Differential Sugar Absorption Test Research Articles

A corn-fermented protein ingredient can be included in early nursey diets without compromising pig growth performance and health status.

In nursery diets, ingredients with high protein content and highly digestible nutrients, such as corn-fermented protein product with added yeast mass (GDDY), can be included as an alternative to common protein sources. This study investigated the dietary inclusion of GDDY as an alternative protein source on growth performance and intestinal health of weaned pigs. A total of 594 weaned pigs (5.7 ± 0.9kg; 18.5 days of age) were allotted to 36 pens in a randomized incomplete block design. Pens were assigned to one of 4 dietary treatments: CON: a common nursery feeding program; SBM75: CON diet replacing 75% of soybean meal (SBM) with GDDY; FM/ESBM: CON diet without fish meal (FM) and enzyme-treated SBM (ESBM) + GDDY; GDDY50: CON diet replacing 50% of SBM, FM, and ESBM with GDDY. Experimental diets were formulated to meet nutrient requirements of nursery pigs and provided in meal form through four phases during the nursery period. Pig growth performance was assessed on days 7, 14, 21, 28, 42, and 53. Pen fecal score was assessed daily from days 0 to 14, and 3 times per week from days 15 to 35. Intestinal health was assessed based on plasma immunoglobulin A (IgA) concentration and the differential sugar absorption test. The total tract digestibility of dry matter (DM), crude protein (CP), gross energy (GE), and phosphorus was also evaluated. From days 0 to 7 and days 7 to 14, dietary treatment had no effect (P > 0.05) on BW, ADG, and ADFI. For the rest of the experimental period, ADG and ADFI were greater (P < 0.05) in pigs fed CON in comparison with those fed SBM75 and GDDY50 and did not differ from pigs fed FM/ESBM. Pigs fed GDDY50 tended (P = 0.082) to have greater serum IgA concentration on day 20 when compared with SBM75 and FM/ESBM pigs. There were no differences among dietary treatments for DM, CP, and GE digestibility. Phosphorus digestibility was higher in FM/ESBM (P < 0.05) compared with SBM75 and GDDY50. These results supported the hypothesis that GDDY can be incorporated in nursery pig diets during the first couple weeks after weaning without affecting growth performance. However, in the late nursery period, inclusion levels starting at 14% can compromise performance.

PSXIII-B-7 Effect of Replacing soy Protein Concentrate with Corn Fermented Protein on Growth Performance and gut Integrity of Weaned Pigs

Abstract NexPRO™, a corn fermented protein (CFP) derived from the dry-mill bioethanol production process, has demonstrated potential as a high-quality protein ingredient in weaned pig diets. Therefore, the objective of this study was to determine the effects of increasing dietary inclusion of CFP to replace soy protein concentrate (SPC) in the diet on weight gain, feed intake, feed efficiency and gut integrity of weaned pigs in a large-scale system. A total of 1144 pigs were distributed evenly into 44 pens (13 barrows and 13 gilts/pen; initial BW 6.0±0.1 kg) with 286 pigs assigned per treatment and 11 replications. The four treatments were designed as a titration of CFP inclusion at 0%, 4%, 8% and 12% in Phase 1 (3.6 kg/hd budget) and 0%, 2%, 4% and 6% in Phase 2 (5.5 kg/hd budget) replacing SPC. Pigs were fed a common diet through Phase 3. To determine gut integrity, a differential sugar absorption test (DSAT) administered a 5% lactulose and 5% mannitol solution on the tenth day to representative pigs consuming the 0% and 12% CFP diets. Urine was collected to measure differences in sugar ratios to access gut permeability. Average daily gain responded similarly for the 0%, 4% and 8% CFP diets during Phase 1, however greater than 12% (P&amp;lt; 0.01; 0.15 vs. 0.11 kg/d). Pigs fed diets with 4% and 8% CFP in Phase 1 had a greater ADFI than pigs fed 12% CFP (0.19 vs. 0.17 kg/d; P˂0.01); 0% diets were intermediate. At the end of Phase 2, pigs fed 0%, 2%, and 4% CFP diets had greater (P˂0.01) ADFI than pigs fed diets with 6% CFP (0.60 vs. 0.44 kg/d), but lower (P&amp;lt; 0.01) G:F (0.62 vs. 0.78). No observed differences were measured between treatments for gut permeability. Due to similar responses in performance, CFP can replace soy protein concentrate in nursery diets.

Effects of water quality on growth performance and health of nursery pigs.

An experiment was conducted to determine the effects of providing drinking water of differing qualities on growth performance and health of nursery pigs. Weanling pigs (n = 450; 150 pigs/group; 10 pigs/pen) were assigned randomly to one of three experimental groups consisting of three water sources of varying qualities: 1) Water source A containing 1,410 ppm hardness (CaCO3 equivalent), 1,120 ppm sulfates, and 1,500 ppm total dissolved solids (TDS); 2) Water source B containing 909 ppm hardness (CaCO3 equivalent), 617 ppm sulfates, and 1,050 ppm TDS; and 3) Water source C containing 235 ppm hardness (CaCO3 equivalent), 2 ppm sulfates, and 348 ppm TDS. Pigs were provided ad libitum access to their respective water sources for the duration of the study which began at weaning (21 d of age) and ended 40 d later (61 d of age). Individual pig weights were recorded weekly along with feed intake on a pen basis. Occurrences of morbidity and mortality were recorded daily. Subjective fecal scores were assigned on a pen basis and blood samples were used to evaluate blood chemistry, cytokine concentrations, and phagocytic activity. A differential sugar absorption test was used to assess intestinal permeability. Fecal grab samples were used to establish diet digestibility, and drinking behavior was video-recorded to assess pigs’ acceptance of water sources provided. The statistical model considered fixed effects of water source, room, and their interaction with the random effect of pen. A repeated measures analysis was conducted to determine the effects of water quality over time. There were no differences (P > 0.440) among water sources in average daily gain (A, 0.46 kg/d; B, 0.46 kg/d; C, 0.47 kg/d) or average daily feed intake (A, 0.68 kg/d; B, 0.69 kg/d; C, 0.71 kg/d). Overall mortality of pigs was 0.44% and did not differ across the three water sources. There were no differences in apparent total tract digestibility of the diet, intestinal permeability, immune parameters, or blood chemistry attributable to quality of water consumed by pigs. Pigs did not show an aversion to the water sources provided, because total time pigs spent at the drinker did not differ (P > 0.750) among water sources on days 1 through 3 of the experiment. These data indicate that the water sources of differing quality studied did not affect growth performance or health of nursery pigs.

Post-Delivery Milking Delay Influence on the Effect of Oral Supplementation with Bovine Colostrum as Measured with Intestinal Permeability Test.

Background and objective: The health supplement bovine colostrum reportedly improves immunity and regulates intestinal homeostasis. Reliable assessment methods are needed to ensure the satisfactory biological activity of all marketed colostrum products. Of the well-established effects of colostrum use, the restoration of appropriate intestinal permeability assessed with the lactulose/mannitol (L/M) differential sugar absorption test upon supplementation with colostrum has been consistently observed. Milking time after delivery is one of the factors that influences the composition of bovine colostrum, which causes a rapid decrease in bioactive components. Materials and methods: We use the L/M test to evaluate the intestinal permeability reduction upon supplementation with colostrum (2 × 500 mg) harvested at various times after delivery (2, 24, and 72 h) or a placebo (whey). In our randomized, double-blind placebo-controlled (DBPC) trial, 31 healthy athletes were divided into four groups and assessed at baseline and after the intervention. Results: The trial revealed that only colostrum collected after 2 h and 24 h caused a significant reduction of intestinal permeability. The comparison of post-intervention vs. baseline Δ values produced statistically significant results for 2 h colostrum versus the placebo and 72 h colostrum groups. Conclusions: We conclude that the change of bovine colostrum composition over the first three days of lactation is accompanied by a decrease in its biological activity as measured with the L/M test. This test may offer a biological quality measure for colostrum.

Serum zonulin measured by enzyme-linked immunosorbent assay may not be a reliable marker of small intestinal permeability in healthy adults

The association between intestinal permeability (IP) and body composition remains unclear. The gold standard differential sugar-absorption test is arduous to complete, with zonulin being increasingly used as an independent biomarker of IP. This pilot study aimed to explore the association between small IP, zonulin concentrations, and body composition in healthy adults. The urinary lactulose-rhamnose ratio was used to measure small IP. Serum zonulin, lipopolysaccharide (LPS) and high-sensitivity C-reactive protein (hs-CRP) were analyzed in serum. Body composition was measured using dual-energy X-ray absorptiometry and anthropometric measurements were collected. In total, 34 participants were included (12 males, median age 28 years, body mass index 24 kg/m2, waist circumference 77cm). No correlation was observed between the lactulose-rhamnose ratio and zonulin (r = -.016, P = .929). The lactulose-rhamnose ratio displayed a strong positive correlation with LPS (n 20, r = .536, P = .018) but did not correlate with body composition measures. Conversely, zonulin displayed a moderate positive correlation with waist circumference (r = .437, P = .042) in female participants and hs-CRP (r = .485, P = .004) in all participants. These findings raise important considerations for the measurement of small IP, warranting exploration in larger powered studies that address the limitations of the present study.

Perméabilité intestinale et cirrhose

Patients with cirrhosis are at increased risk of developing infections due to bacterial translocation. This process depends on three principal factors: bacterial overgrowth, immunodepression, and altered intestinal permeability. Intestinal barrier functions may be disturbed in cirrhosis, related to the toxic effects of alcohol (on mucosa and biological membranes) and portal hypertensive enteropathy. Few studies on the assessment of intestinal permeability in cirrhotic patients are available, and contradictory results may be explained by methodological differences. However, four studies using a differential sugar absorption test (lactulose-mannitol test, a combination of an oligosaccharide and a monosaccharide) showed an increased intestinal permeability in cirrhotic patients. The recurrence of spontaneous bacterial peritonitis can be appreciated only by one similar case history, a low rate of protides in ascites (<10 g/L), bilirubinemia > 55 micromol/L, and thrombocytopenia<98.000/mm3. These results suggest that primary antibiotherapy prophylaxis should be recommended, but this recommendation is limited by the risk of bacterial resistant selection and by the fact that no patient survival benefits was shown. Intestinal permeability could be another predictive factor to justify preventive antibiotherapy; but more studies are needed and methods should be standardized (technique used to measure permeability, patient groups involved).

Intestinal permeability and function in dogs with small intestinal bacterial overgrowth

Small intestinal bacterial overgrowth (SIBO) has been reported to occur commonly in dogs with signs of chronic intestinal disease. There are usually few intestinal histological changes, and it is uncertain to what extent bacteria cause mucosal damage. The aim of this study was to apply a differential sugar absorption test for intestinal permeability and function to the objective assessment of intestinal damage in dogs with SIBO. Studies were performed on 63 dogs with signs of chronic small and, or, large bowel disease, in which SIBO (greater than 10(5) total or greater than 10(4) anaerobic colony forming units/ml) was diagnosed by quantitative culture of duodenal juice obtained endoscopically. None of the dogs had evidence of intestinal pathogens, parasites, systemic disease or pancreatic insufficiency. differential sugar absorption was performed by determining the ratios of urinary recoveries of lactulose/rhamnose (L/R ratio, which reflects permeability) and D-xylose/3-O-methylglucose (X/G ratio, which reflects intestinal absorptive function) following oral administration. Dogs with SIBO comprised 28 different breeds, including 13 German shepherd dogs. SIBO was aerobic in 18/63 dogs (29 per cent), and anaerobic in 45/63 (71 per cent). Histological examination of duodenal biopsies showed no abnormalities in 75 per cent, and mild to moderate lymphocytic infiltrates in 25 per cent of the dogs. The L/R ratio was increased (greater than 0.12) in 52 per cent, and the X/G ratio reduced (less than 0.60) in 33 per cent of the dogs. Differential sugar absorption was repeated in 11 dogs after their four weeks of oral antibiotic therapy. The L/R ratio declined in all 11 dogs (mean +/- SD pre: 0.24 +/- 0.14; post: 0.16 +/- 0.11; P < 0.05), but changes in the X/G ratio were more variable. These findings show that SIBO is commonly associated with mucosal damage not detected on histological examination of intestinal biopsies, and that changes in intestinal permeability following oral antibiotics may be used to monitor response to treatment.

The value of the D-xylose test compared with the differential sugar absorption test in recognizing coeliac disease

Objective: To compare the value of the differential sugar absorption test (SAT) with the blood and urine D-xylose tests (DXTs and DXTu) in diagnosing coeliac disease (CD) the SAT and the standard DXTs and DXTu were performed in 14 coeliacs with abnormal small bowel histology and in 12 patients with aspecific gastrointestinal complaints.Methods: In the SAT a solution of lactulose (L) and mannitol (M) was given to the fasting patient after which the LM ratio was measured in 5 h urine by gas chromatography. In the DXTs and DXTu a solution of 25 g D-xylose was given to the fasting patient and blood was drawn at 0, 30 and 120 min and urine was collected for 5 h, respectively. Results: To measure the power in diagnosing CD of the SAT, DXTs 30 min, DXTs 120 min and DXTu, the test results were plotted in ROC curves and the areas under the curves (AUCs) were calculated. The AUCs were 0.97, 0.77, 0.78 and 0.63, respectively. Conclusion: In our opinion, the DXTs and DXTu are no longer useful in the investigation of mucosal function of the small bowel.

Intestinal permeability and orocaecal transit time in elderly patients with Parkinson's disease.

The aetiology of weight loss in patients with Parkinson's disease is likely to be multifactorial. We studied 15 patients with Parkinson's disease and 15 age- and sex-matched controls and looked for evidence of malabsorption due to small bowel bacterial overgrowth or alteration of intestinal permeability. There was a marked increase in orocaecal transit time in the patients with Parkinson's disease, although lactulose hydrogen breath testing did not show evidence of small bowel bacterial contamination. Intestinal permeability measured by the differential sugar absorption test was also deranged. There was reduced absorption of mannitol in patients with Parkinson's disease while lactulose absorption was similar in both groups, suggesting decreased non-mediated uptake across the enterocyte brush border membrane in patients with Parkinson's disease.

Intestinal permeability testing in dogs with diet-responsive intestinal disease.

Fifteen dogs with signs of small and, or, large bowel disease that responded clinically to an exclusion diet were studied, using differential sugar absorption as an objective parameter of the mucosal response to the diet. Intestinal permeability and function were assessed by determining the urinary excretion ratios of lactulose/rhamnose and xylose/3-O-methylglucose, respectively, following oral administration of a mixture of these four sugars. Five dogs, all retrievers, were tentatively diagnosed as having dietary hypersensitivity, based upon resolution of clinical signs and normalisation of high intestinal permeability following an exclusion diet and recurrence of signs (in four of five dogs) upon challenge with the original diet. The fifth dog did not become symptomatic when challenged, but intestinal permeability increased. The remaining 10 dogs were diagnosed as having food intolerance, based upon clinical improvement on an exclusion diet, relapse on challenge with their original diet, but lack of improvement in intestinal permeability. These findings suggest that a differential sugar absorption test may be useful to determine the reasons for clinical response to exclusion diets. Demonstration of increased intestinal permeability with subsequent normalisation following an exclusion diet may be useful in the diagnosis of dietary hypersensitivity, while persistent abnormalities in intestinal permeability are suggestive of underlying intestinal disease and food intolerance.

Intestinal permeability in the critically ill.

Alterations in intestinal permeability reflect one component of intestinal epithelial barrier function. The objective of this study was to assess the degree of derangement of intestinal permeability in critically ill patients and to investigate the relationship of this to markers of disease severity and sepsis. Sixteen patients admitted to the intensive care unit for a variety of problems were studied with the severity of illness and degree of sepsis recorded daily. A differential sugar absorption test, using lactulose and mannitol as markers, was performed, and in 10 patients this was repeated after an interval of between 4-11 days. The use of the lactulose/mannitol (L/M) ratio corrects for variables unrelated to permeability such as gastric emptying. The L/M ratio was significantly higher in patients (median 0.98) compared to normal controls (median 0.008). The ratios showed no relation to disease severity or sepsis. These results establish that increased intestinal permeability occurs in the general ICU patient but that it is not uniquely related to sepsis. The extent of this abnormality suggests that further study is required to show the various influences on this process.

Intestinal permeability in pediatric gastroenterology.

The role of the physiologic barrier function of the small bowel and its possible role in health and disease has attracted much attention over the past decade. The intestinal mucosal barrier for luminal macromolecules and microorganism is the result of non-immunologic and immunologic defense mechanisms. The non-immunologic mechanisms consist of intraluminal factors such as gastric acid, proteolytic activity, and motility and of mucosal surface factors like mucin and the microvillous membrane. The immunologic mechanisms include secretary IgA and cell-mediated immunity. Both types of mechanism are not completely mature at birth. Maturation of this barrier is not finished before the 2nd year of life. One of the aspects of the mucosal barrier function can be estimated by the intestinal permeability (IP) for macromolecules. We use the differential sugar absorption test (SAT), in which the ratio of urinary excretion of a relatively large molecule, lactulose, is compared with that of a relatively small molecule, mannitol, after oral ingestion. Although the small intestine is permeable to certain macromolecules in normal developmental conditions, an increased IP could be involved in the pathophysiology of several diseases, including infectious diarrhea, food allergy, celiac disease, and Crohn's disease. It can be concluded that IP, as measured with the SAT, reflects the state of the mucosal barrier and is altered in several gastrointestinal diseases. The SAT is a non-invasive IP test that can be of diagnostic help to demonstrate alterations in the small-mucosal barrier function and may be useful to evaluate therapeutic interventions.(ABSTRACT TRUNCATED AT 250 WORDS)

Aggressive chemotherapy for acute leukaemia frequently causes intestinal protein leakage

Cytostatic drugs are known to produce disturbances in intestinal absorption of carbohydrates. To further explore the gastrointestinal (GI) toxicity of cytostatic therapy, 37 patients with acute leukaemia were investigated during and/or after remission induction courses by the use of the differential sugar absorption test (DSAT) and the intestinal clearance of alpha-1-antitrypsin (ClAAT). The ratio of the lactulose to the mannitol excretion in the urine was found abnormal in 44% of the tests. The ClAAT was increased in 74% of tests. The test results differed considerably from patient to patient and depended on the chemotherapy course; correlation between the tests was low, probably indicating that unrelated pathophysiological processes were measured. After haematological regeneration, abnormal test results normalised. It is concluded that aggressive chemotherapy not only causes a reduction in the absorption of sugars, but commonly also protein leakage. These GI side-effects are reversible, and the application of both tests in combination provides a practical and reproducible method for investigation of GI toxicity in patients treated with cytostatic drugs.

Simultaneous Assessment of Intestinal Permeability and Lactose Tolerance with Orally Administered Raffinose, Lactose and 1-Arabinose

1. In order to develop an improved differential sugar absorption test for simultaneously assessing intestinal permeability and lactose intolerance, methods were established for determining raffinose, lactose and L-arabinose in human urine. Using NAD(P)H-coupled enzymatic assays and fluorimetry, each sugar was measurable over a concentration range of approximately 3-300 mumol/l in diluted urine specimens. 2. After an overnight fast, 40 normal volunteers drank an iso-osmotic solution containing raffinose, lactose and L-arabinose. The median 5 h urinary sugar excretion was 0.26% of the ingested raffinose, 0.05% of lactose and 17.5% of L-arabinose. 3. In 143 patients with gastrointestinal disease, excretion of both ingested raffinose and lactose was significantly increased in coeliac disease in relapse or in partial remission and in Crohn's disease, but not in the irritable bowel syndrome, coeliac disease in remission or ulcerative colitis. Excretion of lactose, but not raffinose, was increased in patients with mucosal lactase deficiency, whereas excretion of L-arabinose was reduced in all disease groups except ulcerative colitis. 4. Discrimination between diseases was poor when based on individual sugar recoveries, but improved dramatically when excretion was expressed relative to that of L-arabinose. The raffinose/L-arabinose excretion ratio, an index of intestinal permeability, was greater than 0.08 in 15/15 untreated coeliac patients but less than 0.06 in all normal subjects and in 9/9 lactase-deficient patients, 15/16 recovered coeliac patients, 5/6 patients with ulcerative colitis, 13/16 patients with Crohn's disease and 61/62 patients with irritable bowel syndrome.

Combined assessment of intestinal disaccharidases in congenital asucrasia by differential urinary disaccharide excretion.

Investigation of intestinal disaccharide hydrolysis and permeability by means of a non-invasive differential sugar absorption test was performed in a family containing two siblings with primary sucrase-isomaltase deficiency. The procedure, which depends on measurement of urinary excretion ratios after the oral administration of lactose, sucrose, palatinose, lactulose and L-rhamnose, is capable of simultaneous determination of intestinal lactase, sucrase, and isomaltase activity and lactulose:rhamnose permeability. The results corresponded well with those of disaccharidase assay and histological findings in jejunal biopsy tissue obtained from the patients. Palatinose proved a satisfactory substrate for in vivo assessment of intestinal isomaltase activity. The method described provides a reliable and comprehensive assessment of intestinal disaccharide hydrolysis, and simultaneous estimation of permeability assists discrimination of primary from secondary disaccharidase deficiency. The ability to assess three different disaccharidase activities in addition to intestinal permeability by means of a single test, and the simplicity of preservation and transport of urine samples for sugar analysis, makes this a convenient, definitive method for the investigation of defective sugar absorption in both patients and population groups.

Small intestinal permeability in pediatric clinical practice.

Passive permeability of small intestine to lactulose and mannitol was studied in children suspected of having intestinal disease, using a hypertonic differential sugar absorption test. Children with coeliac disease and cows' milk intolerance were shown to have an elevated urinary lactulose/mannitol recovery ratio when compared with controls, children with normal jejunal biopsy, or children in whom alternative explanations for failure to thrive had been demonstrated. The abnormality in permeability ratio principally reflects a reduced urinary recovery of mannitol following oral administration. This study demonstrates that a hypertonic sugar absorption test is well tolerated even by young children, is practicable in routine clinical pediatric practice, and is capable of demonstrating abnormal intestinal function in children with small intestinal disease.

Small Intestinal Permeability in Pediatric Clinical Practice

SummaryPassive permeability of small intestine to lactulose and mannitol was studied in children suspected of having intestinal disease, using a hypertonic differential sugar absorption test. Children with coeliac disease and cows' milk intolerance were shown to have an elevated urinary lactulose/mannitol recovery ratio when compared with controls, children with normal jejunal biopsy, or children in whom alternative explanations for failure to thrive had been demonstrated. The abnormality in permeability ratio principally reflects a reduced urinary recovery of mannitol following oral administration. This study demonstrates that a hypertonic sugar absorption test is well tolerated even by young children, is practicable in routine clinical pediatric practice, and is capable of demonstrating abnormal intestinal function in children with small intestinal disease.

Small Intestinal Permeability in Dermatological Disease

Passive small intestinal permeability was investigated in 62 patients with atopic eczema, 29 with psoriasis and 18 with dermatitis herpetiformis, using the cellobiose/mannitol differential sugar absorption test. Urinary recovery of cellobiose and mannitol in patients with both psoriasis and eczema were similar to values in a control population, and were not affected by the extent or activity of skin disease. The cellobiose/mannitol recovery ratio was abnormally high in seven patients with eczema, six of whom underwent jejunal biopsy. Jejunal mucosal morphology was normal in five, and one patient was found to have coeliac disease. Cellobiose/mannitol recovery ratio was also abnormal in seven patients with psoriasis, and in 11 with dermatitis herpetiformis, seven of whom had a normal jejunal biopsy. These findings demonstrate that the passive permeability of the small intestine is normal in the majority of patients with atopic eczema and psoriasis. Increased absorption of macromolecules from the gut lumen cannot be ascribed to defective intestinal integrity, and is unlikely to be relevant to the pathogenesis of eczema. Abnormal intestinal permeability may be a more sensitive manifestation of gluten-sensitive enteropathy than jejunal biopsy in dermatitis herpetiformis.