Microbiota benefits after inulin and partially hydrolized guar gum supplementation: a randomized clinical trial in constipated women.

INTRODUCTION: Prebiotics positively affect gut microbiota composition, thus improving gut function. These properties may be useful for the treatment of constipation. OBJECTIVES: This study assessed the tolerance and effectiveness of a prebiotic inulin/partially hydrolyzed guar gum mixture (I-PHGG) for the treatment of constipation in females, as well as its influence on the composition of intestinal microbiota and production of short chain fatty acids. METHODS: Our study enrolled 60 constipated female health worker volunteers. Participants reported less than 3 bowel movements per week. Volunteers were randomized to treatment with prebiotic or placebo. Treatment consisted of 3 weeks supplementation with 15 g/d IPHGG (fiber group) or maltodextrin (placebo group). Abdominal discomfort, flatulence, stool consistency, and bowel movements were evaluated by a recorded daily questionnaire and a weekly interview. Changes in fecal bacterial population and short chain fatty acids were assessed by real-time PCR and gas chromatography, respectively. RESULTS: There was an increased frequency of weekly bowel movements and patient satisfaction in both the fiber and placebo groups with no significant differences. Total Clostridium sp significantly decreased in the fiber group (p = 0.046) and increased in the placebo group (p = 0.047). There were no changes in fecal short chain fatty acid profile. CONCLUSIONS: Consumption of I-PHGG produced clinical results comparable to placebo in constipated females, but had additional protective effects on gut microbiota by decreasing the amount of pathological bacteria of the Clostridium genera.

Microbiota benefits after inulin and partially hydrolized guar gumsupplementation - a randomized clinical trial in constipated women / Beneficios en la microbiota intestinal después de la suplementación con inulina y la goma guar parcialmente hidrolizada - un ensayo clínico aleatorizado en mujeres con estreñimiento

Introduction: Prebiotics positively affect gut microbiota composition, thus improving gut function. These properties may be useful for the treatment of constipation. Objectives: This study assessed the tolerance and effectiveness of a prebiotic inulin/partially hydrolyzed guargum mixture (I-PHGG) for the treatment of constipation in females, as well as its influence on the composition of intestinal microbiota and production of short chain fattyacids. Methods: Our study enrolled 60 constipated female health worker volunteers. Participants reported less than3 bowel movements per week. Volunteers were randomized to treatment with prebiotic or placebo. Treatment consisted of 3 weeks supplementation with 15 g/d IPHGG (fiber group) or maltodextrin (placebo group).Abdominal discomfort, flatulence, stool consistency, and bowel movements were evaluated by a recorded daily questionnaire and a weekly interview. Changes in fecal bacterial population and short chain fatty acids were assessed by real-time PCR and gas chromatography, respectively. Results: There was an increased frequency of weekly bowel movements and patient satisfaction in both the fiber and placebo groups with no significant differences. Total Clostridium sp significantly decreased in the fibergroup (p = 0.046) and increased in the placebo group (p =0.047). There were no changes in fecal short chain fatty acid profile. Conclusions: Consumption of I-PHGG produced clinical results comparable to placebo in constipated females, but had additional protective effects on gut microbiota by decreasing the amount of pathological bacteria of the Clostridium genera (AU)

Introducción: Los prebióticos influyen positivamente en la composición de la microbiota intestinal, mejorando así la función intestinal. Estas propiedades pueden ser útiles para el tratamiento del estreñimiento. Objetivos: Este estudio evaluó la tolerancia y la eficacia de una mezcla de prebiótico inulina con la goma guar parcialmente hidrolizada (I-PHGG) para el tratamiento de mujeres con estreñimiento, así como su influencia en la composición de la microbiota intestinal y la producción de ácidos grasos de cadena corta. Métodos: Nuestro estudio contó con la participación de60 mujeres voluntarias con estreñimiento y profesionales de la salud. Las participantes informaron tener menos de tres evacuaciones por semana y fueron asignadas aleatoriamente a tratamiento con prebióticos o placebo. El tratamiento consistió en 3 semanas de suplementación con 15 gd I-PHGG (grupo de fibras) o maltodextrina (grupo placebo). Malestar abdominal, flatulencia, consistencia de las heces, y los movimientos intestinales se evaluaron mediante un cuestionario de registro diario y una entrevista semanal. Cambios en la población de bacterias fecales y los ácidos grasos de cadena corta fueron evaluados por PCR entiempo real y cromatografía de gases, respectivamente. Resultados: Hubo un aumento en la frecuencia de las evacuaciones intestinales por semana y la satisfacción del paciente, tanto en la fibra y el grupo placebo, sin diferencias significativas. El total de Clostridium sp disminuyó significativamente en el grupo de fibras (p = 0,046) y aumentó en el grupo placebo (p = 0,047). No hubo cambios en el perfil fecal de ácidos grasos de cadena corta. Conclusiones: El consumo de I-PHGG ha producido resultados clínicos comparables a placebo en mujeres con estreñimiento, pero ofreció otros efectos protectores sobre la microbiota intestinal al disminuir la cantidad de bacterias patológicas de lo género Clostridium (AU)

Long-term nutritional assessment of patients with severe short bowel syndrome managed with home enteral nutrition and oral intake / Evaluación nutricional a largo plazo de pacientes con grave síndrome de intestino corto controlada con nutrición enteral e ingestión oral

Background: Parenteral nutrition (PN) is used to control the nutritional state after severe intestinal resections. When ever possible, enteral nutrition (EN) is used to promote intestinal rehabilitation and reduce PN dependency. Our aim is to verify whether EN + oral intake (OI) in severe short bowel syndrome (SBS) surgical adult patients can maintain adequate nutritional status in the long term. Methods: This longitudinal retrospective study included 10 patients followed for 7 post-operative years. Body mass index (BMI), percentage of involuntary loss of usual body weight (UWL), free fat mass (FFM), and fat mass(FM) composition assessed by bioelectric impedance, and laboratory tests were evaluated at 6, 12, 24, 36, 48, 60, 72,and 84 months after surgery. Energy and protein offered in HPN and at long term by HEN+ oral intake (OI), was evaluated at the same periods. The statistical model of generalized estimating equations with p < 0,05 was used. Results: With long term EN + OI there was a progressive increase in the UWL, a decrease in BMI, FFM, and FM (p < 0,05). PN weaning was possible in eight patients. Infection due to central venous catheter (CVC) contamination was the most common complication (1.2 episodes CVC/patient/year). There was an increase in energy and protein intake supply provided by HEN+OI (p < 0.05). All patients survived for at least 2 years, seven for 5 years and six for 7 years of follow-up. Conclusions: In the long term SBS surgical adult patients fed with HEN+OI couldn’t maintain adequate nutritional status with loss of FM and FFM (AU)

Antecedentes: La nutrición parenteral (NP) se emplea para controlar el estado nutricional después de resecciones intestinales extensas. Siempre que sea posible, se empleará la nutrición enteral (NE) para favorecer la rehabilitación intestinal y reducir la dependencia de la NP. Nuestro propósito fue verificar si la NE + ingesta oral (IO) en el síndrome del intestino corto (SIC) grave en pacientes adultos quirúrgicos puede mantener un estado nutricional adecuado a largo plazo. Métodos: Este estudio longitudinal retrospectivo incluyó 10 pacientes seguidos durante 7 años tras la intervención quirúrgica. Se evaluaron el índice de masa corporal (IMC), el porcentaje de pérdida involuntaria del peso corporal habitual (PCH), la masa grasa libre (MGL) y la composición de la masa grasa (MG) mediante impedancia bioeléctrica, así como los datos de laboratorio a los 6, 12, 24, 36, 48, 60, 72 y 84 meses tras la cirugía. Se evaluaron en los mismos periodos la energía y las proteínas aportadas con la NPD y a largo plazo con la NED + ingesta oral (IO). Se utilizó un modelo estadístico de ecuaciones estimativas generalizadas con una p < 0,05. Resultados: Con la NE + IO a largo plazo hubo un aumento progresivo del PCH, una descenso del IMC, la MGL y la MG (p < 0,05). La retirada de la NP fue posible en ocho pacientes. La complicación más frecuente fue la infección por contaminación del catéter venoso central (CVC) (1,2 episodios CVC/paciente/año). Hubo un aumento en el consumo de energía y proteínas proporcionadas por la NED + IO (p < 0,05). Todos los pacientes sobrevivieron al menos dos años, siete durante 5 años y seis durante los 7 años de seguimiento. Conclusiones: los pacientes adultos con SIC quirúrgico nutridos a largo plazo con NED + IO no pudieron mantener un adecuado estado nutricional con una pérdida de MG y de MGL (AU)

Safety of oral glutamine in the abbreviation of preoperative fasting: a double-blind, controlled, randomized clinical trial.

INTRODUCTION: No study so far has tested a beverage containing glutamine 2 h before anesthesia in patients undergoing surgery. OBJECTIVES: The aim of the study was to investigate: 1) the safety of the abbreviation of preoperative fasting to 2 h with a carbohydrate-L-glutamine-rich drink; and 2) the residual gastric volume (RGV) measured after the induction of anesthesia for laparoscopic cholecystectomies. METHODS: Randomized controlled trial with 56 women (42 (17-65) years-old) submitted to elective laparoscopic cholecystectomy. Patients were randomized to receive either conventional preoperative fasting of 8 hours (fasted group, n = 12) or one of three different beverages drunk in the evening before surgery (400 mL) and 2 hours before the initiation of anesthesia (200 mL). The beverages were water (placebo group, n = 12), 12.5% (240 mOsm/L) maltodextrine (carbohydrate group, n = 12) or the latter in addition to 50 g (40 g in the evening drink and 10 g in the morning drink) of L-glutamine (glutamine group, n = 14). A 20 F nasogastric tube was inserted immediately after the induction of general anesthesia to aspirate and measure the RGV. RESULTS: Fifty patients completed the study. None of the patients had either regurgitation during the induction of anesthesia or postoperative complications. The median (range) of RGV was 6 (0-80) mL. The RGV was similar (p = 0.29) between glutamine group (4.5 [0-15] mL), carbohydrate group (7.0 [0-80] mL), placebo group (8.5 [0-50] mL), and fasted group (5.0 [0-50] mL). CONCLUSION: The abbreviation of preoperative fasting to 2 h with carbohydrate and L-glutamine is safe and does not increase the RGV during induction of anesthesia.

Safety of oral glutamine in the abbreviation of preoperative fasting; a double-blind, controlled, randomized clinical trial / Seguridad de la glutamina oral en la abreviación del ayuno preoperatorio; un ensayo clínico doble ciego, controlado, aleatorizado

Introduction: No study so far has tested a beverage containing glutamine 2 h before anesthesia in patients undergoing surgery. Objectives: The aim of the study was to investigate: 1) the safety of the abbreviation of preoperative fasting to 2 h with a carbohydrate-L-glutamine-rich drink; and 2) the residual gastric volume (RGV) measured after the induction of anesthesia for laparoscopic cholecystectomies. Methods: Randomized controlled trial with 56 women (42 (17-65) years-old) submitted to elective laparoscopic cholecystectomy. Patients were randomized to receive either conventional preoperative fasting of 8 hours (fasted group, n = 12) or one of three different beverages drunk in the evening before surgery (400 mL) and 2 hours before the initiation of anesthesia (200 mL). The beverages were water (placebo group, n = 12), 12.5% (240 mOsm/L) maltodextrine (carbohydrate group, n = 12) or the latter in addition to 50 g (40 g in the evening drink and 10g in the morning drink) of L-glutamine (glutamine group, n = 14). A 20 F nasogastric tube was inserted immediately after the induction of general anesthesia to aspirate and measure the RGV. Results: Fifty patients completed the study. None of the patients had either regurgitation during the induction of anesthesia or postoperative complications. The median (range) of RGV was 6 (0-80) mL. The RGV was similar (p = 0.29) between glutamine group (4.5 [0-15] mL), carbohydrate group (7.0 [0-80] mL), placebo group (8.5 [0-50] mL), and fasted group (5.0 [0-50] mL). Conclusion: The abbreviation of preoperative fasting to 2 h with carbohydrate and L-glutamine is safe and does not increase the RGV during induction of anesthesia (AU)

Introducción: Ningún estudio hasta el momento ha investigado una bebida que contiene glutamina 2 h antes de la anestesia en pacientes sometidos a cirugía. Objetivos: El objetivo del estudio fue investigar: 1) la seguridad de la abreviación del ayuno preoperatorio para 2 h con una bebida conteniendo carbohidratos y L-glutamina, y 2) el volumen gástrico residual (RGV), medido después de la inducción de la anestesia en colecistectomías laparoscópicas. Métodos: Ensayo controlado aleatorizado con 56 mujeres (42 (17-65) años) sometidas a colecistectomía laparoscópica electiva. Las pacientes fueron aleatorizadas para recibir ayuno preoperatorio convencional de 8 horas (grupo ayuno, n = 12) o una de tres bebidas diferentes tomadas la noche antes de la cirugía (400 ml) y también 2 horas antes del inicio de la anestesia (200 ml). Las bebidas eran agua (grupo placebo n = 12), 12,5% (240 mOsm/l) maltodextrina (grupo carbohidrato, n = 12) o carbohidrato además de 50 g (40 g la noche anterior y 10 g por la mañana) de L-glutamina (grupo glutamina, n = 14). Una sonda nasogástrica 20 F fue insertada inmediatamente después de la inducción de la anestesia general para aspirar y medir el RGV. Resultados: Cincuenta pacientes completaron el estudio. Ninguno de los pacientes han presentado regurgitación durante la inducción de la anestesia ni complicaciones postoperatorias. La mediana (variación) del RGV fue de 6 (00-80) mL. El RGV fue similar (p = 0,29) entre el grupo glutamina (4,5 [0-15] mL), el grupo carbohidrato (7,0 [0,80] mL), grupo placebo (8,5 [0-50] mL), y grupo ayuno (5,0 [0-50] mL). Conclusión: La abreviación del ayuno preoperatorio para 2 h con carbohidratos y L-glutamina es seguro y no aumenta el RGV durante la inducción de la anestesia (AU)

Long-term nutritional assessment of patients with severe short bowel syndrome managed with home enteral nutrition and oral intake.

BACKGROUND: Parenteral nutrition (PN) is used to control the nutritional state after severe intestinal resections. Whenever possible, enteral nutrition (EN) is used to promote intestinal rehabilitation and reduce PN dependency. Our aim is to verify whether EN + oral intake (OI) in severe short bowel syndrome (SBS) surgical adult patients can maintain adequate nutritional status in the long term. METHODS: This longitudinal retrospective study included 10 patients followed for 7 post-operative years. Body mass index (BMI), percentage of involuntary loss of usual body weight (UWL), free fat mass (FFM), and fat mass (FM) composition assessed by bioelectric impedance, and laboratory tests were evaluated at 6, 12, 24, 36, 48, 60, 72, and 84 months after surgery. Energy and protein offered in HPN and at long term by HEN+ oral intake (OI), was evaluated at the same periods. The statistical model of generalized estimating equations with p < 0,05 was used. RESULTS: With long term EN + OI there was a progressive increase in the UWL, a decrease in BMI, FFM, and FM (p < 0,05). PN weaning was possible in eight patients. Infection due to central venous catheter (CVC) contamination was the most common complication (1.2 episodes CVC/patient/year). There was an increase in energy and protein intake supply provided by HEN+OI (p < 0.05). All patients survived for at least 2 years, seven for 5 years and six for 7 years of follow-up. CONCLUSIONS: In the long term SBS surgical adult patients fed with HEN+OI couldn't maintain adequate nutritional status with loss of FM and FFM.

Anti-inflammatory effect of parenteral fish oil lipid emulsion on human activated mononuclear leukocytes.

BACKGROUND & AIM: To compare the effect of fish oil-based (FO) lipid emulsions (LE) for parenteral administration with standard LE and a new FO containing LE composed of four different oils on the antigen presentation and inflammatory variables. METHODS: Phytohemagglutinin (PHA) activated human mononuclear leukocytes were cultured with different LE - Control: without LE; SO: soybean oil; SO/FO: soybean and FO (4:1); MCT/SO: medium chain triglycerides and SO (1:1); MCT/SO/FO: MCT/SO and FO (4:1) and SMOF: a new LE containing FO. Cytokine production was evaluated by ELISA, the expression of antigen-presenting and co-stimulatory surface molecules were analyzed by flow cytometry and lymphocyte proliferation was assessed by H(3)-Thymidine incorporation, after tetanus toxoid-induced activation. RESULTS: All LE decreased the HLA-DR and increased CD28 and CD152 expression on monocytes/macrophages and lymphocytes surface (p < 0.05). SO/FO and MCT/SO/FO decreased lymphocyte proliferation (p<0.05). All LE decreased IL-2 production, but this effect was enhanced with MCT/SO/FO and SMOF (p < 0.05). MCT/SO/FO decreased IL-6 and increased IL-10, whereas SO had the opposite effect (p < 0.05). CONCLUSION: FO LE inhibited lymphocyte proliferation and had an anti-inflammatory effect. These effects seem to be enhanced when FO is mixed with MCT/SO. SMOF had a neutral impact on lymphocyte proliferation and IL-6 and IL-10 production.

Anti-inflammatory effect of parenteral fish oil lipid emulsion on human activated mononuclear leukocytes / Efecto del fármaco antiinflamatorio no esteroideo etoricoxib sobre los parámetros hematológicos y las enzimas del colon y el riñón

Background & aim: To compare the effect of fish oilbased (FO) lipid emulsions (LE) for parenteral administration with standard LE and a new FO containing LE composed of four different oils on the antigen presentation and inflammatory variables. Methods: Phytohemagglutin in (PHA) activated human mononuclear leukocytes were cultured with different LE - Control: without LE; SO: soybean oil; SO/FO: soybean and FO (4:1); MCT/SO: medium chain triglycerides and SO (1:1); MCT/SO/FO: MCT/SO and FO (4:1) and SMOF: a new LE containing FO. Cytokine production was evaluated by ELISA, the expression of antigen-presenting and co-stimulatory surface molecules were analyzed by flow cytometry and lymphocyte proliferation was assessed by H3-Thymidine incorporation, after tetanus toxoid-induced activation. Results: All LE decreased the HLA-DR and increased CD28 and CD152 expression on monocytes/macrophages and lymphocytes surface (p < 0.05). SO/FO and MCT/SO/FO decreased lymphocyte proliferation (p<0.05). All LE decreased IL-2 production, but this effect was enhanced with MCT/SO/FO and SMOF (p < 0.05). MCT/SO/FO decreased IL-6 and increased IL-10, whereas SO had the opposite effect (p < 0.05). Conclusion: FO LE inhibited lymphocyte proliferation and had an anti-inflammatory effect. These effects seem to be enhanced when FO is mixed with MCT/SO. SMOF had a neutral impact on lymphocyte proliferation and IL-6 and IL-10 production (AU)

Antecedentes & objetivo: Comparar el efecto de las emulsiones lipídicas (EL) basadas en aceite de pescado (AP) para la administración parenteral con las EL estándar y una nueva EL que contiene AP compuesta por cuatro aceites distintos sobre la presentación antigénica y las variables inflamatorias. Métodos: se cultivaron leucocitos mononucleares activados con fitohemaglutinina (PHA) con diferentes EL - Control: sin EL; AS: aceite de soja; AS/AP: soja y AP (4:1); TCM/AS: triglicéridos de cadena media y AS (1:1); TCM/AS/AP: TCM/AS y AP (4:1) y SMOF: una nueva EL que contiene AP. Se evaluó la producción de citocinas mediante ELISA, se analizó la expresión de moléculas de superficie de presentación de antígeno y co-estimuladoras mediante citometría de flujo y se evaluó la proliferación linfocitaria mediante la incorporación de timidina-H3 tras la activación inducida por el toxoide tetánico. Resultados: Todas las EL disminuyeron la expresión de HLA-DR y aumentaron la expresión de CD28 y CD152 sobre superficie de monocitos/macrófagos y linfocitos (p < 0,05). La AS/AP y la TCM/AS/AP disminuyeron la proliferación linfocitaria (p < 0,05). Todas las EL disminuyeron la producción de IL-2, pero su efecto se incrementó con las emulsiones TCM/AS/AP y SMOF (p < 0,05). La TCM/AS/AP disminuyó la IL-6 y aumentó la IL-10, mientras que el AS tuvo el efecto opuesto (p < 0,05). Conclusión: La EL AP inhibió la proliferación linfocitaria y tuvo un efecto antiinflamatorio. Estos efectos parecen estar potenciados cuando el AP se mezcla con TCM/AS. La SMOF tuvo un efecto neutro sobre la proliferación linfocitaria y la producción de IL-6 e IL-10 (AU)

Resistance and reactance in patients undergoing coronary artery bypass / Resistencia y reactancia de los pacientes sometidos a cirugía de revascularización coronaria

Purpose: The purpose of this study was to evaluate the effect of different surgical variables, such as perfusion duration and number of grafts, on resistance and reactance, in heart surgery patients. Methods: 77 patients submitted to coronary artery bypass were studied. The variable concerning time of extracorporeal circulation was classified in four progressive degrees. Resistance and reactance measurements were performed and compared to time of extracorporeal circulation and to number of grafts. Ten measurements were performed by bioelectrical impedance equipment. Results: The comparison of reactance before surgery to the first measurement at the first postoperative day, for the different times of extracorporeal circulation, showed decrease (p = 0.01). Regarding gender, resistance and reactance showed significant differences (p < 0.001). There was also significant difference (p = 0.001) for the number of grafts. Conclusion: The decrease of resistance and reactance is related not only with surgery procedure, but also with the number of grafts and time of extracorporeal circulation (AU)

Objetivo: El objetivo de este estudio fue evaluar el efecto de diferentes técnicas quirúrgicas, tales como la duración de perfusión y el número de injertos, sobre la resistencia y la reactancia en pacientes sometidos a cirugía cardíaca. Métodos: Fueron incluidos 77 pacientes remitidos para bypass de arteria coronaria. La variable referente al tiempo de circulación extracorpórea fue clasificada en cuatro grados. Se midió la resistencia y la reactancia y se comparó con el tiempo de circulación extracorpórea y con el número de injertos. Se hicieron 10 mediciones con un equipo de impedancia bioeléctrica. Resultados: La comparación de la reactancia antes de la cirugía con la primera medida el primer día de postoperatorio en los diferentes tipos de circulación extracorpórea mostró una disminución (P = 0,01). En cuanto al sexo, la resistencia y la reactancia mostraron diferencias significativas (P < 0,01). Hubo también una diferencia significativa (P = 0,01) en la relación con el número de injertos. Conclusión: La disminución de la resistencia y de la reactancia está relacionada no solo con el procedimiento quirúrgico sino también con el número de injertos y con el tiempo de circulación extracorpórea (AU)