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A comparison was made of the digestibility and tolerance of lactose from three semi-solid fermented diary products with similar amounts of lactose but different lactase contents and bacterial cultures in lactase deficient adults. The design involved measuring the breath hydrogen concentration and clinical symptoms after consumption of the test meals. The results indicate that lactose was well digested and tolerated from the three different semi-solid fermented dairy products in spite of the differences in the lactase and bacterial content.

The ingestion of Bifidobacterium sp fermented milk (BFM) increases the concentration of colon bifidobacteria and the increase is unaffected by a simultaneous intake of inulin. BFM ingestion along with a placebo enhances the total and exogenous bifidobacteria levels, and reduces beta-glucuronidase activity. The ingestion of BFM with inulin increases the total and the exogenous bifidobacteria, but has no effect on beta-glucuronidase activity. Fecal total anaerobe level, pH, nitrate reductase, nitroreductase, and azoreductase activities are unaffected by BFM.

Healthy volunteers who consumed a indigestible bulking sweetener containing fructo-oligosaccharides (FOS) either occasionally or regularly throughout the day showed excessive flatus as the first symptom of malabsorption of these sugars. Borborygmi and bloating were observed when the consumption was more than 40 g/day while consumption of more than 50 g/day caused abdominal cramps and diarrhoea. The excretion of H2 during respiration was the same in the two groups but only six out of nine individuals showed a decrease in the excretion of H2.

Abstract: Background: The hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) are effective cholesterol lowering medications, however, statins may interfere with CoQ10 biosynthesis. We examined the effect of statin therapy as well as nutritional supplements on plasma, cardiac and skeletal muscle concentrations of CoQ10. Methods: Forty patients with left ventricular dysfunction had fasting blood samples collected at baseline and following four weeks of supplementation (150mg/day of CoQ10). Cardiac and skeletal muscle biopsies were collected at the time of surgery and frozen in liquid nitrogen until analyzed for CoQ10 levels by high performance liquid chromatography. Results: Nutrient supplementation significantly increased plasma [(1.8 (1.2, 2.7) vs 0.8 (0.6, 0.94) μg/ml plasma, median+IQR; p =0.001)] and cardiac tissue concentrations of CoQ10 [(120.5 (76.5, 177.1) vs 87.3 (60.5, 110.8) nmol/g wet weight, p =0.04)]. No effect of supplementation was seen on samples of skeletal muscle from the chest wall. Statin therapy was not found to influence plasma, cardiac or chest wall levels of CoQ10. Conclusion: Nutrient supplementation significantly increased plasma and cardiac tissue levels of CoQ10 but did not influence chest wall muscle concentrations. Statin therapy did not significantly influence tissue concentrations of CoQ10. Longer term studies are needed to confirm this observation. [Copyright &y& Elsevier]

Lactose digestion improves when the energy content of a meal is raised, perhaps due to delayed gastric emptying; however, this has not been demonstrated directly. It is not known whether lactose-intolerant subjects should consume full-fat or high energy milk instead of half-skimmed milk. In this study, breath 13CO2 and hydrogen (H2) measurements were combined to assess simultaneously the effect of increasing milk energy content on gastric emptying, digestion, and tolerance of lactose. On two separate days, 11 adult lactose maldigesters ingested, in the fasting state, a single dose of 710 kJ half-skimmed milk or 1970 kJ high energy milk. Both contained 18 g lactose and were supplemented with 100 mg 13C-glycine for breath 13CO2 measurement. For 6 h after milk ingestion, samples of expired breath were collected, and subjects scored their symptoms on a four-grade questionnaire. Gastric emptying was measured from excretion of breath 13CO2. The mean gastric emptying half-time was significantly longer after ingestion of high energy milk than after half-skimmed milk (84 +/- 4 vs. 64 +/- 4 min, P = 0.004). The mean area under the breath H2 excretion curve measured for 6 h was 330 +/- 61 microL/L after subjects consumed high energy milk vs. 470 +/- 82 microL/L after they consumed half-skimmed milk (P = 0.07). Mean symptom scores did not differ after ingestion of the two milks, but only two subjects experienced disturbing symptoms after high energy milk ingestion compared with five subjects after ingestion of half-skimmed milk (P = 0.56). Although ingestion of high energy milk delayed the gastric emptying of lactose for significantly longer than the ingestion of half-skimmed milk (P < 0.01), it did not lead to significant improvement in symptoms and reflected only a trend toward improved lactose digestion (P = 0.07), as measured by the area under the breath H2 excretion curve. These results indicate that it is not beneficial for most lactose-intolerant subjects to replace consumption of half-skimmed milk by milk with a higher energy content. [ABSTRACT FROM AUTHOR]

Purpose: Hemodilution in perioperative patients has been associated with neurological morbidity and increased mortality by undefined mechanisms. This study assesses whether hemodilutional anemia up-regulated inflammatory cerebral gene expression (microarray) to help define the mechanism., Methods: Hemodilution was performed in anesthetized rats by exchanging 50% of the estimated blood volume (30 mL kg(-1)) with pentastarch. Two groups of control animals were utilized, i.e., a non-anesthetized control (Normal Control) and an anesthetized control group (Anesthesia Control). Blood pressure, hemoglobin concentration, and arterial blood gas analysis were performed before and after hemodilution. Cerebral cortex was harvested from isoflurane-anesthetized rats (n = 6) after 6 and 24 hr of recovery and was used to perform complimentary DNA (cDNA) microarray analyses. Pro-inflammatory chemokine and cytokine protein levels were also measured., Results: Microarray analysis demonstrated up-regulation of 72 and 27 genes (6 and 24 hr, respectively) in anemic cerebral cortex. These genes were involved in a number of biological functions, including (1) inflammatory responses; (2) angiogenesis; (3) vascular homeostasis; (4) cellular biology; and (5) apoptosis. Chemokine ribonucleic acid (RNA) expression (CXCL-1, -10, and -11) was highest in anemic brain tissue (P < 0.0125 for each). Protein measurements demonstrated a significant increase in interleukin-6, tumor necrosis factor alpha, and monocyte chemoattractant protein-1 (P < 0.05 for each)., Conclusion: This study utilizes microarray technology to elucidate changes in cerebral cortical gene expression in response to acute hemodilution. These findings demonstrate an increase in pro-inflammatory chemokines (RNA, protein) and cytokines (protein). An improved understanding of the inflammatory response to anemia may help to minimize associated morbidity and mortality.

Liver cirrhosis is associated with malnutrition and often, after liver transplantation, with the development of obesity and the inability to gain lean body mass. We have previously shown that peripheral blood mononuclear cell (PBMNC) complex I activity could be an appropriate marker for nutritional assessment. In this context, we hypothesized that a low pretransplant PBMNC complex I activity may predict a poor nutritional status in cirrhotic patients undergoing liver transplantation. Fifteen cirrhotic patients (CP) (8 men and 7 women) were recruited and investigated before and 4 months after liver transplantation. Body weight, body composition by DEXA, anthropometric measures (triceps skinfold thickness and midarm muscle circumference), resting energy expenditure, respiratory quotient and PBMNC complex I activity were measured on both time points. Patients were divided into 2 groups depending on their pretransplant PBMNC complex I activity (low vs high complex I activity [CP(low CI) vs CP(high CI)]), using as an arbitrary cutoff value-the mean complex I activity observed in age-matched healthy controls. Before transplantation, the CP(low CI) group who showed a lower complex I activity (2.11 +/- 0.53 vs 4.54 +/- 0.98 nmol/min per milligram of protein, P < .01) was significantly younger (44 +/- 9 vs 62 +/- 8 years old, P < .01); no differences were observed for any other nutritional parameters when compared to the CP(high CI) group. After transplantation, only the CP(low CI) group demonstrated a significant increase of complex I activity (+77%, P < .01), respiratory quotient (+10.5%, P < .02), triceps skinfold thickness (+126%, P < .005), and a significant decrease of fat-free mass (-8%, P < .01). In summary, our findings indicate that a low pretransplant PBMNC complex I activity in cirrhotic patients could be a useful marker of poor nutritional status despite the lack of traditional indicators of malnutrition by predicting metabolic disturbances and an inability to regain fat-free mass after liver transplantation.

Background and Aim: We evaluated the impact of triple nutrient supplementation (TNS: carnitine, taurine and coenzyme Q(10)) vs. carnitine alone (CARN) or placebo on survival, infarct size, cardiac function and metabolic gene expression using a model of myocardial infarction (MI) in rats., Methods and Results: Male Wistar rats were randomized to three groups divided in two independent studies prior to ligation of the left anterior descending coronary artery (LAD): TNS vs. Placebo and TNS vs. CARN. Nutrient supplementation [L-carnitine (300 mg/day), coenzyme Q(10) (15 mg/kg body weight/day) and taurine (0.1M)] was administered daily for four weeks prior to and for 10 days after MI. At that time, cardiac function and infarct size were measured. Metabolic gene (mRNA) expression in the peri-infarct tissue of left ventricle from TNS, placebo or corresponding time-control rats (TNS or placebo without LAD ligation) was measured 10 days after MI. When compared to placebo, TNS significantly improved survival (60% vs. 34%, p<0.02), cardiac function, and reduced infarct size (30+/-7% vs. 42+/-9%, p<0.001). Although CARN improved survival like TNS (45% vs. 50%, not significant), it did not reduce infarct size (32+/-14% vs. 19+/-10%, p<0.05) or delay myocardial remodeling. In the placebo group, MI was associated with a significantly altered pattern of metabolic gene expression (glucose transporter 1, liver carnitine palmitoyl transferase 1, medium-chain acyl-CoA dehydrogenase; p<0.01 for all three) in the left ventricle peri-infarct tissue. In contrast, gene expression was normalized in the group receiving TNS., Conclusions: Our results support the potential cardioprotective impact of TNS during myocardial ischemia. In contrast to carnitine supplementation alone, TNS improved survival as well as cardiac function, gene expression and delayed remodeling.

Objective: Hemodilution and endothelial nitric oxide synthase genetic polymorphism may contribute to cerebral and renal injury after cardiopulmonary bypass. This study tested the hypothesis that cardiopulmonary bypass and anemia stimulate an increase in cerebral and renal endothelial nitric oxide synthase gene expression in an experimental model of cardiopulmonary bypass., Methods: Anesthetized rats underwent a sham procedure without cardiopulmonary bypass (sham, n = 5), normothermic bypass for 1 hour (CPB, n = 7), or bypass plus hemodilutional anemia (CPB anemia, n = 9). After 24 hours of recovery, RNA was extracted from the cerebral cortex, renal cortex, and renal medulla. Quantitative reverse transcriptase polymerase chain reaction was used to assess endothelial nitric oxide synthase messenger RNA levels in brain and kidney tissues., Results: The hemoglobin concentration of anemic CPB rats was significantly lower than that of nonanemic rats on bypass (64 +/- 5 vs 99 +/- 8 g x L(-1), P < .001). Cerebral cortical endothelial nitric oxide synthase messenger RNA levels were increased after cardiopulmonary bypass relative to those of the sham group (11.2 +/- 4.2 vs 6.3 +/- 1.5 fg, P = .031), without a further increase in anemic rats. Renal medullary endothelial nitric oxide synthase messenger RNA levels were significantly higher in the CPB anemia group than in the sham and CPB groups (7.1 +/- 4.4 fg vs 1.8 +/- 0.4 fg vs 3.0 +/- 0.6 fg, P < .001). Renal cortical endothelial nitric oxide synthase messenger RNA levels did not change significantly., Conclusions: Normothermic cardiopulmonary bypass was associated with higher endothelial nitric oxide synthase messenger RNA levels in kidney and brain than was the sham procedure 24 hours after cardiopulmonary bypass. Anemia accentuated the increase in renal medullary, but not cerebral cortical, endothelial nitric oxide synthase expression. These data provide an approach for exploring potential mechanisms by which endothelial nitric oxide synthase may contribute to renal and cerebral dysfunction after cardiopulmonary bypass and anemia.

Background: We showed previously that the activity of complex I (the first enzyme of the electron transport chain) in peripheral blood mononuclear cells decreases with malnutrition and increases to a subnormal value after 1 wk of refeeding, but the traditional markers of nutritional status do not do so., Objective: The aim of this study was to ascertain whether a period of nutritional intervention longer than 1 wk would normalize complex I activity and traditional markers of nutritional status., Design: Fifteen malnourished patients (7 women and 8 men) with > or =10% body weight loss over the previous 6 mo were studied on the day of their admission to hospital and 7, 14 and 30 d after the beginning of nutritional support. Complex I activity in peripheral blood mononuclear cells, weight, height, body composition, body water compartments, dietary intake, and serum albumin concentrations were measured on each occasion. The results before and during nutritional intervention were compared with values obtained in 30 healthy volunteers (17 women and 13 men)., Results: Complex I activity increased significantly after the first week of refeeding (P < 0.001) and reached a normal value after 1 mo of nutritional supplementation. Among the classic markers of nutritional status, only the ratio of extracellular water to intracellular water tended to decrease over the refeeding period., Conclusion: Complex I activity increases rapidly and is normalized by refeeding at a time when other markers of nutritional status do not change significantly.

Background: Previous investigations in rats have shown that the first enzyme of the mitochondrial electron transport chain (complex I) is altered in peripheral blood mononuclear cells (PBMCs) and muscle by dietary manipulations., Objective: We hypothesized that similar changes would occur in human PBMCs as a result of dietary malnutrition and short-term refeeding irrespective of the presence or absence of active inflammatory bowel disease (IBD)., Design: Fourteen malnourished patients with active IBD, 13 malnourished patients without IBD, and 42 healthy subjects were investigated. Complex I activity, body mass index, body composition, energy and protein intakes, and resting energy expenditure were measured. Five patients without IBD and 6 patients with IBD were investigated after 7 d of refeeding., Results: In patients without IBD, weight loss was mainly due to a loss of fat mass. In contrast, weight loss in IBD patients was due to a loss of both fat-free mass and fat mass. Complex I activity was reduced to the same degree in both groups of patients and was significantly lower than that observed in healthy subjects. In both groups of patients, complex I activity correlated significantly with body weight, body mass index, percentage weight loss, and fat mass. Complex I activity increased significantly after 1 wk of refeeding in both groups of patients before observed changes of measured nutritional assessment indexes., Conclusion: Our study showed that mitochondrial complex I activity measured in PBMCs seems to be a specific marker of dietary malnutrition and responds rapidly to refeeding.

Background: Previous studies suggested that cell energetics are altered by malnutrition., Objective: We hypothesized that nutritional manipulations influence mitochondrial enzyme activities of the electron transport chain in both skeletal muscle and blood mononuclear cells., Design: After a gastrostomy tube was inserted, 44 rats were randomly assigned to 1 of 4 experimental groups: control fed (CF; 364 kJ/d for 7 d), hypoenergetic fed (HF; 92 kJ/d for 7 d), hypoenergetic protein refed (HPR; 92 kJ/d for 7 d and then 129 kJ/d for 1 d), and hypoenergetic glucose refed (HGR; 92 kJ/d for 7 d and then 129 kJ/d for 1 d). The protein and glucose contents of the liquid formulas were different for the HPR and HGR groups. After mitochondria were isolated from the soleus muscle, the activities of complexes I--IV were measured spectrophotometrically. Because of the lack of available tissue, only the activity of complex I was measured in the mononuclear cell extract., Results: The recovery of complex activities in the CF and HF groups was not significantly different in the mitochondrial fraction of the soleus muscle. Compared with that in the CF group, the activities of complexes I--III in the mitochondrial fraction of the soleus muscle and the activity of complex I in mononuclear cells were significantly lower in the HF group. The activities of complexes I--III in the mitochondrial fraction of the soleus muscle and the activity of complex I in mononuclear cells were significantly higher in the HPR than in the HF group. The activity of complex IV was generally not affected by nutritional manipulations., Conclusion: Malnutrition decreases activities of mitochondrial complexes, which are restored by protein but not glucose refeeding.

Helicobacter pylori gastric infection in children is a public health problem. Classical diagnostic tools such as endoscopy are excessively invasive in the usual clinical context. Serology at this age has multiple drawbacks. The urea-13C breath test seems today the most appropriate alternative method. The principle of the test relies upon the indirect detection of H pylori through its high urease activity. The test uses a stable (ie, non radioactive) isotope, which allows its repeated use. The main indications are the detection and the follow-up of H pylori infection.

The possibility of delaying gastric emptying and improving lactose digestion and tolerance by increasing milk viscosity was studied in 13 lactose maldigesters who ingested three test milks with different viscosities (range: 33-1892 mPa.s) in random order at intervals of 1 wk. Each test portion was 500 mL and provided approximately equal to 1900 kJ and 18 g lactose. The different viscosities were obtained by adding varying proportions of rice starch and maltodextrin to a basic milk formula. A combined [13C]glycine-hydrogen breath test was used to measure gastric emptying and lactose digestion simultaneously. Participants reported their gastrointestinal symptoms by using a four-grade scale. Mean (+/- SEM) gastric-emptying half times were 78 +/- 5.7 min for low-viscosity milk (30 mPa.s), 86 +/- 5.0 min for moderate-viscosity milk (80 mPa.s), and 78 +/- 4.5 min for high-viscosity milk (1.9.10(3) mPa.s). Mean orocecal transit times (180 +/- 24, 163 +/- 23, and 180 +/- 24 min, respectively) were not significantly different. There were no milk-dependent differences in breath-hydrogen excretion or in the severity of gastrointestinal symptoms. The milks were well tolerated; > 50% of the subjects reported nondisturbing symptoms or none. We conclude that gastric emptying, orocecal transit time, and lactose digestion and tolerance were not affected by altering milk viscosity. This may have been due to the high energy content of the test milks, which in itself led to slow gastric emptying.

Background & Aims: Long-term carbohydrate malabsorption in patients with short bowel and colon in continuity (SBC) could result in a more efficient fermentation. The bacterial fermentation capacity in patients with SBC was assessed., Methods: Eleven fasting patients with SBC ingested 60 g lactulose with 10 g polyethylene glycol. Stool specimens were analyzed. Patients were compared with 8 normal subjects who ingested 60 g lactulose on two occasions, separated by 8 days during which 20 g lactulose was taken twice daily. Moreover, the daily amount of bacteria excreted in stools was measured in 6 patients with SBC and 6 normal subjects., Results: Despite fast transit time, patients fermented more lactulose and hexoses and had a higher activity of beta-galactosidase in stools than nonadapted normal subjects (P < 0.01); these parameters were roughly similar in patients and adapted normal subjects. The fecal output of short-chain fatty acids was significantly lower in patients than in nonadapted normal subjects (P < 0.03). Patients excreted a significantly greater amount of bacteria in stools than normal subjects (P < 0.05)., Conclusions: In patients with SBC, the capacity of bacterial flora to ferment lactulose and fecal bacterial mass is spontaneously increased, suggesting that hyperfermentation may affect other carbohydrates. Moreover, hyperfermentation is associated with efficient removal of extra short-chain fatty acids from fecal water.