Macronutrient Absorption Characteristics in Humans With Short Bowel Syndrome and Jejunocolonic Anastomosis: Starch Is the Most Important Carbohydrate Substrate, Although Pectin Supplementation May Modestly Enhance Short Chain Fatty Acid Production and Fluid Absorption
Macronutrient Absorption Characteristics in Humans With Short Bowel Syndrome and Jejunocolonic Anastomosis: Starch Is the Most Important Carbohydrate Substrate, Although Pectin Supplementation May Modestly Enhance Short Chain Fatty Acid Production and Fluid Absorption
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DOI：
10.1177/0148607110378410
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发表时间：
2011-03-01
影响因子：
3.4
通讯作者：
Buchman, Alan L.
中科院分区：
文献类型：
--
作者：
Atia, Antwan;Girard-Pipau, Fernand;Buchman, Alan L.
背景：饮食可能在结肠连续性短肠综合征患者的管理中发挥重要作用。然而，大量营养素的吸收还没有得到很好的表征，最合适的饮食成分还没有得到很好的定义。目的：确定短肠综合征患者的碳水化合物吸收特征，并确定果胶作为膳食基质的潜在作用。研究方法：作者研究了6名年龄在29-67岁之间接受空肠结肠吻合术的受试者（3名男性/3名女性）使用定制果胶补充剂的效果，其中4名受试者需要长期胃肠外营养。测定小肠吸收能力、大量营养素和液体平衡、胃肠通过时间和能量消耗。结果：数据显示，53%的氮，50%的脂肪和32%的总能量吸收不良。相比之下，总碳水化合物的大部分（92%）被利用。粪便短链脂肪酸（SCFA）增加，表明发酵增加。虽然在粪便中仅回收4%的淀粉，但这表明相当大的淀粉吸收不良，从而为结肠细菌发酵提供主要的碳水化合物底物。相比之下，非淀粉多糖是一个相对较小的发酵底物，只有49%的利用。80%的果胶被发酵。补充与增加总SCFAs，乙酸盐和丙酸盐排泄有关。在补充果胶后观察到更大的液体吸收趋势（-5.9% +/-54.4%至26.9% +/-25.2%）。观察到胃排空时间和口结肠通过时间无显著增加。结论：尽管吸收不良，但淀粉是短肠综合征患者结肠细菌发酵的主要碳水化合物底物，尽管可溶性纤维摄入也可增强结肠SCFA的产生。(JPEN肠外肠内营养杂志2011;35：229-240）
Background: Diet may play an important role in the management of patients with short bowel syndrome who have colon in continuity. However, macronutrient absorption has not been well characterized, and the most appropriate dietary constituents have not been well defined. Objective: To define carbohydrate absorption characteristics in patients with short bowel syndrome and determine the potential role of pectin as a dietary substrate. Methods: The authors studied the effect of a custom pectin-based supplement in 6 subjects (3 male/3 female) aged 29-67 years with jejunocolonic anastomosis, 4 of whom required long-term parental nutrition. Small intestinal absorption capacity, macronutrient and fluid balance, gastrointestinal transit time, and energy consumption were measured. Results: Data showed that 53% nitrogen, 50% fat, and 32% total energy were malabsorbed. In contrast, the majority (92%) of total carbohydrate was utilized. Fecal short-chain fatty acids (SCFAs) were increased, an indication of increased fermentation. Although only 4% of starch was recovered in stool, it is indicative of considerable starch malabsorption, thus providing the main carbohydrate substrate, for colonic bacterial fermentation. In contrast, nonstarch polysaccharide was a relatively minor fermentation substrate with only 49% utilized. Eighty percent of the pectin was fermented. Supplementation was associated with increased total SCFAs, acetate, and propionate excretion. There was a trend observed toward greater fluid absorption (-5.9% +/- 54.4% to 26.9% +/- 25.2%) following pectin supplementation. Nonsignificant increases in gastric emptying time and orocolonic transit time were observed. Conclusion: Despite malabsorption, starch is the primary carbohydrate substrate for colonic bacterial fermentation in patients with short bowel syndrome, although soluble fiber intake also enhances colonic SCFA production. (JPEN J Parenter Enteral Nutr. 2011;35:229-240)