RESUMO
BACKGROUND: The hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) are effective cholesterol lowering medications, however, statins may interfere with CoQ(10) biosynthesis. We examined the effect of statin therapy as well as nutritional supplements on plasma, cardiac and skeletal muscle concentrations of CoQ(10). METHODS: Forty patients with left ventricular dysfunction had fasting blood samples collected at baseline and following four weeks of supplementation (150mg/day of CoQ(10)). Cardiac and skeletal muscle biopsies were collected at the time of surgery and frozen in liquid nitrogen until analyzed for CoQ(10) levels by high performance liquid chromatography. RESULTS: Nutrient supplementation significantly increased plasma [(1.8 (1.2, 2.7) vs 0.8 (0.6, 0.94) mug/ml plasma, median+IQR; p=0.001)] and cardiac tissue concentrations of CoQ(10) [(120.5 (76.5, 177.1) vs 87.3 (60.5, 110.8) nmol/g wet weight, p=0.04)]. No effect of supplementation was seen on samples of skeletal muscle from the chest wall. Statin therapy was not found to influence plasma, cardiac or chest wall levels of CoQ(10). CONCLUSION: Nutrient supplementation significantly increased plasma and cardiac tissue levels of CoQ(10) but did not influence chest wall muscle concentrations. Statin therapy did not significantly influence tissue concentrations of CoQ(10). Longer term studies are needed to confirm this observation.
Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/tratamento farmacológico , Suplementos Nutricionais , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Músculo Esquelético/efeitos dos fármacos , Miocárdio/enzimologia , Ubiquinona/análogos & derivados , Idoso , Coenzimas/análise , Coenzimas/sangue , Doença da Artéria Coronariana/enzimologia , Doença da Artéria Coronariana/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/enzimologia , Cuidados Pré-Operatórios , Resultado do Tratamento , Ubiquinona/análise , Ubiquinona/sangue , Regulação para CimaRESUMO
BACKGROUND: Previous studies suggested that cell energetics are altered by malnutrition. OBJECTIVE: We hypothesized that nutritional manipulations influence mitochondrial enzyme activities of the electron transport chain in both skeletal muscle and blood mononuclear cells. DESIGN: After a gastrostomy tube was inserted, 44 rats were randomly assigned to 1 of 4 experimental groups: control fed (CF; 364 kJ/d for 7 d), hypoenergetic fed (HF; 92 kJ/d for 7 d), hypoenergetic protein refed (HPR; 92 kJ/d for 7 d and then 129 kJ/d for 1 d), and hypoenergetic glucose refed (HGR; 92 kJ/d for 7 d and then 129 kJ/d for 1 d). The protein and glucose contents of the liquid formulas were different for the HPR and HGR groups. After mitochondria were isolated from the soleus muscle, the activities of complexes I--IV were measured spectrophotometrically. Because of the lack of available tissue, only the activity of complex I was measured in the mononuclear cell extract. RESULTS: The recovery of complex activities in the CF and HF groups was not significantly different in the mitochondrial fraction of the soleus muscle. Compared with that in the CF group, the activities of complexes I--III in the mitochondrial fraction of the soleus muscle and the activity of complex I in mononuclear cells were significantly lower in the HF group. The activities of complexes I--III in the mitochondrial fraction of the soleus muscle and the activity of complex I in mononuclear cells were significantly higher in the HPR than in the HF group. The activity of complex IV was generally not affected by nutritional manipulations. CONCLUSION: Malnutrition decreases activities of mitochondrial complexes, which are restored by protein but not glucose refeeding.
Assuntos
Nutrição Enteral , Mitocôndrias Musculares/enzimologia , Mitocôndrias/enzimologia , Músculo Esquelético/enzimologia , Trifosfato de Adenosina/metabolismo , Animais , Carboidratos da Dieta , Proteínas Alimentares , Complexo I de Transporte de Elétrons , Complexo II de Transporte de Elétrons , Complexo III da Cadeia de Transporte de Elétrons/metabolismo , Complexo IV da Cadeia de Transporte de Elétrons/metabolismo , Leucócitos Mononucleares/enzimologia , Masculino , Complexos Multienzimáticos/metabolismo , NADH NADPH Oxirredutases/metabolismo , Oxirredutases/metabolismo , Desnutrição Proteico-Calórica/enzimologia , Ratos , Ratos Wistar , Análise de Regressão , Succinato Desidrogenase/metabolismoRESUMO
Twelve healthy volunteers were studied for two test periods, at the beginning of which they ingested a diarrheogenic load (60 g) of lactulose in 350 mL water with 10 g polyethylene glycol 4000 (PEG); the two periods were separated by a lactulose feeding period of 8 d, during which a nondiarrheogenic load (20 g) of lactulose was taken twice daily. The transit time and flow rates of water and lactulose in the distal ileum of four subjects were not different before and after the lactulose feeding period. In the other eight subjects, stool weight and frequency, fecal pH, and fecal outputs of carbohydrates and osmotic moieties after the ingestion of 60 g lactulose dropped significantly (P < 0.05) after the lactulose feeding period, whereas the orofecal transit time and fecal concentrations of beta-galactosidase and lactic acid increased (P < 0.05). We conclude that changes in colonic function induced by prolonged exposure to a nondiarrheogenic amount of lactulose mitigate the severity of the diarrhea because of the larger dose of lactulose.
Assuntos
Diarreia/induzido quimicamente , Diarreia/tratamento farmacológico , Lactulose/uso terapêutico , Adulto , Defecação , Fezes/química , Feminino , Trânsito Gastrointestinal , Humanos , Íleo/metabolismo , Lactatos/análise , Ácido Láctico , Masculino , Fatores de Tempo , Água/metabolismo , beta-Galactosidase/análiseRESUMO
This study aimed to compare the absorption and tolerance of 20-g lactose loads as milk and yogurt in 17 patients with short-bowel syndrome with either a terminal jejunostomy (group A, n = 6) or a jejunocolic anastomosis (group B, n = 11). Records and measurements during the 8 h after the meals included fecal weight, symptoms, lactose and hexose flow rates in stomal effluents (group A), and breath-hydrogen excretion (group B). In group A lactose was better absorbed in the form of yogurt than in the form of milk (mean +/- SE: 76 +/- 6% vs 50 +/- 9%, P < 0.05), whereas no significant difference could be detected by using the breath-hydrogen test in group B. The excellent tolerance to 20 g lactose from milk and yogurt suggests that lactose should not be excluded from the diet of these subjects.
Assuntos
Absorção Intestinal , Intolerância à Lactose , Lactose/metabolismo , Leite , Síndrome do Intestino Curto/metabolismo , Iogurte , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Testes Respiratórios , Fezes , Feminino , Humanos , Hidrogênio/metabolismo , Lactase , Masculino , Pessoa de Meia-Idade , beta-Galactosidase/metabolismoRESUMO
The possibility of delaying gastric emptying and improving lactose digestion and tolerance by increasing milk viscosity was studied in 13 lactose maldigesters who ingested three test milks with different viscosities (range: 33-1892 mPa.s) in random order at intervals of 1 wk. Each test portion was 500 mL and provided approximately equal to 1900 kJ and 18 g lactose. The different viscosities were obtained by adding varying proportions of rice starch and maltodextrin to a basic milk formula. A combined [13C]glycine-hydrogen breath test was used to measure gastric emptying and lactose digestion simultaneously. Participants reported their gastrointestinal symptoms by using a four-grade scale. Mean (+/- SEM) gastric-emptying half times were 78 +/- 5.7 min for low-viscosity milk (30 mPa.s), 86 +/- 5.0 min for moderate-viscosity milk (80 mPa.s), and 78 +/- 4.5 min for high-viscosity milk (1.9.10(3) mPa.s). Mean orocecal transit times (180 +/- 24, 163 +/- 23, and 180 +/- 24 min, respectively) were not significantly different. There were no milk-dependent differences in breath-hydrogen excretion or in the severity of gastrointestinal symptoms. The milks were well tolerated; > 50% of the subjects reported nondisturbing symptoms or none. We conclude that gastric emptying, orocecal transit time, and lactose digestion and tolerance were not affected by altering milk viscosity. This may have been due to the high energy content of the test milks, which in itself led to slow gastric emptying.
Assuntos
Digestão , Esvaziamento Gástrico , Intolerância à Lactose , Leite , Adulto , Animais , Testes Respiratórios , Estudos Cross-Over , Feminino , Trânsito Gastrointestinal , Humanos , Masculino , Pessoa de Meia-Idade , ViscosidadeRESUMO
We studied seven healthy volunteers before and during acute (PD1) and chronic (PD2) ingestion of 30 g polydextrose (PD)/d. The energy value of PD was assessed after [U-14C]PD was added to the 10-g morning dose of PD during PD1 and at the end of PD2. Thirty-one +/- five percent (mean +/- SD) (PD1) and 29 +/- 4% (PD2) of the dose appeared in breath within 48 h. A small fraction of the ingested radioactivity was recovered in urine (4 +/- 1%) and excreted in flatus (< or = 1%) and in feces as volatile fatty acids (VFAs) (< 1%) and bacteria (3-4%); the remaining radioactivity in stools, 33 +/- 3% (PD1) and 32 +/- 4% (PD2), was assumed to be intact PD. Breath excretion of the label was 49 +/- 5% after intracolonic infusion of [U-14C] acetate. The energy value of PD, calculated by means of Miller and Wolin's stoichiometric equation of colonic fermentation, was similar during PD1 and PD2: 4.0 and 6.1 kJ/g, respectively, when breath 14CO2 and VFA production from PD were used for calculation.
Assuntos
Sistema Digestório/efeitos dos fármacos , Metabolismo Energético/fisiologia , Aditivos Alimentares/metabolismo , Glucanos/metabolismo , Adulto , Testes Respiratórios , Dióxido de Carbono/análise , Sistema Digestório/microbiologia , Fezes/química , Fermentação , Aditivos Alimentares/farmacologia , Glucanos/farmacologia , Humanos , Masculino , Modelos Teóricos , Obesidade/metabolismo , Valores de ReferênciaRESUMO
To assess the effect of colonic fermentation on respiratory gas exchanges, six methane-nonproducing healthy volunteers ingested in the postabsorptive state 1 wk apart either 90 mL lactulose syrup containing 60 g lactulose, 4 g lactose, and 7 g galactose or the same solution but without lactulose (control solution). Six patients with short bowel and remnant colon (SBS) also ingested 90 mL lactulose syrup. Carbon dioxide production (VCO2), oxygen consumption (VO2), respiratory quotient (RQ), and hydrogen excreted in breath were measured basally and for 4 h after the ingestion of solutions. In healthy volunteers within 4 h after ingestion of the control solution, VCO2 and the RQ decreased whereas VO2 remained unchanged. In contrast, in healthy volunteers and patients with SBS, VCO2 and the RQ increased after lactulose ingestion, whereas VO2 did not change. The increase in VCO2 appeared to be accounted for mainly by bacterial production of carbon dioxide and was significantly related to breath-hydrogen concentration (r = 0.56, P < 0.02 for healthy subjects; r = 0.59, P < 0.01 for SBS subjects). A breath-hydrogen test should be performed in conjunction with indirect calorimetry to determine whether colonic fermentation is taking place and, if so, to correct appropriately the VCO2 value in calorimetric equations.
Assuntos
Colo/metabolismo , Carboidratos da Dieta/metabolismo , Absorção Intestinal/fisiologia , Troca Gasosa Pulmonar/fisiologia , Síndrome do Intestino Curto/metabolismo , Adulto , Metabolismo Basal , Testes Respiratórios , Calorimetria Indireta , Dióxido de Carbono/análise , Dióxido de Carbono/metabolismo , Feminino , Fermentação/fisiologia , Humanos , Hidrogênio/análise , Hidrogênio/metabolismo , Lactulose/metabolismo , Masculino , Pessoa de Meia-Idade , Oxirredução , Consumo de OxigênioRESUMO
To compare the effects of digestible (pregelatinized) and partially indigestible (retrograded) cornstarches on some metabolic indexes, we studied eight healthy volunteers during two periods separated by 1 wk. In each period, fasting volunteers consumed at 0800 the test meal containing either the digestible or partially indigestible cornstarch; blood and breath were sampled in the absorptive period for 8 h. To study its late effects, the same test meal as that served at 0800 was given again at 2200, and blood and breath were sampled for 3 h in the postabsorptive period the next morning, i.e., 10 h after ingestion of the test meal. In the absorptive period, blood glucose and insulin were significantly higher after ingestion of digestible cornstarch than after partially indigestible cornstarch. In the postabsorptive period concentrations of blood glucose, insulin, and fatty acids were not significantly different, whereas concentrations of blood acetate, breath hydrogen, methane, and 13CO2, and the respiratory quotient and satiety were significantly higher (P < 0.05) and concentrations of blood glycerol significantly lower (P < 0.05) after ingestion of partially indigestible cornstarch than after digestible cornstarch. We conclude that in healthy humans, digestion of partially indigestible cornstarch is slow in the small intestine and its colonic fermentation continues 10-13 h after its ingestion. Compared with pregelatinized cornstarch, the shift in starch digestion induced by retrogradation leads to a reduction in glycemic and insulinemic responses in the absorptive period and in lipolysis in the postabsorptive.
Assuntos
Amido/metabolismo , Adolescente , Adulto , Glicemia/efeitos dos fármacos , Testes Respiratórios , Dióxido de Carbono/análise , Cromatografia Gasosa , Digestão , Metabolismo Energético/efeitos dos fármacos , Feminino , Fermentação , Humanos , Hidrogênio/análise , Insulina/sangue , Absorção Intestinal , Masculino , Metano/análise , Amido/administração & dosagem , Amido/farmacocinéticaRESUMO
BACKGROUND AND AIMS: Previous investigations showed that mitochondrial complex I activity seems to be a specific marker of dietary malnutrition in human. Since cancer has a more complex etiology than simple calorie deficiency, the aim of this study was to investigate the relationship between mitochondrial complex I activity and cancer. METHODS: Nine cancer patients (CaPs) with weight loss and 14 age-matched healthy volunteers (HVs) were recruited. Body mass index (BMI), body composition as well as resting energy expenditure (REE) and RQ were measured. Mitochondrial complex I activity was measured as described previously in isolated peripheral blood mononuclear cells. Six patients were investigated again after 7 days of refeeding. RESULTS: Weight loss in CaPs was mainly due to a loss of fat mass (FM), while fat-free mass (FFM) was preserved. The RQ was significantly lower in CaPs compared to HVs (P<0.001) and peripheral blood mononuclear cell complex I activity was significantly correlated with the %FM and RQ in CaPs. Furthermore, complex I activity increased significantly after 1 week of refeeding. CONCLUSIONS: Our study showed that mitochondrial complex I activity was inversely correlated to parameters of increased fat oxidation and reduced FM, which are indices of dietary insufficiency rather than loss of lean body mass, which is an index of increased catabolism in cancer.
Assuntos
Metabolismo Energético/fisiologia , Leucócitos Mononucleares/enzimologia , Mitocôndrias/enzimologia , Complexos Multienzimáticos/metabolismo , Neoplasias/metabolismo , Redução de Peso/fisiologia , Tecido Adiposo/metabolismo , Adulto , Idoso , Composição Corporal , Estudos de Casos e Controles , Ingestão de Alimentos/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/metabolismo , Neoplasias/sangue , Distúrbios Nutricionais/sangue , Distúrbios Nutricionais/complicações , Distúrbios Nutricionais/metabolismo , Apoio NutricionalRESUMO
OBJECTIVE: To compare the digestibility and tolerance of lactose from three semi-solid fermented dairy products with the same amount of lactose but different lactase contents and bacterial cultures in lactase deficient adults. DESIGN: Measurement of breath hydrogen (H2) concentration and of clinical symptoms after consumption of the test meals. SETTING: Metabolic ward for healthy volunteers, INSERM U290, Hôpital St. Lazare, Paris. SUBJECTS: Fifteen lactase-deficient healthy adult volunteers (20-45 y) started the study. One subject became a non-H2-producer during the study; therefore the results of 14 subjects are presented. INTERVENTION: Each subject consumed, on four different days and in random order, after a 12 h fast, three semisolid test meals containing 18 g of lactose, and a 10 g dose of lactulose which allowed calculation of lactose malabsorption. The three meals were: traditional yoghurt, fermented milk (Ofilus) that contained Lactobacillus acidophilus and Bifidobacterium sp., and a similar product 'Bulgofilus' enriched with Lactobacillus bulgaricus to increase the lactase content. RESULTS: Compared with lactulose, the sum of symptoms was significantly lower for Bulgofilus (P = 0.05), and bloating was less severe for Ofilus (P = 0.06). Between the fermented milks, there were no differences. The area under the breath H2 curve was significantly lower for each fermented milk when compared to lactulose (P < 0.0001). The degree of maldigestion of lactose did not differ significantly between the products; it was 21 +/- 3% (range 6-52) for Ofilus, 21 +/- 3% (range 6-44) for Bulgofilus, and 18 +/- 3% (range 3-43) for yoghurt. CONCLUSION: Despite the differences in the lactase and bacterial content, lactose was as well digested and tolerated from the three different semi-sold fermented dairy products. This could be due to a slow gastric emptying of the semi-solid milk.
Assuntos
Bifidobacterium , Digestão , Lactobacillus acidophilus , Intolerância à Lactose/metabolismo , Iogurte , beta-Galactosidase/deficiência , Adulto , Testes Respiratórios , Feminino , Fermentação , Humanos , Hidrogênio/análise , Lactase , Masculino , Pessoa de Meia-Idade , beta-Galactosidase/fisiologiaRESUMO
OBJECTIVE: To assess in healthy humans the effects of prolonged ingestion of Bifidobacterium sp fermented milk (BFM) with or without inulin on fecal bifidobacteria and some bacterial enzymatic activities. DESIGN: Twelve volunteers randomly divided into two groups were studied for three consecutive periods. During the ingestion period, they received BFM in association with ether 18g/d inulin or placebo in three oral doses for 12 days. Stools were regularly collected for bacteriological analysis. SETTING: Clinical Nutrition Unit, Hopital Saint-Lazare, Paris. RESULTS: The administration of BFM with placebo led to an increase in total bifidobacteria (indigenous and exogenous) (P < 0.01) and exogenous bifidobacteria (P < 0.01) and a decrease in beta-glucuronidase activity (P < 0.01). Simultaneous administration of BFM and inulin led to an increase in total bifidobacteria (P < 0.01) and exogenous bifidobacteria (P < 0.01), but had no effect on beta-glucuronidase activity. No differences were found for fecal concentrations reached by exogenous and indigenous bifidobacteria between the two groups. Administrated alone or with inulin, BFM did not change fecal total anaerobe counts, pH, nitrate reductase, nitroreductase and azoreductase activities. CONCLUSIONS: Administration of BFM substantially increases the proportion of bifidobacteria in the colonic flora, but the concurrent administration of inulin does not enhance this effect.
Assuntos
Bifidobacterium/isolamento & purificação , Bifidobacterium/metabolismo , Colo/microbiologia , Inulina/farmacologia , Leite/metabolismo , Adulto , Animais , Bactérias Anaeróbias/enzimologia , Bactérias Anaeróbias/isolamento & purificação , Bactérias Anaeróbias/metabolismo , Bifidobacterium/enzimologia , Colo/enzimologia , Fezes/química , Fezes/microbiologia , Feminino , Fermentação/fisiologia , Glucuronidase/análise , Humanos , Concentração de Íons de Hidrogênio , Masculino , Nitrato Redutases/análise , Nitrorredutases/análiseRESUMO
OBJECTIVE: To evaluate in 14 healthy volunteers the gastrointestinal tolerance to an indigestible bulking sweetener containing fructo-oligosaccharides (FOS). DESIGN: In order to mimic their usual pattern of consumption, FOS were ingested throughout the day either occasionally (once a week, first period) or regularly (every day, second period). In the two patterns of consumption, daily sugar doses were increased until diarrhoea and/or a symptom graded 3 (i.e. severe) occurred, or when subjects did not want to ingest more candies. SETTING: Clinical Nutrition Unit, Hôpital Saint-Lazare, Paris. RESULTS: In both periods, the first symptom which occurred was excessive flatus (> 30 g FOS/day): borborygmi and bloating appeared at a higher level (> 40 g/day); lastly, abdominal cramps and diarrhoea occurred at a very much higher level (50 g/day). The volumes of hydrogen excreted in breath in response to the same load of FOS were not different between the two periods. CONCLUSIONS: Chronic consumption of FOS initiated cautiously with subsequent gradual increase did not improve tolerance, nor reduce breath excretion of hydrogen.
Assuntos
Carboidratos da Dieta/efeitos adversos , Oligossacarídeos/efeitos adversos , Adulto , Testes Respiratórios , Estudos Cross-Over , Diarreia/induzido quimicamente , Carboidratos da Dieta/administração & dosagem , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Intolerância à Frutose/induzido quimicamente , Humanos , Hidrogênio/análise , Masculino , Oligossacarídeos/administração & dosagemRESUMO
We compared the tolerance of a diet providing 20 g/d lactose and a lactose-free diet in 14 patients with short-bowel syndrome with either the colon in continuity (group A, n = 8) or a terminal jejunostomy (group B, n = 6). Lactose tolerance was studied after a single 20-g lactose load in the fasting state, and during two 3-d periods during which the subjects consumed their usual diet plus either 20 g/d lactose, with no more than 4 g/d as milk, or no lactose. Records and measurements included symptoms, fecal weight, and during the 8 h after the lactose load, breath-hydrogen excretion (group A) or lactose and hexoses flow rates in stomal effluents (group B). Results are expressed as medians with ranges in parentheses. Lactose absorption was 61% (0-90) in group A and 53% (18-84) in group B, and no symptoms of intolerance were noticed. During the lactose-rich diet as compared to the lactose-free diet, no symptoms were noticed nor was there any worsening of diarrhea: 1534 g/d (240-4760) versus 1466 (1590-7030) in group A, and 4122 g/d (1730-6830) versus 3496 (1590-7030) in group B. We conclude that a diet providing 20 g/d lactose with no more than 4 g/d as milk is well tolerated in the majority of patients with short-bowel syndrome, and that a lactose-free diet has usually no benefit in these subjects.
Assuntos
Intolerância à Lactose/dietoterapia , Lactose/administração & dosagem , Síndrome do Intestino Curto/dietoterapia , Animais , Testes Respiratórios , Estudos Cross-Over , Fezes/química , Feminino , Humanos , Intolerância à Lactose/complicações , Masculino , Pessoa de Meia-Idade , Leite/metabolismo , Síndrome do Intestino Curto/complicaçõesRESUMO
Helicobacter pylori gastric infection in children is a public health problem. Classical diagnostic tools such as endoscopy are excessively invasive in the usual clinical context. Serology at this age has multiple drawbacks. The urea-13C breath test seems today the most appropriate alternative method. The principle of the test relies upon the indirect detection of H pylori through its high urease activity. The test uses a stable (ie, non radioactive) isotope, which allows its repeated use. The main indications are the detection and the follow-up of H pylori infection.
Assuntos
Testes Respiratórios/métodos , Infecções por Helicobacter/diagnóstico , Helicobacter pylori , Adulto , Fatores Etários , Isótopos de Carbono , Criança , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Helicobacter pylori/enzimologia , Humanos , Masculino , Espectrometria de Massas , Gravidez , Ureia , Urease/análiseRESUMO
BACKGROUND: Uncontrolled studies of lactose intolerant subjects have shown that symptom severity decreases after chronic lactose consumption. Adaptation of the colonic flora might explain this improvement. AIMS: To compare the effects of regular administration of either lactose or sucrose on clinical tolerance and bacterial adaptation to lactose. METHODS: Forty six lactose intolerant subjects underwent two 50 g lactose challenges on days 1 and 15. Between these days they were given 34 g of lactose or sucrose per day, in a double blind protocol. Stool samples were obtained on days 0 and 14, to measure faecal beta-galactosidase and pH. Symptoms, breath H2 excretion, faecal weight and electrolytes, and orofaecal transit time were assessed. RESULTS: Except for faecal weight, symptoms were significantly milder during the second challenge in both groups, and covariance analysis showed no statistical difference between them. In the lactose group, but not in the sucrose group, faecal beta-galactosidase activity increased, pH dropped, and breath H2 excretion decreased. CONCLUSION: Bacterial adaptation occurred when lactose intolerant subjects ingested lactose for 13 days, and all symptoms except diarrhoea regressed. Clinical improvement was also observed in the control group which displayed no signs of metabolic adaptation. This suggests that improved clinical tolerance may be just a placebo effect.
Assuntos
Intolerância à Lactose/terapia , Lactose/administração & dosagem , Sacarose/administração & dosagem , Adulto , Bactérias/metabolismo , Testes Respiratórios , Colo/microbiologia , Método Duplo-Cego , Fezes/enzimologia , Feminino , Humanos , Hidrogênio/análise , Concentração de Íons de Hidrogênio , Intolerância à Lactose/enzimologia , Intolerância à Lactose/microbiologia , Masculino , Pessoa de Meia-Idade , Efeito Placebo , beta-Galactosidase/análiseRESUMO
BACKGROUND & AIMS: Long-term carbohydrate malabsorption in patients with short bowel and colon in continuity (SBC) could result in a more efficient fermentation. The bacterial fermentation capacity in patients with SBC was assessed. METHODS: Eleven fasting patients with SBC ingested 60 g lactulose with 10 g polyethylene glycol. Stool specimens were analyzed. Patients were compared with 8 normal subjects who ingested 60 g lactulose on two occasions, separated by 8 days during which 20 g lactulose was taken twice daily. Moreover, the daily amount of bacteria excreted in stools was measured in 6 patients with SBC and 6 normal subjects. RESULTS: Despite fast transit time, patients fermented more lactulose and hexoses and had a higher activity of beta-galactosidase in stools than nonadapted normal subjects (P < 0.01); these parameters were roughly similar in patients and adapted normal subjects. The fecal output of short-chain fatty acids was significantly lower in patients than in nonadapted normal subjects (P < 0.03). Patients excreted a significantly greater amount of bacteria in stools than normal subjects (P < 0.05). CONCLUSIONS: In patients with SBC, the capacity of bacterial flora to ferment lactulose and fecal bacterial mass is spontaneously increased, suggesting that hyperfermentation may affect other carbohydrates. Moreover, hyperfermentation is associated with efficient removal of extra short-chain fatty acids from fecal water.
Assuntos
Síndrome do Intestino Curto/microbiologia , Adaptação Biológica , Adulto , Idoso , Bactérias/metabolismo , Ácidos Graxos Voláteis/metabolismo , Feminino , Fermentação , Hexoses/metabolismo , Humanos , Intestino Delgado/cirurgia , Lactulose/metabolismo , Masculino , Pessoa de Meia-Idade , Síndrome do Intestino Curto/metabolismo , beta-Galactosidase/metabolismoRESUMO
Lactose digestion improves when the energy content of a meal is raised, perhaps due to delayed gastric emptying; however, this has not been demonstrated directly. It is not known whether lactose-intolerant subjects should consume full-fat or high energy milk instead of half-skimmed milk. In this study, breath 13CO2 and hydrogen (H2) measurements were combined to assess simultaneously the effect of increasing milk energy content on gastric emptying, digestion, and tolerance of lactose. On two separate days, 11 adult lactose maldigesters ingested, in the fasting state, a single dose of 710 kJ half-skimmed milk or 1970 kJ high energy milk. Both contained 18 g lactose and were supplemented with 100 mg 13C-glycine for breath 13CO2 measurement. For 6 h after milk ingestion, samples of expired breath were collected, and subjects scored their symptoms on a four-grade questionnaire. Gastric emptying was measured from excretion of breath 13CO2. The mean gastric emptying half-time was significantly longer after ingestion of high energy milk than after half-skimmed milk (84 +/- 4 vs. 64 +/- 4 min, P = 0.004). The mean area under the breath H2 excretion curve measured for 6 h was 330 +/- 61 microL/L after subjects consumed high energy milk vs. 470 +/- 82 microL/L after they consumed half-skimmed milk (P = 0.07). Mean symptom scores did not differ after ingestion of the two milks, but only two subjects experienced disturbing symptoms after high energy milk ingestion compared with five subjects after ingestion of half-skimmed milk (P = 0.56). Although ingestion of high energy milk delayed the gastric emptying of lactose for significantly longer than the ingestion of half-skimmed milk (P < 0.01), it did not lead to significant improvement in symptoms and reflected only a trend toward improved lactose digestion (P = 0.07), as measured by the area under the breath H2 excretion curve. These results indicate that it is not beneficial for most lactose-intolerant subjects to replace consumption of half-skimmed milk by milk with a higher energy content.
Assuntos
Ingestão de Energia , Esvaziamento Gástrico , Intolerância à Lactose/metabolismo , Leite , Adulto , Animais , Testes Respiratórios , Dióxido de Carbono/química , Cromatografia Gasosa , Gorduras na Dieta/administração & dosagem , Gorduras na Dieta/metabolismo , Feminino , Humanos , Hidrogênio/química , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The purpose of the study was to determine the accuracy of the labelled 13carbon urea breath test for the diagnosis of Helicobacter pylori in children and to simplify the 13carbon urea breath test in identifying the most discriminating sampling time. METHODS: H. pylori was searched for in 100 children aged 10.5+/-4.5 years by histology, bacteriological counts, and culture on antral biopsies together with serology and 13carbon urea breath test. Breath samples were obtained before ingestion (T0) of 75 mg urea-13C and every 10 minutes after until T60. 13CO2 excess ratio was measured by isotope ratio mass spectrometry, and values expressed as delta per mil over baseline enrichment (delta 13CO2). The arithmetic mean (Mdelta 13CO2) of T20 to T60 values was calculated and the test considered positive with Mdelta 3CO2 higher than Mdelta 13CO2 + 3 SD as determined in noninfected children. RESULTS: Mdelta 13CO2 of noninfected children as assessed by culture was 1.4+/-0.6 per mil, determining a positive cut-off value of 3.44 per mil. Mdelta 13CO2 was correlated in 11 children with biopsy bacteriological counts. Both culture and 13carbon urea breath test were positive in 38 of 100 children, without any discordance. Plotting 13carbon urea breath test results at each sampling time versus Mdelta 13CO2 showed weaker correlations at T20, T30, T50, and T60, than at T40. The two-sample method at T0 and T30, T40, T50, had high sensitivity and specificity. Single-sample analysis obtained at T40 gave a comparable sensitivity and a slightly reduced specificity. CONCLUSION: 13carbon urea breath test is sensitive and specific in children. Two samples collected at T0 and T40 provide the most discriminating procedure.