Faecal microbiota and short‐chain fatty acids in patients receiving enteral nutrition with standard or fructo‐oligosaccharides and fibre‐enriched formulas

Background: Prebiotics potentially increase the growth of bifidobacteria, which may minimise the risk of diarrhoea in patients receiving enteral nutrition (EN). The present study aimed to compare the concentrations of faecal microbiota and short‐chain fatty acids (SCFA) in patients receiving EN with either a standard formula or one enriched with fructo‐oligosaccharides (FOS) and fibre. Methods: Forty‐one hospitalised adult patients (25 males, 16 females) who were on exclusive EN for at least 12 days were recruited to a cross‐sectional study. Faecal samples were collected and analysed for major groups of microbiota using fluorescent in situ hybridisation and SCFA concentrations were analysed using gas liquid chromatography. Results: There were generally low concentrations of the major bacterial groups, including bifidobacteria, in all patients receiving either standard or FOS/fibre‐enriched formula [bifidobacteria: 6.6 (1.3) versus 7.0 (2.0) log₁₀ cells g^?1 dry faecal, P = 0.199]. However, faecal butyrate concentrations were higher in patients receiving the FOS/fibre‐enriched formula compared to standard formula [20.5 (21.6) versus 4.6 (6.7) μmol g^?1 dry faecal, P = 0.006]. Conclusions: Low concentrations of faecal bifidobacteria were identified in these patients, which potentially increases their risk of diarrhoea. Other microbiota groups may utilise FOS/fibre, leading to different butyrate concentrations between the two cohorts.     

Polyphenols—Gut Microbiota Interrelationship: A Transition to a New Generation of Prebiotics

The present review summarizes the studies carried out on this topic in the last five years. According to the new definitions, among all the compounds included in the group of prebiotics, polyphenols are probably the most important secondary metabolites produced by the plant kingdom. Many of these types of polyphenols have low bioavailability, therefore reaching the colon in unaltered form. Once in the colon, these compounds interact with the intestinal microbes bidirectionally by modulating them and, consequently, releasing metabolites. Despite much research on various metabolites, little is known about the chemistry of the metabolic routes used by different bacteria species. In this context, this review aims to investigate the prebiotic effect of polyphenols in preclinical and clinical studies, highlighting that the consumption of polyphenols leads to an increase in beneficial bacteria, as well as an increase in the production of valuable metabolites. In conclusion, there is much evidence in preclinical studies supporting the prebiotic effect of polyphenols, but further clinical studies are needed to investigate this effect in humans.     

Gastrointestinal Tolerance of Short-Chain Fructo-Oligosaccharides from Sugar Beet: An Observational,Connected, Dose-Ranging Study in Healthy Volunteers

Dietary fibres are important in the human diet with multiple health benefits. This study aimed to determine the gastrointestinal tolerance of short-chain fructo-oligosaccharides (scFOS), well-known prebiotic fibres, at doses up to 40 g/d. An observational, connected, dose-ranging trial was conducted in 116 healthy volunteers. During the first week, the participants were instructed to consume their usual diet. During the second week, half of the subjects consumed 15 g scFOS per day, and the other half consumed 20 g scFOS per day. For the third week, the scFOS dose was doubled for all subjects. Gastrointestinal symptom severity was reported daily, as well as stool consistency and frequency. The results show that scFOS are well tolerated up to 40 g/d; all reported symptoms remained very mild from a clinical perspective. Stool consistency stayed normal, between 3 and 5 on the Bristol stool scale, confirming that no diarrhoea appeared after scFOS intake. Stool frequency also remained within the normal range. In conclusion, scFOS intake is well tolerated up to 40 g/d in healthy subjects. Thanks to their short chains and unique composition, scFOS prebiotic fibres are much better tolerated than other types of inulin-type fructans with longer chains. The digestive tolerance of fibres should be considered when added to foods and beverages.     

Clinical audit of the effects of low‐fibre diet on irritable bowel syndrome

Introduction High‐fibre diets are frequently advocated for the treatment of irritable bowel syndrome (IBS) although there is little scientific evidence to support this. Experience of patients on low‐fibre diets suggests that this may be an effective treatment for IBS, warranting investigation. Methods Symptoms were recorded for 204 IBS patients presenting in the gastroenterology clinic. They were then advised on a low‐fibre diet with bulking agents as appropriate. Symptoms were reassessed by postal questionnaire 4 weeks later. Patients who had improved on the diet were advised on the gradual reintroduction of different types of fibre to determine the quantity and type of fibre tolerated by the individual. Results Seventy‐four per cent of questionnaires were returned. A significant improvement (60–100% improvement in overall well‐being) was recorded by 49% of patients. Conclusion This preliminary study suggests that low‐fibre diets may be an effective treatment for some IBS patients and justifies further investigation as a full clinical trial.     

Community paediatrics moves on—an analysis of changing work patterns 1994–97

Objectives: To describe the current clinical workload of the modern community paediatrician; to outline the changes in this role over recent years and examine the reasons for these.Design and setting: The design is a retrospective analysis of data routinely collected for contracting purposes. Nottingham community paediatric service 1994–97 is the setting.Main outcome measures: These are the characteristics of patients seen, sources of referral, locations of clinical contact, referral rates by area.Results: 36 710 appointments were offered over the time period studied. The non-attendance rate was 17%. Pre-school children made up the largest group seen. Most referrals were from health visitors (23%) and school nurses (29%). There has been a small but significant increase in the numbers of children seen who have developmental problems and disability, and due to child protection issues between the time periods. There has been a shift in the proportions of children seen in a local health centre referral clinic (9.8% increase during 1994–97) rather than in a school setting. Twice as many children are referred to the community paediatrician from inner city areas than from the surrounding county areas.Conclusion: The transfer of child health surveillance to the primary health care team and the increased training of community paediatricians, has resulted in community paediatricians developing an increasingly specialised role particularly in the areas of child growth and development, disability, social and behavioural paediatrics.Public Health (2000) 114, 61–64.     

Impact of 2′-Fucosyllactose on Gut Microbiota Composition in Adults with Chronic Gastrointestinal Conditions: Batch Culture Fermentation Model and Pilot Clinical Trial Findings

Intestinal dysbiosis has been described in patients with certain gastrointestinal conditions including irritable bowel syndrome (IBS) and ulcerative colitis. 2′-fucosyllactose (2′-FL), a prebiotic human milk oligosaccharide, is considered bifidogenic and butyrogenic. To assess prebiotic effects of 2′-FL, alone or in combination with probiotic strains (potential synbiotics), in vitro experiments were conducted on stool from healthy, IBS, and ulcerative colitis adult donors. In anaerobic batch culture fermenters, Bifidobacterium and Eubacterium rectale-Clostridium coccoides counts, and short-chain fatty acids (SCFAs) including butyrate increased during fermentation with 2′-FL and some of the 2′-FL/probiotic combinations. In a subsequent open-label pilot trial, the effect of a 2′-FL-containing nutritional formula was evaluated in twelve adults with IBS or ulcerative colitis. Gastrointestinal Quality of Life Index (GIQLI) total and gastrointestinal symptoms domain scores, stool counts of Bifidobacterium and Faecalibacterium prausnitzii, and stool SCFAs including butyrate, increased after six weeks of intervention. Consistent with documented effects of 2′-FL, the batch culture fermentation experiments demonstrated bifidogenic and butyrogenic effects of 2′-FL during fermentation with human stool samples. Consumption of the 2′-FL-containing nutritional formula by adults with IBS or ulcerative colitis was associated with improvements in intra- and extra-intestinal symptoms, and bifidogenic and butyrogenic effects.     

Defining an epidemic: the body mass index in British and US obesity research 1960–2000

Between the 1970s and the mid‐1990s the body mass index (BMI) became the standard means of assessing obesity both in populations and in individuals, replacing previously diverse and contested definitions of excess body weight. This article draws on theoretical approaches from the sociology of standards and science and technology studies to describe the development of this important new standard and the ways in which its adoption facilitated the development of obesity science, that is, knowledge about the causes, health effects and treatments of excess body weight. Using an analysis of policy and healthcare literatures, I argue that the adoption of the BMI, along with associated standard cut‐off points defining overweight and obesity, was crucial in the framing of obesity as an epidemic. This is because, I suggest, these measures enabled, firstly, the creation of large data sets tracking population‐level changes in average body weight, and, secondly, the construction of visual representations of these changes. The production of these two new techniques of representation made it possible for researchers in this field, and others such as policymakers, to argue credibly that obesity should be described as an epidemic.     

Factors associated with caregiver burden among adult (19–64 years) informal caregivers – An analysis from Dutch Municipal Health Service data

Due to the ageing population and the rising prevalence of chronic diseases, it is expected that the demand on informal caregivers will increase. Many informal caregivers experience burden, which can have negative consequences for their own health and that of the care recipient. To prevent caregiver burden, it is important to investigate factors associated with this burden. We aimed to identify factors associated with caregiver burden in adult informal caregivers. Among a sample of adult informal caregivers (n = 1,100) of the Dutch region of Zaanstreek‐Waterland, perceived caregiver burden, demographic factors, caregiving situation, health‐related factors and socio‐financial factors were measured as part of the national Health Survey in 2016. Using univariate and multivariate logistic regression analysis, for which a backward selection method was applied, associations with caregiver burden were studied. In the multivariate model, time spent providing informal care was significantly associated with perceived caregiver burden, with an odds ratio (OR) [95% confidence interval] of 7.52 [3.93–14.39] for those spending >16 hr compared to 1–2 hr on informal care. Also providing care to their child(ren) (OR: 2.55 [1.51–4.31]), poor perceived health (OR: 1.80 [1.20–2.68]) and loneliness of the caregiver (OR: 2.05 [1.41–2.99]) were significantly associated with caregiver burden. To possibly prevent and reduce informal caregiver burden, factors associated with such burden should be intervened on. As such, special attention should be paid to caregivers who provide many hours of care or provide care to their child(ren), as well as those who have a poor perceived health themselves and/or experience feelings of loneliness.     

Working hours and cardiometabolic health – an emerging area of nutritional research

Multifactorial work‐related diseases are diseases that occur in the general population, but may be exacerbated or partially caused by occupational exposures. There is increasing evidence to suggest that type 2 diabetes and cardiovascular diseases are associated with duration and time of working hours. Despite the role of diet in the aetiology of cardiometabolic disease being well established, gaps remain in understanding the relationship between working hours and diet. Studies that have compared the diets of shift to non‐shift workers have reported inconsistent results, likely due to the heterogeneity of study design, including variations in the industry studied and dietary measurement methods used. There is a paucity of research investigating dietary intakes across different shift types, both inside and outside of working hours and in relation to duration of working hours. From the published research that exists, there appears to be growing consensus that night working is associated with a change in the temporal distribution of energy intake and poorer food choices. Epidemiological studies have shown that consuming a higher percentage of energy during the evening is positively associated with metabolic syndrome, while controlled studies have demonstrated an altered metabolic response to eating at night compared to during daytime hours. In the UK, 15% of the working population are employed in jobs that require shift work and 13% of employees work more than 48 hours per week. Understanding the complex relationship between working hours, diet and cardiometabolic health will provide an opportunity to improve the health of a significant proportion of the population.     

Role of Short Chain Fatty Acids in Epilepsy and Potential Benefits of Probiotics and Prebiotics: Targeting “Health” of Epileptic Patients

The WHO’s definition of health transcends the mere absence of disease, emphasizing physical, mental, and social well-being. As this perspective is being increasingly applied to the management of chronic diseases, research on gut microbiota (GM) is surging, with a focus on its potential for persistent and noninvasive dietary therapeutics. In patients with epilepsy (PWE), a chronic lack of seizure control along with often neglected psychiatric comorbidities greatly disrupt the quality of life. Evidence shows that GM-derived short chain fatty acids (SCFAs) may impact seizure susceptibility through modulating (1) excitatory/inhibitory neurotransmitters, (2) oxidative stress and neuroinflammation, and (3) psychosocial stress. These functions are also connected to shared pathologies of epilepsy and its two most common psychiatric consequences: depression and anxiety. As the enhancement of SCFA production is enabled through direct administration, as well as probiotics and prebiotics, related dietary treatments may exert antiseizure effects. This paper explores the potential roles of SCFAs in the context of seizure control and its mental comorbidities, while analyzing existing studies on the effects of pro/prebiotics on epilepsy. Based on currently available data, this study aims to interpret the role of SCFAs in epileptic treatment, extending beyond the absence of seizures to target the health of PWE.     

FROM SOCIAL CAPITAL TO HEALTH – AND BACK

We assess the causal relationship between health and social capital, measured by generalized trust, both at the individual and the community level. The paper contributes to the literature in two ways: it tackles the problems of endogeneity and reverse causation between social capital and health by estimating a simultaneous equation model, and it explicitly accounts for mis‐reporting in self‐reported trust. The inter‐relationship is tested using data from the first four waves of the European Social Survey for 25 European countries, supplemented by regional data from Eurostat. Our estimates show that a causal and positive relationship between self‐perceived health and social capital does exist and that it acts in both directions. In addition, the magnitude of the structural coefficients suggests that individual social capital is a strong determinant of health, whereas community level social capital plays a considerably smaller role in determining health. Copyright © 2013 John Wiley & Sons, Ltd.     

Response to an indigenous smoking cessation media campaign – It's about whānau

Objective: To assess any effects among Māori (the indigenous people of New Zealand) smokers and their whānau (the traditional Māori family unit) of a campaign designed to support Māori smokers to quit smoking. Method: New Zealand‐wide cross sectional population surveys between 2000 and 2002 of smokers and whānau pre‐ and post‐airing of the campaign. Measures included recall and awareness of the campaign; perceptions of the campaign; and campaign‐attributed changes in quitting‐related attitudes and behaviours. Results: Seventy‐eight per cent of smokers and 73% of whānau were able to recall the campaign one year following its launch. The television commercials (TVCs) were consistently rated very believable or very relevant by over half of the smokers who had seen them. More than half of smokers (54%) stated that the campaign had made them more likely to quit. Conclusion: This nationwide mass media cessation campaign developed to deliver a cessation message to indigenous people was received positively by Māori smokers and their whānau and played a role in prompting quit attempts. Implications: Social marketing campaigns have an important role as part of a tobacco control program to reduce high smoking prevalence among Māori and inequalities in health outcomes between Māori and other New Zealanders.     

Food additives: Assessing the impact of exposure to permitted emulsifiers on bowel and metabolic health – introducing the FADiets study

Emulsifiers are common components of processed foods consumed as part of a Western diet. Emerging in vitro cell‐line culture, mouse model and human intestinal tissue explant studies have all suggested that very low concentrations of the food emulsifier polysorbate 80 may cause bacterial translocation across the intestinal epithelium, intestinal inflammation and metabolic syndrome. This raises the possibility that dietary emulsifiers might be factors in conditions such as coronary artery disease, type 2 diabetes and Crohn's disease. The potential mechanism behind the observed effects of this emulsifier is uncertain but may be mediated via changes in the gut microbiota or by increased bacterial translocation, or both. It is also unknown whether these effects are generalisable across all emulsifiers and detergents, including perhaps the natural emulsifier lecithin or even conjugated bile acids, particularly if the latter escape reabsorption and pass through to the distal ileum or colon. A major objective of the Medical Research Council (MRC)‐funded Mechanistic Nutrition in Health (MECNUT) Emulsifier project is therefore to investigate the underlying mechanisms and effects of a range of synthetic and natural emulsifiers and detergents in vitro and in vivo, and to determine the effects of a commonly consumed emulsifier (soya lecithin) on gut and metabolic health through a controlled dietary intervention study in healthy human volunteers – the FADiets study. This report provides an overview of the relevant literature, discussing the impact of emulsifiers and other additives on intestinal and metabolic health, and gives an overview of the studies being undertaken as part of the MECNUT Emulsifier project.     

Distributional Cost‐Effectiveness Analysis of Health Care Programmes – A Methodological Case Study of the UK Bowel Cancer Screening Programme

This paper presents an application of a new methodological framework for undertaking distributional cost‐effectiveness analysis to combine the objectives of maximising health and minimising unfair variation in health when evaluating population health interventions. The National Health Service bowel cancer screening programme introduced in 2006 is expected to improve population health on average and to worsen population health inequalities associated with deprivation and ethnicity – a classic case of ‘intervention‐generated inequality’. We demonstrate the distributional cost‐effectiveness analysis framework by examining two redesign options for the bowel cancer screening programme: (i) the introduction of an enhanced targeted reminder aimed at increasing screening uptake in deprived and ethnically diverse neighbourhoods and (ii) the introduction of a basic universal reminder aimed at increasing screening uptake across the whole population. Our analysis indicates that the universal reminder is the strategy that maximises population health, while the targeted reminder is the screening strategy that minimises unfair variation in health. The framework is used to demonstrate how these two objectives can be traded off against each other, and how alternative social value judgements influence the assessment of which strategy is best, including judgements about which dimensions of health variation are considered unfair and judgements about societal levels of inequality aversion. © 2014 The Authors. Health Economics published by John Wiley & Sons Ltd.     

The Hugh Sinclair Unit of Human Nutrition – 20 years of research 1995–2015

The Hugh Sinclair Unit of Human Nutrition (HSUHN) at the University of Reading was founded in October 1995 with the appointment of Christine Williams OBE as the first Hugh Sinclair Chair in Human Nutrition. This was made possible by the competitively won funds from the estate and legacy of the late Professor Hugh Macdonald Sinclair (1910–1990). The vision for the newly established HSUHN was to ‘strengthen the evidence base for dietary recommendations for prevention of degenerative chronic diseases’. This has remained the research focus of the HSUHN under the leadership of Professors Christine Williams (1995–2005), Ian Rowland (2006–2013) and Julie Lovegrove (2014‐present). Our mission is to improve population health and evaluate mechanisms of action for the effects of dietary components on health, which reflects Hugh Sinclair's life ambition within nutritional science. Over the past 20 years, the HSUHN has developed an international reputation within the nutrition science community, and in recognition of the 20th anniversary, this paper highlights Hugh Sinclair's contributions to the field of nutrition and key research achievements by members of the Unit.