Gastric emptying rates of solid food in relation to body mass index: an ultrasonographic and scintigraphic study

Lower body mass index potentiates the association between skipping breakfast and prevalence of proteinuria

BACKGROUND

Proteinuria is an important predictor of cardiovascular disease and mortality. Several studies reported the association between skipping breakfast and the prevalence of proteinuria. Furthermore, skipping breakfast was associated with an increased risk of obesity. Although proteinuria is highly prevalent in obese individuals, the association between the prevalence of proteinuria and low body mass index (BMI) was reported in a previous cross-sectional study in asymptomatic individuals without known kidney diseases. The aim of this cross-sectional study was to assess the clinical impact of BMI on the association between skipping breakfast and the prevalence of proteinuria in normal renal function subjects.

METHODS

The present study included 26,888 subjects (15,875 males and 11,013 females) with an estimated glomerular filtration rate ≥60 ml/min/1.73 m² and no history of kidney disease who underwent a health checkup in Sumitomo Hospital. The association between skipping breakfast and the prevalence of proteinuria (defined as dipstick proteinuria of ≥1+) was assessed using logistic regression models adjusted for clinically relevant factors.

RESULTS

Skipping breakfast was reported in 3,306 males (20.8%) and 1,514 females (13.8%). Multivariable adjusted logistic regression models showed that skipping breakfast was significantly associated with the prevalence of proteinuria above 1+. This association was evident in lower BMI subjects, even after adjusting for clinically relevant factors (adjusted odds ratios of males and females were 1.67 [1.17-2.38] and 1.92 [1.31-2.82], respectively), whereas this association was not evident in higher BMI subjects.

CONCLUSION

Lower BMI subjects with proteinuria might need to be careful about skipping breakfast.

Body mass index modifies the association between frequency of alcohol consumption and incidence of hypertension in men but not in women: a retrospective cohort study

Alcohol consumption is one of the major modifiable risk factors of hypertension. The aim of the present retrospective study was to assess the clinical impact of obesity on the association between alcohol consumption and the incidence of hypertension. The present study included 5116 male and 6077 female university employees with a median age of 32 (interquartile range 27-39) who underwent annual health checkups between January 2005 and March 2013. Self-reported drinking frequency was recorded at their first checkup and categorized into rarely and 1-3, 4-6, and 7 days/week. During the median observational period of 4.9 years (interquartile range 2.1-8.3), hypertension, defined as systolic/diastolic blood pressure of ≥140/90 mmHg and/or self-reported treatment for hypertension, was observed in 1067 (20.9%) men and 384 (6.3%) women. Poisson regression models adjusted for clinically relevant factors revealed a dose-dependent association between drinking frequency and the incidence of hypertension in men (adjusted incidence rate ratio [95% confidence interval] of men who drank rarely, 1-3, 4-6, and 7 days/week was 1.00 [reference], 1.12 [0.97-1.30], 1.42 [1.19-1.70], and 1.35 [1.14-1.59], respectively; P_trend < 0.001). However, this association was not observed in women. The dose-dependent association was significant in nonobese men (body mass index (BMI) < 25 kg/m²), but not in obese men (BMI ≥25 kg/m²) (P for interaction between drinking frequency and BMI = 0.072). The present study provides clinically useful evidence to identify the drinkers who may reap the health benefits of abstinence from alcohol consumption.

Mechanism-Based Modeling of Gastric Emptying Rate and Gallbladder Emptying in Response to Caloric Intake

Bile acids released postprandially modify the rate and extent of absorption of lipophilic compounds. The present study aimed to predict gastric emptying (GE) rate and gallbladder emptying (GBE) patterns in response to caloric intake. A mechanism‐based model for GE, cholecystokinin plasma concentrations, and GBE was developed on data from 33 patients with type 2 diabetes and 33 matched nondiabetic individuals who were administered various test drinks. A feedback action of the caloric content entering the proximal small intestine was identified for the rate of GE. The cholecystokinin concentrations were not predictive of GBE, and an alternative model linking the nutrients amount in the upper intestine to GBE was preferred. Relative to fats, the potency on GBE was 68% for proteins and 2.3% for carbohydrates. The model predictions were robust across a broad range of nutritional content and may potentially be used to predict postprandial changes in drug absorption.

Gender Difference of Gastric Emptying in Healthy Volunteers and Patients with Functional Dyspepsia

BACKGROUND AND AIM

Delayed gastric emptying is one of the reasons why functional dyspepsia (FD) occurs. The 13C-acetate breath test is widely used to evaluate gastric emptying. Nevertheless, the standard value of 13C-acetate breath test has not taken into account the gender difference of gastric emptying among healthy individuals. The main aim of this study was to readjust the standard value of 13C-acetate breath test in the light of gender differences. In addition, we clarified the prevalence and clinical characteristics of delayed gastric emptying in patients with FD using the modified standard values of 13C-acetate breath test.

METHODS

Fifty-two healthy individuals and 126 patients with patients with FD were enrolled. Gastric emptying was evaluated by the 13C-acetate breath test. The cut-off points of Tmax for the diagnosis of delayed gastric emptying were determined on the basis of results from healthy individuals making a distinction of genders. Gastroesophageal reflux symptoms, dyspeptic symptoms, scores of anxiety and depression, age, body mass index (BMI), smoking and alcohol consumption were compared between the delayed gastric emptying group and the non-delayed gastric emptying group.

RESULTS

Since gastric emptying was delayed in healthy women compared with that in healthy men (Tmax, 53.6 ± 19.3 vs. 42.7 ± 16.9 min, p = 0.04), we set the cut-off points of Tmax at 60 min in men and at 75 min in women. In patients with FD, the prevalence of delayed gastric emptying was not different between men and women with the modified standard values of 13C-acetate breath test. (31.0 vs. 27.4%, p = 0.68). BMI was lower in the delayed gastric emptying group than in the non-delayed group among the male patients. Reflux symptoms were more severe in delayed gastric emptying group than in the non-delayed group among the female patients.

CONCLUSION

The standard values of 13C-acetate breath test should be modified bearing the gender difference in mind. It provides us more appropriate information to understand the mechanisms of FD.

Gastroretentive systems - a proposed strategy to modulate anthocyanin release and absorption for the management of diabetes

Several reports have indicated a positive correlation between the consumption of anthocyanins (ACN) and biomarkers relating to the improvement of type 2 diabetes (T2D). However, the results from in vitro studies often do not translate into clinical evidence. Potential causes of these discrepancies are experimental conditions that lack physiological relevancy; extensive degradation of these compounds in vivo due to changes in pH and metabolism; and a short residence time in the absorption window in relation to the absorption rate. Here, gastroretentive systems (GRS) are proposed as a strategy to overcome the limitations in ACN delivery and to reduce the existing bench-to-subject gap. This review summarizes recent literature on the use of ACN for the management and control of T2D, followed by GRS platforms to promote a sustained release of ACN for increased health benefits.

Does age affect gastric emptying time? A model-based meta-analysis of data from premature neonates through to adults

Purpose. Gastric emptying (GE) is often reported to be slower and more irregular in premature neonates than in older children and adults. The aim of this study was to investigate the impact of age and other covariates on the rate of GE. Methods. The effect of age on the mean gastric residence times (MGRT) of liquid and solid food was assessed by analysing 49 published studies of 1457 individuals, aged from 28 weeks gestation to adults. The data were modelled using the nonlinear mixed‐effects approach within NONMEM version 7.2 (ICON, Dublin, Ireland), with evaluation of postnatal age, gestational age and meal type as covariates. A double Weibull function was selected as a suitable model since it could account for the typical biphasic nature of GE. Results. Age was not a significant covariate for GE but meal type was. Aqueous solutions were associated with the fastest emptying time (mean simulated gastric residence time of 45 min) and solid food was associated with the slowest (98 min). Conclusions. These findings challenge the assertion that GE is different in neonates, as compared with older children and adults due to age, and they reinforce the significance of food type in modulating GE. © 2015 The Authors. Biopharmaceutics & Drug Disposition Published by John Wiley & Sons Ltd.

Conference on "Multidisciplinary approaches to nutritional problems". Postgraduate Symposium. The role of fat in gastric emptying and satiety: acute and chronic effects

Dietary fat is an important factor in the aetiology of obesity and the metabolic syndrome. It has been widely debated whether gastric emptying (GE) is altered in obesity. GE times have been reported as both longer and shorter in obese individuals compared with matched lean individuals. However, the general consensus is that GE is accelerated and satiety is lower in obesity. Research has implicated a high-fat (HF) diet in these findings. A single HF meal has a longer GE time than a low-fat meal and can even delay GE of the subsequent meal. However, an HF diet has shown different effects. Feeding a HF diet adapts gastrointestinal function to reduce GE times in comparison with a low-fat diet. Increased GE may lead to decreased satiety and faster onset of subsequent eating episodes. Further results have suggested that consuming an HF diet for 14 d increases the GE rate of HF food but not low-fat food. Consuming HF diets for 2 weeks has also been shown to increase food intake. Decreased satiation following an HF diet may cause increased food intake and a positive energy balance, potentially resulting in a gradual increase in adiposity. Recent results have suggested that gastrointestinal transit is accelerated following only 3 d on a HF diet. The variable GE times reported in obesity may be associated with interactions between the HF diet and obesity and not simply the obese state.

Radioisotopic assessment of gastric emptying of solids in elderly subjects

BACKGROUND AND AIMS

Few studies in literature have investigated the gastric emptying of solids in elderly subjects. We assessed the differences between young and elderly subjects in the gastric emptying rate of solids by a radioisotopic method.

METHODS

Two groups of 15 elderly male subjects (mean age 68.20 years and 77.26 years, respectively) and a group of young male subjects (mean age 30.23 years) underwent a radioisotopic study of gastric emptying after eating a radiolabeled solid meal. Half-time of gastric emptying (T1/2) and emptying index (EI), i.e. rate of gastric emptying at 120 min, were measured with two opposing detectors connected to a computerized rate-meter. Results are expressed as means +/- SD.

RESULTS

Significantly different values were obtained in the two groups both at T1/2 (183+/-88 and 195+/-75, respectively) and EI (0.40+/-0.3 and 0.36+/-0.4), compared with young subjects (T1/2=53+/-23; EI=1.10+/-0.3) (p<0.0001).

CONCLUSIONS

Gastric emptying of solids is significantly delayed in elderly men; this variable must be taken into account when studies on gastric emptying rates are performed.

Regional gastric emptying abnormalities in functional dyspepsia and gastro-oesophageal reflux disease

To characterize proximal and distal stomach emptying in functional dyspepsia (FD) and gastro-oesophageal reflux disease (GORD). Eighty-three patients underwent gastric emptying (GE) scintigraphy and symptom scoring for the evaluation of upper gastrointestinal symptoms and were divided into three groups: FD (n = 25), GORD (n = 20) and FD + GORD (n = 38). Total, proximal and distal gastric retention were determined scintigraphically and compared with normal controls. Delayed total GE was observed in each subgroup: FD (56%), GORD (45%) and FD + GORD (55%). Greater proximal gastric retention was observed after meal ingestion in GORD compared to FD. Greater distal gastric retention was observed in FD and FD + GORD but it was only mild in GORD. Nausea, vomiting, early satiety, distention and regurgitation were associated with proximal gastric retention whereas there was no symptom associated with distal gastric retention. Multiple regression demonstrated total gastric retention at 30 min and 1 h was positively correlated with regurgitation whereas early proximal gastric retention was positively correlated with regurgitation and negatively correlated with nausea. Selective abnormalities of proximal and distal stomach emptying were demonstrated in GORD and FD. GORD and FD symptoms were associated with proximal gastric retention suggesting that proximal stomach motor function may be important in the pathogenesis of symptoms associated with these disorders.

Familial risk of tumors associated with hereditary non-polyposis colorectal cancer: a Swedish population-based study

BACKGROUND

Familial clustering, which may be due to inherited predisposition, is seen in several common cancer types. The aim of this study was to assess the familial risk of tumors that are associated with hereditary non-polyposis colorectal cancer (HNPCC), a familial cancer syndrome that confers an increased risk of several cancer types, and is associated with a low age at onset.

METHODS

The National Swedish Cancer Registry and population registers were utilized to identify all tumors among the offspring of individuals who had developed any of the diagnoses included in the Amsterdam II criteria for HNPCC. In all, 204,358 offspring of 102,814 individuals with cancer of the colorectum, endometrium, upper urinary tract or small intestine were identified.

RESULTS

Significantly increased risks for several tumor types were demonstrated. If the parent was below age 50 at diagnosis, the offspring Standard Incidence Ratios (SIRs) were 3.6 for colon cancer, 3.8 for rectal cancer, 2.8 for gastric cancer, and 2.3 for ovarian cancer. Offspring who had both a parent and a sibling with HNPCC-associated cancer showed even higher SIRs for cancer of the colorectum, endometrium, ovary, and urinary tract. The highest values were observed in the subgroup whose parent had developed multiple primary tumors; SIR 34.0 for colon cancer, 17.9 for rectal cancer, 21.8 for endometrial cancer, and 5.8 for ovarian cancer.

CONCLUSIONS

The study demonstrates that there is an increased risk for several tumor types among individuals whose parents developed HNPCC-associated tumors, where a young age at diagnosis and development of multiple tumors in the parents lead to the highest SIRs.

Gastric clearance of radiopaque markers in the evaluation of gastric emptying rate

BACKGROUND

The study of gastric emptying rate of solids using radiopaque indigestible solid markers has been a poorly employed technique because some kinds of markers do not leave the stomach at the same time as the meal but during the interdigestive migrating motor complex (IMMC). The aim of this study was to evaluate whether markers of particular shape and size can be successfully employed for this purpose.

METHODS

Twenty-eight non-ulcer dyspeptic (NUD) patients and 20 healthy volunteers received a standard solid meal (790 Kcal) together with 20 small polyethylene radiopaque cylinders (5 mm x 2 mm in diameter). Gastric emptying rate was evaluated by ultrasound while the emptying of markers was simultaneously followed by X-rays using a brilliance intensifier.

RESULTS

Final emptying time (FET = time when the antrum area returns to fasting size) of digestible solids was 355+/-35 min in NUD patients versus 265+/-20 min in controls (P < 0.001). The gastric emptying curve of digestible solids correlated with emptying of markers both in NUD patients (r= +0.96) and in controls (r= +0.93).

CONCLUSIONS

The assessment of gastric clearance of radiopaque cylinders of 2 mm x 5 mm in size is a reliable tool for the study of gastric emptying rate of digestible solids. This is a readily available and easily performed test in any radiology unit.

Effect of body size on gastric emptying using the 13C-octanoic acid breath test

The 13C-octanoic acid breath test (OABT) may be a useful non-invasive method for assessing the rate of gastric emptying in dogs. The aim of this study was to determine whether an association exists between body size and rate of gastric emptying in dogs. Fifty-five dogs ranging from 6 to 39 kg were recruited and rate of gastric emptying was assessed using the OABT. The time to peak 13CO2 excretion (tmax) and half-dose recovery time (t1/2) were calculated. The OABT was simple to perform and well tolerated by the dogs. Mean (sd) tmax was 2.67 hours (0.6) and mean t1/2 was 3.38 hours (0.79). Inter-individual variation in the rate of gastric emptying was 23.3 per cent for t1/2 and 22.5 per cent for tmax. No association was detected between the rate of gastric emptying and body surface area, mass, age, sex or test operator. The OABT may be a useful non-invasive and non-radioactive test for assessment of the rate of gastric emptying in dogs in clinical practice.

Review article: recognition and treatment of eating disorders in primary and secondary care

Eating disorders are serious illnesses affecting 1-2% of young women. Patients may present to any doctor, sometimes atypically (e.g. unexplained weight loss, food allergy, infertility, diarrhoea), delaying diagnosis and leading to needless investigation. The cardinal signs are weight loss, amenorrhoea, bingeing with vomiting and other compensatory behaviours, and disturbances in body image with an exaggeration of the importance of slimness. When other causes have been excluded, useful investigations are serum potassium, bone mineral density scanning and pelvic ultrasound. In emaciated patients multiple systems may fail with pancytopaenia, neuromyopathy and heart failure. Clinical assessment of muscle power is used to monitor physical risk. Treatment may involve individual, group or family sessions, using cognitive-behavioural, psychodynamic and family approaches. More severe or intractable illness is treated with day care, with in-patient care in a medical or specialist psychiatric unit reserved for the most severely ill patients. Antidepressants have a place in the treatment of bulimia nervosa unresponsive to psychological approaches, and when severe depressive symptoms develop. The children of people with eating disorders may have an increased risk of difficulties. Support for the patient and family, and effective liaison between professionals, are essential in the treatment of severe eating disorders.

Pharmacokinetics and pharmacodynamics of gliclazide in Caucasians and Australian Aborigines with type 2 diabetes

AIMS

Gliclazide pharmacokinetics and pharmacodynamics were assessed in 9 Caucasians and 10 Australian Aborigines with uncomplicated type 2 diabetes.

METHODS

Subjects were on a stable dose of 80 mg gliclazide twice daily, took 160 mg on the morning of study and had a standard breakfast. No further gliclazide was given over the next 48 h. Regular blood samples were drawn for serum glucose, insulin and gliclazide assay. Gliclazide was measured using h.p.l.c. Noncompartmental analysis was used to describe primary data. A multicompartment model incorporating entero-hepatic recirculation was fitted to group mean serum gliclazide profiles.

RESULTS

The Caucasians were older than the Aborigines (mean +/- s.d. age 53.4 +/- 12.2 vs 40.3 +/- 6.9 years, P < 0.05) but had similar diabetes duration, body mass index and glycated haemoglobin. Noncompartmental analysis revealed no between-group differences in gliclazide kinetics. Post-breakfast serum glucose and insulin responses were also similar apart from a longer time to maximum concentration (tmax) for glucose amongst the Aborigines (2.6 +/- 0.4 vs 2.2 +/- 0. 3 h in Caucasians; P = 0.024). Gliclazide tmax exhibited a skewed unimodal distribution and was not associated with gliclazide maximum concentration, or glucose or insulin responses. Most patients had a serum gliclazide profile suggestive of enterohepatic recirculation and/or biphasic absorption. Model-derived estimates of the extent of putative enterohepatic recirculation were 30% and 20% of dose in Caucasians and Aborigines, respectively.

CONCLUSIONS

Gliclazide is equally effective in Caucasian and Aboriginal diabetic patients. The pharmacokinetics of oral gliclazide appear more complex than previously thought. Gliclazide pharmacodynamics are unrelated to rate and extent of absorption, consistent with a threshold concentration for hypoglycaemic effect.

Gastroduodenal motility

Several major themes emerged over the past year in the area of gastroduodenal motility. Mostly, these themes represented extensions of research areas discussed in prior reviews in this series rather than the emergence of completely new concepts. Thus, for example, considerable emphasis has again been placed on regional gastric motor function in dyspepsia and on the role of fundic relaxation and accommodation, in particular. Not surprisingly, basic physiologic research has also shown a keen interest in the regulation of fundic relaxation. One new and exciting development is the recognition of the stomach's role in satiety. The spectrum of gastric motor dysfunction in diabetes mellitus continues to be explored, and the important role of hyperglycemia in regulating gastric function has been further emphasized. More data have been provided on noninvasive alternatives to gastric motor function testing, and several studies have looked at factors that may influence variability in these various tests. There have been few innovations over the past year in the therapeutic arena; rather, the indications and limitations of current therapies have been further developed.