Imaging gastric structuring of lipid emulsions and its effect on gastrointestinal function: a randomized trial in healthy subjects

Mechanisms of interesterified fat digestibility in a muffin matrix using a dynamic gastric model

Industrially generated trans-fats have been linked with cardiovascular disease (CVD) and have thus been replaced by interesterified (IE) fats, in foods. Interesterification rearranges fatty acids on the glycerol backbone of a triacylglycerol molecule. However, the impact of IE fat on health is unknown. We recently reported differences in lipid absorption kinetics between IE and rapeseed oil (RO). Here, we investigated the mechanisms underpinning IE fat digestion kinetics in the same muffins baked using an IE fat, non-IE fat [with the same fatty acid composition] and rapeseed oil (RO) under simulated conditions. IE and non-IE fats were largely solid in the gastric phase and strongly associated within the muffin matrix, whereas RO formed liquid droplets which separated from the matrix. No significant difference in lipolysis rates was detected between IE and non-IE fats. The lipolysis of the RO fat was slower, due to long-chain PUFAs. Interesterification itself did not affect digestibility, but the strong interaction between the hard fats and the muffin matrix resulted in extensive creaming of the matrix in the stomach, leading to delayed gastric emptying compared to the RO sample. The rate and extent of lipolysis were determined by the amount of fat available and the structure of the fat. This demonstrates the importance of the physical behaviour of the fats during digestion and provides a mechanistic understanding of the overall lipid digestion of IE fats, which relates to their physiological response.

Lipid emulsion structure, digestion behavior, physiology, and health: a scoping review and future directions

Research investigating the effects of the food matrix on health is needed to untangle many unresolved questions in nutritional science. Emulsion structure plays a fundamental role in this inquiry; however, the effects of oil-in-water emulsion structure on broad metabolic, physiological, and health-related outcomes have not been comprehensively reviewed. This systematic scoping review targets this gap and examines methodological considerations for the field of relating food structure and health. MEDLINE, Web of Science, and CAB Direct were searched from inception to December 2022, returning 3106 articles, 52 of which were eligible for inclusion. Many investigated emulsion lipid droplet size and/or gastric colloidal stability and their relation to postprandial weight-loss-related outcomes. The present review also identifies numerous novel relationships between emulsion structures and health-related outcomes. "Omics" endpoints present an exciting avenue for more comprehensive analysis in this area, yet interpretation remains difficult. Identifying valid surrogate biomarkers for long-term outcomes and disease risk will be a turning point for food structure research, leading to breakthroughs in the pace and utility of research that generates advancements in health. The review's findings and recommendations aim to support new hypotheses, future trial design, and evidence-based emulsion design for improved health and well-being.

Strategies for modulating the lipid digestion of emulsions in the gastrointestinal tract

The structural changes in emulsion products can be used to control the bioavailability of fatty acids and lipophilic compounds. After ingestion, lipid droplets undergo breakdown and structural changes as they pass through the gastrointestinal tract. The oil-water interface plays a critical role in modulating the digestive behavior of lipid droplets because changes in the interfacial layer control the adsorption of lipase and bile salts and determine the overall rate and extent of lipid digestion. Therefore, lipid digestibility can be tuned by selecting the appropriate types and levels of stabilizers. The stabilizer can change the lipase accessibility and exposure of lipid substrates, resulting in variable digestion rates. However, emulsified lipids are not only added to food matrixes but are also co-ingested from other dietary components. Therefore, overall consumption behaviors can affect the digestion rate and digestibility of emulsified lipids. Although designing an emulsion structure is challenging, controlling lipid digestion can improve the health benefits of products. Therefore, a thorough understanding of the process of emulsified lipid digestion is required to develop food products that enable specific physiological responses. The targeted or delayed release of lipophilic molecules and fatty acids through emulsion systems has significant applications in healthcare and pharmaceuticals.

In vitro digestion models for the design of safe and nutritious foods

Responsible development of future foods requires in depth understanding of food digestion in the human body based on robust research models, ranging from in vitro models to randomized controlled human trials. This chapter overviews fundamental aspects of food digestion, namely bioaccessibility and bioavailability, and models mirroring gastric, intestinal, and colonic conditions. Second, the chapter demonstrates the potential of in vitro digestion models to help screen adverse effects of food additives, such as Titanium dioxide or carrageenan, or underpin the determinants of macro- and micronutrient digestion in different strata of the population, for example digestion of emulsions. Such efforts support rationalized design of functional foods, such as infant formulae, cheese, cereals and biscuits which are validated in vivo or in randomized controlled trials.

Designing Gastric-Stable Adsorption Layers by Whey Protein-Pectin Complexation at the Oil-Water Interface

This work aims to design gastric-stable emulsions with food-grade biopolymers using a novel multiscale approach. The adsorption layer formation at the oil-water interface was based on opposite charge interactions between whey proteins and pectin (with different esterification levels) at pH 3.0 by a sequential adsorption method. The interfacial assembly and disassembly (interfacial complexation, proteolysis, lipolysis) during in vitro gastric digestion were evaluated using a quartz crystal microbalance with dissipation monitoring, ζ-potential, dynamic interfacial tension, and interfacial dilatational rheology. Besides, the evolution of the particle size and microstructure of bulk emulsions during the digestion was investigated by static light scattering and light microscopy. Compared with whey protein isolate (WPI)-stabilized emulsions, the presence of an additional pectin layer can prevent or at least largely delay gastric destabilization (giving rise to coalescence or/and oiling off). Especially, the esterification degree of the pectin used was found to largely affect the emulsion stability upon gastric digestion.

Pre-duodenal lipid digestion of emulsions: Relevance, colloidal aspects and mechanistic insight

The digestion of lipids in the human body has several health and nutritional implications. Lipid digestion is an interfacial phenomenon meaning that water-soluble lipases need to first adsorb to the oil-water interface before enzymatic conversions can start. The digestion of lipids mainly occurs on colloidal structures dispersed in water, such as oil-in-water (o/w) emulsions, which can be designed during food formulation/processing or structured during digestion. From a food design perspective, different in vitro studies have demonstrated that the kinetics of lipid digestion can be influenced by emulsion properties. However, most of these studies have been performed with pancreatic enzymes to simulate lipolysis in the small intestine. Only few studies have dealt with lipid digestion in the gastric phase and its subsequent impact on intestinal lipolysis. In this aspect, this review compiles information on the physiological aspects of gastric lipid digestion. In addition, it deals with colloidal and interfacial aspects starting from emulsion design factors and how they evolve during in vitro digestion. Finally, molecular mechanisms describing gastric lipolysis are discussed.

Lipid emulsion interfacial design modulates human in vivo digestion and satiation hormone response

Lipid emulsions (LEs) with tailored digestibility have the potential to modulate satiation or act as delivery systems for lipophilic nutrients and drugs. The digestion of LEs is governed by their interfacial emulsifier layer which determines their gastric structuring and accessibility for lipases. A plethora of LEs that potentially modulate digestion have been proposed in recent years, however, in vivo validations of altered LE digestion remain scarce. Here, we report on the in vivo digestion and satiation of three novel LEs stabilized by whey protein isolate (WPI), thermo-gelling methylcellulose (MC), or cellulose nanocrystals (CNCs) in comparison to an extensively studied surfactant-stabilized LE. LE digestion and satiation were determined in terms of gastric emptying, postprandial plasma hormone and metabolite levels characteristic for lipid digestion, perceived hunger/fullness sensations, and postprandial food intake. No major variations in gastric fat emptying were observed despite distinct gastric structuring of the LEs. The plasma satiation hormone and metabolite response was fastest and highest for WPI-stabilized LEs, indicating a limited capability of proteins to prevent lipolysis due to fast hydrolysis under gastric conditions and displacement by lipases. MC-stabilized LEs show a similar gastric structuring as surfactant-stabilized LEs but slightly reduced hormone and metabolite responses, suggesting that thermo-gelling MC prevents lipase adsorption more effectively. Ultimately, CNC-stabilized LEs showed a drastic reduction (>70%) in plasma hormone and metabolite responses. This confirms the efficiency of particle (Pickering) stabilized LEs to prevent lipolysis proposed in literature based on in vitro experiments. Subjects reported more hunger and less fullness after consumption of LEs stabilized with MC and CNCs which were able to limit satiation responses. We do not find evidence for the widely postulated ileal brake, i.e. that delivery of undigested nutrients to the ileum triggers increased satiation. On the contrary, we find decreased satiation for LEs that are able to delay lipolysis. No differences in food intake were observed 5 h after LE consumption. In conclusion, LE interfacial design modulates in vivo digestion and satiation response in humans. In particular, Pickering LEs show extraordinary capability to prevent lipolysis and qualify as oral delivery systems for lipophilic nutrients and drugs.

Lipid emulsions (LEs) with tailored digestibility have the potential to modulate satiation or act as delivery systems for lipophilic nutrients and drugs.

Palm Lipid Emulsion Droplet Crystallinity and Gastric Acid Stability in Relation to in vitro Bioaccessibility and in vivo Gastric Emptying

It is poorly understood how the physical state of emulsified triacylglycerol (TAG) alters colloidal behavior in the gastrointestinal tract to modulate lipid digestion and absorption. We, therefore, aimed to investigate the individual and combined effects on fatty acid (FA) bioaccessibility using the dynamic TIM-1 in vitro digestion model and integrate the results with those from a human clinical study. Four 20% oil-in-water emulsions with overlapping particle size distributions contained either partially crystalline solid (palm stearin) or liquid (palm olein) lipid droplets at 37°C and either the colloidally acid-stable Tween 80 (2.2%) or acid-unstable Span 60 (2.5%) emulsifier. Experimental meals were fed to the TIM-1, and jejunal and ileal dialysates were analyzed over 6 h to measure free FA concentration. Cumulative FA bioaccessibility was significantly higher for the liquid stable emulsion compared to all others (p < 0.05), which did not differ (p > 0.05). Emulsified TAG physical state was associated with differences in overall bioaccessibility (higher for liquid state TAG) in the colloidally stable emulsions, but this difference was blunted in droplets susceptible to acidic flocculation. In contrast, human postprandial TAG concentrations did not differ significantly between the emulsions. The discrepancy may relate to differences in in vivo gastric emptying (GE) as evidenced by ultrasonography. When the in vivo differences in GE were accounted for in follow-up TIM-1 experiments, the findings aligned more closely. Cumulative FA bioaccessibility for the liquid stable emulsion no longer differed significantly from the other emulsions, and SU’s bioaccessibility was the lowest, consistent with the in vivo observations. This work highlights the potential for TAG physical state and colloidal stability to interactively alter behavior in the gastrointestinal tract with implications for FA absorption, and the importance of establishing and improving in vitro–in vivo correlations in food-nutrition research.

Production and characterization of nanoemulsion with low-calorie structured lipids and its potential to modulate biomarkers associated with obesity and comorbidities

Structured lipids (SL) containing behenic acid have been produced in order to obtain low-calorie lipids for foods; however, the development of a high nutritional value and a stable nanoemulsion carrier system for these SL is an interesting breakthrough for this field of research, improving technologic and biological potential for food application. In this sense, the aim of this study was to evaluate the stability of a nanoemulsion containing SL NeSL (produced with olive oil, soybean oil and fully hydrogenated crambe oil), the behavior during in vitro digestion and the effects on biomarkers involved in the obesity in cell models. The samples showed good stability throughout storage (30 days) under refrigeration and room temperature and after the gastric digestion phase compared to the controls (nanoemulsion of olive and soybean oil). After the intestinal phase, there was an increase in oil droplet size and zeta potential, a characteristic of coalescence. In the lipid accumulation model in adipocytes, the highest concentration (50 µL/mL) of NeSL resulted in 42% less lipid accumulation, compared to the control. Furthermore, the sample was able to reduce inflammatory cytokines produced by macrophages provoked by LPS (lipopolysaccharide). The combination of the oils in NeSL resulted in a fatty acid profile with beneficial health properties, which may have contributed to less lipid accumulation and improved inflammatory parameters. This SL in the form of a nanoemulsion, may be used as a partial fat substitute in low-calorie food products.

Biophysical insights into modulating lipid digestion in food emulsions

During the last decade, major scientific advances on understanding the mechanisms of lipid digestion and metabolism have been made, with a view to addressing health issues (such as obesity) associated with overconsumption of lipid-rich and sucrose-rich foods. As lipids in common foods exist in the form of emulsions, the structuring of emulsions has been one the main strategies for controlling the rate of lipid digestion and absorption, at least from a colloid science viewpoint. Modulating the kinetics of lipid digestion and absorption offers interesting possibilities for developing foods that can provide control of postprandial lipaemia and control the release of lipophilic compounds. Food emulsions can be designed to achieve considerable differences in the kinetics of lipid digestion but most research has been applied to relatively simple model systems and in in vitro digestion models. Further research to translate this knowledge into more complex food systems and to validate the results in human studies is required. One promising approach to delay/control lipid digestion is to alter the stomach emptying rate of lipids, which is largely affected by interactions of emulsion droplets with the food matrices. Food matrices with different responses to the gastric environment and with different interactions between oil droplets and the food matrix can be designed to influence lipid digestion. This review focuses on key scientific advances made during the last decade on understanding the physicochemical and structural modifications of emulsified lipids, mainly from a biophysical science perspective. The review specifically explores different approaches by which the structure and stability of emulsions may be altered to achieve specific lipid digestion kinetics.

Emulsion acid colloidal stability and droplet crystallinity modulate postprandial gastric emptying and short-term satiety: a randomized, double-blinded, crossover, controlled trial in healthy adult males

BACKGROUND

Emulsion droplet triacylglycerol (TAG) crystallinity and colloidal stability can alter the postprandial metabolism, although evidence of their interactive effects is limited.

OBJECTIVES

This acute meal crossover study investigated the influences of droplet TAG crystallinity at 37°C and colloidal gastric stability on gastric emptying (GE), acute lipemia, and satiety.

METHODS

We gave 15 healthy adult males (mean ± SD age, 24.9 y ± 4.5 y; BMI, 26.0 kg/m2 ± 2.0 kg/m2; fasting TAG, 0.9 mmol/L  ± 0.3 mmol/L) 250 mL of four 20% palm stearin or palm olein emulsions with similar particle size distributions and containing partially crystalline droplets that remained stable (SS) or destabilized (SU) or containing liquid droplets that remained stable (LS) or destabilized (LU) when exposed to simulated gastric conditions. Baseline and 6-h postprandial ultrasound gastric antrum measurements, satiety visual analogue scales (VAS), and blood samples for analyses of plasma TAG, peptide YY (PYY), glucagon-like peptide-1 (GLP-1), ghrelin, leptin, glucose-dependent insulinotropic polypeptide, insulin, and glucose were collected. Changes from baseline and incremental area under the curve (iAUC) values were analyzed by repeated-measures ANOVA.

RESULTS

TAG responses did not differ significantly. The gastric antrum area decreased faster (P ≤ 0.01) after treatment with the acid-unstable emulsions (SU and LU), and satiety VAS ratings and plasma endpoints differed between treatments. After LS treatment, participants had 65% and 59% lower 3-h iAUC values for hunger (P = 0.021) and desire to eat (P = 0.031), respectively, compared to after SU treatment. LS treatment resulted in higher 6-h iAUC values for ghrelin (141%; P = 0.023) and PYY (150%; P = 0.043) compared to SU treatment, and LS treatment also resulted in higher GLP-1 values compared to SU (38%; P = 0.016) and LU (76%; P = 0.001) treatment.

CONCLUSION

Emulsion acid colloidal stability, independent of TAG physical state, delayed GE, and satiety was enhanced after consuming acid stable emulsions containing TAG in the liquid state. The study was registered at clinicaltrials.gov as NCT03990246.

Physiological fluid interfaces: Functional microenvironments, drug delivery targets, and first line of defense

Fluid interfaces, i.e. the boundary layer of two liquids or a liquid and a gas, play a vital role in physiological processes as diverse as visual perception, oral health and taste, lipid metabolism, and pulmonary breathing. These fluid interfaces exhibit a complex composition, structure, and rheology tailored to their individual physiological functions. Advances in interfacial thin film techniques have facilitated the analysis of such complex interfaces under physiologically relevant conditions. This allowed new insights on the origin of their physiological functionality, how deviations may cause disease, and has revealed new therapy strategies. Furthermore, the interactions of physiological fluid interfaces with exogenous substances is crucial for understanding certain disorders and exploiting drug delivery routes to or across fluid interfaces. Here, we provide an overview on fluid interfaces with physiological relevance, namely tear films, interfacial aspects of saliva, lipid droplet digestion and storage in the cell, and the functioning of lung surfactant. We elucidate their structure-function relationship, discuss diseases associated with interfacial composition, and describe therapies and drug delivery approaches targeted at fluid interfaces. STATEMENT OF SIGNIFICANCE: Fluid interfaces are inherent to all living organisms and play a vital role in various physiological processes. Examples are the eye tear film, saliva, lipid digestion & storage in cells, and pulmonary breathing. These fluid interfaces exhibit complex interfacial compositions and structures to meet their specific physiological function. We provide an overview on physiological fluid interfaces with a focus on interfacial phenomena. We elucidate their structure-function relationship, discuss diseases associated with interfacial composition, and describe novel therapies and drug delivery approaches targeted at fluid interfaces. This sets the scene for ocular, oral, or pulmonary surface engineering and drug delivery approaches.

New insights into in vivo gastroduodenal digestion of oil-in-water emulsions: gastric stability and in vitro digestion modeling

In this paper, effect of emulsion stability on gastroduodenal emptying/secretion was reviewed and differentiated. Moreover, novel perspectives on physiology of gastric lumen, duodenum, and gall bladder were achieved using mathematical models, being useful for designing artificial digestive systems. In this regard, numerical data for dynamic gastric emptying/secretion were offered for gastric-stable and gastric-unstable emulsion intakes. It was shown that alterations in human gastric and duodenal volume follow, respectively, linear and sinusoidal curves, with high correlation coefficients (r² > 0.93). For both emulsions, about 30-40 mL ingesta discharged rapidly from stomach upon ingestion; However, further gastric emptying was regulated for the rest of digestion period, so that 0.1 mL/min oil was passing through duodenum. Intragastric evacuation of both emulsions started with a lag phase during which stomach stored secretions incrementally by slow gastric discharge. Lag phase ended with fat layering, when emptying considerably enhanced. This reduction was gradual for stable emulsion while unstable emulsion experienced a rapid emptying before slow declining trend. Along with initial gastric emptying, 87% of gallbladder content discharged into duodenum, prolonged up to the gradual reduction phase of stomach. Supplementary investigations are needed to quantify gastroduodenal secretions, particularly pepsin and pancreas in response to emulsion ingesta.

Emulsion Droplet Crystallinity Attenuates Short-Term Satiety in Healthy Adult Males: A Randomized, Double-Blinded, Crossover, Acute Meal Study

BACKGROUND

The influence of triacylglycerol (TAG) physical properties on satiety remains poorly understood.

OBJECTIVES

The objective was to investigate if and how TAG digestion and absorption, modulated only by differences in TAG crystallinity, would differentially affect short-term satiety in healthy men.

METHODS

We tempered 500 mL 10% palm stearin oil-in-water emulsions such that the lipid droplets were either undercooled liquid (LE) or partially crystalline solid (SE). Fifteen healthy men (mean ± SD age: 27.5 ± 5.7 y; BMI: 24.1 ± 2.5 kg/m2; fasting TAG: 0.9 ± 0.3 mmol/L) consumed each beverage at two 6-h study visits separated by ≥6 d after an overnight fast, along with 1500 mg acetaminophen suspended in water. The participants characterized the emulsion sensory properties, completed satiety visual analog scale ratings, and had serial blood samples collected for 6-h analysis of plasma peptide YY (PYY), glucagon-like peptide-1 (GLP-1), ghrelin, leptin, glucose-dependent insulinotropic polypeptide (GIP), insulin, and acetaminophen (for assessing gastric emptying). Repeated-measures ANOVAs and 2-tailed paired t tests were used to analyze the changes from baseline and incremental area under the curve (iAUC) values, respectively.

RESULTS

With consumption of LE compared with SE, there was a 358% higher fullness (P = 0.015) and a 103% lower average appetite (P = 0.041) score, along with higher iAUC values for PYY (P = 0.011) and GLP-1 (P = 0.028) (103% and 66% higher, respectively), but not for ghrelin (P = 0.39), based on change from baseline values. Acetaminophen response trended toward significance (P = 0.08) and was 15% higher with LE. SE was rated as 44% thicker (P = 0.034) and 24% creamier (P = 0.05) than LE.

CONCLUSIONS

The suppression of TAG digestion by the presence of partially crystalline lipid droplets blunted the appetite-suppressing effects of an oil-in-water emulsion.This trial was registered at clinicaltrials.gov as NCT03990246.

Effects of Laparoscopic Sleeve Gastrectomy on Gastric Structure and Function Documented by Magnetic Resonance Imaging Are Strongly Associated with Post-operative Weight Loss and Quality of Life: a Prospective Study

BACKGROUND

This prospective study applied magnetic resonance imaging (MRI) to assess the effect of laparoscopic sleeve gastrectomy (LSG) on gastric structure and function. The impact of these changes on patient outcomes was analyzed.

METHOD

Obese patients without gastrointestinal symptoms referred for bariatric surgery were recruited prospectively. Pre-operative assessment included (i) high-resolution manometry and pH-impedance monitoring and (ii) magnetic resonance imaging (MRI) measurement of gastric capacity, accommodation, and emptying with the 400 ml liquid Nottingham test meal (NTM). Studies were repeated 6-7 months after LSG. Weight loss and changes in the Gastrointestinal Quality of Life Index (GIQLI) assessed patient outcomes.

RESULTS

From 35 patients screened, 23 (66%) completed the study (17 females, age 36 ± 10 years, BMI 42 ± 5 kg/m2). Mean excess weight loss was 59 ± 18% at follow-up. Total gastric volume (capacity) after the meal was 467 mL (455-585 ml) before and 139 mL (121-185 ml) after LSG (normal reference 534 (419-675) mL), representing a mean 70% reduction (p < 0.0001). Similar findings were present for gastric content volume indicating rapid early-phase gastric emptying (GE) post-LSG. Conversely, late-phase GE was slower post-LSG (2.5 ± 1.0 vs. 1.4 ± 0.6 mL/min; p < 0.0001; (reference 1.5(1.4-4.9) mL/min)). Patients with ≥ 80% reduction in gastric capacity had greater weight loss (p = 0.008), but worse gastrointestinal outcomes (p = 0.023).

CONCLUSIONS

MRI studies quantified the marked reduction in gastric capacity after LSG. The reduction in capacity was associated with rapid early- but slow late-phase GE after surgery. These changes were associated with weight loss; however, reductions in gastric capacity ≥ 80% were linked to increased acid reflux and impacted on gastrointestinal quality of life.

Destructuring and restructuring of foods during gastric digestion

All foods harbor unique length scale-dependent structural features that can influence the release, transport, and utilization of macro- or micronutrients in the human gastrointestinal tract. In this regard, food destructuring and restructuring processes during gastric passage significantly influence downstream nutrient assimilation and feelings of satiety. This review begins with a synopsis of the effects of oral processing on food structure. Then, stomach-centric factors that contribute to the efficacy of gastric digestion are discussed, and exemplified by comparing the intragastric de- and restructuring of a number of common foods. The mechanisms of how intragastric structuring influences gastric emptying and its relationship to human satiety are then discussed. Finally, recently developed, non-destructive instrumental approaches used to quantitively and qualitatively characterize food behavior during gastric destructuring and restructuring are described.

PHTF2 regulates lipids metabolism in gastric cancer

Identification of hub genes and key pathways of gastric cancer was recognized to be essential to elucidate the tumorigenesis of GC. This study was aimed to identify the differentially expressed genes (DEGs) in GC via bioinformatics methods and their related pathways involved in the pathological process of GC. Gene expression profile datasets acquired by microarray chips or RNA-seq were downloaded from GEO dataset and TCGA, and 298 differentially expressed genes was identified. The Gene Ontology (GO) and Kyoto Gene and Genomic Encyclopedia (KEGG) pathways of DEGs were then analyzed by the DAVID database to elucidate the potential molecular functions of DEGs. The protein-protein interaction (PPI) network of DEGs was further analyzed with the STRING database and PHTF2 was identified as a hub gene in the PPI network. Subsequently, PHTF2 was found to be highly expressed in different subtypes of gastric cancer tissues obtained from TCGA database or clinical patients, resulting with a poor prognosis. By GSEA, PHTF2 was found to significantly enrich the fatty acid metabolism pathway in gastric cancer. Moreover, PHTF2-regulated lipids metabolism significantly affected the tumorigenesis of GC cells. In summary, this work identified a new mechanism by which PHTF2 precipitated in the pathological process of GC by regulating cellular lipid metabolism.

Simulating human digestion: developing our knowledge to create healthier and more sustainable foods

The gold standard for nutrition studies is clinical trials but they are expensive and variable, and do not always provide the mechanistic information required, hence the increased use ofin vitroand increasinglyin silicosimulations of digestion.

A standardised semi-dynamic in vitro digestion method suitable for food – an international consensus

Standardised recommendations for a physiologically relevant, semi-dynamic in vitro simulation of upper GI tract digestion.

Emulsion Droplet Crystallinity Attenuates Postprandial Plasma Triacylglycerol Responses in Healthy Men: A Randomized Double-Blind Crossover Acute Meal Study

BACKGROUND

The presence of triacylglycerol (TAG) cystallinity is assumed to influence digestibility and postprandial lipemia (PPL), although studies to date are limited.

OBJECTIVE

This study aimed to investigate whether the presence of solid fat compared with undercooled liquid oil, specifically, plays a role in determining PPL by comparing emulsion droplets differing only in terms of physical state.

METHODS

Ten percent palm stearin and 0.4% sorbitan monostearate emulsions were tempered to contain identically sized, charged, and shaped (spherical) undercooled liquid (LE) compared with partially crystalline solid (SE; mean ± SEM: 33.2% ± 0.03% solid fat at 37°C) droplets. Fifteen healthy fasting adult men (mean ± SD age: 27.5 ± 5.7 y; BMI: 24.1 ± 2.5 kg/m2) consumed 500 mL of each emulsion on separate occasions and plasma TAG concentrations, particle size of the plasma chylomicron-rich fraction (CMRF), and fatty acid (FA) composition of the CMRF-TAG were serially determined in a 6-h postprandial randomized double-blind crossover acute meal study. Changes from baseline values were analyzed by repeated-measures ANOVA.

RESULTS

An earlier (2 compared with 3 h, P < 0.05) significant rise, a 39.9% higher mean postprandial TAG change from baseline (P = 0.08), and higher peak concentration (mean ± SEM: 1.47 ± 0.19 compared with 1.20 ± 0.15 mmol/L, P = 0.04) and iAUC (1.95 ± 0.39 compared with 1.45 ± 0.31 mmol/L × h, P = 0.03) values were observed for LE compared with SE. The compositions of the CMRF-TAG FAs shifted toward those of the ingested palm stearin by 4 h but did not differ between SE and LE (P = 0.90). Nor were there differences in postprandial changes in CMRF particle size (P = 0.79) or nonesterified FAs (P = 0.72) based on lipid physical state.

CONCLUSIONS

Despite their identical compositions and colloidal properties, differences in lipid absorption were observed between SE and LE in healthy adult men. This is direct evidence that TAG physical state contributes to PPL, with the presence of solid fat having an attenuating influence.This trial was registered at clinicaltrials.gov as NCT03515590.

A Rat Model of Human Lipid Emulsion Digestion

A better understanding of how dietary lipids are processed by the human body is necessary to allow for the control of satiation and energy intake by tailored lipid systems. To examine whether rats are a valid model of human dietary lipid processing and therefore useful for further mechanistic studies in this context, we tested in rats three lipid emulsions of different stability, which alter satiety responses in humans. Different sets of 15 adult male Sprague Dawley rats, equipped with gastric catheters alone or combined with hepatic portal vein (HPV) and vena cava (VC) catheters were maintained on a medium-fat diet and adapted to an 8 h deprivation/16 h feeding schedule. Experiments were performed in a randomized cross-over study design. After gastric infusion of the lipid emulsions, we assessed gastric emptying by the paracetamol absorption test and recorded in separate experiments food intake and plasma levels of gastrointestinal hormones and metabolites in the HPV. For an acid stable emulsion, slower gastric emptying and an enhanced release of satiating gastrointestinal (GI) hormones were observed and were associated with lower short-term energy intake in rats and less hunger in humans, respectively. The magnitude of hormonal responses was related to the acid stability and redispersibility of the emulsions and thus seems to depend on the availability of lipids for digestion. Plasma metabolite levels were unaffected by the emulsion induced changes in lipolysis. The results support that structured lipid systems are digested similarly in rats and humans. Thus unstable emulsions undergo the same intragastric destabilization in both species, i.e., increased droplet size and creaming. This work establishes the rat as a viable animal model for in vivo studies on the control of satiation and energy intake by tailored lipid systems.

Hierarchically structured phase separated biopolymer hydrogels create tailorable delayed burst release during gastrointestinal digestion

The on demand delivery of novel peptide actives, traditional pharmaceuticals, nutrients and/or vitamins is a ever present challenge due to the digestive and metabolic degradation of the active and the delivery vehicle. Biodegradable biopolymer hydrogels have long held promise as candidates for creating tailored release profiles due to the ability to control gel porosity. The present study describes the creation of novel hierarchical biopolymer hydrogels for the controlled release of lipids/lipophilic actives pharmaceutical ingredients (APIs), and mathematically describes the mechanisms that affect the timing of release. The creation of phase separated protein/polysaccharide core (6.6 wt% gelatin, 40 wt% Oil in water emulsion) shell structures (7 g/L xanthan with 70-140 g/L β-lactoglobulin) altered enzyme mass transport processes. This core shell structure enabled the creation of a tailorable burst release of API during gastrointestinal digestion where there is a delay in the onset of release, without affecting the kinetics of release. The timing of the delay could be readily programmed (with release of between 60 and 240 min) by controlling either the thickness or protein concentration (between 70 g/L and 140 g/L β-lactoglobulin) of the outer mixed biopolymer hydrogel shell (7 g/L xanthan with 70-140 g/L β-lactoglobulin). Enzyme diffusion measurements demonstrated that surface erosion was the main degradation mechanism. A kinetic model was created to describe the delayed burst release behaviour of APIs encapsulated within the core, and successfully predicted the influence of shell thickness and shell protein density on the timing of gastro-intestinal release (in vitro). Our work highlights the creation of a novel family of core-shell hydrogel oral dosage forms capable of programmable delivery of lipids/lipophilic APIs. These findings could have considerable implications for the delivery of peptides, poorly soluble drugs, or the programmed delivery of lipids within the gastrointestinal tract.

Effect of Nutrient and Micronutrient Intake on Chylomicron Production and Postprandial Lipemia

Postprandial lipemia, which is one of the main characteristics of the atherogenic dyslipidemia with fasting plasma hypertriglyceridemia, low high-density lipoprotein cholesterol and an increase of small and dense low-density lipoproteins is now considered a causal risk factor for atherosclerotic cardiovascular disease and all-cause mortality. Postprandial lipemia, which is mainly related to the increase in chylomicron production, is frequently elevated in individuals at high cardiovascular risk such as obese or overweight patients, type 2 diabetic patients and subjects with a metabolic syndrome who share an insulin resistant state. It is now well known that chylomicron production and thus postprandial lipemia is highly regulated by many factors such as endogenous factors: circulating factors such as hormones or free fatty acids, genetic variants, circadian rhythms, or exogenous factors: food components, dietary supplements and prescription drugs. In this review, we focused on the effect of nutrients, micronutrients and phytochemicals but also on food structure on chylomicron production and postprandial lipemia.

Variations in gastrointestinal lipases, pH and bile acid levels with food intake, age and diseases: Possible impact on oral lipid-based drug delivery systems

The lipids and some surfactants present in oral lipid-based drug delivery systems are potential substrates for the various lipases involved in gastrointestinal (GI) lipolysis. The levels of these enzymes, together with pH and biliairy secretion, are important parameters that condition the fate of lipid-based formulations (LBF) and the dispersion, solubilization and absorption of lipophilic drugs in the GI tract. Since in vitro methods of digestion are now combined with dissolution assays for a better assessment of LBF performance, it is essential to have a basic knowledge on lipase, pH and bile acid (BA) levels in vivo to develop relevant in vitro models. While these parameters and their variations in healthy subjects are today well documented, in vivo data on specific populations (age groups, patients with various diseases, patients with treatment affecting GI tract parameters, …) are scarce and obtaining them from clinical studies is sometimes difficult due to ethical limitations. Here we collected some in vivo data already available on the levels of digestive lipases, gastric and intestinal pH, and BAs at various ages and in patients with exocrine pancreatic insufficiency, a pathological situation that leads to drastic changes in GI tract parameters and impacts pharmacological treatments.

Gastric motor and sensory function in health assessed by magnetic resonance imaging: Establishment of reference intervals for the Nottingham test meal in healthy subjects

BACKGROUND

Current investigations of gastric emptying rarely identify the cause of symptoms or provide a definitive diagnosis in patients with dyspepsia. This study assessed gastric function by magnetic resonance imaging (MRI) using the modular "Nottingham test meal" (NTM) in healthy volunteers (HVs).

METHODS

The NTM comprises (a) 400 mL liquid nutrient (0.75 kcal/mL) labeled with Gadolinium-DOTA and (b) an optional solid component (12 agar-beads [0 kcal]). Filling sensations were documented. MRI measurements of gastric volume, emptying, contraction wave frequency, and secretion were obtained using validated methods.

KEY RESULTS

Gastric function was measured in a population of 73 HVs stratified for age and sex. NTM induced moderate satiety and fullness. Labeled fluid was observed in the small bowel in all subjects after meal ingestion ("early-phase" GE). Secretion was rapid such that postprandial gastric content volume was often greater than meal volume (GCV0 > 400 mL), and there was increasing dilution of the meal during the study (P < 0.001). Gastric half-time was median 66-minutes (95% reference interval 35 to 161-minutes ["late-phase" GE]). The number of intact agar beads in the stomach was 7/12 (58%) at 60-minutes and 1/12 (8%) at 120-minutes. Age, bodyweight and sex had measurable effects on gastric function; however, these were small compared to inter-individual variation for most metrics.

CONCLUSIONS AND INFERENCES

Reference intervals are presented for MRI measurements of gastric function assessed for the mixed liquid/solid NTM. Studies in patients will determine which metrics are of clinical value and also whether the reference intervals presented here offer optimal diagnostic sensitivity and specificity.

Attenuation of Palm Stearin Emulsion Droplet in Vitro Lipolysis with Crystallinity and Gastric Aggregation

Emulsions with partially crystalline solid (SE) and undercooled-liquid (LE) droplets with equivalent droplet sizes (centering ∼416 nm), surface charges (∼-56 mV), and spherical morphologies were prepared by hot microfluidization based on 10% palm stearin and 0.4% Span 60. Lipid crystallinity attenuated early gastroduodenal lipolysis in vitro ( p < 0.05), both with and without inclusion of a gastric phase ( p < 0.05). Gastric exposure, in particular acidic pH, led to partial coalescence of SE and flocculation and partial crystallization of LE, and it attenuated the rate and extent of lipolysis in both samples. In vitro shear conditions further impacted colloidal stability, particularly for SE, with implications for digestibility. Although lipid crystallinity consistently attenuated early lipolysis, gastric-phase SE partial coalescence had a relatively greater impact on digestibility than did droplet physical state. These findings show that a complex interplay exists among a droplet's physical state, colloidal properties, and digestion conditions, which combine to impact emulsion in vitro lipolysis.

Enhanced delivery of lipophilic bioactives using emulsions: a review of major factors affecting vitamin, nutraceutical, and lipid bioaccessibility

Many researchers are currently developing emulsion-based delivery systems to increase the bioavailability of lipophilic bioactive agents, such as oil-soluble vitamins, nutraceuticals, and lipids. Oil-in-water emulsions can be specifically designed to improve the bioavailability of these bioactives by altering their composition and structural organization. This article reviews recent progress in understanding the impact of emulsion properties on the bioaccessibility of lipophilic bioactive agents, including oil phase composition, aqueous phase composition, droplet size, emulsifier type, lipid physical state, and droplet aggregation state. This knowledge can be used to design emulsions that can enhance the bioavailability and efficacy of encapsulated hydrophobic bioactives.

Tailoring Emulsions for Controlled Lipid Release: Establishing in vitro-in Vivo Correlation for Digestion of Lipids

The use of oil-in-water emulsions for controlled lipid release is of interest to the pharmaceutical industry in the development of poorly water soluble drugs and also has gained major interest in the treatment of obesity. In this study, we focus on the relevant in vitro parameters reflecting gastric and intestinal digestion steps to reach a reliable in vitro-in vivo correlation for lipid delivery systems. We found that (i) gastric lipolysis determines early lipid release and sensing. This was mainly influenced by the emulsion stabilization mechanism. (ii) Gastric mucin influences the structure of charge-stabilized emulsion systems in the stomach, leading to destabilization or gel formation, which is supported by in vivo magnetic resonance imaging in healthy volunteers. (iii) The precursor structures of these emulsions modulate intestinal lipolysis kinetics in vitro, which is reflected in plasma triglyceride and cholecystokinin concentrations in vivo.

Lipid droplet size and emulsification on postprandial glycemia, insulinemia and lipidemia

Previous studies have suggested that a smaller lipid droplet size results in a greater rate of lipolysis. However, acute health impacts of emulsification and small lipid droplet size are not well understood. We aimed to investigate the effect of emulsification and lipid droplet size on postprandial lipidemia, glycemia and insulinemia. Fifteen healthy Chinese males (mean ± SD, age of 26 ± 6 years and BMI of 22.2 ± 1.2 kg m^-2) participated on 3 separate occasions in a randomized order. Participants received an olive oil-water beverage and white bread as test meals. The three test beverages were as follows: (1) an olive oil-water mixture (non-emulsified, control), (2) fine olive oil-water emulsion (small lipid droplet size) and (3) coarse olive oil-water emulsion (large lipid droplet size). Glucose, insulin, triglyceride, non-esterified fatty acid (NEFA), gastric antral distention and appetite measurements were recorded for 4 hours. Glucose and insulin concentrations increased rapidly after administration of non-emulsified beverages as compared to fine and coarse emulsions with a significant difference at 30 min (95% confidence interval, P < 0.05). Fine emulsion led to a significant increase in triglyceride responses, a smaller suppression of NEFA responses and slowed gastric emptying compared to the non-emulsified beverage and coarse emulsion (iAUC, 95% confidence interval, P < 0.05). Emulsification and alteration of lipid droplet size have acute effects on glucose, insulin, triglyceride and fatty acid responses.

The Physical State of Emulsified Edible Oil Modulates Its in Vitro Digestion

Emulsified lipid digestion was tailored by manipulating the physical state of dispersed oil droplets in whey protein stabilized oil-in-water (O/W) emulsions, where the oil phase consisted of one of five ratios of soybean oil (SO) and fully hydrogenated soybean oil (FHSO). The evolution in particle size distribution, structural changes during oral, gastric, and intestinal digestion, and free fatty acid release during intestinal digestion were all investigated. Irrespective of the physical state and structure of the dispersed oil/fat, all emulsions were stable against droplet size increases during oral digestion. During gastric digestion, the 50:50 SO:FHSO emulsion was more stable against physical breakdown than any other emulsion. All emulsions underwent flocculation and coalescence or partial coalescence upon intestinal digestion, with the SO emulsion being hydrolyzed the most rapidly. The melting point of all emulsions containing FHSO was above 37 °C, with the presence of solid fat within the dispersed oil droplets greatly limiting lipolysis. Fat crystal polymorph and nanoplatelet size did not play an important role in the rate and extent of lipid digestion. Free fatty acid release modeled by the Weibull distribution function showed that the rate of lipid digestion (κ) decreased with increasing solid fat content, and followed an exponential relationship (R² = 0.95). Overall, lipid digestion was heavily altered by the physical state of the dispersed oil phase within O/W emulsions.

Infant milk fat droplet size and coating affect postprandial responses in healthy adult men: a proof-of-concept study

BACKGROUND/OBJECTIVES

Fat droplets in human milk (HM) are larger and surrounded by a phospholipid membrane compared with infant milk formulas (IMF). Since the physical structure of fat droplets might affect digestion and postprandial metabolism, an IMF was developed more mimicking HM lipid structure than current IMF.

SUBJECTS/METHODS

A randomised, double-blind, crossover study was performed in 29 fasted healthy men (aged 18-25 years, BMI: 18-25 kg/m²) to compare 5-hour postprandial responses after consumption of an experimental IMF (Concept, Nuturis) with a current IMF (Control).

RESULTS

Postprandial triacylglycerol (TAG) concentrations tended to increase faster after intake of Concept IMF (P=0.054), but peaked 3 h after intakes at similar concentrations. ApoB48 increased steadily and peaked 3 h after consumption. Increases in plasma glucose concentrations were comparable, but peak concentrations were reached faster after consumption of Concept IMF (P<0.05). Peak insulin concentrations were higher and reached earlier after intake of Concept IMF, causing a sharper decremental glucose rebound (P<0.05) and an earlier time to nadir in non-esterified fatty acid (NEFA) concentrations (P<0.01). Changes in plasma amino acids (AA), apoB100 and apoA1 were comparable. The incremental or decremental areas under-the-curve did not differ between Concept and Control IMF. Satiety scores and changes in the satiety hormones ghrelin and peptide YY were comparable, while cholecystokinin responses were earlier and higher after consumption of Control IMF (P<0.05).

CONCLUSIONS

This proof-of-concept study suggests that fats and carbohydrates from the Concept IMF with larger and phospholipid-coated fat droplets are more rapidly absorbed than those from the current IMF.

The Dynamics of Gastric Emptying and Self-Reported Feelings of Satiation Are Better Predictors Than Gastrointestinal Hormones of the Effects of Lipid Emulsion Structure on Fat Digestion in Healthy Adults-A Bayesian Inference Approach

Background: Limited information exists on the relation between fat emulsion structure and its effect on the release of gastrointestinal hormones and feelings of satiation.Objective: We investigated the impact of fat emulsion droplet size, gravitational and acid stability, and redispersibility on gastrointestinal responses and sought to deduce the relative importance of the hormones ghrelin, cholecystokinin, glucagon-like peptide-1, and peptide YY (PYY) in controlling fat emptying and related satiation.Methods: Within a randomized, double-blind, 4-armed crossover study, an extensive data set was generated by MRI of gastric function, analysis of hormone profiles, and ratings of satiation in healthy participants [10 women and 7 men with a mean ± SD age of 25 ± 7 y and body mass index (in kg/m²) of 22 ± 1] after intake of 4 different fat emulsions. Iterative Bayesian model averaging variable selection was used to investigate the influence of hormone profiles in controlling fat emulsion emptying and satiation.Results: The emulsion structure had a distinct effect on the gastric emptying (primary outcome), gastrointestinal hormone profiles, and ratings of satiation (secondary outcomes). Gravitational and acid stability were stronger modulators of fat emptying and hormone profiles than were emulsion droplet size or redispersibility. Cholecystokinin and PYY were most strongly affected by fat emulsion instability and droplet size. Although both hormones were relevant predictors of gastric emptying, only PYY was identified as a relevant predictor of satiation.Conclusions: This work indicates that evenly dispersed, stable, small-emulsion droplets within the stomach lead to prolonged gastric distension, longer ghrelin suppression, and accelerated fat sensing (cholecystokinin and PPY), triggering prolonged feelings of satiation. It suggests that the effects of emulsion instability and droplet size on energy consumption are best studied by assessing changes in gastric emptying and ratings of satiation rather than changes in venous hormone profiles. This trial was registered at clinicaltrials.gov as NCT01253005.

Biological fate of food nanoemulsions and the nutrients they carry – internalisation, transport and cytotoxicity of edible nanoemulsions in Caco-2 intestinal cells

Internalisation of edible food nanoemulsions by CaCo-2 intestinal cells. The structure of edible nanoemulsions increases five times upon incorporation of reactive/ROS producing nutrients/APIs.

Small particle size lipid emulsions, satiety and energy intake in lean men

Lipid emulsions have been proposed to suppress hunger and food intake. Whilst there is no consensus on optimal structural properties or mechanism of action, small particle size (small-PS) stable emulsions may have greatest efficacy. Fabuless®, a commercial lipid emulsion reported in some studies to decrease energy intake (EI), is a small-PS, 'hard' fat emulsion comprising highly saturated palm oil base (PS, 82nm). To determine whether small-PS dairy lipid emulsions can enhance satiety, firstly, we investigated 2 'soft' fat dairy emulsions generated using dairy and soy emulsifying agents (PS, 114nm and 121nm) and a non-emulsified dairy control. Secondly, we investigated a small-PS palmolein based 'hard' fat emulsion (fractionated palm oil, PS, 104nm) and non-emulsified control. This was a 6 arm, randomized, cross-over study in 18 lean men, with test lipids delivered in a breakfast meal: (i) Fabuless® emulsion (F_EM); (ii) dairy emulsion with dairy emulsifier (DE_DE); (iii) dairy emulsion with soy lecithin emulsifier (DE_SE); (iv) dairy control (DC_ON); (v) palmolein emulsion with dairy emulsifier (PE_DE); (vi) palmolein control (PC_ON). Participants rated postprandial appetite sensations using visual analogue scales (VAS), and ad libitum energy intake (EI) was measured at a lunch meal 3.5h later. Dairy lipid emulsions did not significantly alter satiety ratings or change EI relative to dairy control (DE_DE, 4035kJ; DE_SE, 3904kJ; DC_ON, 3985kJ; P>0.05) nor did palm oil based emulsion relative to non-emulsified control (PE_DE, 3902 kJ; PC_ON, 3973kJ; P>0.05). There was no evidence that small-PS dairy lipid emulsions or commercial Fabuless altered short-term appetite or food intake in lean adults.

Lipid-associated oral delivery: Mechanisms and analysis of oral absorption enhancement

The majority of newly discovered oral drugs are poorly water soluble, and co-administration with lipids has proven effective in significantly enhancing bioavailability of some compounds with low aqueous solubility. Yet, lipid-based delivery technologies have not been widely employed in commercial oral products. Lipids can impact drug transport and fate in the gastrointestinal (GI) tract through multiple mechanisms including enhancement of solubility and dissolution kinetics, enhancement of permeation through the intestinal mucosa, and triggering drug precipitation upon lipid emulsion depletion (e.g., by digestion). The effect of lipids on drug absorption is currently not quantitatively predictable, in part due to the multiple complex dynamic processes that can be impacted by lipids. Quantitative mechanistic analysis of the processes significant to lipid system function and overall impact on drug absorption can aid in the understanding of drug-lipid interactions in the GI tract and exploitation of such interactions to achieve optimal lipid-based drug delivery. In this review, we discuss the impact of co-delivered lipids and lipid digestion on drug dissolution, partitioning, and absorption in the context of the experimental tools and associated kinetic expressions used to study and model these processes. The potential benefit of a systems-based consideration of the concurrent multiple dynamic processes occurring upon co-dosing lipids and drugs to predict the impact of lipids on drug absorption and enable rational design of lipid-based delivery systems is presented.