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Maximizing the Estrogenic Potential of Soy Isoflavones through the Gut Microbiome: Implication for Cardiometabolic Health in Postmenopausal Women. Nutrients 2022; 14:nu14030553. [PMID: 35276910 PMCID: PMC8840243 DOI: 10.3390/nu14030553] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 12/24/2022] Open
Abstract
Soy isoflavones have been suggested as an alternative treatment for managing postmenopausal symptoms and promoting long-term health due to their structural similarity to mammalian estrogen and ability to bind to estrogen receptors. Among all soy isoflavones and their metabolites, (S)-equol is known for having the strongest estrogenic activity. Equol is a metabolite of the soy isoflavone daidzein produced through intestinal bacterial metabolism. However, more than half of the human population is not able to produce equol due to the lack of equol-producing bacteria in their gastrointestinal tract. The interpersonal variations in the gut microbiome complicate the interpretation of data collected from humans. Furthermore, because rodents are efficient equol-producers, translatability between rodent models and humans is challenging. Herein, we first summarized the current knowledge of the microbial conversion of daidzein to equol, its relation to health, and proposed the need for developing model systems by which equol production can be manipulated while controlling other known confounding factors. Determining the necessity of equol-producing capacity within a gut microbial community when consuming soy as a functional ingredient, and identifying strategies to maximize equol production by modulating the gut microbiome, may provide future therapeutic approaches to improve the health of postmenopausal women.
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Lecerf JM, Arnoldi A, Rowland I, Trabal J, Widhalm K, Aiking H, Messina M. Soyfoods, glycemic control and diabetes. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.02.437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ismaiel M, Yang H, Cui M. Evaluation of High Fibers Okara and Soybean Bran as Functional Supplements for Mice with Experimentally Induced Type 2 Diabetes. POL J FOOD NUTR SCI 2017. [DOI: 10.1515/pjfns-2017-0003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Tenore GC, Caruso D, Buonomo G, D'Urso E, D'Avino M, Campiglia P, Marinelli L, Novellino E. Annurca (Malus pumila Miller cv. Annurca) apple as a functional food for the contribution to a healthy balance of plasma cholesterol levels: results of a randomized clinical trial. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2017; 97:2107-2115. [PMID: 27571713 DOI: 10.1002/jsfa.8016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Recent human studies have evaluated the effect of daily apple consumption on plasma cholesterol level, which is recognized as an important risk factor for cardiovascular disease (CVD). Nevertheless, slightly significant effects have been generally registered although consuming more than two apples a day for several weeks. RESULTS This study describes the influence of daily consumption of Annurca apples on the cholesterol levels of mildly hypercholesterolaemic healthy subjects. A monocentric, randomized, parallel-group, placebo-controlled, 4-month study was conducted. The subjects (n = 250) were randomly assigned to five treatment groups (each one of 50 subjects: 28 men and 22 women). Four groups were administered one apple per day among the following: Red Delicious, Granny Smith, Fuji, Golden Delicious. The fifth group was asked to consume two Annurca apples per day, since the weight of this cultivar is on average half that of the commercial ones considered in this study. Comparing results, Annurca led to the most significant outcome, allowing a reduction in total and low-density lipoprotein cholesterol levels by 8.3% and 14.5%, respectively, and an increase in high-density lipoprotein cholesterol levels by 15.2% (all P < 0.001). CONCLUSION Our data would reasonably indicate Annurca apple as a useful tool to contribute to the prevention of CVD risk through normal diet. © 2016 Society of Chemical Industry.
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Affiliation(s)
- Gian Carlo Tenore
- Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy
| | - Domenico Caruso
- Department of Internal Medicine, Hospital Cardarelli, 80131 Naples, Italy
| | | | - Emanuela D'Urso
- Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy
| | - Maria D'Avino
- Department of Internal Medicine, Hospital Cardarelli, 80131 Naples, Italy
| | - Pietro Campiglia
- Department of Pharmaceutical and Biomedical Sciences, University of Salerno, 84084 Salerno, Italy
| | - Luciana Marinelli
- Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy
| | - Ettore Novellino
- Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy
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Ai Y, Jane JL. Macronutrients in Corn and Human Nutrition. Compr Rev Food Sci Food Saf 2016; 15:581-598. [DOI: 10.1111/1541-4337.12192] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Yongfeng Ai
- Dept. of Food Science and Human Nutrition; Michigan State Univ; East Lansing MI 48824 U.S.A
| | - Jay-lin Jane
- Dept. of Food Science and Human Nutrition; Iowa State Univ; Ames IA 50011 U.S.A
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Tahavorgar A, Vafa M, Shidfar F, Gohari M, Heydari I. Beneficial effects of whey protein preloads on some cardiovascular diseases risk factors of overweight and obese men are stronger than soy protein preloads – A randomized clinical trial. JOURNAL OF NUTRITION & INTERMEDIARY METABOLISM 2015. [DOI: 10.1016/j.jnim.2015.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Makarova E, Górnaś P, Konrade I, Tirzite D, Cirule H, Gulbe A, Pugajeva I, Seglina D, Dambrova M. Acute anti-hyperglycaemic effects of an unripe apple preparation containing phlorizin in healthy volunteers: a preliminary study. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2015; 95:560-568. [PMID: 24917557 DOI: 10.1002/jsfa.6779] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 05/06/2014] [Accepted: 06/05/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND The health-promoting properties of apples are directly related to the biologically active compounds that they contain, such as polyphenols. The objective of this study was to prepare a low-sugar, fibre- and phlorizin-enriched powder from unripe apples and to gain insight regarding its anti-hyperglycaemic activity in healthy volunteers. RESULTS The unripe apples (Malus domestica Borkh.) were collected 30 days after the full bloom day; blanched and pressed to obtain apple pomace which was then processed with a food cutter, oven-dried and milled to prepare apple powder. The concentrations of total sugars, water-soluble pectin and phlorizin in the apple preparation were 153.44 ± 2.46, 27.73 ± 0.51 and 12.61 ± 0.15 g kg(-1), respectively. Acute ingestion of the apple preparation improved glucose metabolism in the oral glucose tolerance test (OGTT) in six healthy volunteers by reducing the postprandial glucose response at 15 to 30 min by approximately two-fold (P < 0.05) and by increasing urinary glucose excretion during the 2- to 4-h interval of the OGTT by five-fold (P < 0.05). CONCLUSION The results obtained indicate that the dried and powdered pomace of unripe apples can be used as a health-promoting natural product for the reduction of postprandial glycaemia and to improve the health of patients with diabetes.
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Affiliation(s)
- Elina Makarova
- Latvian Institute of Organic Synthesis, Aizkraukles Street 21, LV-1006, Riga, Latvia
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Intake of whole apples or clear apple juice has contrasting effects on plasma lipids in healthy volunteers. Eur J Nutr 2012; 52:1875-89. [DOI: 10.1007/s00394-012-0489-z] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
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Abstract
Evidence from observational, animal and human studies supports a role for soya protein and its isoflavones in the improvement of glycaemic control in type 2 diabetes. The objective of the present study was to determine the effect of isoflavone-rich soya protein on markers of glycaemic control in adults with type 2 diabetes. Using a randomised, crossover, double-blind, placebo-controlled design, adults with diet-controlled type 2 diabetes (n 29) consumed soya protein isolate (SPI) and milk protein isolate (MPI) for 57 d each separated by a 4-week washout. Blood was collected on days 1 and 57 of each treatment period for analysis of fasting HbA1C, and fasting and postprandial glucose, insulin and calculated indices of insulin sensitivity and resistance. Urine samples of 24 h were collected at the end of each treatment period for analysis of isoflavones. Urinary isoflavone excretion was significantly greater following consumption of SPI compared with MPI, and 20.7 % of the subjects (n 6) were classified as equol excretors. SPI consumption did not significantly affect fasting or postprandial glucose or insulin, fasting HbA1C, or indices of insulin sensitivity and resistance. These data do not support a role for soya protein in the improvement of glycaemic control in adults with diet-controlled type 2 diabetes and contribute to a limited literature of human studies on the effects of soya protein on the management of type 2 diabetes.
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Antihypertensive properties of plant-based prebiotics. Int J Mol Sci 2009; 10:3517-3530. [PMID: 20111692 PMCID: PMC2812835 DOI: 10.3390/ijms10083517] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 07/14/2009] [Accepted: 07/28/2009] [Indexed: 11/17/2022] Open
Abstract
Hypertension is one of the major risk factors for cardiovascular disease. Although various drugs for its treatment have been synthesized, the occurring side effects have generated the need for natural interventions for the treatment and prevention of hypertension. Dietary intervention such as the administration of prebiotics has been seen as a highly acceptable approach. Prebiotics are indigestible food ingredients that bypass digestion and reach the lower gut as substrates for indigenous microflora. Most of the prebiotics used as food adjuncts, such as inulin, fructooligosaccharides, dietary fiber and gums, are derived from plants. Experimental evidence from recent studies has suggested that prebiotics are capable of reducing and preventing hypertension. This paper will discuss some of the mechanisms involved, the evidence generated from both in-vitro experiments and in-vivo trials and some controversial findings that are raised.
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Mani UV, Parulkar J, Iyer U, Prabhu B, Rai V, Kurian E, Mukherjee N, Mani I, Mehta NC, Patel KH, Desikachar HSR. Glycaemic index of a cereal-pulse mix (diabetic mix) in non insulin dependent diabetes mellitus (NIDDM) subjects. Int J Food Sci Nutr 2009. [DOI: 10.3109/09637489409166153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Theuwissen E, Mensink RP. Water-soluble dietary fibers and cardiovascular disease. Physiol Behav 2008; 94:285-92. [PMID: 18302966 DOI: 10.1016/j.physbeh.2008.01.001] [Citation(s) in RCA: 266] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 12/24/2007] [Accepted: 01/02/2008] [Indexed: 01/12/2023]
Abstract
One well-established way to reduce the risk of developing cardiovascular disease (CVD) is to lower serum LDL cholesterol levels by reducing saturated fat intake. However, the importance of other dietary approaches, such as increasing the intake of water-soluble dietary fibers is increasingly recognized. Well-controlled intervention studies have now shown that four major water-soluble fiber types-beta-glucan, psyllium, pectin and guar gum-effectively lower serum LDL cholesterol concentrations, without affecting HDL cholesterol or triacylglycerol concentrations. It is estimated that for each additional gram of water-soluble fiber in the diet serum total and LDL cholesterol concentrations decrease by -0.028 mmol/L and -0.029 mmol/L, respectively. Despite large differences in molecular structure, no major differences existed between the different types of water-soluble fiber, suggesting a common underlying mechanism. In this respect, it is most likely that water-soluble fibers lower the (re)absorption of in particular bile acids. As a result hepatic conversion of cholesterol into bile acids increases, which will ultimately lead to increased LDL uptake by the liver. Additionally, epidemiological studies suggest that a diet high in water-soluble fiber is inversely associated with the risk of CVD. These findings underlie current dietary recommendations to increase water-soluble fiber intake.
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Affiliation(s)
- Elke Theuwissen
- Department of Human Biology, Maastricht University, Maastricht, The Netherlands.
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Abstract
Interest in the physiologic and pharmacologic role of bioactive compounds present in plants has increased dramatically over the last decade. Of particular interest in relation to human health are the classes of compounds known as the phytoestrogens, which embody several groups of non-steroidal estrogens, including isoflavones and lignans that are widely distributed within nature. The impact of dietary phytoestrogens on normal biologic processes was first recognized in sheep. Observations of sheep grazing on fields rich in clover and cheetahs fed high soy diets in zoos suggested that flavonoids and related phytochemicals can affect mammalian health. Endogenous estrogens have an important role not only in the hypothalamic-pituitary-gonadal axis, but also in various non-gonadal systems, such as cardiovascular systems, bone, and central nervous systems, and lipid metabolism. There have been several clinical studies of hormone replacement therapy (HRT) in post-menopausal women to examine whether HRT has beneficial effects on the cardiovascular system, bone fractures, lipid metabolism, and Alzheimer's disease. In addition, estrogen contributes to the development of some estrogen-dependent cancers, such as breast cancer and prostate cancer and the number of patients with these cancers is increasing in developed countries. Although recent mega-studies showed negative results for classical HRT in the prevention of some of these diseases, the molecules that interact with estrogen receptors are candidate drugs for various diseases, including hormone-dependent cancers. This review focuses on the molecular properties and pharmaceutical potential of phytoestrogens.
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Affiliation(s)
- Takeshi Usui
- Division of Endocrinology, Clinical Research Center, National Hospital Organization Kyoto Medical Center, Japan
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Franzon R, Chiarani F, Mendes RH, Belló-Klein A, Wyse ATS. Dietary soy prevents brain Na+, K(+)-ATPase reduction in streptozotocin diabetic rats. Diabetes Res Clin Pract 2005; 69:107-12. [PMID: 16005358 DOI: 10.1016/j.diabres.2004.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Accepted: 11/15/2004] [Indexed: 02/02/2023]
Abstract
The aim of this study was to investigate Na+, K(+)-ATPase activity in cerebral cortex, hippocampus and hypothalamus of diabetic rats. The action of dietary soy protein on the effect produced by diabetes on this activity was also tested. Forty-nine-day-old Wistar were divided into two groups: diabetes streptozotocin (50 mg/kg body weight) and control (citrate solution). Rats were sacrificed 56 days later. In other set of experiments, rats received a dietary with casein (control) from day 21 to the 49 of postnatal-age and were subjected to diabetes or received citrate (control). One week later, rats received a special dietary with soy protein with isoflavones or casein (control) from day 56 to the 105 of postnatal-age. Results showed that diabetic rats presented a reduction ( approximately 40%) of Na+, K(+)-ATPase activity in all structures studied. Pretreatment with soy protein prevented the inhibitory effects of diabetes on the enzyme activity. Assuming the possibility that these effects might also occur in the human condition, our findings may be relevant to explain, at least in part, the neurologic dysfunction associated with diabetes and might support a novel therapeutic strategy (soy protein) to slow the progression of neurodegeneration in this disorder.
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Affiliation(s)
- Renata Franzon
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Anexo, CEP 90035-003 Porto Alegre, RS, Brazil
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Zhao Z, Egashira Y, Sanada H. Phenolic antioxidants richly contained in corn bran are slightly bioavailable in rats. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2005; 53:5030-5. [PMID: 15941352 DOI: 10.1021/jf050111n] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Phenolic acids (PAs) have been shown to be beneficial to human health and are found most abundantly in corn bran ( approximately 4%, w/w), one of the main dietary fibers. This study therefore evaluated the bioavailabilities of phenolic antioxidants ferulic acid (FA) and p-coumaric acid (PCA) in refined corn bran (RCB) by determining their recovery in the plasma, urine, and feces of rats fed a single meal of a RCB diet containing 5% RCB or adapted to the RCB diet for 10 days. In both studies, 0.4-0.5% of ingested FA and 1.2-2.3% of ingested PCA were recovered in rat urine. By contrast, approximately 81% of FA and approximately 64% of PCA ingested with the single meal were excreted through the rat feces within 3 days after the ingestion. On the other hand, after rats were fed the RCB diet, total FA (all forms of FA) was recovered in plasma at a concentration of 35.0 +/- 2.0 microg/L, total FA and total PCA were excreted through urine at levels of 155.4 +/- 5.8 and 50.9 +/- 6.6 microg/day, respectively. These parameters showed no significant change (P = 0.93, 0.09, and 0.66, respectively) after rats were fed the RCB diet continuously for up to 10 days. These results suggest that the PAs in RCB are bioavailable in rats. Their bioavailabilities, however, are relatively low compared with their high content in RCB and not improved by the adaptation for 10 days to the enriched RCB diet. Additionally, comparison with the results of other studies revealed that high contents of FA and, especially, diferulic acids in cereal bran, which act as cross-links between bran cell wall polysaccharides, may not improve but, rather, limit the bioavailabilities of PAs in vivo.
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Affiliation(s)
- Zhaohui Zhao
- Laboratory of Food and Nutrition, Graduate School of Science and Technology, Chiba University, 648 Matsudo, Matsudo, Chiba 271-8510, Japan.
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Yang G, Shu XO, Jin F, Elasy T, Li HL, Li Q, Huang F, Zhang XL, Gao YT, Zheng W. Soyfood consumption and risk of glycosuria: a cross-sectional study within the Shanghai Women's Health Study. Eur J Clin Nutr 2004; 58:615-20. [PMID: 15042129 DOI: 10.1038/sj.ejcn.1601855] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the association between soyfood intake and risk of glycosuria. DESIGN AND METHODS A cross-sectional study was conducted among participants of the Shanghai Women's Health Study, a population-based cohort study of women aged 40-70 y. Information on usual intake of soyfoods was obtained at baseline survey through an in-person interview using a validated food-frequency questionnaire. Included in this study were 39,385 cohort members screened for diabetes at the baseline survey and free of previously diagnosed diabetes, cardiovascular diseases, kidney diseases, and cancer. There were 323 women who tested positive for urine glucose. Odds ratios (ORs) and 95% confidence intervals (CIs) were employed to measure the association between soyfood intake and glycosuria using unconditional logistic regression. SETTING Urban communities of Shanghai, China. RESULTS Overall, soyfood intake was not related to the risk of glycosuria. Among postmenopausal women, however, intake of tofu and other soy products was inversely associated with risk of glycosuria after adjustment for potential confounders. The ORs across quintiles of intake were 1.0, 0.75 (95% CI=0.47-1.20), 0.79 (95% CI=0.51-1.25), 0.53 (95% CI=0.32-0.88), and 0.51 (95% CI=0.26-0.98; P for trend=0.05). Further analyses showed that the inverse association was primarily confined to postmenopausal women with a body mass index (BMI) of <25 kg/m2. The adjusted OR comparing the extreme quintiles was 0.36 (95% CI=0.13-0.97; P for trend=0.004). CONCLUSIONS Soyfoods may play a role in the development of glycosuria, an important indicator of diabetes, among postmenopausal women with a low BMI.
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Affiliation(s)
- G Yang
- Center for Health Service Research, Vanderbilt University Medical Center, Nashville, TN 37232-8300, USA.
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Guillon F, Champ MMJ. Carbohydrate fractions of legumes: uses in human nutrition and potential for health. Br J Nutr 2002; 88 Suppl 3:S293-306. [PMID: 12498630 DOI: 10.1079/bjn2002720] [Citation(s) in RCA: 160] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Starch and fibre can be extracted, using wet or dry processes, from a variety of grain legumes and used as ingredients for food. alpha-Galactosides can be isolated during wet processes from the soluble extract. Starch isolates or concentrates are mostly produced from peas, whereas dietary fibre fractions from peas and soyabean are commercially available. The physico-chemical characteristics of fibre fractions very much depend on their origin, outer fibres being very cellulosic whereas inner fibres contain a majority of pectic substances. Inner fibres are often used as texturing agents whereas outer fibres find their main uses in bakery and extruded products, where they can be introduced to increase the fibre content of the food. Most investigations on impacts on health have been performed on soyabean fibres. When positive observations were made on lipaemia, glucose tolerance or faecal excretion, they were unfortunately often obtained after non-realistic daily doses of fibres. Legume starches contain a higher amount of amylose than most cereal or tuber starches. This confers these starches a lower bioavailability than that of most starches, when raw or retrograded. Their low glycaemic index can be considered as beneficial for health and especially for the prevention of diseases related to insulin resistance. When partly retrograded, these starches can provide significant amount of butyrate to the colonic epithelium and may help in colon cancer prevention. alpha-Galactosides are usually considered as responsible for flatus but their apparent prebiotic effects may be an opportunity to valorize these oligosaccharides.
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Affiliation(s)
- F Guillon
- URPOI & UFDNH, National Institute for Agronomic Research (INRA), Rue de la Géraudière, BP 71627, 44316 Nantes Cedex, 03, France.
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Bhathena SJ, Velasquez MT. Beneficial role of dietary phytoestrogens in obesity and diabetes. Am J Clin Nutr 2002; 76:1191-201. [PMID: 12450882 DOI: 10.1093/ajcn/76.6.1191] [Citation(s) in RCA: 408] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Evidence is emerging that dietary phytoestrogens play a beneficial role in obesity and diabetes. Nutritional intervention studies performed in animals and humans suggest that the ingestion of soy protein associated with isoflavones and flaxseed rich in lignans improves glucose control and insulin resistance. In animal models of obesity and diabetes, soy protein has been shown to reduce serum insulin and insulin resistance. In studies of human subjects with or without diabetes, soy protein also appears to moderate hyperglycemia and reduce body weight, hyperlipidemia, and hyperinsulinemia, supporting its beneficial effects on obesity and diabetes. However, most of these clinical trials were relatively short and involved a small number of patients. Furthermore, it is not clear whether the beneficial effects of soy protein and flaxseed are due to isoflavones (daidzein and genistein), lignans (matairesinol and secoisolariciresinol), or some other component. Isoflavones and lignans appear to act through various mechanisms that modulate pancreatic insulin secretion or through antioxidative actions. They may also act via estrogen receptor-mediated mechanisms. Some of these actions have been shown in vitro, but the relevance of these studies to in vivo disease is not known. The diversity of cellular actions of isoflavones and lignans supports their possible beneficial effects on various chronic diseases. Further investigations are needed to evaluate the long-term effects of phytoestrogens on obesity and diabetes mellitus and their associated possible complications.
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Affiliation(s)
- Sam J Bhathena
- Phytonutrients Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, US Department of Agriculture, Beltsville, MD 20705, USA.
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Jayagopal V, Albertazzi P, Kilpatrick ES, Howarth EM, Jennings PE, Hepburn DA, Atkin SL. Beneficial effects of soy phytoestrogen intake in postmenopausal women with type 2 diabetes. Diabetes Care 2002; 25:1709-14. [PMID: 12351466 DOI: 10.2337/diacare.25.10.1709] [Citation(s) in RCA: 246] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Phytoestrogen consumption has been shown to reduce risk factors for cardiovascular disease. Type 2 diabetes confers an adverse cardiovascular risk profile particularly in women after menopause. The aim of this study was to determine whether a dietary supplement with soy protein and isoflavones affected insulin resistance, glycemic control, and cardiovascular risk markers in postmenopausal women with type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 32 postmenopausal women with diet-controlled type 2 diabetes completed a randomized, double blind, cross-over trial of dietary supplementation with phytoestrogens (soy protein 30 g/day, isoflavones 132 mg/day) versus placebo (cellulose 30 g/day) for 12 weeks, separated by a 2-week washout period. RESULTS Compliance with the dietary supplementation was >90% for both treatment phases. When compared with the mean percentage change from baseline seen after 12 weeks of placebo, phytoestrogen supplementation demonstrated significantly lower mean values for fasting insulin (mean +/- SD 8.09 +/- 21.9%, P = 0.006), insulin resistance (6.47 +/- 27.7%, P = 0.003), HbA(1c) (0.64 +/- 3.19%, P = 0.048), total cholesterol (4.07 +/- 8.13%, P = 0.004), LDL cholesterol (7.09 +/- 12.7%, P = 0.001), cholesterol/HDL cholesterol ratio (3.89 +/- 11.7%, P = 0.015), and free thyroxine (2.50 +/- 8.47%, P = 0.004). No significant change occurred in HDL cholesterol, triglycerides, weight, blood pressure, creatinine, dehydroepiandrosterone sulfate, androstenedione, and the hypothalamic-pituitary-ovarian axis hormones. CONCLUSIONS These results show that dietary supplementation with soy phytoestrogens favorably alters insulin resistance, glycemic control, and serum lipoproteins in postmenopausal women with type 2 diabetes, thereby improving their cardiovascular risk profile.
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Ebihara K, Nakamoto Y. Effect of the particle size of corn bran on the plasma cholesterol concentration, fecal output and cecal fermentation in rats. Nutr Res 2001. [DOI: 10.1016/s0271-5317(01)00380-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hermansen K, Søndergaard M, Høie L, Carstensen M, Brock B. Beneficial effects of a soy-based dietary supplement on lipid levels and cardiovascular risk markers in type 2 diabetic subjects. Diabetes Care 2001; 24:228-33. [PMID: 11213870 DOI: 10.2337/diacare.24.2.228] [Citation(s) in RCA: 176] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Consumption of soy protein has recently been shown to improve the blood lipid levels in nondiabetic subjects. The purpose of this study was to evaluate if a dietary supplement of soy protein, isoflavones, and cotyledon fiber (Abalon) affects cardiovascular risk markers, blood glucose, and insulin levels in type 2 diabetic subjects. RESEARCH DESIGN AND METHODS Twenty type 2 diabetic subjects participated in a crossover trial. They were randomized to double-blind supplementation for 6 weeks with Abalon (soy protein [50 g/day] with high levels of isoflavones [minimum 165 mg/day] and cotyledon fiber [20 g/day]) or placebo (casein [50 g/day] and cellulose [20 g/day]), separated by a 3-week wash-out period. RESULTS The results are expressed as means +/- SD. The percentage mean treatment difference between Abalon and placebo demonstrated significantly lower mean values after Abalon for LDL cholesterol (10 +/- 15%, P < 0.05), LDL/UHDL ratio (12 +/- 18%, P < 0.05), apolipoprotein (apo) B100 (30 +/- 38%, P < 0.01), triglycerides (22 +/- 10%, P < 0.05), and homocysteine (14 +/- 21%, P < 0.01), whereas the total cholesterol value tended to be less significant but still lower (8 +/- 15%, P < 0.08). No change occurred in HDL cholesterol, apo B100/apo A1 ratio, plasminogen activator inhibitor 1, factor VIIc, von Willebrand factor, fibrinogen, lipoprotein(a), glucose, HbA1c, or 24-h blood pressure. CONCLUSIONS These results indicate beneficial effects of dietary supplementation with Abalon on cardiovascular risk markers in type 2 diabetic subjects. This improvement is seen even in individuals with near-normal lipid values.
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Affiliation(s)
- K Hermansen
- Department of Endocrinology and Metabolism, Aarhus University Hospital, Denmark.
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Tsiodras S, Shin RK, Christian M, Shaw LM, Sass DA. Anticholinergic toxicity associated with lupine seeds as a home remedy for diabetes mellitus. Ann Emerg Med 1999. [DOI: 10.1016/s0196-0644(99)80012-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr 1999; 69:30-42. [PMID: 9925120 DOI: 10.1093/ajcn/69.1.30] [Citation(s) in RCA: 1020] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The effects of dietary soluble fibers on blood cholesterol are uncertain. OBJECTIVE This meta-analysis of 67 controlled trials was performed to quantify the cholesterol-lowering effect of major dietary fibers. DESIGN Least-squares regression analyses were used to test the effect on blood lipids of pectin, oat bran, guar gum, and psyllium. Independent variables were type and amount of soluble fiber, initial cholesterol concentration, and other important study characteristics. RESULTS Soluble fiber, 2-10 g/d, was associated with small but significant decreases in total cholesterol [-0.045 mmol L(-1).g soluble fiber(-1) (95% CI: -0.054, -0.035)] and LDL cholesterol [-0.057 mmol.L(-1).g(-1) (95% CI: -0.070, -0.044)]. The effects on plasma lipids of soluble fiber from oat, psyllium, or pectin were not significantly different. We were unable to compare effects of guar because of the limited number of studies using 2-10 g/d. Triacylglycerols and HDL cholesterol were not significantly influenced by soluble fiber. Lipid changes were independent of study design, treatment length, and background dietary fat content. CONCLUSIONS Various soluble fibers reduce total and LDL cholesterol by similar amounts. The effect is small within the practical range of intake. For example, 3 g soluble fiber from oats (3 servings of oatmeal, 28 g each) can decrease total and LDL cholesterol by approximately 0.13 mmol/L. Increasing soluble fiber can make only a small contribution to dietary therapy to lower cholesterol.
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Affiliation(s)
- L Brown
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA
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Feldman N, Norenberg C, Voet H, Manor E, Berner Y, Madar Z. Enrichment of an Israeli ethnic food with fibres and their effects on the glycaemic and insulinaemic responses in subjects with non-insulin-dependent diabetes mellitus. Br J Nutr 1995; 74:681-8. [PMID: 8541274 DOI: 10.1079/bjn19950171] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The effects of various sources of dietary fibre on the high glycaemic index of an Israeli ethnic food, melawach, were investigated in subjects with non-insulin-dependent diabetes mellitus (NIDDM). Locust-bean (Ceratonia siliqua) gum significantly decreased the glucose response to, and glycaemic index of, melawach in these diabetic subjects (P < 0.05). It also tended to decrease their insulinaemic response and insulinaemic index, but differences were not significant. Dietary fibre from lupin (Lupinus albus) and insoluble maize-cob fibre did not affect glucose and insulin levels in NIDDM volunteers. Subjects with a BMI < 30 kg/m2 exhibited similar glucose, but not insulin, responses to fibre. Locust-bean gum had no significant effect on glycaemic response in NIDDM subjects with a BMI > 30 kg/m2, whereas insulinaemic response decreased. The results indicate that foods containing the same nutrients in almost the same amounts, but differing in added dietary fibre, lead to different physiological responses in diabetic subjects. Furthermore, insulin response should be considered when fibre is incorporated into the diabetic's diet.
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Affiliation(s)
- N Feldman
- Department of Biochemistry and Human Nutrition, Faculty of Agriculture, Hebrew University, Rehovot, Israel
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Shane JM, Walker PM. Corn bran supplementation of a low-fat controlled diet lowers serum lipids in men with hypercholesterolemia. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1995; 95:40-5. [PMID: 7798579 DOI: 10.1016/s0002-8223(95)00011-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the lipid-lowering effects of dietary corn bran fed in moderate supplemental doses to men with hypercholesterolemia consuming a low-fat diet. DESIGN The 98-day study was divided into one 2-week preperiod and two 6-week experimental periods in a cross-over design. SETTING The study was conducted in the metabolic diet kitchen of the Department of Home Economics and the Nutrition Research Laboratory of the Department of Agriculture at Illinois State University, Normal. SUBJECTS Twenty-nine sedentary men with hypercholesterolemia, aged 38 to 70 years, participated in the project. All of them completed the study. INTERVENTIONS After a 2-week adjustment period in which subjects consumed a low-fat controlled diet, subjects were assigned to one of two experimental treatments: low-fat controlled diet plus 20 g corn bran supplement or low-fat controlled diet plus 20 g wheat bran supplement. MAIN OUTCOME MEASURES Lipid measurements included total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), very-low-density lipoprotein cholesterol (VLDL-C), and triglyceride concentrations. STATISTICAL ANALYSES PERFORMED Differences in lipid parameters were analyzed using two-way analysis of variance with repeated measures (P < .05). A paired t test was used to assess differences between treatment periods for each subject. RESULTS The low-fat controlled diet significantly lowered all serum parameters analyzed except HDL-C. Corn fiber supplementation resulted in an additional lowering of serum total cholesterol, triglyceride, and VLDL-C concentrations. Serum LDL-C and HDL-C concentrations were not significantly altered by corn fiber or wheat fiber supplementation. APPLICATIONS This study suggests that supplementing a low-fat diet with corn bran is affective in reducing serum lipid concentrations for men with hypercholesterolemia.
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Affiliation(s)
- J M Shane
- Department of Family and Consumer Sciences, Illinois State University, Normal 61790
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Hazan A, Madar Z. Preparation of a dietary fiber mixture derived from different sources and its metabolic effects in rats. J Am Coll Nutr 1993; 12:661-8. [PMID: 8294721 DOI: 10.1080/07315724.1993.10718357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In this study we analyzed a commercial dietary fiber blend known as Fiber-Plus and a dietary fiber mixture (DFM) prepared in our lab (10% apple pectin, 10% orange pectin, 36% locust bean gum and 44% corncob composed of 56% fiber). DFM provided greater inhibition of starch digestion and glucose absorption (p < 0.05) than did Fiber-Plus. DFM was also found to be significantly more efficient (p < 0.05) than Fiber-Plus at reducing the glycemic response following starch loading. Rats fed DFM or corncob demonstrated a much lower glycemic response following a test meal as compared to those fed a fiber-free diet. Both fiber sources decreased fasting cholesterol and triglyceride concentrations; transit time was shortened and fecal values were higher than those of controls. beta-glucuronidase activity in intestinal segment contents and feces was lower in rats fed fiber. We conclude that DFM is effective in controlling plasma glucose and lipid levels. Corncob, a novel fiber source, could be beneficial in the treatment of gastrointestinal tract disorders and in the elimination of carcinogenic elements.
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Affiliation(s)
- A Hazan
- Department of Biochemistry and Human Nutrition, Hebrew University of Jerusalem, Faculty of Agriculture, Rehovot, Israel
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Perturbations of blood chemistry and after the short-term feeding of a fiber supplement in noninsulin dependent diabetic and nondiabetic subjects. J Nutr Biochem 1992. [DOI: 10.1016/0955-2863(92)90027-g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Dietary Fibre and Plasma Lipids: Potential for Prevention and Treatment of Hyperlipidaemias. DIETARY FIBRE — A COMPONENT OF FOOD 1992. [DOI: 10.1007/978-1-4471-1928-9_17] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Bruttomesso D, Biolo G, Inchiostro S, Fongher C, Briani G, Duner E, Marescotti MC, Iori E, Tiengo A, Tessari P. No effects of high-fiber diets on metabolic control and insulin-sensitivity in type 1 diabetic subjects. Diabetes Res Clin Pract 1991; 13:15-21. [PMID: 1663445 DOI: 10.1016/0168-8227(91)90028-c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The metabolic effects of a three-month treatment with a high-fiber diet (15 grams of guar-gum added to a standard diet) were investigated in seven type 1 diabetic subjects, with a moderately poor metabolic control. HbA1c levels, daily insulin requirement, cholesterol, triglyceride, amino acid and intermediate metabolite concentrations were evaluated before and following the high fiber diet, both in the postabsorptive state at euglycemia and during a euglycemic, hyperinsulinemic, hyperaminoacidemic clamp. Insulin-mediated glucose utilization, an index of insulin-sensitivity, was also measured during the clamp. Following the diet, no differences in HbA1c levels (7.6 +/- 0.7%----7.3 +/- 0.6%), daily insulin requirement (50 +/- 5----51 +/- 3 U/d), triglyceride, amino acid and intermediary metabolite concentrations in the basal, euglycemic state, were observed. Only cholesterol concentrations decreased significantly (from 165 +/- 12 to 142 +/- 12 mg/dl, P less than 0.01) after the diet. During the clamp, the concentrations of all measured substrates were comparable before and after high fiber treatment. Insulin-mediated glucose disposal was also unchanged by guar-gum treatment. Patients' body weights were not modified by the diet. In conclusion, our study shows that a high fiber diet, obtained with the addition of 15 grams of guar-gum to a standard diet, is of no benefit to IDDM either as regards the metabolic control or insulin sensitivity. Only cholesterol levels were decreased. Therefore, the costs and benefits of these diets in the treatment of IDDM should be reconsidered.
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Affiliation(s)
- D Bruttomesso
- Istituto di Medicina Clinica, University of Padova, Italy
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Gallaher DD, Schaubert DR. The effect of dietary fiber type on glycated hemoglobin and renal hypertrophy in the adult diabetic rat. Nutr Res 1990. [DOI: 10.1016/s0271-5317(05)80168-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Anderson JW, Deakins DA, Floore TL, Smith BM, Whitis SE. Dietary fiber and coronary heart disease. Crit Rev Food Sci Nutr 1990; 29:95-147. [PMID: 2165783 DOI: 10.1080/10408399009527518] [Citation(s) in RCA: 175] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- J W Anderson
- Department of Medicine, University of Kentucky, Lexington
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MUZILLA M, UNKLESBAY N, HELSEL Z, UNKLESBAY K, ELLERSIECK M. EFFECT OF PARTICLE SIZE AND HEAT ON ABSORPTIVE PROPERTIES OF SOY HULLS2. J FOOD QUALITY 1989. [DOI: 10.1111/j.1745-4557.1989.tb00331.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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MUZILLA M, UNKLESBAY N, HELSEL Z, UNKLESBAY K, ELLERSIECK M. WATER AND LIPID ABSORPTION PROPERTIES OF LIGNIN-REDUCED SOY HULLS2. J FOOD QUALITY 1989. [DOI: 10.1111/j.1745-4557.1989.tb00332.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Rathje W, Ho EE. Meat fat madness: Conflicting patterns of meat fat consumption and their public health implications. ACTA ACUST UNITED AC 1987. [DOI: 10.1016/s0002-8223(21)03322-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hollenbeck CB, Coulston AM. Effect of variation in diet on lipoprotein metabolism in patients with diabetes mellitus. DIABETES/METABOLISM REVIEWS 1987; 3:669-89. [PMID: 3038489 DOI: 10.1002/dmr.5610030304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Mani I, Mani UV. Effect of wheat bran supplementation on blood sugar, glycosylated protein and serum lipids in NIDDM subjects. ACTA ACUST UNITED AC 1987. [DOI: 10.1007/bf01092052] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Arrigoni E, Caprez A, Amadò R, Neukom H. Chemical composition and physical properties of modified dietary fibre sources. Food Hydrocoll 1986. [DOI: 10.1016/s0268-005x(86)80007-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Debry G, Drouin P, Gariot P, Pointel JP, Louis J, Gross P, Couet C. Nutritional management of diabetes mellitus: rationale, ethics and practicability. J Am Coll Nutr 1986; 5:9-30. [PMID: 3009588 DOI: 10.1080/07315724.1986.10720109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
Generalized effects of dietary fiber on lipid absorption and blood serum lipid patterns of humans have not been defined and may not even exist. The term dietary fiber covers a wide variety of materials with different chemical and physical characteristics. The ability of pectins and mucilages, often classed as soluble fibers, to lower blood and liver lipids has been demonstrated repeatedly and consistently. However, demonstrated hypolipidemic effects of feeding such non-soluble fibers as cellulose, hemicellulose and bran are by no means consistent. On the basis of pooled data, it appears that hypolipidemic response or non-response of humans to inclusion of non-soluble fibers in diets is in part related to the degree of fecal bulking as a result of in vitro water holding capacity and in part related to pre-study blood serum lipid levels of the individual subjects.
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Johnson IT, Gee JM, Mahoney RR. Effect of dietary supplements of guar gum and cellulose on intestinal cell proliferation, enzyme levels and sugar transport in the rat. Br J Nutr 1984; 52:477-87. [PMID: 6093854 DOI: 10.1079/bjn19840115] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Male Wistar rats (approximately 200 g) were given fibre-free semi-synthetic diets containing either sucrose (S) or a sucrose-starch mixture (SS) as the carbohydrate component, or a diet similar to SS containing 40 g guar gum/kg (G), or 100 g cellulose/kg (C). The animals remained healthy, and weight gain after 30 d was similar in all groups. The small intestines of the animals given diet G were significantly longer than those of the other groups, and showed signs of increased mitotic activity and mucosal growth. No significant differences in mucosal enzyme activity were detected between the two fibre-free control groups. Lactase (EC 3.2.1.23) and alkaline phosphatase (EC 3.1.3.1) activities were significantly lower than controls in group G, but were higher in group C. Kinetic analysis of 3-O-methyl glucose uptake by isolated intestine indicated that the maximum transport rate (Vmax) of tissue from group G tended to be lower than from the fibre-free group SS and group C. It is concluded that materials which are classed as dietary fibre but which differ markedly in their physical properties may also differ in the functional changes to which they give rise in the small intestine. These changes may be at least partially mediated by effects on mucosal cell proliferation.
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