through the TARGet Kids! practice-based research network. For the primary analysis, the degree of agreement between geographic reclassification of the Canadian census maternal ethnicity variables and the new geographically based closed-ended maternal ethnicity variable completed by the same respondent was evaluated using a kappa analysis. RESULTS: Eight hundred sixty-two mothers who completed both measures of ethnicity were included in the analysis. The kappa agreement statistic for the two definitions of maternal ethnicity was 0.87 (95% confidence interval, 0.84-0.90) indicating good agreement. Overall accuracy of the measurement was 93%. Sensitivity and specificity ranged from 83% to 100% and 96% to 100%, respectively. CONCLUSIONS: The new standardized closed-ended geographically based ethnicity question represents a practical alternative to widely used open-ended ethnicity questions. It may reduce risk of misinterpretation of ethnicity by respondents, simplify analysis, and improve the accuracy of ethnicity measurement.

Non-Western immigrant children have lower 25-hydroxyvitamin D than children from Western families.

OBJECTIVE: To determine if children aged 1-6 years from non-Western immigrant families have lower serum 25-hydroxyvitamin D (25(OH)D) levels than children from Western-born families and examine which factors influence this relationship. DESIGN: Cross-sectional study. SETTING: Toronto, Canada. SUBJECTS: Healthy children (n 1540) recruited through the TARGet Kids! practice-based research network. Serum 25(OH)D concentrations of non-Western immigrants were compared with those of children from Western-born families. Children from non-Western immigrant families were defined as those born, or their parents were born, outside a Western country. Univariate and multiple linear regression analyses were used to identify factors which might influence this relationship. RESULTS: Median age was 36 months, 51 % were male, 86 % had 'light' skin pigmentation, 55 % took vitamin D supplements, mean cow's milk intake was 1·8 cups/d and 27 % were non-Western immigrants. Median serum 25(OH)D concentration was 83 nmol/l, with 5 % having 25(OH)D < 50 nmol/l. Univariable analysis revealed that non-Western immigrant children had serum 25(OH)D lower by 4 (95 % CI 1·3, 8·0) nmol/l (P = 0·006) and increased odds of 25(OH)D < 50 nmol/l (OR = 1·9; 95 % CI 1·3, 2·9). After adjustment for known vitamin D determinants the observed difference attenuated to 0·04 (95 % CI -4·8, 4·8) nmol/l (P = 0·99), with higher cow's milk intake (P < 0·0001), vitamin D supplementation (P < 0·0001), summer season (P = 0·008) and increased age (P = 0·04) being statistically significant covariates. Vitamin D supplementation was the strongest explanatory factor of the observed difference. CONCLUSIONS: There is an association between non-Western immigration and lower 25(OH)D in early childhood. This difference appears related to known vitamin D determinants, primarily vitamin D supplementation, representing opportunities for intervention.

Reflections on Perceived Preparedness of Dietetic Internship Graduates Following Entry into Practice.

PURPOSE: To report on the perceived level of preparedness of dietetic internship (DI) graduates for entrance into practice as dietitians. METHODS: Graduates of an Ontario based, nonintegrated DI program from 2007-2011 who were at least 1 year postgraduation were surveyed to determine their level of perceived preparedness for practice using an electronic, content validated, self-administered questionnaire. RESULTS: Of 38 eligible graduates, 23 (61%) responded. Seventy-five percent of respondents were working as clinical dietitians, and 30% were working as community dietitians. Eighty-five percent of graduates reported feeling well or very well prepared for practice. Clinical and professional practice tasks were scored highest in terms of preparedness (ratings above 4.5/5) and research-related tasks such as using the research literature (4.1/5), making evidence-based decisions (4.2/5), and engaging in practice-based research (4.1/5) scored lower. Training gaps identified by 32% of respondents included community nutrition and management skill training. CONCLUSIONS: Overall, results indicate that this DI program provides a positive training experience that prepares its graduates for entrance into practice as dietitians. Qualitative comments identifying gaps and improvements have guided changes to the curriculum including strengthening community-based placements. Post-graduate surveys represent an important tool in assuring that training programs evolve to meet the needs of students entering the workforce.

Use of an abridged scored Patient-Generated Subjective Global Assessment (abPG-SGA) as a nutritional screening tool for cancer patients in an outpatient setting.

The scored Patient-Generated Subjective Global Assessment tool (PG-SGA), regarded as the most appropriate means of identifying malnutrition in cancer patients, is often challenging to implement in a busy outpatient setting. We assessed the validity of an abridged version of the PG-SGA (abPG-SGA), which forgoes the physical examination, and compared its usefulness in discerning malnutrition to the full PG-SGA and Malnutrition Screening Tool (MST). The nutritional status of 90 oncology outpatients receiving chemotherapy was assessed according to SGA global rating, PG-SGA, and MST. Receiver operating characteristic (ROC) curves were generated to estimate the sensitivity and specificity of various cut-off scores for malnutrition. Thirty-six percent of patients were malnourished (SGA). The abPG-SGA yielded 94% sensitivity and 78% specificity and area under the curve (AUC) = 0.956, which was slightly lower than PG-SGA (97% sensitivity, 86% specificity, AUC = 0.967) and higher than MST (81% sensitivity, 72% specificity, AUC = 0.823). Patient reported symptoms included loss of appetite (30%), altered taste (31%), fatigue (30%), and decreased ability to perform activities of daily living (53%). In conclusion, the abPG-SGA is a practical, informative and valid tool for detecting malnutrition in the outpatient oncology setting.

Longitudinal trends in nutritional status and the relation between lung function and BMI in cystic fibrosis: a population-based cohort study.

BACKGROUND: A high-calorie diet has been a standard of care in cystic fibrosis (CF) for >3 decades. However, energy requirements may have changed with new treatments and milder genotypes. OBJECTIVES: The objectives of this study were to describe longitudinal trends in nutritional status and to evaluate the relation between nutritional status and lung function. DESIGN: This longitudinal cohort study included 909 individuals followed at the Adult CF Clinic in Toronto from 1985 to 2011. Nutritional status was classified on the basis of WHO BMI guidelines. Multivariable linear regression with the use of generalized estimating equations was applied to evaluate the relation between BMI and lung function. RESULTS: The proportion of underweight individuals decreased from 20.6% before 1990 to 11.1% in the most recent decade, whereas the proportion of overweight and obese subjects increased from 7.0% to 18.4% (P < 0.001). Overweight and obese subjects were older, had better lung function, had milder genotypes, and were more often male and pancreatic sufficient. Multivariable regression analyses showed that within the underweight group, an increase in BMI resulted in improved lung function, whereas this effect was half of that in overweight individuals. The greatest advantage of improved nutrition on lung function was observed in the underweight group and in pancreatic- insufficient patients. CONCLUSIONS: Modification to a high-fat diet may be required in some individuals with CF to optimize nutritional health. Higher BMI is associated with improvements in lung function, although the lung function benefit of increasing one's BMI (in kg/m(2)) to >25 is small and needs to be balanced against the known health risks of obesity.

Glutathione and riboflavin status in supplemented patients undergoing home nocturnal hemodialysis versus standard hemodialysis.

BACKGROUND: Patients on conventional hemodialysis (HD) have elevated markers of oxidative stress and chronic inflammation, which may contribute to a high prevalence of cardiovascular disease. Glutathione (GSH), an important intracellular antioxidant, requires cysteine as a rate-limiting amino acid for its synthesis and riboflavin for its regeneration. OBJECTIVES: We aimed to examine whether erythrocyte GSH (eGSH) concentrations and riboflavin status are influenced by the increased dialysis dose provided to vitamin-supplemented patients receiving home nocturnal hemodialysis (HNHD) (6-8 hours/session, 5-7 nights/week) compared with patients on standard hemodialysis (SHD) (4 hours/session, 3 days/week). METHOD: This was a cross-sectional comparative study involving 30 patients undergoing SHD or HNHD regimens and a group of 15 healthy control subjects (HC). We measured eGSH concentration by liquid chromatography-tandem mass spectrometry, riboflavin status by eGSH reductase activity coefficient (EGRAC) as well as plasma total cysteine (Cys) and total homocysteine (Hcy), vitamin C by high-performance liquid chromatography, and C-reactive protein (CRP) by standard method. Estimated dietary protein and energy intakes were determined by 3-day food records, and nutritional status was assessed by subjective global assessment (SGA). RESULTS: There were no significant differences among groups in eGSH concentration, EGRAC, dietary protein intake, and SGA score. SHD patients had significantly higher plasma Cys (P < .001) and Hcy compared with HNHD and HC groups (P = .048). Vitamin C was significantly lower (P = .01) and CRP significantly higher (P = .048) in both HD groups compared with HC. CONCLUSION: eGSH concentration appears to be unaffected by dialysis dose in well-nourished HD patients.

B-vitamin deficiency in hospitalized patients with heart failure.

The impact of heart failure and its treatment on specific nutrient requirements is unknown. Furthermore, depletion of water-soluble B vitamins that play key roles in the production of cellular energy in patients with heart failure can contribute to depletion of energy reserves observed in the failing heart. A cross-sectional study recently reported that approximately one third of hospitalized patients with heart failure had tissue levels suggestive of thiamin deficiency (vitamin B-1). Riboflavin (vitamin B-2) and pyridoxine (vitamin B-6) are similar to thiamin in that they are water-soluble, subject to renal excretion, have limited tissue storage, and are dependent on intake. Therefore, it was hypothesized that the status of these B vitamins may also be adversely affected by heart failure. As a result, the prevalence of patients at risk of vitamin B-2 (erythrocyte glutathione reductase activity coefficient > or = 1.2) and B-6 deficiency (plasma B-6 < or = 20 nmol/L) was determined in a cross-section of 100 patients hospitalized with heart failure between April 2001 and June 2002 as well as in a group of volunteers without heart failure. Twenty-seven percent of patients with heart failure had biochemical evidence of vitamin B-2 deficiency, while 38% had evidence of B-6 deficiency. These prevalence rates were significantly higher than those observed in the volunteers without heart failure (2% and 19%, respectively; P < or = 0.02). Use of common B-vitamin-containing supplements by patients with heart failure did not significantly reduce deficiency rates in comparison with those who did not use supplements (B-2 P=0.38 or B-6 P=0.18)). Finally, while 80% of patients with heart failure took diuretics, neither the dose nor the duration of furosemide use was related to the presence of either B-2 or B-6 deficiency. Given the physiologic importance of these vitamins, further investigations aimed at determining the effect of heart failure on specific nutrient requirements as well as the safety and efficacy of B-vitamin supplementation are warranted.

Postnatal growth failure in preterm infants: ascertainment and relation to long-term outcome.

OBJECTIVE: Traditional measure of postnatal growth failure assessment has poor discriminatory power for long-term outcomes. Our objective was to identify measure of postnatal growth failure associated with long-term outcome in preterm infants born at < 28 weeks' gestation. PATIENTS AND METHODS: Four measures of defining postnatal growth failure at 36 weeks corrected gestational age: (1) weight < 10(th) centile, (2) weight < 3(rd) centile, (3) z score difference from birth > 1 and, (4) z score difference from birth > 2; were compared for their predictive values and strength of association with adverse neurodevelopmental outcomes at 18-24 months. RESULTS: Postnatal growth failure defined as a decrease in z score of > 2 between birth and 36 weeks corrected gestational age had the best predictive values compared to other postnatal growth failure measures, however, it was significantly associated with psychomotor developmental (P=0.006) but not with mental developmental indices (P=0.379). CONCLUSION: Postnatal growth failure defined by z score change influenced psychomotor but not mental tasks in this cohort. This method of ascertainment could be useful to identify infants who might benefit from nutritional interventions.

The prevalence of thiamin deficiency in hospitalized patients with congestive heart failure.

OBJECTIVES: The purpose of this study was to determine the prevalence of thiamin deficiency (TD) in a cross section of hospitalized congestive heart failure (CHF) patients and to investigate factors that contribute to its development. BACKGROUND: Thiamin deficiency manifests as symptoms of CHF and, therefore, may worsen existing heart failure. Congestive heart failure patients may be at increased risk for TD as a result of diuretic-induced urine thiamin excretion, disease severity, malnutrition, and advanced age. METHODS: Erythrocyte thiamin pyrophosphate concentrations, using high-performance liquid chromatography, were measured in 100 CHF patients and compared to 50 control subjects. Variables including diuretics (type and dose), left ventricle dysfunction, New York Heart Association functional classification, creatinine clearance, thiamin intake (diet and supplements), malnutrition, appetite ratings, and age were related to TD using univariate statistics and multiple logistic regression analysis. RESULTS: Thiamin deficiency was more prevalent in CHF patients (33%) compared to control subjects (12%) (p = 0.007). Thiamin deficiency was related to urine thiamin loss (p = 0.03), non-use of thiamin-containing supplements (p = 0.06), and preserved renal function (p = 0.05). Increased urinary thiamin loss (mug/g creatinine) was found to be the only significant positive predictor of thiamin status on multiple logistic regression analysis (p = 0.03). CONCLUSIONS: One-third of hospitalized CHF patients were TD. In contrast to previous studies, increased urinary losses of thiamin were predictive of improved thiamin status. Thiamin supplementation may be protective against TD in the clinical setting. Future studies are warranted to determine if thiamin supplementation improves thiamin status and disease severity in CHF patients.

Phenylalanine kinetics differ between formula-fed and human milk-fed preterm infants.

Infants fed casein-dominant formulas have higher plasma phenylalanine and tyrosine concentrations than those fed mother's milk. Conversely, elevated plasma threonine concentrations are observed in infants fed whey-dominant formulas. We recently showed that formula-fed preterm infants have a lower capacity to degrade threonine than do preterm infants fed mother's milk. We hypothesized that these same infants (n = 18) would differ in their catabolism of phenylalanine in response to phenylalanine loads provided by formulas with increasing casein content of formulas (whey:casein 60:40, 40:60, and 20:80) compared with preterm infants fed mother's milk. Plasma phenylalanine concentrations significantly rose (49, 46, 79 micromol . L(-1) for whey:casein 60:40, 40:60, and 20:80, respectively, pooled SD 8, P < 0.05); and plasma phenylalanine concentrations in infants fed mother's milk were low (40 +/- 4 micromol . L(-1)). Using [1-(13)C]phenylalanine tracer and (13)CO(2) production in breath we found that although there was a significant positive relation between phenylalanine oxidation and phenylalanine intake in formula-fed infants (r(2) = 0.43, P = 0.03), these infants were not able to increase their oxidation of phenylalanine enough to prevent a significant rise in plasma phenylalanine when fed the 20:80 formula. Compared to infants fed mother's milk, formula-fed infants had significantly lower phenylalanine oxidation (39.1 vs. 30.7% of phenylalanine intake, respectively, P < 0.05). We conclude that one of the mechanisms for the differences in plasma amino acid concentration between formula-fed and mother's milk-fed preterm infants may be in vivo down-regulated catabolism of 2 important essential amino acids (phenylalanine in addition to threonine) in formula-fed preterm infants.

A large pool of available folate exists in the large intestine of human infants and piglets.

Many microorganisms in the large intestine are capable of synthesizing folate. Preliminary evidence suggests that this folate may be absorbed. The purpose of the 2 experiments reported herein was to estimate the pool of folate in the feces of human infants and piglets and to ascertain, if absorbed, whether the quantity and form of folate are sufficient to potentially affect the folate status of the host organism. The folate content of milk fed to and of fecal solids collected from exclusively human milk-fed (n = 12) and formula-fed (n = 10) term infants (1-6 mo old) was determined microbiologically before (short-chain folates) and after folate conjugase (total folate) treatment. The folate content of formula fed and of feces collected from 10-d-old piglets (n = 10) was also determined microbiologically. The proportion of 5-methyltetrahydrofolate (5-methylTHF) in feces of human infants and piglets that was monoglutamylated was determined by HPLC analysis. The folate content of fecal solids collected from infants was 93.2 +/- 92.8 nmol/d (mean +/- SD), representing on average 50% (8.0-170.1%) of their mean estimated dietary folate intake. Fecal folate was largely present as short-chain folate (66 +/- 21.3%) with the predominant form being 5-methylTHF, 52.5 +/- 30.1% of which was monoglutamylated. In piglets, the folate content of feces was 301.3 +/- 145.7 nmol/d, representing 36% of their dietary folate intake. Piglet fecal folate was largely present as short-chain folate (68.1 +/- 12.6%) with the predominant species being 5-methylTHF, 29.3 +/- 33.2% of which was monoglutamylated. Collectively, these data suggest that the quantity and form of folate (monoglutamylated) in the large intestine of human infants and piglets are sufficiently large to potentially affect folate status.