Effects of breakfast meal composition on second meal metabolic responses in adults with Type 2 diabetes mellitus.

OBJECTIVE: We tested the relative importance of a low-glycemic response versus a high glycemic response breakfast meal on postprandial serum glucose, insulin and free fatty acid (FFA) responses after consumption of a standardized mid-day meal in adult individuals with Type 2 diabetes mellitus (DM). DESIGN: Following an overnight fast of 8-10 h, a randomized crossover intervention using control and test meals was conducted over a 3-week-period. A fasting baseline measurement and postprandial measurements at various time intervals after the breakfast and mid-day meal were taken. SUBJECTS: Forty-five Type 2 DM subjects completed the requirements and were included in the study results. INTERVENTIONS: Two different breakfast meals were administered during the intervention: (A) a high glycemic load breakfast meal consisting of farina (kJ 1833; carbohydrate (CHO) 78 g and psylium soluble fiber 0 g), (B) a low-glycemic load breakfast meal consisting of a fiber-loop cereal (kJ 1515; CHO 62 g and psyllium soluble fiber 6.6 g). A standardized lunch was provided approximately 4 h after breakfast. Blood plasma concentrations and area under the curve (AUC) values for glucose, insulin and FFA were measured in response to the breakfast and mid-day lunch. Statistical analyses were performed using SAS software (8.02). Comparisons between diets were based on adjusted Bonferroni t-tests. RESULTS: In post-breakfast analyses, Breakfast B had significantly lower area under the curve (AUC) values for plasma glucose and insulin compared to Breakfast A (P<0.05) (95% confidence level). The AUC values for FFA were higher for Breakfast B than for Breakfast A (P<0.05) (95% confidence level). Post-lunch analyses indicated similar glucose responses for the two breakfast types. Insulin AUC values for Breakfasts B were significantly lower than Breakfast A (P<0.05) (95% confidence level). The AUC values for FFA were unaffected by breakfast type. CONCLUSIONS: These data indicate that ingesting a low-glycemic load meal containing psyllium soluble fiber at breakfast significantly improves the breakfast postprandial glycemic, insulinemic and FFA responses in adults with Type 2 DM. These data revealed no residual postprandial effect of the psyllium soluble fiber breakfast meal beyond the second meal consumed. Thus, there was no evidence of an improvement postprandially in the glycemic, insulinemic and FFA responses after the consumption of the lunch meal.

Dietary fiber modulates intestinal proglucagon messenger ribonucleic acid and postprandial secretion of glucagon-like peptide-1 and insulin in rats.

Intestinal hormones stimulate more than 50% of the insulin response after oral glucose administration. Short chain fatty acids stimulate mucosal adaptation and may alter proglucagon messenger RNA and release of the insulin secretagogue, glucagon-like peptide-1 (GLP-1). Sprague-Dawley rats ingested a fiber-free elemetnal diet or an elemental diet supplemented with 30% fiber providing similar energy and nutrients for 14 days. The cecal and colonic short chain fatty acids contents were significantly higher in the 30% fiber group. Ileal proglucagon messenger RNA levels were significantly higher in the 30% group vs. the 0% group (11.47 +/- 0.87 vs. 6.52 +/- 0.87 densitometer units), respectively. Similar trends were seen in the colon (13.36 +/- 1.0 vs. 10.90 +/- 0.77 densitometer units; P = 0.07). Plasma GLP-1, insulin, and C peptide levels 30 min postoral glucose were significantly higher in the 30% fiber group vs. the 0% group (19.8 +/- 1.2 vs. 15.4 +/- 1.2 pg/ml, 2.67 +/- 0.4 vs. 1.29 +/- 0.5 ng/ml, and 964.4 +/- 94.4 vs. 530.2 +/- 120.4 pM, respectively). Plasma glucose and glucagon did not differ between groups. A diet supplemented with fiber is able to significantly alter proglucagon gene expression and modulate GLP-1 and insulin secretion. These novel findings deepen our understanding of the beneficial role of fiber in improving glucose homeostasis.

Ileal recovery of nutrients and mucin in humans fed total enteral formulas supplemented with soy fiber.

The objective of this study was to determine whether soy fiber supplementation of total enteral nutrition formulas affected small intestinal recovery of nitrogen, amino acids, and carbohydrates or mucin output in eight human subjects (four males, four females) with ileostomies. The subjects ingested five test diets to provide 1.0-16.5 g soy fiber/L for 2 consecutive days each. The five test diets, each with a different soy fiber content were formulated by varying the relative proportion (1:0, 0.75:0.25, 0.5:0.5, 0.25:0.75, and 0:1) of two commercially available formulas. Effluent dry matter increased with soy fiber intake as a result of the quantitative recovery of soy fiber nonstarch polysaccharide. Nitrogen and amino acid digestibilities were unchanged by the ingestion of soy fiber. Nutrients from the total enteral nutrition formulas were well digested in the small intestine with true nitrogen and amino acid digestibilities in excess of 90% and starch digestibilities approaching 100%. Ileal mucin output was higher in male subjects and was unaffected by soy fiber intake. In summary, soy fiber supplementation does not compromise protein and carbohydrate absorption from the small intestine of humans.

Short-chain fatty acid-supplemented total parenteral nutrition alters intestinal structure, glucose transporter 2 (GLUT2) mRNA and protein, and proglucagon mRNA abundance in normal rats.

Intestinal adaptation is a complex physiologic process that is not completely understood. Intravenous short-chain fatty acids (SCFAs) enhance intestinal adaptation after 80% enterectomy in rats. The purpose of this study was to examine rapid responses to SCFA-supplemented total parenteral nutrition (TPN) in the normal small intestine. After jugular catheterization, 31 Sprague-Dawley rats (weighing 258 +/- 3 g) were randomly assigned to receive standard TPN or an isoenergetic, isonitrogenous TPN solution supplemented with SCFAs (TPN+SCFA). Intestinal samples were obtained after 24 or 72 h of nutrient infusion. TPN+SCFA for 24 h increased (P < 0.05) the ileal RNA concentration (microg RNA/mg ileum) whereas TPN+SCFA for 72 h increased (P < 0.05) the ileal DNA concentration (microg DNA/mg ileum) and decreased (P < 0.05) the ileal protein concentration (microg protein/mg ileum). Ileal proglucagon mRNA abundance was elevated (P < 0.05) after 24 h of TPN+SCFA infusion and returned to levels seen with control TPN by 72 h. Glucose transporter 2 (GLUT2) mRNA was significantly higher (P < 0.05) in the TPN+SCFA groups at both time points when compared with control TPN groups. Ileal GLUT2 protein abundance in the 72-h TPN+SCFA group was significantly higher (P < 0.05) than that of all other groups. Sodium-glucose cotransporter (SGLT-1) mRNA and protein abundance and uptake of D-fructose and D-glucose did not differ between groups. Jejunal uptake of L-glucose and lauric acid was significantly higher (P < 0.05) after 72 h of TPN+SCFA than after 24 h, whereas the 24- and 72-h TPN groups did not differ. In summary, SCFAs led to rapid changes in ileal proglucagon and glucose transporter expression in rats receiving TPN and provide insights into therapeutic management of individuals with short bowel syndrome or intestinal malabsorption syndromes.

Comparison of high- and low-glycemic-index breakfast cereals with monounsaturated fat in the long-term dietary management of type 2 diabetes.

BACKGROUND: Results of 6-wk studies suggest that high-carbohydrate diets are deleterious for people with type 2 diabetes. OBJECTIVE: Our objective was to see whether long-term replacement of dietary monounsaturated fatty acids (MUFAs) with carbohydrate from breakfast cereals with either a high or a low glycemic index (GI) affected blood glucose and lipids in subjects with type 2 diabetes. DESIGN: Subjects with type 2 diabetes (n = 91) were randomly assigned to receive approximately 10% of energy from a low-GI breakfast cereal, a high-GI cereal, or oil or margarine containing MUFA for 6 mo. Eating breakfast cereal was prohibited for subjects in the MUFA group. RESULTS: Seventy-two subjects completed the trial. The subjects who received cereals consumed approximately 10% more energy from carbohydrate than did the subjects in the MUFA group. Changes in glycated hemoglobin, body weight, and fasting cholesterol and triacylglycerol did not differ significantly among groups. HDL cholesterol increased by approximately 10% in the MUFA group compared with subjects who consumed either high- or low-GI cereals (P = 0.002). The ratio of total to HDL cholesterol was higher in the subjects who consumed the high-GI cereal than in the MUFA group at 3 mo but not at 6 mo (diet x time interaction, P = 0.041). During 8-h metabolic profiles, mean plasma insulin was higher and mean free fatty acids were lower in the 2 cereal groups than in the MUFA group (P < 0.05). CONCLUSIONS: A 10% increase in carbohydrate intake associated with breakfast cereal consumption had no deleterious effects on glycemic control or blood lipids over 6 mo in subjects with type 2 diabetes. The increase in plasma insulin and the reduction in free fatty acids associated with higher carbohydrate intake may reduce the rate of progression of diabetes.

The effects of fiber enrichment of pasta and fat content on gastric emptying, GLP-1, glucose, and insulin responses to a meal.

OBJECTIVE: To assess whether the addition of viscous fiber at an amount recommended by the US FDA to allow a 'low saturated fat, cholesterol, soluble fiber and coronary heart disease', health claim label on a food package (1.7 g psyllium) and/or fat (30 g sunflower oil and 3 g sodium propionate) to a pasta meal would affect gastric emptying, postprandial glucose, insulin and GLP-1 concentrations. DESIGN: Ten subjects participated in a two-by-two single blind randomized crossover study. Four meals containing 50 g of available carbohydrate were consumed: pasta with or without psyllium enrichment served with a tomato sauce with (520 kcal per meal) and without (240 kcal per meal) fat. Blood samples were taken for 240 min following the meal and all subjects consumed a buffet meal at the end of the study. Gastric emptying was measured using the paracetamol absorption test. Blood was analysed for glucose, insulin, GLP-1. Visual analog scales were used to record feelings of hunger, pleasantness and nausea. RESULTS: The psyllium-enriched pasta had no significant effect on gastric emptying or the incremental area under the curve (IAUC) for GLP-1, insulin or glucose compared with the control pasta. The addition of polyunsaturated fat and sodium propionate significantly increased the IAUC for GLP-1 (P<0.001), delaying gastric emptying (P<0.002), and decreasing glucose (P<0.002). CONCLUSIONS: A dose of 1.7 g psyllium did not evoke measurable effects on gastric emptying, postprandial GLP-1, insulin or glucose metabolism. However the addition of 30 g of oil and 3 g of sodium propionate to the pasta did reduce gastric emptying, increase GLP-1 and reduce glucose and insulin concentrations. While this short-term study may have implications in terms of reducing the risk of diabetes and improving coronary risk factor profiles the long term effects of these nutrients need to be studied.

Potential water-holding capacity and short-chain fatty acid production from purified fiber sources in a fecal incubation system.

Liquid enteral diets supplemented with dietary fiber, typically soy fiber, are in widespread use to increase stool bulking and maintain gastrointestinal function. Yeast cells, containing beta-glucans, represent another commercially available fiber source that could be added to enteral diets. The objective of this study was to compare commercially available purified fiber sources, i.e., mixed fiber (Fibrad), psyllium hydrocolloid (Metamucil), and yeast cell walls (Fibercel), for potential use in liquid diets in terms of potential water-holding capacity (PWHC) and SCFA production (mmol SCFA/g organic matter [OM]). Fiber samples were fermented in vitro with human fecal microbiota from three donors for 24 h, and SCFA production was greatest from beta-glucan (8.24 mmol/g OM), followed by psyllium (5.57 mmol/g OM) and mixed fiber (4.50 mmol/g OM) (p less than 0.0001). WHCs of the original materials (g H2O/g OM) differed (p less than 0.02) at 4.59, 5.79, and 8.63 for beta-glucan, mixed fiber, and psyllium, respectively. PWHC (g H2O/g OM), an in vitro measure of stool bulking, differed (p less than 0.0001) with psyllium (4.48) greater than mixed fiber (3.52) greater than beta-glucan (2.22). These three fiber systems appear to have distinctly different physiological effects in vivo. Of the three products, mixed fiber was the most inert. Psyllium seems to enhance both SCFA production and stool bulk relative to mixed fiber, whereas beta-glucan most significantly increases SCFA production with a minimal effect on stool bulk.

The fermentable fiber content of the diet alters the function and composition of canine gut associated lymphoid tissue.

The ingestion of plant fibers and their susceptibility to microbial fermentation in the large bowel modulate intestinal morphology but little is known about effects on the gut associated lymphoid tissue (GALT). The aim of the present study was to determine the effect of consuming diets containing different levels of fermentability fiber on immune function. Sixteen adult mongrel dogs (23 +/- 2 kg) were fed (14 days) in a randomized cross over design two isoenergetic isonitrogenous diets containing 8.3 g/kg non-fermentable or 8.7 g/kg fermentable fibers. Lymphocytes were isolated from blood prior to starting the study and at the end of each diet period. At study completion, lymphocytes were isolated from the gut associated lymphoid tissue (GALT) of the small intestine for characterization by immunofluorescence and to determine their ability to respond to mitogenic stimulation. Feeding high fermentable fibers increased (P < 0.05) the CD4/CD8 ratio and decreased (P < 0.05) the proportion of B cells in peripheral blood without changing natural killer cell activity or the response to mitogens. Mesenteric lymph node cells from dogs fed the low then high fermentable fiber diet contained a higher (P < 0.05) proportion of CD4+ cells and a higher (P < 0.05) response to mitogens. Intraepithelial, Peyer's patches and lamina propria cells contained a greater (P < 0.05) proportion of CD8+ cells when dogs were fed a low fermentable fiber diet followed by a high fermentable fiber diet. T cell mitogen responses in vitro were higher for intraepithelial but lower for Peyer's patches and lamina propria cells from dogs who were fed the low fermentable fiber diet followed by the high fermentable fiber diet (P < 0.05). In conclusion, the fermentable fiber content of the diet had very little effect on the type and function of immune cells in peripheral blood. However, feeding dogs a high fermentable fiber diet for 2 weeks (after 2 weeks of consuming a low fermentable fiber diet) altered the T-cell composition of GALT and produced a higher mitogen response in the predominantly T cell tissues and a lower response in areas involved in B cell functions. In conclusion, the level of fermentable fiber in the diet appears to alter GALT properties. Further studies are required to determine the direct contribution of a high or low fiber diet to these changes and the physiological implications to the health of the animal.

Dietary fiber and total enteral nutrition: fermentative assessment of five fiber supplements.

Total enteral nutrition (TEN) formulas supplemented with dietary fiber, typically soy polysaccharide, are in widespread clinical use. Five commercially available dietary fiber supplements obtained from fruits (apple, grapefruit, orange, prune, tomato) were examined for potential use in TEN formulas. In vitro fermentations of 0, 4, 8, 12, and 24 hours' duration with human fecal microbiota from three different donors were conducted to assess colonic fermentative effects. Short-chain fatty acid and hydrogen productions differed significantly with fiber source. The most rapid fermentation rate was with tomato followed by orange, grapefruit, apple, and finally prune fiber. Such differences in fermentability should be considered when fiber sources are selected to supplement TEN formulas.

Luminal glutamine perfusion alters endotoxin-related changes in ileal permeability of the piglet.

BACKGROUND: The objective of this study was to investigate whether luminal perfusion with glutamine or with oxygenated glutamine solutions prevents endotoxin-induced changes in mucosal permeability. METHODS: Three 15-cm segments of distal ileum were isolated in anesthetized 21-day-old piglets (n = 4) and perfused (50 mL/h) with Ringer's lactate solution, Ringer's lactate solution with 2% glutamine (wt/vol), glutamine, or glutamine purged with oxygen at 37 degrees C for 280 minutes. Plasma-to-lumen clearances of 51Cr-EDTA and urea were measured to assess mucosal permeability. At time 0 minutes, loading and maintenance IV infusions of markers were begun. Baseline permeabilities were obtained from time 60 to 80 minutes, and IV endotoxin (50 micrograms/kg) was introduced from time 80 to 140 minutes. RESULTS: Results are expressed as the ratio of the clearances of the two probes (CEDTA/CUREA). Permeability increased from baseline in loops perfused with Ringer's lactate solution vs loops perfused with glutamine purged with oxygen and with glutamine alone (p < .01). Saturation with oxygen was without effect inasmuch as glutamine alone negated permeability increases. Intestinal myeloperoxidase activity did not differ with perfusate (p > .05). CONCLUSIONS: These data suggest that endotoxin-induced permeability changes can be prevented or delayed by the supply of luminal glutamine at the time of insult.

Short-chain fatty acid-supplemented total parenteral nutrition improves nonspecific immunity after intestinal resection in rats.

BACKGROUND: Total parenteral nutrition (TPN) alters both specific and nonspecific immune functions, resulting in immunosuppression. Short-chain fatty acids have been shown to improve the adaptive responses of the gut after surgery. The following study investigates the effects of adding short-chain fatty acids to TPN on the immune system after an 80% small bowel resection. METHODS: Rats (237 +/- 3 g) were infused with either TPN (n = 25) or TPN supplemented with short-chain fatty acids (n = 26) for 3 or 7 days. Hematologic analysis was performed on peripheral blood and splenocytes were isolated to characterize cell phenotypes, natural killer cell cytotoxicity and to estimate proliferative response. RESULTS: The relative percent of T (CD3+) cells increased (p < .05) and the relative percent of macrophages decreased (p < .001, n = 13) in the spleens of the 3-day TPN-fed rats. By day 7, these differences disappeared. The natural killer cells from rats that were supplemented with short-chain fatty acids had higher (p < .0001) cytotoxic activity than the TPN groups at day 3. Mitogenic response did not differ between groups but were depressed compared with sham-treated rats. By day 7, rats on standard TPN had larger (p < .0001) spleens than all other groups. This group also had a higher total white blood cell count because of increased numbers of macrophages and neutrophils (p < .02). CONCLUSION: Short-chain fatty acids improve components of nonspecific immune responses and may be beneficial in reducing certain aspects of TPN-associated immunosuppression after major surgery.

Short-chain fatty acids increase proglucagon and ornithine decarboxylase messenger RNAs after intestinal resection in rats.

BACKGROUND: Intestinal adaptation is a complex physiological process that is not completely understood. Systemic administration of short-chain fatty acids (SCFAs) has been shown to facilitate adaptation to small bowel resection; however the mechanisms underlying this phenomena are unknown. METHODS: Forty-six male Sprague-Dawley rats underwent an 80% jejunoileal resection and jugular catheterization. After surgery, rats were randomly assigned to receive standard total parenteral nutrition (TPN) or an isoenergetic, isonitrogenous TPN supplemented with SCFAs. On day 3 or 7 after surgery, ileal samples were removed for determination of mucosal wet weight, DNA, RNA, and protein concentrations. Total cellular RNA was extracted for use in Northern blot analysis to quantify proglucagon and ornithine decarboxylase messenger RNAs (mRNAs). RESULTS: Total, mucosal, and submucosal weights were increased (p < .05) in the SCFA group both 3 and 7 days after surgery. Ileal DNA and RNA concentrations were increased (p < .05) in the SCFA group at both time points; however ileal protein concentration did not differ between groups until 7 days after resection. Levels of proglucagon and ornithine decarboxylase messenger RNAs were higher (p < .05) in the SCFA group at both time points. CONCLUSION: The upregulation of proglucagon and ornithine decarboxylase gene expression may be the mechanism by which SCFAs facilitate intestinal adaptation.

Estimation by regression analysis of endogenous amino acid levels in digesta collected from the distal ileum of pigs.

An experiment was conducted to estimate by simple linear regression the levels of endogenous amino acids in digesta collected from the distal ileum in pigs. Six barrows, average initial BW 35 kg, were fitted with a simple T-cannula at the distal ileum and fed six diets according to a 6 x 6 Latin square design. Six cornstarch-based diets containing six levels of CP from soybean meal (4, 8, 12, 16, 20, and 24% CP, respectively) were formulated. Chromic oxide (.4%) was included as the digestibility marker. Each experimental period consisted of 8 d. Ileal digesta were collected, at 2-h intervals, for a total of 24 h during d 7 and 8. There were linear relationships (P < .001) between dietary contents of apparent ileal digestible and total amino acids, irrespective of the ranges in graded dietary levels of amino acids. Determined with the regression technique, the endogenous levels of the indispensable amino acids (grams/kilogram of DMI) were as follows: arginine, .64; histidine, .23; isoleucine, .46; leucine, .69; lysine, .47; methionine, .13; phenylalanine, .31; threonine, .69; and valine, .54. Differences in the ranges of graded dietary levels of amino acids resulted in large differences in the estimated amounts of endogenous amino acids in ileal digesta. Furthermore, it seems that the levels of endogenous amino acids, as grams/kilogram of DMI, were constant at different dietary levels of amino acids, whereas the contributions of endogenous amino acids, as percentages of their dietary contents, decreased curvilinearly with increasing dietary contents. Therefore, apparent ileal digestibilities of amino acids were quadratically related to their dietary contents until plateau digestibilities were reached, whereas the true ileal digestibilities of amino acids were independent of their respective dietary contents. Furthermore, true ileal amino acid digestibilities should be determined from their corresponding plateau apparent ileal digestibilities. In conclusion, the levels of endogenous amino acids in ileal digesta can be determined reliably from the linear relationships between dietary contents of apparent ileal digestible and total amino acids. An important methodological consideration in the determination of endogenous amino acids by regression analysis is to design an appropriate range of graded dietary levels of amino acids.

Intestinal nutrient-gene interaction: the effect of feed deprivation and refeeding on cholecystokinin and proglucagon gene expression.

We tested the hypothesis that dietary components reaching the bovine small intestine influence the expression of genes that encode the gastrointestinal neuropeptides cholecystokinin (CCK) and glucagon-like peptide-1 (GLP-1). The amount of digesta reaching the intestine was manipulated during the experiment by withholding feed from five heifers fitted with ruminal, duodenal, and ileal cannulas for 48 h and then subsequent refeeding. Duodenal and ileal biopsies were collected using a fiber-optic endoscope. A Northern hybridization procedure was used to evaluate changes in gene expression. Blood concentrations of CCK and GLP-1 were determined with RIA. The data indicate that CCK blood concentration and mRNA abundance decreased during the period of feed deprivation, but they returned to predeprivation values within 16 to 24 h of refeeding. The GLP-1 blood concentration also decreased during feed deprivation and returned to predeprivation values within 4 to 8 h of refeeding, despite the fact that proglucagon mRNA abundance did not change significantly during feed deprivation and refeeding. These findings provide evidence that CCK and GLP-1 are released in response to nutrients that reach the small intestine and may be involved in the physiological process of digestion and possibly play a role in regulating feed intake in ruminants.

Dietary lipids alter the effect of steroids on the transport of fructose following intestinal resection in rats.

BACKGROUND: Glucocorticosteroids alter intestinal morphology and transport. We tested the hypothesis that the desired intestinal adaptive response following intestinal resection may be enhanced further by the locally active steroid budesonide, and by feeding a saturated as compared with a polyunsaturated fatty acid diet. METHODS: An in-vitro uptake method was used to assess intestinal fructose uptake by rats of semisynthetic diets enriched in saturated or polyunsaturated fatty acids, and injected with budesonide or control solution. RESULTS: Budesonide increased ileal fructose uptake in chow and PUFA-fed animals, but reduced jejunal fructose uptake in rats fed SFA. GLUT5 and GLUT2 protein and mRNA did not correlate with changes in fructose uptake. Steroids reduced jejunal proglucagon expression in animals fed chow. Animals fed SFA and given budesonide had a reduction in jejunal ODC mRNA compared with those fed PUFA or chow. CONCLUSIONS: (1) budesonide increases ileal fructose uptake following intestinal resection, and this beneficial effect is prevented by feeding SFA rather than PUFA; (2) fructose uptake does not correlate with GLUT5 and GLUT2 protein and mRNA; (3) ODC and proglucagon may be involved in this adaptive response.

Candidate foods in the Asia-Pacific region for cardiovascular protection: relevance of grains and grain-based foods to coronary heart disease.

This review elucidates the importance of healthy dietary and lifestyle habits to reduce morbidity and mortality associated with coronary heart disease (CHD), stroke and cardiovascular diseases. Given published evidence of the poor compliance, increased cost, and decreased benefit/risk ratios of medical therapies, individuals (and populations) are encouraged to adopt healthy life habits. The three most atherogenic dietary risk factors are saturated fat, cholesterol and obesity. Dietary patterns associated with the consumption of grains and grain-based foods predict risk of CHD independently of other life habits. Epidemiological and intervention studies elucidating the strong protective associations of grains, cereal fibers and anti-oxidant vitamins on CHD are reviewed. In summary, the consumption of grains and grain-based cereals is repeatedly associated with the ingestion of many nutrients, e.g., dietary fiber and anti-oxidants, that alter energy balance and nutrient intakes to positively affect cardiovascular health, especially when combined with healthy life habits,

Starch malabsorption and stool excretion are influenced by the menstrual cycle in women consuming low-fibre Western diets.

The objectives of the study were to determine whether the follicular (F; days 6-11) and luteal (L; days 16-21) phases of the menstrual cycle were associated with changes in starch malabsorption, stool bulking, stool mucinase, and beta-glucuronidase activities in 10 women (24.1 +/- 0.7 years old) eating a standardized low-fibre diet. Starch malabsorption, measured by breath hydrogen excretion after a breakfast of pureed chickpea (days 10 and 20) versus 10 g lactulose (days 11 and 21), decreased from 9.7 +/- 1.8 g/50 g starch ingested (F) to 6.6 +/- 1.8 g/50 g starch ingested (L) (P less than 0.05). Stool wet weight decreased from 84.5 +/- 10.1 g/day (F) to 52.2 +/- 5.8 g/day (L) (P less than 0.002). Stool dry weight decreased from 20.2 +/- 1.9 g/day (F) to 14.2 +/- 1.1 g/day (L) (P less than 0.006). Stool nitrogen excretion decreased from 1.81 +/- 0.19 g/day (F) to 0.82 +/- 0.06 g/day (L) (P less than 0.006). Stool mucinase and beta-glucuronidase activities were unaffected by the menstrual cycle. These results indicate that women eating low-fibre Western diets may be more prone to constipation during the luteal phase of the menstrual cycle.

The gut: central organ in nutrient requirements and metabolism.

The gut is an important organ, which not only digests and absorbs food but selectively excludes bacteria and toxins from entering the body. It has one of the highest rates of protein turnover of any tissue in the body. Maintenance of epithelial cell proliferation and secretory, digestive, and gut-associated lymphatic tissues (GALT) function requires a constant supply of substrates. A primary feature of the metabolic response to fasting, accidental injury, or surgery is accelerated skeletal muscle proteolysis and translocation of amino acids from the periphery to visceral organs. Nevertheless, the serosal supply of nutrients may be inadequate to maintain normal gut barrier function. The following factors influencing gut nutrient requirements and the effect of the gut on the whole-body metabolism are discussed: (i) diet composition and gut mass, (ii) physiological and pathologic nutrient requirements of epithelial and GALT cells, (iii) route of nutrition (enteral versus parenteral), and (iv) nutrient inadequency and gut barrier dysfunction (structural or immune mediated).