Low FODMAPs diet for functional abdominal pain disorders in children: critical review of current knowledge / Dieta com baixo teor de FODMAPs para distúrbios de dor abdominal funcional em crianças: revisão crítica do conhecimento atual

ABSTRACT Objective: This narrative review aimed to provide practitioners a synthesis of the current knowledge on the role of a low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols diet in reducing symptoms associated with functional abdominal pain disorders in children. This review is focused on the pathophysiology, efficacy and criticism of low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols diet in children. Sources: Cochrane Database, Pubmed and Embase were searched using specific terms for Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols diet interventions and functional abdominal pain disorders. Summary of the findings: In children, only one Randomized Control Trial and one open-label study reported positive results of low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols diet; one Randomized Control Trial showed exacerbation of symptoms with fructans in children with Irritable Bowel Syndrome; no effect was found for the lactose-free diet whilst fructose-restricted diets were effective in 5/6 studies. Conclusions: In children there are few trials evaluating low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols in functional abdominal pain disorders, with encouraging data on the therapeutic efficacy particularly of fructose-restricted diet. Additional efforts are still needed to fill this research gap and clarify the most efficient way for tailoring dietary restrictions based on the patient's tolerance and/or identification of potential biomarkers of low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols efficacy, to maintain nutritional adequacy and to simplify the adherence to diet by labeling Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols content in commercial products.

RESUMO Objetivo: Nos últimos anos, foram feitos esforços consideráveis para esclarecer o papel da dieta com baixo teor de oligossacarídeos fermentáveis, dissacarídeos, monossacarídeos e polióis (FODMAPs) para o tratamento de distúrbios gastrintestinais funcionais (DGIFs). Esta revisão narrativa teve como objetivo fornecer aos profissionais uma síntese do conhecimento atual sobre o papel de uma dieta com baixo teor de FODMAPs (BFM) na redução dos sintomas associados a distúrbios funcionais de dor abdominal (DFDA) em crianças. Esta revisão está focada na fisiopatologia, eficácia e crítica da dieta BFM em crianças. Fontes: O banco de dados Cochrane, Pubmed e Embase foram pesquisados com o uso dos termos específicos para intervenções na dieta FODMAP e DFDA. Resumo dos achados: Em crianças, apenas um estudo controlado randomizado e um estudo aberto relataram resultados positivos da dieta BFM; um estudo controlado randomizado mostrou exacerbação dos sintomas com frutanos em crianças com síndrome do intestino irritável; nenhum efeito foi encontrado para a dieta livre de lactose, enquanto dietas com restrição de frutose foram eficazes em 5/6 estudos. Conclusões: Existem poucos estudos que avaliam BFM em DFDA em crianças, com dados encorajadores sobre a eficácia terapêutica, particularmente de dietas com restrição de frutose. Esforços adicionais ainda são necessários para preencher essa lacuna de pesquisa e esclarecer a maneira mais eficiente de adaptar as restrições dietéticas com base na tolerância do paciente e/ou identificação de biomarcadores potenciais de eficácia da BFM, para manter a adequação nutricional e simplificar a adesão à dieta, ao incluir informações sobre conteúdo de FODMAPs em rótulos de produtos comerciais.

Chronic lactose intake modifies the gastric emptying of monosaccharides but not of disaccharides in weanling rats

Ninety-six weanling male Wistar rats were fed for four weeks one of two different chows: a normal rat chow containing 55.5 percent (w/w) starch (control group, N = 48) or a rat chow in which starch was partially replacced by lactose, in such a way that the experimental group (N = 48) received 35.3 per cent (w/w) starch and 20 percent (w/w) lactose. The gastric emptying of fluid was then studied by measuring the gastric retention of four test meals containing lactose (5 percent or 10 percent, w/v) or glucose + galactose (5 percent or 10 percent, w/v). Homogenates of the small intestine were assayed for lactase activity. The gastric retention values were obtained 15 min after orogastric infusion of the liquid meals. The median values for gastric retention of the 5 percent lactose solutions were 37.7 percent for the control group and 37.0 percent for the experimental group (P>0.02) For the 10 percent lactose solution the median values were 51.2 percent and 47.9 percent (P>0.02) for the control and experimental groups, respectively. However, for the 2.5 percent glucose + 2.5 percent galactose meal the median gastric retention was lower (P<0.02) in the group fed a lactose-enriched chow (38.5 percent) than in the control group (41.6 percent). For the 5 percent glucose + 5 percent galactose solution the median values were not statistically different between groups, 65.0 percent for the control group and 58.8 percent for the experimental group. The median values of the specific lactase activity in the small intestine homogenate was 0.74 U/g in the control group and 0.91 U/g in the experimental group. These values were not statistically different (P>0.05). These results suggest that the prolonged ingestion of lactose by young adult rats changes the gastric emptying of a solution containing 5 percent monosaccharides. This adaptation may reflect the desensitization of intestinal nutrient receptors, possibly by an osmotic effect of lactose present in the chow.

Estudo comparativo do esvaziamento gástrico de dissacarídios e de seus respectivos monossacarídios em ratos com deficiência ontogênica de lactase / Comparative study of the gastric emptying of disaccharides and their respective monosaccharides in rats with ontogenic lactase deficiency

Com a finalidade de avaliar o esvaziamento gástrico de dissacarídios e monossacarídios, foram empregados no estudo 64 ratos Wistar, machos, pesando, em média, 180g. com idade de 8-10 semanas de vida, divididos em grupos de oito animais cada. Os grupos foram assim constituídos: grupo maltose, grupo sacarose, grupo lactose e grupo lactulose e os correspondentes grupos de monossacarídios: grupos glicose, grupo frutose + glicose, grupo galactose + glicose e grupo galactose + frutose. Cada animal de cada grupo recebeu, por via orogástrica, após jejum alimentar de 20h, refeiçäo de prova constituída de uma soluçäo a 10% (p/v) de açucar, acrescida de fenol vermelho na concentraçäo de 6mg/dl, como marcador. O volume empregado foi de 2ml/100g de peso do animal. A retençäo gástrica foi determinada aos 10 min após infusäo da refeiçäo de prova, e expressa em porcentagem. Os resultados (X ñ SE) das retençöes gástricas (%) da sacarose (35,0ñ 1,8), lactose (30,4 ñ 1,5) e lactulose (29,5 ñ 1,6 foram significativamente menores (teste t, alfa = 0,05) que os observados com os respectivos monossacarídios, ou seja, glicose + frutose (46,9 ñ 2,6), glicose + galactose (48,3 ñ 2,4), galactose + frutose (43,5 ñ 1,5). Näo foi observada diferença da retençäo gástrica de maltose (49,0 ñ 4,7), quando comparada com a glicose (53,0 ñ 3,0). Entre os dissacarídios, a análise estatístoca (análise de variância seguida do teste de Tukey, alfa = 0,05) dos resultados näo mostrou diferenças na retençäo gástrica de sacarose, lactose e lactulose. A retençäo gástrica da maltose foi significativamente maior em relaçäo aos outros dissacarídios. Näo foram observadas diferenças significativas na retençäo gástrica dos monossacarídios. Estas observaçöes indicam que a menor concentraçäo de dissacaridases (sacarase, lactase) ou aausência de uma enzima específica (lactulase), na mucosa do intestino delgado, induz um esvaziamento gástrico mais rápido dos respectivos dissacarídios. O fenômeno pode ser explicado pela falta de estímulo dos receptores que modulam o esvaziamento gástrico, lcoalizados mais profundamente em relaçäo às enzimas

Gastric emptying of maltose, sucrose, lactose and lactulose in rats with ontogenic lactase deficiency

The gastric emptying of maltose, sucrose, lactose and lactulose was compared in young adult ratswith ontogenic lactase deficiency. Eight animalswere employed for each sugar meal at each time od study (total number of animals = 192). Each animal received a test meal consisting of a solution of the sugar (100 mg/ml) and phenol red as marker and gastric retention was measured at 5,10,20,30,45 and 60 min after orogastric infusion of the test meal. Gastric retention was determined by measuring the concentration of the marker in the residual test meal recovered from the stomach after killing the animal. There was no difference between the gastric emptying of lactose and lactulose. The gastric emptying of maltose was significantly slower during the initial 30 min and the emptying of sucrose was identical to that of maltose only at 5 min and could not be distinguished from that oflactose and lactulose at later times. These data support the observation, made in human subjects, that under conditions of ontogenic lactase deficiency, the modulation of gastric emptying of lactose is ineffective. It is possible that the rapid emptying of sucrose is due to the saturation of sucrase because of substrate overload which impairs the intestinal inhibitory control of gastric emptying

Fructose 2,6-bisphosphate and trehalose metabolism in Saccharomyces cerevisiae

1. A regulatory mutant of Sccharomyces (fdp) unable to activate fructose 1,6-bisphosphatase present a normal response to the glucose and fructose signals as measured by trehalase activation, indicating that the inability of the strain to grow on these sugars is caused by a defect located beyond membrane interactions. 2. In vivo experiments with a mutant strain bearing a phosphoglucoisomerase gene (pgil-delta) deletion showed that activation of trehalase and deactivation of the tehalose-6-phosphate synthase complex occurred to the same extent whether glucose or fructose was used as signal. 3. These results suggest that fructose-2,6-bisphosphate is not involved in the interconversion of forms of the enzymes of trehalose metabolism. Furthermore, when fructose-2,6-bisphosphate was assayed on trehalose synthesizing activity using cell-free extracts and partially purified preparations of the complex, no effect was observed. 4. We conclude that regulation by cAMP fulfills the requirements for control of trehalose levels in Saccharomyces