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Chen Y, Hu X, Shi Q, Lu Y, Yan J, Wu DT, Qin W. Changes in the Fruit Quality, Phenolic Compounds, and Antioxidant Potential of Red-Fleshed Kiwifruit during Postharvest Ripening. Foods 2023; 12:foods12071509. [PMID: 37048330 PMCID: PMC10094503 DOI: 10.3390/foods12071509] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
Kiwifruit is very popular for its unique flavor and nutritional value, and for its potential health benefits, which are closely related to its richness in a variety of natural antioxidant substances, in which polyphenolics play a non-negligible role. This study investigated changes in the fruit quality, phenolic compounds, and antioxidant potential of Chinese red-fleshed kiwifruit “Hongshi No. 2” during postharvest ripening at room temperature (20 ± 1 °C). Results showed that the weight loss rate slowly increased, the firmness rapidly decreased, and the soluble solid concentration gradually increased during the postharvest ripening of red-flesh kiwifruit. In addition, the total phenolic (TPC), total flavonoid (TFC), and total proanthocyanidin (TPAC) contents gradually increased during postharvest ripening. The most abundant phenolic compounds in kiwifruit throughout postharvest ripening were catechin (CC), proanthocyanidin B1 (PB1), and proanthocyanidin B2 (PB2). Furthermore, the methanolic extracts of red-flesh kiwifruit exhibited remarkable antioxidant activities throughout postharvest ripening stages. Indeed, some phenolic compounds showed good correlations with antioxidant activities; for instance, chlorogenic acid (CHL) showed a significantly positive correlation with ferric reducing antioxidant power (FRAP), and isoquercitrin (IS) showed a significantly negative correlation with DPPH free radical scavenging ability. The findings from this study are beneficial to better understanding the quality profile of red-flesh kiwifruit “Hongshi No. 2” during postharvest ripening.
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Affiliation(s)
- Yi Chen
- College of Food Science, Sichuan Agricultural University, Ya’an 625014, China
| | - Xiaomin Hu
- College of Food Science, Sichuan Agricultural University, Ya’an 625014, China
| | - Qingke Shi
- College of Food Science, Sichuan Agricultural University, Ya’an 625014, China
| | - Yue Lu
- College of Food Science, Sichuan Agricultural University, Ya’an 625014, China
| | - Jing Yan
- College of Food Science, Sichuan Agricultural University, Ya’an 625014, China
- Institute of Food Processing and Safety, Sichuan Agricultural University, Ya’an 625014, China
| | - Ding-Tao Wu
- Institute for Advanced Study, Chengdu University, Chengdu 610106, China
| | - Wen Qin
- College of Food Science, Sichuan Agricultural University, Ya’an 625014, China
- Institute of Food Processing and Safety, Sichuan Agricultural University, Ya’an 625014, China
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Wang W, Sun M, Yu J, Ma X, Han C. Relationship between Components, Intestinal Microbiota, and Mechanism of Hypoglycemic Effect of the Saggy Ink Cap Medicinal Mushroom (Coprinus Comatus, Agaricomycetes): A Review. Int J Med Mushrooms 2023; 25:81-90. [PMID: 37947066 DOI: 10.1615/intjmedmushrooms.2023050474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Coprinus comatus is rich in a variety of nutrients, which has been reported to display a good hypoglycemic effect. However, there is no consensus on the hypoglycemic mechanism of this mushroom. Intestinal microbiota, a complex and intrinsic system, is closely related to metabolism. In this review, we discussed the potential relationship between certain components of C. comatus and intestinal microbiota to illustrate the possible hypoglycemic mechanism of C. comatus through intestinal microbiota. It will provide a new perspective for the study of hypoglycemic mechanism of C. comatus and promote the development and utilization of this mushroom.
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Affiliation(s)
- Wei Wang
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, P.R. China
| | - Min Sun
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, People's Republic of China
| | - Jinyan Yu
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, P.R. China
| | - Xumin Ma
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, P.R. China
| | - Chunchao Han
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, People's Republic of China; Shandong Provincial Collaborative Innovation Center for Quality Control and Construction of the Whole Industrial Chain of Traditional Chinese Medicine, Jinan, Shandong, 250355, People's Republic of China
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Abstract
Fruits are the seed-bearing product of plants and have considerable nutritional importance in the human diet. The consumption of fruits is among the dietary strategies recommended for constipation due to its potential effects on the gut microbiota and gut motility. Dietary fiber from fruits has been the subject of research on the impact on gut microbiota, gut motility and constipation, however, fruits also contain other components that impact the intestinal luminal environment that may impact these outcomes including sorbitol and (poly)phenols. This review aims to explore the mechanisms of action and effectiveness of fruits and fruit products on the gut microbiota, gut motility and constipation, with a focus on fiber, sorbitol and (poly)phenols. In vitro, animal and human studies investigating the effects of fruits on gut motility and gut microbiota were sought through electronic database searches, hand searching and consulting with experts. Various fruits have been shown to modify the microbiota in human studies including blueberry powder (lactobacilli, bifidobacteria), prunes (bifidobacteria), kiwi fruit (Bacteroides, Faecalibacterium prausnitzii) and raisins (Ruminococcus, F. prausnitzii). Prunes, raisins and apple fiber isolate have been shown to increase fecal weight in humans, whilst kiwifruit to increase small bowel and fecal water content. Apple fiber isolate, kiwifruit, fig paste, and orange extract have been shown to reduce gut transit time, while prunes have not. There is limited evidence on which fruit components play a predominant role in regulating gut motility and constipation, or whether a synergy of multiple components is responsible for such effects.
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Affiliation(s)
- Zoi Katsirma
- Department of Nutritional Sciences, King's College London, 150 Stamford Street, SE1 9NH, London, UK.
| | - Eirini Dimidi
- Department of Nutritional Sciences, King's College London, 150 Stamford Street, SE1 9NH, London, UK.
| | - Ana Rodriguez-Mateos
- Department of Nutritional Sciences, King's College London, 150 Stamford Street, SE1 9NH, London, UK.
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, 150 Stamford Street, SE1 9NH, London, UK.
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Montoya CA, Blatchford P, Moughan PJ. In vitro ileal and caecal fermentation of fibre substrates in the growing pig given a human-type diet. Br J Nutr 2021; 125:998-1006. [DOI: 10.1017/s0007114520003542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractThis study characterised the in vitro ileal fermentability of different substrates in the growing pig, adopted as an animal model for the adult human, and compared in vitro ileal and caecal fermentation in the pig. Substrates (arabinogalactan (AG), cellulose, fructo-oligosaccharide (FOS), inulin, mucin, citrus pectin and resistant starch) were fermented in vitro (ileal 2 h and caecal 24 h) with an ileal or caecal inoculum prepared from ileal or caecal digesta collected from growing pigs (n 5) fed a human-type diet for 15 d. The organic matter (OM) fermentability and production of organic acids were determined. In general, there was considerable in vitro ileal fermentation of fibre, and the substrates differed (P < 0·001) for both in vitro ileal and caecal OM fermentability and for organic acid production. Pectin had the greatest in vitro ileal OM fermentability (26 %) followed by AG, FOS and resistant starch (15 % on average), and cellulose, inulin and mucin (3 % on average). The fermentation of FOS, inulin and mucin was greater for in vitro caecal fermentation compared with the ileal counterpart (P ≤ 0·05). In general, the organic acid production was higher for in vitro caecal fermentation (P ≤ 0·05). For instance, the in vitro ileal acetic acid production represented 4–46 % of in vitro caecal production. Energy from fibre fermentation of 0·6–11 kJ/g substrate fermented could be expected in the ileum of the pig. In conclusion, substrates are fermented in both the ileum and caecum. The degree of fermentation varies among substrates, especially for in vitro ileal fermentation.
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Mottawea W, Sultan S, Landau K, Bordenave N, Hammami R. Evaluation of the Prebiotic Potential of a Commercial Synbiotic Food Ingredient on Gut Microbiota in an Ex Vivo Model of the Human Colon. Nutrients 2020; 12:nu12092669. [PMID: 32882999 PMCID: PMC7551822 DOI: 10.3390/nu12092669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/19/2020] [Accepted: 08/28/2020] [Indexed: 12/28/2022] Open
Abstract
Behavior and mood disorders have been linked to gut microbiota dysbiosis through the “microbiota-gut-brain axis”. Microbiota-targeting interventions are promising therapeutic modalities to restore or even maintain normal microbiome composition and activity in these disorders. Here, we test the impact of a commercial synbiotic formulation on gut microbiota composition and metabolic activity. We employed an ex-vivo continuous fermentation model that simulates the proximal colon to assess the effect of this formulation on microbiota structure and functionality as compared to no treatment control and microcrystalline cellulose as a dietary fiber control. The test formulation did not alter the diversity of gut microbiota over 48 h of treatment. However, it induced the enrichment of Lactobacillus, Collinsella and Erysipelotrichaceae. The test formulation significantly increased the level of microbiota-generated butyrate within 12 h of treatment as compared to 24 h required by microcrystalline cellulose to boost its production. The test formulation did not lead to a significant change in amino acid profiles. These results provide evidence of potential benefits related to synbiotic effects and general gut health and support the potential of this food formulation as a therapeutic dietary intervention in mood and behavior disorders.
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Affiliation(s)
- Walid Mottawea
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (W.M.); (S.S.); (N.B.)
- Department of Microbiology and Immunology, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - Salma Sultan
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (W.M.); (S.S.); (N.B.)
| | - Kara Landau
- Uplift Food Pty Ltd., New York, NY 10001, USA;
| | - Nicolas Bordenave
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (W.M.); (S.S.); (N.B.)
- School of Chemistry and Biomolecular Sciences, Faculty of Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Riadh Hammami
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (W.M.); (S.S.); (N.B.)
- Correspondence: ; Tel.: +1-613-562-5800 (ext. 4110)
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Blatchford PA, Parkar SG, Hopkins W, Ingram JR, Sutton KH. Dose-Dependent Alterations to In Vitro Human Microbiota Composition and Butyrate Inhibition by a Supercritical Carbon Dioxide Hops Extract. Biomolecules 2019; 9:E390. [PMID: 31438572 PMCID: PMC6769549 DOI: 10.3390/biom9090390] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 12/16/2022] Open
Abstract
Hop cones (Humulus lupulus L.) have been used throughout history as an additive in beer brewing and as herbal supplements with medicinal and culinary properties. The objective of this study was to ascertain the effect of a range of concentrations of a supercritical CO2 extract of hops on the composition and metabolism of human gut bacterial communities using in vitro batch culture systems. Fermentations were conducted over 24 h using a mixed human fecal inoculum. Microbial metabolism was assessed by measuring organic acid production and microbial community alterations were determined by 16S rRNA gene sequencing. Butyrate, an important short chain fatty acid in maintaining colonic well-being, decreased at elevated concentrations of hops, which may partly be accounted for by the concomitant reduction of Eubacterium and Coprococcus, known butyrate-producing genera, and also the inhibition of Bifidobacterium, a beneficial organism that has a butyrogenic effect through metabolic cross-feeding with intestinal commensals. The hops compounds also caused dose-dependent increases in the potentially pathogenic Enterobacteriaceae and potentially beneficial Akkermansia. Thus, hops compounds had a significant impact on the structure of the bacterial consortium, which warrants further study including human clinical trials.
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Affiliation(s)
- Paul A Blatchford
- The New Zealand Institute for Plant and Food Research Limited (PFR), Private Bag 11600, Palmerston North 4442, New Zealand
| | - Shanthi G Parkar
- The New Zealand Institute for Plant and Food Research Limited (PFR), Private Bag 11600, Palmerston North 4442, New Zealand.
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Abstract
PURPOSE To describe the nutritional and health attributes of kiwifruit and the benefits relating to improved nutritional status, digestive, immune and metabolic health. The review includes a brief history of green and gold varieties of kiwifruit from an ornamental curiosity from China in the 19th century to a crop of international economic importance in the 21st century; comparative data on their nutritional composition, particularly the high and distinctive amount of vitamin C; and an update on the latest available scientific evidence from well-designed and executed human studies on the multiple beneficial physiological effects. Of particular interest are the digestive benefits for healthy individuals as well as for those with constipation and other gastrointestinal disorders, including symptoms of irritable bowel syndrome. The mechanisms of action behind the gastrointestinal effects, such as changes in faecal (stool) consistency, decrease in transit time and reduction of abdominal discomfort, relate to the water retention capacity of kiwifruit fibre, favourable changes in the human colonic microbial community and primary metabolites, as well as the naturally present proteolytic enzyme actinidin, which aids protein digestion both in the stomach and the small intestine. The effects of kiwifruit on metabolic markers of cardiovascular disease and diabetes are also investigated, including studies on glucose and insulin balance, bodyweight maintenance and energy homeostasis. CONCLUSIONS The increased research data and growing consumer awareness of the health benefits of kiwifruit provide logical motivation for their regular consumption as part of a balanced diet. Kiwifruit should be considered as part of a natural and effective dietary strategy to tackle some of the major health and wellness concerns around the world.
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Affiliation(s)
| | - Juliet Ansell
- Zespri International Ltd., 400 Maunganui Road, Mount Maunganui 3116, Tauranga, New Zealand
| | - Lynley N Drummond
- Drummond Food Science Advisory Ltd., 1137 Drain Road, Killinchy, 7682, New Zealand.
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Wilson R, Willis J, Gearry RB, Hughes A, Lawley B, Skidmore P, Frampton C, Fleming E, Anderson A, Jones L, Tannock GW, Carr AC. SunGold Kiwifruit Supplementation of Individuals with Prediabetes Alters Gut Microbiota and Improves Vitamin C Status, Anthropometric and Clinical Markers. Nutrients 2018; 10:E895. [PMID: 30002355 PMCID: PMC6073280 DOI: 10.3390/nu10070895] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 06/28/2018] [Accepted: 07/02/2018] [Indexed: 01/08/2023] Open
Abstract
Kiwifruit are a nutrient dense food and an excellent source of vitamin C. Supplementation of the diet with kiwifruit enhances plasma vitamin C status and epidemiological studies have shown an association between vitamin C status and reduced insulin resistance and improved blood glucose control. In vitro experiments suggest that eating kiwifruit might induce changes to microbiota composition and function; however, human studies to confirm these findings are lacking. The aim of this study was to investigate the effect of consuming two SunGold kiwifruit per day over 12 weeks on vitamin C status, clinical and anthropometric measures and faecal microbiota composition in people with prediabetes. This pilot intervention trial compared baseline measurements with those following the intervention. Participants completed a physical activity questionnaire and a three-day estimated food diary at baseline and on completion of the trial. Venous blood samples were collected at each study visit (baseline, 6, 12 weeks) for determination of glycaemic indices, plasma vitamin C concentrations, hormones, lipid profiles and high-sensitivity C-reactive protein. Participants provided a faecal sample at each study visit. DNA was extracted from the faecal samples and a region of the 16S ribosomal RNA gene was amplified and sequenced to determine faecal microbiota composition. When week 12 measures were compared to baseline, results showed a significant increase in plasma vitamin C (14 µmol/L, p < 0.001). There was a significant reduction in both diastolic (4 mmHg, p = 0.029) and systolic (6 mmHg, p = 0.003) blood pressure and a significant reduction in waist circumference (3.1 cm, p = 0.001) and waist-to-hip ratio (0.01, p = 0.032). Results also showed a decrease in HbA1c (1 mmol/mol, p = 0.005) and an increase in fasting glucose (0.1 mmol/L, p = 0.046), however, these changes were small and were not clinically significant. Analysis of faecal microbiota composition showed an increase in the relative abundance of as yet uncultivated and therefore uncharacterised members of the bacterial family Coriobacteriaceae. Novel bacteriological investigations of Coriobacteriaceae are required to explain their functional relationship to kiwifruit polysaccharides and polyphenols.
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Affiliation(s)
- Renée Wilson
- Department of Medicine, University of Otago, Christchurch 8140, New Zealand.
| | - Jinny Willis
- New Zealand Nursing Organisation, Christchurch 8140, New Zealand.
| | - Richard B Gearry
- Department of Medicine, University of Otago, Christchurch 8140, New Zealand.
- Microbiome Otago, University of Otago, Dunedin 9054, New Zealand.
| | - Alan Hughes
- Department of Microbiology and Immunology, University of Otago, Dunedin 9054, New Zealand.
| | - Blair Lawley
- Department of Microbiology and Immunology, University of Otago, Dunedin 9054, New Zealand.
| | - Paula Skidmore
- Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand.
| | - Chris Frampton
- Department of Medicine, University of Otago, Christchurch 8140, New Zealand.
| | - Elizabeth Fleming
- Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand.
| | - Angie Anderson
- Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand.
| | - Lizzie Jones
- Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand.
| | - Gerald W Tannock
- Microbiome Otago, University of Otago, Dunedin 9054, New Zealand.
- Department of Microbiology and Immunology, University of Otago, Dunedin 9054, New Zealand.
- Riddet Centre of Research Excellence, Massey University, Palmerston North 4442, New Zealand.
| | - Anitra C Carr
- Department of Pathology & Biomedical Science, University of Otago, Christchurch 8140, New Zealand.
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Blatchford P, Stoklosinski H, Eady S, Wallace A, Butts C, Gearry R, Gibson G, Ansell J. Consumption of kiwifruit capsules increases Faecalibacterium prausnitzii abundance in functionally constipated individuals: a randomised controlled human trial. J Nutr Sci 2017; 6:e52. [PMID: 29152256 DOI: 10.1017/jns.2017.52] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/19/2017] [Accepted: 08/01/2017] [Indexed: 12/12/2022] Open
Abstract
This study investigated the impact of ACTAZIN™ green (2400 and 600 mg) and Livaux™ (2400 mg) gold kiwifruit supplements on faecal microbial composition and metabolites in healthy and functionally constipated (FC) participants. The participants were recruited into the healthy group (n 20; one of whom did not complete the study) and the FC group (n 9), each of whom consumed all the treatments and a placebo (isomalt) for 4 weeks in a randomised cross-over design interspersed with 2-week washout periods. Modification of faecal microbiota composition and metabolism was determined by 16S rRNA gene sequencing and GC, and colonic pH was calculated using SmartPill® wireless motility capsules. A total of thirty-two taxa were measured at greater than 1 % abundance in at least one sample, ten of which differed significantly between the baseline healthy and FC groups. Specifically, Bacteroidales and Roseburia spp. were significantly more abundant (P < 0·05) in the healthy group and taxa including Ruminococcaceae, Dorea spp. and Akkermansia spp. were significantly more abundant (P < 0·05) in the FC group. In the FC group, Faecalibacterium prausnitzii abundance significantly increased (P = 0·024) from 3·4 to 7·0 % following Livaux™ supplementation, with eight of the nine participants showing a net increase. Lower proportions of F. prausnitzii are often associated with gastrointestinal disorders. The discovery that Livaux™ supplementation increased F. prausnitzii abundance offers a potential strategy for improving gut microbiota composition, as F. prausnitzii is a butyrate producer and has also been shown to exert anti-inflammatory effects in many studies.
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Mezoff EA, Hawkins JA, Ollberding NJ, Karns R, Morrow AL, Helmrath MA. The human milk oligosaccharide 2'-fucosyllactose augments the adaptive response to extensive intestinal. Am J Physiol Gastrointest Liver Physiol 2016; 310:G427-38. [PMID: 26702137 PMCID: PMC4796291 DOI: 10.1152/ajpgi.00305.2015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/22/2015] [Indexed: 01/31/2023]
Abstract
Intestinal resection resulting in short bowel syndrome (SBS) carries a heavy burden of long-term morbidity, mortality, and cost of care, which can be attenuated with strategies that improve intestinal adaptation. SBS infants fed human milk, compared with formula, have more rapid intestinal adaptation. We tested the hypothesis that the major noncaloric human milk oligosaccharide 2'-fucosyllactose (2'-FL) contributes to the adaptive response after intestinal resection. Using a previously described murine model of intestinal adaptation, we demonstrated increased weight gain from 21 to 56 days (P < 0.001) and crypt depth at 56 days (P < 0.0095) with 2'-FL supplementation after ileocecal resection. Furthermore, 2'-FL increased small bowel luminal content microbial alpha diversity following resection (P < 0.005) and stimulated a bloom in organisms of the genus Parabacteroides (log2-fold = 4.1, P = 0.035). Finally, transcriptional analysis of the intestine revealed enriched ontologies and pathways related to antimicrobial peptides, metabolism, and energy processing. We conclude that 2'-FL supplementation following ileocecal resection increases weight gain, energy availability through microbial community modulation, and histological changes consistent with improved adaptation.
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Affiliation(s)
- Ethan A. Mezoff
- 1Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Hepatology, and Nutrition;
| | - Jennifer A. Hawkins
- 2Cincinnati Children's Hospital Medical Center, Division of Pediatric General and Thoracic Surgery;
| | - Nicholas J. Ollberding
- 3Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology;
| | - Rebekah Karns
- 4Cincinnati Children's Hospital Medical Center, Division of Biomedical Informatics; and
| | - Ardythe L. Morrow
- 5Cincinnati Children's Hospital Medical Center, Division of Neonatology and Pulmonary Biology
| | - Michael A. Helmrath
- 2Cincinnati Children's Hospital Medical Center, Division of Pediatric General and Thoracic Surgery;
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