Prebiotic Galacto-Oligosaccharides Impact Stool Frequency and Fecal Microbiota in Self-Reported Constipated Adults: A Randomized Clinical Trial.

Constipation is a major issue for 10-20% of the global population. In a double-blind randomized placebo-controlled clinical trial, we aimed to determine a dose-response effect of galacto-oligosaccharides (GOS) on stool characteristics and fecal microbiota in 132 adults with self-reported constipation according to Rome IV criteria (including less than three bowel movements per week). Subjects (94% females, aged: 18-59 years) received either 11 g or 5.5 g of BiotisTM GOS, or a control product, once daily for three weeks. Validated questionnaires were conducted weekly to study primarily stool frequency and secondary stool consistency. At base- and endline, stool samples were taken to study fecal microbiota. A trend towards an increased stool frequency was observed after the intervention with 11 g of GOS compared to control. While during screening everybody was considered constipated, not all subjects (n = 78) had less than three bowel movements per week at baseline. In total, 11 g of GOS increased stool frequency compared to control in subjects with a low stool frequency at baseline (≤3 bowel movements per week) and in self-reported constipated adults 35 years of age or older. A clear dose-response of GOS was seen on fecal Bifidobacterium, and 11 g of GOS significantly increased Anaerostipes hadrus. In conclusion, GOS seems to be a solution to benefit adults with a low stool frequency and middle-aged adults with self-reported constipation.

Whey protein supplementation does not accelerate recovery from a single bout of eccentric exercise.

The current double blind, randomized, placebo-controlled trial with two parallel groups aimed to assess the impact of whey protein supplementation on recovery of muscle function and muscle soreness following eccentric exercise. During a 9-day period, forty recreationally active males received twice daily supplementation with either whey protein (PRO; 60 g/day) or an iso-energetic amount of carbohydrate (CON). Muscle function and soreness were assessed before, and 0, 3, 24, 48, and 72 h after performing 100 drop jumps. Recovery of isometric maximal voluntary contraction (MVC) did not significantly differ between groups (timextreatment, P = 0.56). In contrast, the recovery of isokinetic MVC at 90°·s-1 was faster in CON as opposed to PRO (timextreatment interaction, P = 0.044). Recovery of isokinetic MVC at 180°·s-1 was also faster in CON as opposed to PRO (timextreatment interaction, P = 0.011). Recovery of countermovement jump performance did not differ between groups (timextreatment interaction, P = 0.52). Muscle soreness, CK and CRP showed a transient increase over time (P < 0.001), with no differences between groups. In conclusion, whey protein supplementation does not accelerate recovery of muscle function or attenuate muscle soreness and inflammation during 3 days of recovery from a single bout of eccentric exercise.

Stool characteristics of infants receiving short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides: a review.

Human milk is considered to be the optimal source of infant nutrition. Some of the benefits of breastfeeding have been ascribed to human milk oligosaccharides (HMO). For instance, HMO can affect faecal characteristics such as stool consistency and stool frequency. Such effects on stool characteristics can be beneficial for young infants as hard stools and even constipation is common in that age group. Prebiotics in infant milk formulas have been introduced to exert similar functionalities. A specific mixture of prebiotics consists of a combination of short chain galacto-oligosaccharides and long-chain fructo-oligosaccharides (scGOS/lcFOS) in a ratio of 9:1. This specific mixture has been developed to closely resemble the molecular size composition of HMO. Many studies have been done with scGOS/lcFOS, and indicators for digestive comfort have often been included as secondary outcomes. This review summarizes the effects of scGOS/lcFOS (9:1) on stool consistency, stool frequency and transit time in healthy term and preterm infants. In several of the studies with scGOS/lcFOS in a ratio of 9:1 in infant milk formulas, positive effects of this mixture on stool characteristics such as stool consistency and stool frequency were observed. As stool consistency was shown to be correlated to whole gut transit time, scGOS/lcFOS can be hypothesised to have a role in reducing the risk of constipation.

The early settlers: intestinal microbiology in early life.

The human intestinal microbiota forms an integral part of normal human physiology, and disturbances of the normal gut microbiology have been implicated in many health and disease issues. Because newborns are essentially sterile, their microbiota must establish and develop from the very first days of life. The first colonizers play an important role in the development of the ecosystem and may impact the long-term composition and activity of the microbiota. These first settlers obviously develop and proliferate dependent on host characteristics and diet, but other factors can also significantly contribute to this vital biological process. Considering the importance of the microbiota for the human immune, metabolic, and neurological systems, it is important to understand the dynamics and driving determinants of this development. This review gives a global overview of our current understanding of the different factors impacting the intestinal microbiology in early life.

Development of healthy eating habits early in life. Review of recent evidence and selected guidelines.

Encouraging healthy eating habit development early in life is a way to prevent the onset of diet-related diseases. This review focuses on the period ranging from the beginning of complementary feeding until the age of 3 years. Its first objective was to review relevant themes in the most recent literature on the development of healthy eating habits in this period. Its second objective was to evaluate to what extent international and national feeding guidelines cover these themes. Analysed guidelines included WHO, European Network for Public Health Nutrition, US and two European national guidelines (UK and France). They were evaluated using a 4-pt scale and compared. Well-covered themes in current literature include the influence of exposure on later acceptance, the role of variety and parental styles. Themes that occur more rarely include the role of texture, the development of autonomy, the optimization of variety, acceptable consumption levels of sweet and salty foods, and the way to cope with food refusal. Guidelines in general cover most of the themes, but some of the national guidelines are incomplete. Finally, guidelines should give more practical tips to parents, especially to help them establish a responsive feeding behaviour.

A dietary fiber mixture versus lactulose in the treatment of childhood constipation: a double-blind randomized controlled trial.

BACKGROUND: Constipation is a common problem in children. As first-line treatment, increased dietary fiber is often advocated. To our knowledge, however, no large studies evaluating the effect of dietary fibers in childhood constipation have been published. PATIENTS AND METHODS: A randomized, double-blind, prospective controlled study was performed. Patients received either a fiber mixture or lactulose in a yogurt drink. After a baseline period of 1 week, patients were treated for 8 weeks followed by 4 weeks of weaning. Polyethylene glycol 3350 was added if no clinical improvement was observed after 3 weeks. Using a standardized bowel diary, parents recorded defecation frequency during the treatment period. In addition, incontinence frequency, stool consistency, presence of abdominal pain and flatulence, necessity for step-up medication, and dry weight of feces were recorded, as were adverse effects. RESULTS: A total of 147 children were eligible; 12 children wished not to participate. Of the remaining children, 65 were randomized to treatment with fiber mixture and 70 to treatment with lactulose. In all, 97 children completed the study. No difference was found between the groups after the treatment period concerning defecation frequency (P = 0.481) and fecal incontinence frequency (P = 0.084). However, consistency of stools was softer in the lactulose group (P = 0.01). Abdominal pain and flatulence scores were comparable (P = 0.395 and P = 0.739, respectively). The necessity of step-up medication during the treatment period was comparable (P = 0.996), as were taste scores (P = 0.657). No serious adverse effects were registered. CONCLUSIONS: A fluid fiber mixture and lactulose give comparable results in the treatment of childhood constipation.

Fecal secretory immunoglobulin A is increased in healthy infants who receive a formula with short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides.

In this double-blind, randomized, placebo-controlled study, we investigated the effect of an infant milk formula with 6 g/L short-chain galacto- and long-chain fructo-oligosaccharides [(scGOS/lcFOS) ratio 9:1] on the development of the fecal secretory immunoglobulin A (sIgA) response and on the composition of the intestinal microbiota in 215 healthy infants during the first 26 wk of life. The infants received breast milk or were randomized to receive an infant milk formula with or without scGOS/lcFOS. Stool samples were collected after 8 and 26 wk of intervention. The concentration of fecal sIgA was determined by ELISA, and the composition of the intestinal microbiota was determined by quantitative fluorescent in situ hybridization. The scGOS/lcFOS group and the control group were compared in the statistical analysis. A breast fed group was included as a reference. In total, 187 infants completed the study. After 26 wk of intervention, in infants that were exclusively formula fed, the concentration of sIgA was higher (P < 0.001) in the scGOS/lcFOS group (719 microg/g) than in the control group (263 microg/g). In addition, the percentages of bifidobacteria were higher in the scGOS/lcFOS group (60.4%) than in the control group (52.6%, P = 0.04). The percentages of Clostridium spp. were 0.0 and 3.27%, respectively (P = 0.006). In conclusion, an infant milk formula with 6 g/L scGOS/lcFOS results in higher concentrations of fecal sIgA, suggesting a positive effect on mucosal immunity.

Effect of prebiotic galacto-oligosaccharide, long-chain fructo-oligosaccharide infant formula on serum cholesterol and triacylglycerol levels.

OBJECTIVE: Cholesterol is a nutrient of essential importance in infant feeding because it is necessary in membrane development. In adults with high lipid levels, high doses of inulin (oligofructose) inconsistently decreased levels of serum cholesterol. The aim of the present study was to evaluate cholesterol and triacylglycerol levels in infants receiving a formula with a specific mixture of 0.6 g/100 mL of galacto-oligosaccharides (GOS) and long-chain fructo-oligosaccharides (lcFOS) in a ratio of 9/1, a control formula, or breast milk. Because the level of lcFOS in the infant milk is low, we hypothesized that there would be no differences between the formula groups. METHODS: Two hundred fifteen infants were included in a prospective, randomized, double-blinded, placebo-controlled trial during the first 6 mo of life. Formula-fed infants were randomized to receive a standard infant formula with a specific mixture of 0.6 g/100 mL of GOS/lcFOS, in a ratio of 9/1, or a control formula. Breast-fed infants were randomized to receive one of these two formulas after the mother had decided to discontinue breastfeeding. Serum levels of cholesterol, high-density lipoprotein, low-density lipoprotein (LDL), and triacylglycerol were determined at 8 and 26 wk of age and were provided for infants who received the GOS/lcFOS formula or control formula from birth or after cessation of breastfeeding and for the subgroups that were fully fed with breast milk and formula. RESULTS: One hundred eighty-seven infants completed the study. Total cholesterol and LDL levels at 8 and 26 wk were significantly lower in the formula-fed groups than in the breast-fed infants. There were no significant differences between the formula-fed groups. Levels of triacylglycerols and high-density lipoprotein did not differ between groups. CONCLUSION: Our study demonstrated no differences in total cholesterol and LDL cholesterol in infants receiving an infant formula with GOS/lcFOS from infants receiving a control infant formula. Furthermore, total cholesterol and LDL cholesterol levels were higher in breast-fed infants than in formula-fed infants.

Dietary fructo-oligosaccharides in healthy adults do not negatively affect faecal cytotoxicity: a randomised, double-blind, placebo-controlled crossover trial.

Fructo-oligosaccharides (FOS) are widely used in commercial food products. Most studies on FOS concern the health benefits, but some negative effects were recently reported concerning the faecal cytotoxicity and excretion of mucin-type oligosaccharides in combination with a Ca-restricted diet. The present study was performed to investigate whether these effects of FOS are observed in adults consuming a regular diet unrestricted in Ca. The study was a randomised, double-blind, placebo-controlled crossover trial, involving eleven healthy adults, who consumed 25-30 g FOS or maltodextrin (control) in a random order for 2 weeks in addition to their regular diet. Stools were collected for analysis of pH and SCFA (as markers of fermentation), for the assessment of faecal water cytotoxicity, and for the analysis of alkaline phosphatase activity (as a marker of epithelial cell turnover) and O-linked oligosaccharides (to estimate the excretion of mucin-type oligosaccharides). FOS consumption significantly altered bacterial fermentation (increased percentage of acetate, decreased percentage of butyrate) and tended to decrease stool pH. Furthermore, FOS consumption resulted in a significantly higher stool frequency and in significantly more complaints of flatulence. No significant differences between the control and FOS period were observed in the mean cytotoxicity of faecal water (37.5 (SEM 6.9)% v. 18.5 (SEM 6.9)%; P=0.084), in mean alkaline phosphatase activity (27.7 (SEM 2.9) v. 24.6 (SEM 3.2) U/g dry faeces; P=0.496) or in the mean excretion of mucin-type oligosaccharides (49.9 (sem 4.0) v. 53.5 (SEM 4.3) mg/g dry faeces; P=0.553). We conclude that dietary FOS in a dose up to 25-30 g/d altered the bacterial fermentation pattern but did not affect faecal cytotoxicity or the faecal concentration of mucin-type oligosaccharides in human adults consuming a regular diet.

Bifidogenic effects of solid weaning foods with added prebiotic oligosaccharides: a randomised controlled clinical trial.

OBJECTIVES: Breast-fed infants have relatively high proportions of faecal bifidobacteria. This bifidogenic microbiota is at least partly explained by the high levels of prebiotic oligosaccharides in human milk. The present study aimed at testing the effect of solid foods with added prebiotic galacto- and fructo-oligosaccharides (GOS/FOS) on the composition of the intestinal microbiota of fully formula-fed infants during the weaning period. METHODS: The study was a double-blind, randomised trial with an intervention period of 6 weeks. Infants aged 4 to 6 months who were about to start consuming solid foods were randomised to receive either weaning products with a mixture of GOS/FOS or control weaning products with maltodextrin. After an adjustment period, the presented daily dose of GOS/FOS was 4.5 g. Total numbers of bacteria and bifidobacteria in faecal samples were analysed with fluorescent in situ hybridization. RESULTS: Thirty-five infants were included in the study, and 20 infants were included in a per-protocol analysis. In the GOS/FOS group, the faecal percentage of bifidobacteria significantly increased from 43% to 57% (P = 0.031) from week 0 to week 6, but did not significantly change in the control group (36% and 32%, respectively; P = 0.387). The change in the percentage of bifidobacteria between week 0 and week 6 in the GOS/FOS was significantly different from this change in the control group (P = 0.026). CONCLUSIONS: We conclude that addition of GOS/FOS to solid foods induces an increase in the faecal proportion of bifidobacteria in the intestinal microbiota of fully formula-fed infants with an established, mixed-type microbiota in the weaning period.

Colon microflora in infants fed formula with galacto- and fructo-oligosaccharides: more like breast-fed infants.

OBJECTIVES: The intestinal flora of breast-fed infants is generally dominated by Bifidobacteria. We aimed to investigate whether an infant formula supplemented with galacto-oligosaccharides and fructo-oligosaccharides (GOS/FOS) is able to establish a bifido-dominant microflora, not only in numbers but also with respect to the metabolic activity in the colon. METHODS: Two groups of infants fed infant formula with 0.8 g/100 ml GOS/FOS in a ratio of 9:1 (OSF group), or control formula (SF group) were evaluated in a randomised, double blind, placebo controlled intervention study. A breast-fed group was studied in parallel. At study onset and after 4 and 6 weeks, faecal samples were examined for the number of bifidobacteria, pH, short chain fatty acids and lactate. RESULTS: After 6 weeks, the mean proportion of bifidobacteria was significantly higher in the OSF group (59.6% versus 49.5% in the SF group; P < 0.05). Compared with controls, infants in the OSF group had a lower stool mean pH and an increased proportion of acetate and a decreased proportion of propionate. The mean pH in the OSF and SF groups were 5.7 and 6.3, respectively (P < 0.001). CONCLUSIONS: The addition of the prebiotic GOS/FOS mixture to an infant formula has a stimulating effect on the growth of bifidobacteria and on the metabolic activity of the total intestinal flora. The changes in short chain fatty acids, lactate and pH in the prebiotic group represent a fermentation profile that is closer to that observed in breast-fed infants compared to infants fed control formula.