Caloric Meal Research Articles

Nissen fundoplication in children with cerebral palsy: Influence on rate of gastric emptying and postprandial symptoms in relation to protein source in caloric liquid meals

The aim was to study the influence of Nissen fundoplication on rate of gastric emptying and postprandial symptoms in relation to protein source in liquid meals in children with cerebral palsy. Ten children with cerebral palsy and Nissen fundoplication and ten with cerebral palsy without Nissen fundoplication were studied. Patients had gastrostomy and received two meals, double-blinded, in random order, on separate days. Meals contained a standardised carbohydrate and fat base plus one of two protein modules (Meal A: 100% casein; Meal B: 40% casein/60% whey). The (13)C octanoic acid breath test was used to assess gastric emptying. Postprandial symptoms were recorded. Results are given as median. For meal A and B, respectively, time until 50% of the meal had emptied (T1/2) was 110 in the Nissen fundoplication- and 181 min in the non-Nissen fundoplication group, (p = 0.35) and 50 and 85 min (p = 0.25). Seven in the Nissen fundoplication group reported postprandial symptoms to meal B, none in the non-Nissen fundoplication group (p < 0.01). Compared with cerebral palsy-children without Nissen fundoplication, those with Nissen fundoplication have postprandial symptoms more frequently after receiving a rapid emptying meal. Gastric emptying alone, however, does not seem to explain the symptom occurrence. ClinicalTrials.gov: UUSKBK 28200706.

Effect of food on the pharmacokinetics of emtricitabine/rilpivirine/tenofovir disoproxil fumarate single‐tablet regimen

PurposeEmtricitabine/rilpivirine/tenofovir disoproxil fumarate (FTC/RPV/TDF; Complera®/Eviplera®) is a recently approved complete single tablet regimen (STR) for treatment‐naïve HIV‐1‐infected patients. Exposures of rilpivirine single agent Edurant®) are 40% lower when administered under fasted conditions versus standard meal (533 kcal) or high‐fat/high caloric meal (928 kcal). The present study evaluated the effect of standard and light meal on FTC/RPV/TDF pharmacokinetics (PK).MethodsThis was a three‐period, six‐sequence, crossover single‐dose study (N = 24) in healthy subjects that received FTC/RPV/TDF with a standard meal (540 kcal, 21 g fat), light meal (390 kcal, 12 g fat) or under fasted conditions (each treatment 18 days apart). Blood sampling was done for 192 hrs and PK of RPV, FTC, and tenofovir (TFV) were evaluated. Safety was monitored throughout the study and at 14‐day follow‐up. Exposures of study drugs from the various treatments were compared to fasted or standard meal as reference using 90% confidence interval (CI) bounds of 80 to 125% about the geometric mean ratio (GMR).ResultsOf the 24 enrolled subjects, 23 completed. There were no Grade 3 or 4 adverse events (AEs), serious AEs, or AEs leading to discontinuation. Compared to fasting conditions, RPV AUCinf was 9% and 16% higher with a light meal or standard meal, respectively. Compared to standard meal, RPV AUCinf was 14% and 6% lower with fasted or light meal administration, respectively. TFV and FTC exposures were consistent with their established PK/food effect (Table 1). Exposure versus standard meal GMR (%) 90% CI fasted/standard GMR (%) 90% CI light meal/standard Rilpivirine AUCinf (ng*h/mL) 85.9 (72.7, 101) 93.8 (79.2, 111) AUClast (ng*h/mL) 83.7 (70.6, 99.3) 94.9 (79.9, 113) Cmax (ng/mL) 79.1 (65.5, 95.5) 106 (87.6, 129) Emtricitabine AUCinf (ng*h/mL) 105 (102, 108) 101 (98.2, 104) AUClast (ng*h/mL) 105 (102, 108) 101 (98.2, 104) Cmax (ng/mL) 107 (101, 114) 103 (96.2, 109) Tenofovir AUCinf (ng*h/mL) 72.5 (68.1, 77.2) 93.0 (87.2, 99.2) AUClast (ng*h/mL) 70.9 (66.3, 75.8) 92.8 (86.7, 99.4) Cmax (ng/mL) 75.8 (67.8, 84.6) 84.8 (75.8, 94.9) ConclusionAdministration with food has a modest effect on RPV PK as FTC/RPV/TDF STR versus fasted dosing, with no relevant differences between a light meal versus standard meal. FTC/RPV/TDF STR can be administered with a light or standard meal.

Tu1483 Symptoms of Small Intestinal Bacterial Overgrowth in Patients With Gastroparesis

Background: Delayed gastric emptying is commonly seen in small intestinal bacterial overgrowth (SIBO), and is often proposed as a major risk factor for this condition. The 14C DXylose breath test (XBT) has been used to diagnose SIBO and based on our data has demonstrated excellent reliability as a diagnostic measure (King & Toskes Gastro 1986). Delayed gastric emptying affects the delivery of nutrients to the small intestine and therefore could impact the results of XBT. Objectives: We aim to evaluate (1) whether delayed gastric emptying affects the pattern of D-Xylose BT results, and (2) whether delayed gastric emptying increases the risk of SIBO. Methods: A retrospective chart review was conducted on 846 patients with XBT between 2005 and 2009, male: female 168:678 (ratio 1:4), median age 57 years (age range 20-88). All of the patients were referred by GI clinics for various GI symptoms to rule out SIBO. The XBT was obtained by measuring 14C at baseline, 30, 60 and 180 minutes as per our protocol. Positive XBT was defined as an increased value of 14C at any one or more time points. A delayed gastric emptying by gastric emptying scintigraphy (GES) was defined by T1/2 greater than 90 minutes after ingestion of a standard 254 calorie meal based on 2 hour continuous scanning. Results: Of 846 patients with XBT, 498 patients tested positive for SIBO. Of these patients positive for SIBO, 229 had GES completed and 41% (94/229) were found to have delayed gastric emptying. Of 348 patients with a negative XBT, 167 had GES with 45% (75/167) having delayed gastric emptying. The risk of delayed gastric emptying was similar in both XBT positive and the negative group, with a likelihood ratio of 0.7, p>0.2. Of 229 patients with a positive XBT, the proportion of patients with a positive D-Xylose BT at 30 and 60 minutes were similar in both the normal and abnormal GES groups. However, a significantly increased number of patients with delayed gastric emptying had a positive XBT at 180 minutes (72.7% vs 54.4%, likelihood ratio = 6, p<0.02). Conclusion: Delayed gastric emptying significantly delays XBT positivity to 180 minutes. Prolonged duration of XBT up to the 180-minute period would increase the sensitivity of the breath test in patients with underlying motility disorders such as gastroparesis or even small bowel dysmotility. Surprisingly, based on our retrospective analysis, delayed gastric emptying was not found to be an independent risk factor of SIBO. A well-designed prospective study in the future with standard GES would be indicated to assess the association of SIBO and gastroparesis. (Acknowledgment: This study was funded by University of Florida CTSI NIH Grant UL1RR029890, and UF KL2RR029888 Award to Baha Moshiree MD, MS)

Tu1481 Slow Gastric Emptying Delays 14c D-Xylose Breath Test PEAK Time in Small Intestinal Bacterial Overgrowth (SIBO)

Background: Delayed gastric emptying is commonly seen in small intestinal bacterial overgrowth (SIBO), and is often proposed as a major risk factor for this condition. The 14C DXylose breath test (XBT) has been used to diagnose SIBO and based on our data has demonstrated excellent reliability as a diagnostic measure (King & Toskes Gastro 1986). Delayed gastric emptying affects the delivery of nutrients to the small intestine and therefore could impact the results of XBT. Objectives: We aim to evaluate (1) whether delayed gastric emptying affects the pattern of D-Xylose BT results, and (2) whether delayed gastric emptying increases the risk of SIBO. Methods: A retrospective chart review was conducted on 846 patients with XBT between 2005 and 2009, male: female 168:678 (ratio 1:4), median age 57 years (age range 20-88). All of the patients were referred by GI clinics for various GI symptoms to rule out SIBO. The XBT was obtained by measuring 14C at baseline, 30, 60 and 180 minutes as per our protocol. Positive XBT was defined as an increased value of 14C at any one or more time points. A delayed gastric emptying by gastric emptying scintigraphy (GES) was defined by T1/2 greater than 90 minutes after ingestion of a standard 254 calorie meal based on 2 hour continuous scanning. Results: Of 846 patients with XBT, 498 patients tested positive for SIBO. Of these patients positive for SIBO, 229 had GES completed and 41% (94/229) were found to have delayed gastric emptying. Of 348 patients with a negative XBT, 167 had GES with 45% (75/167) having delayed gastric emptying. The risk of delayed gastric emptying was similar in both XBT positive and the negative group, with a likelihood ratio of 0.7, p>0.2. Of 229 patients with a positive XBT, the proportion of patients with a positive D-Xylose BT at 30 and 60 minutes were similar in both the normal and abnormal GES groups. However, a significantly increased number of patients with delayed gastric emptying had a positive XBT at 180 minutes (72.7% vs 54.4%, likelihood ratio = 6, p<0.02). Conclusion: Delayed gastric emptying significantly delays XBT positivity to 180 minutes. Prolonged duration of XBT up to the 180-minute period would increase the sensitivity of the breath test in patients with underlying motility disorders such as gastroparesis or even small bowel dysmotility. Surprisingly, based on our retrospective analysis, delayed gastric emptying was not found to be an independent risk factor of SIBO. A well-designed prospective study in the future with standard GES would be indicated to assess the association of SIBO and gastroparesis. (Acknowledgment: This study was funded by University of Florida CTSI NIH Grant UL1RR029890, and UF KL2RR029888 Award to Baha Moshiree MD, MS)

Mo2002 Desensitization of the IGF-I Receptor Signal Transduction in Rat Colon With Experimental Colitis

real-time contrast-enhanced US (CEUS) with low-mechanical index, after the injection of 2.4ml of sulfur hexafluoride-filled microbubbles (SonoVue, Bracco, Milan, Italy). The vascularity of the terminal ileum was quantified by a dedicated software (Qontrast, Bracco, Milan Italy) and different kinetic parameters of vascular perfusion calculated. Inflammation, angiogenesis and endothelial function were evaluated by measuring VEGF, TNFalpha and NO. All measurements were performed before and 30 minutes after a standard caloric meal (Resource Energy Nestle, 300 Kcal). Statistical analysis was performed using Wilcoxon and Spearman’s rank correlation tests. Results: Basal and postprandial SH and CEUS parameters did not significantly differ between CD patients and controls, whilst resistance index of arteriolar bed, detectable only in CD patients, showed a significant reduction after meal. NO and TNF-alpha significantly reduced after meal only in CD patients. A significant correlation was found between CEUS parameters of vascular perfusion, and VEGF before the meal (r = 0.63 0.71; p < 0.05). Furthermore, we found a significant correlation between splanchnic blood flow and CEUS parameters of vascular perfusion during fasting (r = 0.66 0.79; p < 0.05), but not in the postprandial period. Conclusions: In ileal CD patients, splanchnic blood flow is correlated with vascular perfusion of the intestinal wall, which is related to VEGF and likely with angiogenesis. This is evident only during fasting, but not in the post-prandial period, where other vasoactive factors are probably involved.

Assessment of individual metabolic response to a low‐calorie smoothie challenge using targeted metabolomics

Assessing metabolic responsiveness to a standardized meal using metabolomics offers promise for identifying new interventions in metabolic diseases. However, previously tested meals appear to be too high in calories to be applicable to young patients with mitochondrial diseases, who often display a low nutrient handling capacity. This study assessed the metabolic response to a smoothie providing only 9% of daily calories (42% carbohydrate; 46% lipid; 12% protein). Plasma was collected from 4 healthy young adults before and 90 min after the smoothie and 111 metabolites reflecting normal (15 fatty acids; 12 amino acids) or dysregulated (58 organic acids, 25 acylcarnitines) nutrient metabolism were analyzed by mass spectrometry. Of all metabolites assessed, fatty acids displayed the greatest changes, but overall the average coefficient of variation (CV) for fold‐changes (26%) was smaller than inter‐individual CVs for absolute values assessed before and after the meal (40% for both). Principal component analysis revealed the consistency of the postprandial response within individuals, but clearly separated them from each other. This study shows the feasibility of measuring the metabolic response to a low calorie meal despite large inter‐individual variations. For future studies, it appears warranted to include additional metabolite classes, particularly lipids. Supp.: FRSQ &amp; CIHR Emerging Team Grant.

Neural and humoral changes associated with the adjustable gastric band: insights from a rodent model

Bariatric surgical procedures, including the laparoscopic adjustable gastric band (LAGB), are currently the only effective treatments for morbid obesity, however, there is no clear understanding of the mechanisms underpinning the efficacy of LAGB. The aim of this study is to examine changes in activation of the sensory neuronal pathways and levels of circulating gut hormones associated with inflation of an AGB. The trajectory within the central nervous system of polysynaptic projections of sensory neurons innervating the stomach was determined using the transsynaptically transported herpes simplex virus (HSV). Populations of HSV-infected neurons were present in the brainstem, hypothalamus and cortical regions associated with energy balance. An elevation of Fos protein was present within the nucleus of the solitary tract, a region of the brainstem involved in the control of food intake, following acute and chronic band inflation. Two approaches were used to test (1) the impact of inflation of the band alone (on a standard caloric background) or (2) the impact of a standard caloric meal (on the background of the inflated band) on circulating gut hormones. Importantly, there was a significant elevation of glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) following oral gavage of a liquid meal in animals with pre-inflated bands. There was no impact of inflation of the band alone on circulating GLP-1, PYY or ghrelin in animals on a standard caloric background. These data are consistent with the notion that the LAGB exerts its effects on satiety, reduced food intake and reduced body weight by the modulation of both neural and hormonal responses with the latter involving an elevation of meal-related levels of GLP-1 and PYY. These data are contrary to the view that the surgery is purely 'restrictive'.

Correlation of Gastrointestinal Motility with 14C D-Xylose Breath Test in Small Intestinal Bacterial Overgrowth: 2011 ACG Presidential Poster

Purpose: Small intestinal bacteria overgrowth (SIBO) is diagnosed by measuring the early appearance of 14C following administration of 14C D-Xylose, which transits through the small intestine and is broken down by colonic bacteria. Gastrointestinal motility affects the delivery of intestinal contents and could impact the 14C D-Xylose breath test (BT) results. In this study, we aim to evaluate whether delayed gastric emptying, fast bowel transit (represented as diarrhea), and slow bowel transit (represented as constipation) affect the pattern of D-Xylose BT results. Methods: A retrospective chart review was conducted on 401 patients with a positive 14C D-Xylose BT between 2005 and 2009, Male:Female 35:366 (ratio 1:9.6), median age 60 years (age range 21-88). The clinical presentation, past medical history, and gastric emptying scintigraphy results were reviewed. The D-Xylose BT results were obtained by measuring 14C at baseline, 30, 60 and 180 minutes. Positive D-Xylose BT defined as an increase value of 14C at any one or more time frame. A delayed gastric emptying by scintigraphy was defined by T1/2 greater than 90 minutes after ingestion of a standard 254 calorie meal based on 2 hour continuous scanning. Results: Of 401 patients with positive D-Xylose BT, 186 patients had gastric emptying studies, and 77/186 patients were found to have delayed gastric emptying by scintigraphy. The proportion of patients with a positive BT at 30 and 60 minutes were similar in both the normal and abnormal gastric emptying group. However, a significantly increased number of patients with delayed gastric emptying had a positive D-Xylose BT at 180 minutes (84.4% vs. 68.8%, p<0.05). A total of 237 patients had reported diarrhea and 42 patients had reported constipation. Nevertheless, positivity time on the D-Xylose BT did not correlate with symptoms of diarrhea or constipation.Table: Table. Correlation of gastric emptying, diarrhea, and constipation with 14C D-xylose breath testConclusion: This study demonstrates that delayed gastric emptying correlates significantly with D-Xylose BT positivity at 180 minutes. Therefore, findings on the D-Xylose BT over the 180-minute period could warrant further investigations for an underlying motility disorder such as gastroparesis or even small bowel dysmotility. Therefore, performing the D-Xylose BT over a full 180-minute period of time is paramount. Interestingly, neither diarrhea nor constipation affects the pattern of D-Xylose breath test results. (NIH Grant UF CTSI 1UL1RR029890).

Low caloric value and high salt content in the meals served in school canteens

School lunch can contribute to aggravate food quality, by excess or deficiency, or it can contribute to compensate and alleviate them. This school meal should be an answer to combating the epidemic of obesity, and to feed some grace children. The objective was to study the nutritional composition of catering in canteens of public schools, from Northern municipalities in the District of Porto: Vila do Conde, Póvoa de Varzim, Santo Tirso and Trofa. Meals were subjected to laboratory analysis. Thirty two meals, four per each school were analysed, reference values for the analysis of the nutritional composition of meals were dietary reference intakes (USA) and eating well at school (UK). The average energy meal content was 447 kcal and the median 440 kcal (22% of daily calories). The average values of nutrients, per meal, were: lipids 9, 8 g, carbohydrate 65,7 g and proteins 24,0 g. In average the contribution for the meal energy was: 20% fat, 59% carbohydrate and 21% protein. In more than 75% of meals the contribution of lipid content was below the lower bound of the reference range. The average content of sodium chloride per meal was 3.4 g, and the confidence interval 95% to average 3.0 to 3.8 g, well above the recommended maximum value of 1.5 grams. The average content fiber per meal was 10.8 g higher than the minimum considered appropriate. In conclusion, the value low caloric meals was mainly due to the low fat content, and content salt of any of the components of the meal was very high.

Ghrelin inhibits autonomic function in healthy controls, but has no effect on obese and vagotomized subjects

Ghrelin inhibits sympathetic nervous system (SNS) activity in rodents. We studied the effect of ghrelin on healthy humans, in obesity and in vagotomized subjects. Randomized, double-blinded, placebo-controlled crossover. Seven lean [mean body mass index (BMI) 23·6 ± 0·9 kg/m(2) ], seven morbidly obese (mean BMI 50·9 ± 4·4 kg/m(2) ) and seven post-gastrectomy subjects (mean BMI 22·0 ± 1·1 kg/m(2) ). Subjects were randomized to intravenous ghrelin (5 pmol/kg/min) or saline over 270 min. Subjects had a fixed calorie meal and a free choice buffet during the infusion. Heart rate variability (HRV) was measured. Total power (TP) represents overall autonomic function, low-frequency (LF) power represents sympathetic and parasympathetic activity, and high-frequency (HF) power represents parasympathetic activity. Very low (VLO) frequency represents the frequency band associated with thermogenesis. Preliminary anova analysis, looking at all three subject groups together, showed that ghrelin had an overall highly significant inhibitory effect on TP (P = 0·001), HF power (P = 0·04), VLO power (P = 0·03) and no effect on LF (P = 0·07). Further subset analysis revealed that ghrelin had a significant effect on TP (P = 0·03), borderline effect on LF power (P = 0·06) and no effect on HF power (P = 0·1) in healthy controls. By contrast in obese subjects, ghrelin had no effect on TP (P = 0·3), LF (P = 0·5) and HF (P = 0·06) and also no effect in the vagotomized subjects on TP (P = 0·7), LF (P = 0·7) and HF (P = 0·9). Ghrelin had no effect on the LF/HF ratio. Ghrelin inhibits SNS activity in healthy controls with a moderate effect on parasympathetic nervous system activity but had no effect on obese subjects. Vagotomized subjects also did not respond to ghrelin, suggesting the vagus nerve is important for the effects of peripheral ghrelin on the SNS.

The Effect of Different Meal Compositions on the Pharmacokinetics of Treprostinil Diethanolamine in Healthy Volunteers

PURPOSE: Treprostinil diethanolamine (UT-15C) is a prostacyclin analog currently being evaluated as a sustained release (SR) osmotic tablet for the treatment of pulmonary arterial hypertension (PAH). Previous studies have demonstrated an improved pharmacokinetic profile with UT-15C administration following a 500 calorie meal as compared to fasting. Furthermore, anecdotal reports from investigators participating in clinical trials with UT-15C have suggested that some PAH patients may experience decreased tolerability with decreased caloric intake.

W1400 Use of a High Caloric Liquid Meal (Ensure Plus) as a Alternative Meal for Gastric Emptying Scintigraphy

W1400 Use of a High Caloric Liquid Meal (Ensure Plus) as a Alternative Meal for Gastric Emptying Scintigraphy

OC-068 Structure and function of the gastro-oesophageal junction in patients after laparoscopic fundoplication: concurrent magnetic resonance imaging and high-resolution manometry studies

<h3>Introduction</h3> Laparoscopic fundoplication provides effective reflux control in patients with gastro-oesophageal reflux disease (GERD); however a proportion of patients that undergo surgery experience troublesome symptoms. Improved results may be possible if more was known about the structural factors that effect treatment outcome. This study applied concurrent MRI and HRM technology to compare the structure and function of the GEJ in GERD patients after fundoplication to control groups of GERD patients and healthy participants (HPs). <h3>Methods</h3> Eight GERD patients were studied at least 3 months after laparoscopic fundoplication with subjectively good treatment outcome (7M, age 18–67 years). Results of pH-impedance monitoring off acid suppression before and after fundoplication were available. 12 patients with GERD on medical therapy (7M, age 20–55 years) and 12 HPs (7M, age 26–36 years) with no history of gastro-intestinal disease or surgery. Validated MRI measurements of the oesophago-gastric insertion angle (Radiology in press) and gastric volumes were performed at baseline and after ingestion of high calorie meal (McDonalds Cheeseburger, Chips, Milkshake, 735 kcal). Visual Analogue Scales (100 mm VAS) documented dyspeptic symptoms. <h3>Results</h3> GEJ pressure increased from before to after fundoplication (8.3±1.2 vs 14.2±1.7 mm Hg, p=0.03) whereas acid exposure (10.3±2.2 vs 5.4±2.1, p=0.001) and reflux episodes reduced (39±3 vs 24±2, p=0.019). The insertion angle after the meal was more obtuse after surgery than in the disease and healthy controls (61° vs 48° vs 41°, p&lt;0.008). Moreover normal variation of insertion angle with respiration was lost. Postprandial gastric air content was higher after fundoplication compared to the disease and healthy controls in absolute terms (523 vs 146 vs 178 ml, p&lt;0.001) and as a proportion of total gastric content (78% vs 12% vs 16%, p&lt;0.005). There was a positive correlation between insertion angle and gastric air content (r2=0.95, p=0.050). Postprandial abdominal bloating was higher for the fundoplication group compared to the GERD and healthy groups. (VAS 55±21 vs 13±23 vs 20±10 mm, p=0.049) and there was also an association between gastric air content and the this symptom (r2=0.82, p=0.07). <h3>Conclusion</h3> Novel, quantitative MRI measurements demonstrate alterations to GEJ structure after fundoplication, specifically to the oesophago-gastric insertion angle, that are linked to gastric retention of air and the sensation of bloating, even in patients with a good subjective outcome. Modification of surgical technique to restore more normal GEJ morphology may be equally effective for reflux protection but cause less troublesome bloating.

Mechanisms of symptomatic improvement after gastric electrical stimulation in gastroparetic patients

The aims were to investigate the effects of gastric electrical stimulation (GES) on autonomic function, gastric distention and tone, and central control mechanisms in gastroparetic patients. Ten gastroparetic patients refractory to standard medical therapy participated in this study and data were collected at baseline, within two weeks before surgery for implantation of GES system, and at follow-up sessions between 6 and 12 weeks after GES therapy was initiated. In each session, electrocardiogram, electrogastrogram (EGG) and gastric barostat measurements were conducted before and after a caloric liquid meal. Positron Emission Tomography (PET) brain scans were performed on a separate day. During GES therapy there was a significant increase in the discomfort threshold for mean pressure from 21 mmHg at baseline to 25 mmHg at follow-up, and for mean volume from 561 mL to 713 mL. A significant increase in the postprandial EGG power (amplitude) was observed between baseline and follow up. The sympathovagal balance was significantly decreased after GES therapy, indicating a significant increase in vagal activity. The cumulative PET data showed an increase in quantitative radioactive counts relative to the standardized data base in both the thalamic and caudate nuclei after chronic GES therapy. We conclude that our data suggest that the symptomatic improvement achieved by GES in gastroparesis is best explained by activation of vagal afferent pathways to influence CNS control mechanisms for nausea and vomiting accompanied by enhanced vagal efferent autonomic function and decreased gastric sensitivity to volume distention which enhances postprandial gastric accommodation.

A Small-Changes Approach Reduces Energy Intake in Free-Living Humans

Objective: America On the Move (AOM) is a national weight gain prevention initiative that promotes small lifestyle changes by increasing walking by 2000 steps/day and reducing energy intake by about 100 kcal/day. The study's intent was to determine the impact of these small changes recommendations on steps/day and energy intake.Methods: In this cross-sectional study, food and fluid intake and physical activity in 116 healthy overweight adults (BMI: 25–36 kg/m2; age: 18–60y) was compared between a non-intervention and an intervention week using diet diaries and pedometers. The major outcomes were steps/day, daily caloric intake, macronutrient intake and meal size. Within subject ANOVAs were conducted to compare results between intervention and non-intervention weeks.Results: Total energy intake was lower during intervention week than non-intervention week (P < .01), including macronutrient contents (all P's < .01), meal size (P < .01), consumption of sugar (P < .01), sugared sodas (P < .01) and sodium (P < .01). Steps/day were higher during intervention week than non-intervention week (P < .01).Conclusions: The results support previous research showing that the message to increase steps/day results in an increase in physical activity. The results demonstrate for the first time that the message to reduce intake by 100 kcal/day does actually result in a lower intake in the short term. People seem to be able to make positive changes in diet and physical activity in response to these messages. If these small changes can be sustained, this approach could be effective in preventing further weight gain in the population.

Preproghrelin‐derived Peptide, Obestatin, Fails to Influence Food Intake in Lean or Obese Rodents

Obestatin has been initially characterized as a new peptide derived from the ghrelin precursor, which suppresses food intake and inhibits the orexigenic and prokinetic actions of ghrelin when injected peripherally or centrally in lean mice. However, reproducing these data remains controversial. Reasons for the disparity may be the use of different doses, routes, and animal models. We aimed to investigate the effects of peripheral and intracisternal (IC) injection of obestatin on feeding, gastric motility, and blood glucose in rats as well as in diet-induced obese (DIO) mice. Food intake and gastric emptying of a semi-liquid caloric meal were measured after intraperitoneal (IP) injection of obestatin in rats and DIO mice. Gastric phasic motility and blood glucose were monitored in urethane-anesthetized rats after IC or intravenous (IV) injection of obestatin. Obestatin injected intraperitoneally at doses ranging from 0.1 to 3 mg/kg influenced neither acute food intake nor gastric emptying in rats. Obestatin injected intravenously at 0.3 or 3 mg/kg and IC at 7.5 or 30 microg/rat modified neither fasted gastric phasic motility nor blood glucose levels, while ghrelin (30 microg/kg, IV) increased and vagotomy suppressed gastric motility, and an oligosomatostatin analog (3 microg/rat, IC) decreased blood glucose. Obestatin, injected intraperitoneally (0.3 mg/kg) in DIO mice, did not alter feeding response to a fast, while urocortin 1 (10 microg/kg, IP) induced a 73.3% inhibition at 2 hours. Our data demonstrate that peripheral administration of obestatin did not modify food intake in rats or obese mice or gastric motor function in rats.

Low‐dose Pramlintide Reduced Food Intake and Meal Duration in Healthy, Normal‐Weight Subjects

We previously reported that a single preprandial injection (120 microg) of pramlintide, an analog of the beta-cell hormone amylin, reduced ad libitum food intake in obese subjects. To further characterize the meal-related effects of amylin signaling in humans, we studied a lower pramlintide dose (30 microg) in normal-weight subjects. In a randomized, double-blind, placebo-controlled, cross-over study, 15 healthy men (age, 24 +/- 7 years; BMI, 22.2 +/- 1.8 kg/m(2)) underwent a standardized buffet meal test on two occasions. After an overnight fast, subjects received a single subcutaneous injection of pramlintide (30 microg) or placebo, followed immediately by a standardized pre-load meal. After 1 hour, subjects were offered an ad libitum buffet meal, and total caloric intake and meal duration were measured. Compared with placebo, pramlintide reduced total caloric intake (1411 +/- 94 vs. 1190 +/- 117 kcal; Delta, -221 +/- 101 kcal; -14 +/- 9%; p = 0.05) and meal duration (36 +/- 2 vs. 31 +/- 3 minutes; Delta, -5.1 +/- 1.4 minutes; p < 0.005). Visual analog scale profiles of hunger trended lower and fullness higher during the first hour after pramlintide administration. In response to the buffet, hunger and fullness changed to a similar degree after pramlintide and placebo, despite subjects on pramlintide consuming 14% fewer kilocalories. Visual analog scale nausea ratings remained near baseline, without differences between treatments. Plasma peptide YY, cholecystokinin, and ghrelin concentrations did not differ with treatment, whereas glucagon-like peptide-1 concentrations after meals were lower in response to pramlintide than to placebo. These observations add support to the concept that amylin agonism may have a role in human appetite control.

Nutrient modulation of intestinal gas dynamics in healthy humans: dependence on caloric content and meal consistency

Nutrient modulation of intestinal gas dynamics in healthy humans: dependence on caloric content and meal consistency

Extracirculatory effects of noise of various frequency spectra in humans-effect of pink and blue noise on gastric myoelectrical activity and gastrointestinal passage of nutrients

Recent investigations in humans point out to a disturbing effect of auditory stimuli on the functional integrity of the brain-gut axis. The study was devoted to a systematic comparative evaluation of the effect of noises of different frequency spectra on the postprandial electrical and transport functions of the digestive tract in humans. Twenty six healthy subjects attended a cross-over study, which aimed at comparison of the effect of pink contrasted to blue noise within a given category (band or tonal) and a meal stimulus type (semi-liquid or solid test meal). A panel of noninvasive measurement methods was applied: heart rate variability (HRV) analysis, surface electrogastrography, (13)CO(2) breath tests for gastric emptying (GE), lactulose hydrogen breath test for orocecal transit time (OCTT). The blue tonal noise was rated the most annoying one, whereas solely the pink noises exerted discernible cardiovascular effects. No one of the four noises was capable of overriding the meal-induced preponderance of the sympathetic tone. The postprandial gastric myoelectrical activity and the GE of either the semiliquid or the solid test meal appeared to be ;resistant' to the noise exposure, irrespective of the noise type. Similar was the finding in the case of the OCTT, with the exception of a statistically significant retardation of the OCTT with the blue band noise. Ingestion of mixed caloric meals seems to elicit a protective influence against noise-elicited derangements of the functional integrity of the digestive tract proven formerly to occur during the fasting period.

Neostigmine-Induced Postprandial Phasic Contractility in the Proximal Stomach and Dyspepsia-Like Symptoms in Healthy Volunteers

In a subset of functional dyspepsia patients, we have recently described the association between unsuppressed postprandial phasic contractions of the proximal stomach and a specific symptom pattern. To better elucidate the role of phasic contractility of the proximal stomach in symptom generation, we aimed at inducing this motility pattern in healthy volunteers and we carefully monitored symptom onset. Eleven healthy volunteers underwent gastric barostat on two separate days. Gastric tone and phasic contractility were evaluated for a 90-minute period. In particular, after 30 min of basal recording, a caloric liquid meal and neostigmine 0.5 mg IV or saline in a double-blind, randomized, crossover protocol were administered. During the measurement, severity of 9 dyspeptic symptoms was evaluated on a visual analog scale. Computer-aided baseline reconstruction allowed us to quantify phasic contractions as a motility index (MI), reflecting the area between signal and baseline normalized over time. Perception of contractions after placebo or neostigmine was evaluated. Moreover, we tested for influence of gastric tone and phasic contractility on symptoms. After neostigmine, gastric accommodation was not different than after placebo (225 +/- 36 vs 206 +/- 76 mL, P= NS). During the first 30-min postprandial period, the MI was significantly higher after neostigmine than after placebo (26.4 +/- 3 vs 21.4 +/- 3, P < 0.001), confirming the induction of unsuppressed postprandial phasic contractions. The postprandial total symptom score was significantly higher after neostigmine compared to saline; several individual postprandial symptom scores were also significantly higher after neostigmine-compared placebo. After neostigmine, a higher percentage of postprandial contractions was perceived compared to placebo. Unsuppressed postprandial phasic contractility of the proximal stomach is a mechanism potentially involved in the pathogenesis of dyspeptic symptoms.