Faster Gastric Emptying Research Articles

Mechanism of action and selection of endoscopic bariatric therapies for treatment of obesity.

Endoscopic bariatric therapies (EBTs) are minimally invasive and safe procedures with favorable weight loss outcomes in obesity treatment. We aimed to present the weight loss mechanism of action of EBTs and an individualized selection method for patients with obesity. We searched PubMed, Medline, Scopus, Embase, and Google Scholar databases for studies on the topic from databases inception to July 1, 2023, written in English. We focused on EBTs potential mechanism of action to induce weight loss. We also present an expert opinion on a novel selection of EBTs based on their mechanism of action. EBTs can result in weight loss through variable mechanisms of action. They can induce earlier satiation, delay gastric emptying, restrict the accommodative response of the stomach, decrease caloric absorption, and alter the secretion of gastrointestinal hormones. Selecting EBTs may be guided through their mechanism of action by which patients with abnormal satiation may benefit more from tissue apposition devices and aspiration therapy while patients with fast gastric emptying may be better candidates for intragastric devices, endoscopic anastomosis devices, and duodenal mucosal resurfacing. Consequently, the selection of EBTs should be guided by the mechanism of action which is specific to each type of therapy.

Forecasting the effect of water gastric emptying patterns on model drug release in an in vitro glass-bead flow-through system.

Oral solid dosage forms are most frequently administered with a glass of water which empties from the stomach relatively fast, but with a certain variability in its emptying kinetics. The purpose of this study was thus to simulate different individual water gastric emptying (GE) patterns in an in vitro glass-bead flow-through dissolution system. Further, the effect of GE on the dissolution of model drugs from immediate-release tablets was assessed by determining the amount of dissolved drug in the samples pumped out of the stomach compartment. Additionally, different HCl solutions were used as dissolution media to assess the effect of the variability of pH of the gastric fluid on the dissolution of three model drugs: paracetamol, diclofenac sodium, and dipyridamole. The difference in fast and slow GE kinetics resulted in different dissolution profiles of paracetamol in all studied media. For diclofenac sodium and dipyridamole tablets, the effect of GE kinetics was well observed only in media, where the solubility was not a limiting factor. Therefore, GE kinetics of co-ingested water influences the drug release from immediate-release tablets, however, in certain cases, other parameters influencing drug dissolution can partly or fully hinder the expression of this effect.

The impact of heat treatment of bovine milk on gastric emptying and nutrient appearance in peripheral circulation in healthy females: a randomized controlled trial comparing pasteurized and ultra-high temperature milk

BackgroundHeat treatments of dairy, including pasteurization and ultra-high temperature (UHT) processing, alter milk macromolecular structures, and ultimately affect digestion. In vitro, animal, and human studies show faster nutrient release or circulating appearance after consuming UHT milk (UHT-M) compared with pasteurized milk (PAST-M), with a faster gastric emptying (GE) rate proposed as a possible mechanism. ObjectivesTo investigate the impact of milk heat treatment on GE as a mechanism of faster nutrient appearance in blood. We hypothesized that GE and circulating nutrient delivery following consumption would be faster for UHT-M than PAST-M. MethodsIn this double-blind randomized controlled cross-over trial, healthy female (n = 20; 27.3 ± 1.4 y, mean ± SD) habitual dairy consumers, consumed 500 mL of either homogenized bovine UHT-M or PAST-M (1340 compared with 1320 kJ). Gastric content volume (GCV) emptying half-time (T50) was assessed over 3 h by magnetic resonance imaging subjective digestive symptoms, plasma amino acid, lipid and B vitamin concentrations, and gastric myoelectrical activity were measured over 5 h. ResultsAlthough GCV T50 did not differ (102 ± 7 min compared with 89 ± 8 min, mean ± SEM, UHT-M and PAST-M, respectively; P = 0.051), GCV time to emptying 25% of the volume was 31% longer following UHT-M compared with PAST-M (42 ± 2 compared with 32 ± 4 min, P = 0.004). Although GCV remained larger for a longer duration following UHT-M (treatment × time interaction, P = 0.002), plasma essential amino acid AUC was greater following UHT-M than PAST-M (55,324 ± 3809 compared with 36,598 ± 5673 μmol·min·L-1, P = 0.006). Heat treatment did not impact gastric myoelectrical activity, plasma appetite hormone markers or subjective appetite scores. ConclusionsContrary to expectations, GE was slower with UHT-M, yet, as anticipated, aminoacidemia was greater. The larger GCV following UHT-M suggests that gastric volume may poorly predict circulating nutrient appearance from complex food matrices. Dairy heat treatment may be an effective tool to modify nutrient release by impacting digestion kinetics. Clinical Trial Registrywww.anzctr.org.au (ACTRN12620000172909).

A Recent Advantage on Gastroretentive Drug Delivery System: An Overview

In recent years, gastro-retentive drug delivery system (GRDDS) has gained researcher’s interest in the field of oral drug delivery. Various GRDDS approaches can be utilized to retain the dosage forms in the stomach and to release the drug slowly for an extended period of time. GRDDS can be used to prolong the residence time of delivery system in the stomach. This results in targeting of drug release at a specific site for the systemic or local effects. GRDDS can be used to overcome challenges associated with conventional oral dosage forms and to release the drug at a specific absorption site to improve bioavailability of particular drug substance. The challenges include fast gastric emptying of the dosage form which results in the poor bioavailability of the drug. Prolongation of the retention of drugs in stomach those having low solubility at high intestinal pH improves the solubility of drugs. GRDDS has proved to be effective in systemic actions as well as in local actions to treat gastric or duodenal ulcers. Local activity in the upper part of the small intestine can be obtained by improving the residence time of delivery system in the stomach. The system is useful for drugs which are unstable in the intestine or having a low solubility/permeability in the small intestine. Various GRDDS approaches include high density (sinking) systems, low-density (floating systems), muco-adhesive, expandable, unfold able, super porous hydrogel systems, and magnetic systems.

IBCOx-12 The Endoscopic Sleeve Gastroplasty Produces Durable Physiologic Changes: Results from a Randomized US Clinical Trial

Abstract Background Obesity is associated with faster gastric emptying and altered appetite. Endoscopic sleeve gastroplasty (ESG) has gained global adaptation, but our understanding of its physiologic mechanism of action and durability is limited. We sought to determine changes in gastric emptying, weight loss, and eating behaviors after ESG when compared to moderate-intensity lifestyle interventions (LS) in the short and long-term. Methods This is an a priori designed sub-study of a large ongoing multicenter US RCT (MERIT trial), where adults with BMI 30-40 kg/m2 were randomized to ESG versus moderate-intensity LS alone. We measured gastric emptying (T1/2) using a 4- hour gastric emptying breath test at baseline, 3 and 12 months into the study. We reported weight loss outcomes as percent total body weight lost (%TBWL). Changes in three eating behaviour domains (Cognitive Restraint [CR], Emotional Eating [EE], Uncontrolled Eating [UE]) were assessed using the Three-Factor Eating Questionnaire (TFEQ) at 6 months. The primary outcome was the change in T1/2 (minutes) at 3 months, and secondary outcomes were changes in T1/2 at 12 months, %TBWL, and eating behaviours. We used the t-test for the analyses. Linear regression was performed to determine the association between gastric emptying and weight loss. Results 46 patients were randomized in the study (ESG n=26; LS n=20). Baseline characteristics were similar between the two groups. Out of n=46, n=43, and n=31 subjects have reached 3 and 12 months, respectively. Three patients dropped out of the study. At 3 months, T1/2 (minutes) was delayed in the ESG group (n=24) compared to the LS group (n=19) (170.8 vs. 87.5; p<0.0001). At 12 months, T1/2 was still delayed in the ESG group (n=17) vs. control group (n=14) (133.4 vs. 87.6; p=0.0005), and delayed compared to baseline. %TBWL in the ESG group was 12.3%, 15.1% and 15.7% at 3, 6 and 12 months (p <0.01 compared to baseline), while it was 2.3%, 2.2% and 0.3% (p>0.05 compared to baseline) in the LS group. Greater delays in gastric emptying at 3 months correlated with weight loss at all time points. (Figure 1) At 6 months, significant improvements in the EE and UE domains were seen in both groups, but for CR, only significant improvements were seen in the ESG group. Percent total fasting ghrelin, GLP-1, and PYY increased at 12 months in the ESG group compared to LS control (51%, 51%, 6.3% vs. -9%, 4%, -10.5%). Only 1 SAE managed endoscopically with full recovery was reported in the ESG group. Conclusions ESG produces sustained physiologic alterations in appetite regulatory pathways and durable weight-loss. This provides further evidence supporting the clinical adoption of the technique as a durable and effective obesity therapy.

Assessment of Gastric Dysmotility Using Standardized Tc-99m Sulfur Colloid-Labeled Rice Cakes in Diabetic Patients.

Diabetes mellitus is a common lifestyle disease where patients suffer from gastric dysmotility, which is usually underdiagnosed. The aim of this study was to evaluate the utility of Tc-99m sulfur colloid-labeled meal gastric emptying scintigraphy in Type 2 diabetic patients. A total of 43 patients and 30 controls, satisfying the inclusion criteria from March 2019 to August 2020, were included. Serial planar images were acquired in both anterior and posterior projections for an iso-time of 1 min at 1 min, 60 min (1 h), 120 min (2 h), and 240 min (4 h) after consumption of Tc-99m SC-labeled idly (rice cakes). The gastric emptying was considered delayed if there was <10% emptying at 1 h, <70% emptying at 2 h, and <94% emptying at 4 h. The mean T1/2 was similar among cases (44.11 ± 10.52 min) and controls (49.56 ± 13.44 min, P = 0.056) while the mean gastric emptying at 1 h was slower in cases compared to controls, P = < 0.01. Two cases (4.6%) had delayed gastric emptying while none of the controls had delayed gastric emptying. T1/2 showed no association with duration of diabetes or HbA1c levels (P = 0.76, 0.45) and a weak correlation with fasting blood sugar (FBS) on the day of scan (R value = 0.18). In comparison to controls, diabetic patients had faster gastric emptying with no association with duration of diabetes or HbA1c levels and a weak correlation with FBS on the day of scan.

PARAMETER ESTIMATION OF A SIMPLE, REALISTIC STOCHASTIC MODEL OF GASTRIC EMPTYING OF PELLETS UNDER FASTING CONDITIONS

This study is aimed to develop a parameter estimation procedure for a stochastic model of gastric emptying of pellets under fasting conditions of healthy subjects that represent the irregular decrements of gastric contents after administration of pellets. An algorithm for the identification of experimental subjects into subgroups based on their gastric emptying rates has been proposed. The parameter estimation procedure was performed with observational data of gastric emptying profiles of 19 subjects from the existing literature. The identification algorithm was validated through comparison against the original results, showing that seven subjects indicated slow gastric emptying and 12 subjects indicated fast emptying. After excluding one subject with gastric stasis, the optimal results obtained from this study classified subjects into three subgroups: two subjects with slow, five subjects with intermediate and 11 subjects with fast gastric emptying. The proposed parameter estimation procedure of the stochastic model is relatively easy to implement and can be used to analyze real patients’ data. The algorithm for identification of the gastric emptying dynamics in experimental subjects could provide useful information for further investigations of long-term energy balance forecasting.

Highly Branched Cyclic Dextrin and its Ergogenic Effects in Athletes: A Brief Review

Highly branched cyclic dextrin (HBCD) is a relatively new carbohydrate source that has gained much popularity in sports nutrition supplements, quickly becoming one of the most popular sports and fitness supplements globally. Due to its high molecular weight and low osmolality, HBCD is thought to provide an ergogenic advantage over other carbohydrate sources via faster gastric emptying and faster absorption. The purpose of this brief review is to explore performance claims and implications of HBCD use. We provide rationale for recommended use based on results of scientific studies conducted in both animals and humans.

Emulsion Colloidal Gastric Stability and Lipid Droplet Physical State Modulate Gastric Emptying and Short-Term Satiety in Healthy Men

Abstract Objectives The aim of this randomized crossover study was to investigate the influences of TAG droplet physical state at 37°C and emulsion gastric colloidal stability on gastric emptying (GE), postprandial lipemia and satiety in healthy men. It was hypothesized that emulsions susceptible to flocculation in the stomach would augment GE compared to acid stable emulsions, and that the acute lipemic and satiety responses would be attenuated for emulsions containing crystalline TAG and/or an acid unstable emulsifier. Methods Twenty % palm stearin or palm olein emulsions with similar particle size distributions where formulated using either Tween80 (acid stable emulsifier) or Span60 (acid unstable emulsifier). The four emulsions contained partially crystalline droplets that remained stable (SS) or destabilized (SU) or contained liquid droplets that remained stable (LS) or destabilized (LU) when exposed to simulated in vitro gastric conditions. Fifteen healthy adult male non-restrained eaters (mean ± SD age: 24.9 ± 4.5; BMI: 26.0 ± 2.0 kg/m2; fasting TAG: 0.9 ± 0.3 mmol/L) consumed 250 mL of one of the emulsions on four occasions separated by at least 6 days. Baseline fasting and 6-hr postprandial ultrasound gastric antrum measurements, satiety visual analogue scales (VAS), and blood samples for analysis of plasma TAG and hunger and satiety hormones were collected. Results Gastric antrum area decreased faster (P ≤ 0.01) for the acid unstable emulsions (SU and LU) indicating faster GE. Postprandial TAG response did not differ significantly between any of the emulsions, but there were differences in postprandial satiety responses. 3-hr incremental area under the curve (iAUC) was significantly lower for hunger (P = 0.021) and desire to eat (P = 0.031) ratings and 6-hr iAUC was significantly higher for ghrelin (P = 0.028) with LS compared to SU. Plasma PYY and GLP-1 change from baseline values were also higher following consumption of LS compared to LU (P = 0.028) (for PYY), and compared to SU (P = 0.008) and LU (P = 0.001) (for GLP-1). Conclusions Emulsion phase separation in the stomach was associated with delayed GE, which corresponded to enhanced satiety with the acid stable emulsion containing TAG in the liquid state. Funding Sources Canada's Natural Sciences and Engineering Research Council.

Gastric emptying in healthy children using the Spirulina breath test: The impact of gender, body size, and pubertal development

AbstractBackgroundThere are no pediatric norms for gastric emptying (GE) measured by nuclear scintigraphy. The 13C‐labeled, stable isotope GE breath test (GEBT) is a non‐radioactive alternative. We aimed to determine normative GEBT ranges in a cohort of healthy children and examine the influence of age, gender, puberty, and body surface area (BSA).MethodsHealthy children ages 8–18 years completed the [13C]‐Spirulina platensis GEBT after an overnight fast. Breath samples were collected at baseline, every 15 min × 1 h, then every 30 min for 4 h total. The 13CO2 excretion rate was determined by the change in 13CO2/12CO2 over time in each breath sample, expressed as kPCD (Percent 13C Dose excreted/min). A mixed model with random time was used for multivariable analysis and outcome fit into a quadratic model.Key ResultsThe 100 subjects completed the test meal within allotted time. Median (IQR) age was 13.5 (11.3–15.5) years; 51% were female. Females had lower 13CO2 excretion rates (slower GE) than males across time (p &lt; 0.001) while decreased excretion rates correlated with higher BSA (p = 0.015). Gender differences were also noted within pubertal stages with females showing slower GE. Multivariable analysis suggested that pre‐pubertal children have faster GE than both peri‐ and post‐pubertal groups (p &lt; 0.0001).Conclusions &amp; InferencesGender, puberty, and BSA influence GE rates in healthy children more than age. Although further data are needed, pubertal stage and hormonal influences may be unique factors to consider when assessing GE in children.

REVIEW ON GASTRORETENTIVE DRUG DELIVERY SYSTEM

In recent years, gastroretentive drug delivery system (GRDDS) has gained researcher’s interest in the field of oral drug delivery. Various GRDDS approaches can be utilized to retain the dosage forms in the stomach and to release the drug slowly for an extended period of time. GRDDS can be used to prolong the residence time of delivery system in the stomach. This results in targeting of drug release at a specific site for the systemic or local effects. GRDDS can be used to overcome challenges associated with conventional oral dosage forms and to release the drug at a specific absorption site to improve bioavailability of particular drug substance. The challenges include fast gastric emptying of the dosage form which results in the poor bioavailability of the drug. Prolongation of the retention of drugs in stomach those having low solubility at high intestinal pH improves the solubility of drugs. GRDDS has proved to be effective in systemic actions as well as in local actions to treat gastric or duodenal ulcers. Local activity in the upper part of the small intestine can be obtained by improving the residence time of delivery system in the stomach. The system is useful for drugs which are unstable in the intestine or having a low solubility/permeability in the small intestine. Various GRDDS approaches include high density (sinking) systems, low-density (floating systems), mucoadhesive, expandable, unfoldable, superporous hydrogel systems, and magnetic systems.

In situ microbubble-assisted, ultrasound-controlled release of superparamagnetic iron oxide nanoparticles from gastro-retentive tablets.

Organic and inorganic nanomaterials have shown great potential in drug delivery applications due to their unique physical and chemical properties. Orally administered nanoparticles have attracted great attention because it is acceptable, convenient, and safe. However, nanoparticles need to overcome numerous hurdles such as acidic gastric environment, the continuous secretion of mucus, and fast gastric emptying after being delivered via an oral route. Here, we used a stimuli-responsive and triggered release strategy for superparamagnetic iron oxide nanoparticles (SPIONPs)-loaded gastro-retentive tablets for in situ bubbles generation. These materials realize SPIOs controlled release and delivery specific to the stomach. The tablet formulation contains a foaming agent (sodium bicarbonate, NaHCO3), adhesive component (HPMC/carbomer 934 P (1:1)), filler (lactose/mannitol (10:1)) and SPIONPs. The in vitro bubble generation and SPIONPs released from the tablets were characterized. The ex vivo gastric adhesive ability, acoustic stimuli performance, and tissue penetration were further evaluated. The results show that when the fabricated tablets interacted with the acidic microenvironment, the carbon dioxide (CO2) could be generated and be captured by ultrasound (US) imaging. Simultaneous with bubble production, SPIONPs are released from the tablets to further control ultrasound-mediated force and deliver SPIONPs entering through the mucus layer. The SPIONPs were loaded in the tablets and could be released in a controllable way; thus, the magnetic resonance imaging (MRI) could also be used to monitor the tablet status and SPIONP delivery process. Therefore, SPIONPs-loaded gastro-retentive effervescent tablets offer effective release and absorption of nanoparticles in the gastric area and be imaged by MRI and US.

Association between gastrointestinal phenotypes and weight gain in younger adults: a prospective 4-year cohort study.

Background/Objectives:Gastrointestinal phenotypes have previously been associated with obesity, however it is unknown if these phenotypes are a cause or a consequence of obesity and weight gain. Our aim was to assess whether these gastrointestinal phenotypes are associated with future weight gain in younger adults.Subjects/Methods:At baseline, 126 adult participants under the age of 35 were weighed and underwent measurement of gastrointestinal phenotypes including gastric emptying (GE), gastric volume, satiation, satiety and gastrointestinal hormones. Patients were re-appraised after median 4.4 years unless, during the period of follow up, they participated in a formal weight loss program, received obesity-weight loss interventions, or developed a health condition likely to affect weight. Participants were dichotomized into two groups for each phenotype at the median of each phenotype.Results:In total, 60 participants met criteria for inclusion and were evaluated after a median of 4.4 years [IQR: 3.5 to 5],36 participants were excluded due to conditions that would abnormally affect weight during study period including pregnancy and weight loss treatment, and 30 participants were lost to prospective follow-up. Faster GE was significantly associated with weight gain. Those with faster GE at baseline (n=30) gained a median of 9.6 kg [3.1 to 14.9] compared to those with slower GE at baseline (n=30) who gained a median of 2.8 kg [−4.6 to 9.2] (p=0.03), over the follow-up period. There was no association between the other phenotypes and weight gain.Conclusions:In adults ≤35 years old, faster gastric emptying is associated with significantly increased weight gain over the medium term. This provides supportive evidence for the role of gastric emptying in weight gain and development of obesity.

Physical activity is associated with accelerated gastric emptying and increased ghrelin in obesity.

Rapid gastric emptying, increased food intake, and alterations in gastrointestinal hormones are associated with obesity. The effect of regular physical activity (PA) on food intake, gastric emptying (GE), gastric accommodation, and gastrointestinal (GI) hormones in adults with obesity remains unclear. Our aim was to compare, at time of presentation, weight trends, eating behavior, GE, and GI hormone levels among individuals with obesity who engage in regular PA compared to those who do not. In 270 participants with obesity, we performed validated measurements of GI phenotypes: GE of solids and liquids, gastric volume (GV) during fasting and after consumption of 200mL Ensure®, satiety by kcal intake (T-kcal) during a buffet meal, satiation (volume to fullness [VTF] and maximal tolerated volume [MTV]) of a liquid nutrient, and plasma levels of fasting and postprandial GLP-1, PYY, CCK, and ghrelin. Physical Activity Stages of Change Questionnaire was used to assess whether participants were regularly PA or not. PA was associated with lower BMI (Δ 2.01kg/m2 , P=.001) and body weight (Δ 4.42kg, P=.0278). GE of solids (T-50% Δ 7.54min, P=.021) and liquids (T-50% Δ 2.99min, P=.029%) was significantly more rapid in physically active participants. PA was also associated with relatively higher postprandial ghrelin AUC (Δ 10.4pg/mL, P=.015). There was no significant difference in postprandial satiation, satiety, GV, or other GI hormones (CCK, PYY, or GLP-1) between groups. Physical activity is associated with lower BMI, but faster GE and higher postprandial ghrelin levels, two factors that are also associated with obesity.

Reactive hypoglycemia – an interdisciplinary approach of the disease of XXI Century

Reactive hypoglycemia is characterized by low blood glucose level in non-diabetic patients. It manifests as a syndrome of adrenergic and neuroglycopenic symptoms in the postprandial period, and their resolution occurs after consuming carbohydrates. The etiology of reactive hypoglycemia is not fully understood. It may occur in patients after gastrointestinal surgery due to too fast gastric emptying. Decreases in postprandial glucose are also observed in people with a pre-diabetes condition in which insulin secretion is disturbed. Hypoglycaemia can also be seen in patients with insulin resistance and hyperinsulinism. The aim of this study was to summarize existing knowledge about reactive hypoglycemia - etiology, diagnostic model and treatment.

Association between allelic variants in the glucagon-like peptide 1 and cholecystokinin receptor genes with gastric emptying and glucose tolerance.

Nutrient-mediated release of cholecystokinin and glucagon-like peptide-1 (GLP-1) regulates gastric emptying (GE) via duodenogastric feedback mechanisms; GLP-1 also regulates postprandial insulin secretion. Some patients with functional upper gastrointestinal symptoms have impaired glucose tolerance during enteral dextrose infusion. Our hypothesis was that variants in CCK, GLP-1, and TCF7L2 (transcription factor 7-like 2 locus), which is associated with greatest genetic risk for development of type 2 diabetes mellitus, are associated with GE and independently with glucose tolerance. Our aims were to evaluate the associations between these GE, glucose tolerance, and these single nucleotide polymorphisms (SNPs). Genetic variants, scintigraphic GE of solids, plasma glucose, insulin, and GLP-1 during enteral dextrose infusion (75gm over 2hours) were measured. GE and enteral dextrose infusion were, respectively, evaluated in 44 (27 controls and 17 patients with functional dyspepsia or nausea) and 42 (28 controls, 14 patients) participants; of these, 51 participants consented to assessment of SNPs. Four functional SNPs were studied: rs6923761 and rs1042044 at GLP-1 receptor, rs7903146 (TCF7L2), and rs1800857 (CCK receptor). Gastric emptying was normal in 38, rapid in 4, and delayed in two participants; 38 had normal, and four had impaired glucose tolerance. The T allele at rs7903146 (TCF7L2) was non-significantly associated (P=.14) with faster GE. The associations between SNPs and demographic variables, GE thalf , glucose tolerance and plasma GLP1 levels were not significant. There is a trend toward an association between faster GE and the diabetes-associated allele at rs7903146 in TCF7L2. However, these SNPs were not associated with plasma glucose or GLP1 concentrations during enteral dextrose infusion.

Faster Gastric Emptying Is Unrelated to Feeding Success in Preterm Infants: Randomized Controlled Trial.

Objectives: To evaluate the relationship between gastric emptying (GE) time and days to achievement of full enteral feeding (≥140 mL/kg/day) in preterm infants randomly assigned to receive one of two marketed study formulas for the first 14 feeding days: intact protein premature formula (IPF) or extensively hydrolyzed protein (EHF) formula. Methods: In this triple-blind, controlled, prospective, clinical trial, we report GE time (time to half-emptying, t1/2) by real-time ultrasonography on Study Day 14, in preterm infants receiving IPF or EHF formula. The association between GE time and achievement of full enteral feeding was evaluated by Pearson correlation. Per-protocol populations for analysis included participants who (1) completed the study (overall) and (2) who received ≥ 75% study formula intake (mL/kg/day). Results: Median GE time at Day 14 was significantly faster for the EHF vs. IPF group overall and in participants who received ≥ 75% study formula intake (p ≤ 0.018). However, we demonstrated GE time had no correlation with the achievement of full enteral feeding (r = 0.08; p = 0.547). Conclusion: Feeding IP premature formula vs. EH formula was associated with shorter time to full enteral feeding. However, faster GE time did not predict feeding success and may not be a clinically relevant surrogate for assessing feeding tolerance.

Accelerated gastric emptying is associated with improved aspiration efficiency in obesity

BackgroundThe overall effectiveness of aspiration therapy (AT) for obesity relies on optimal aspiration timing after a meal, which can vary depending on a patient’s rate of gastric emptying (GE). Our...

Separate and Combined Glucometabolic Effects of Endogenous Glucose-Dependent Insulinotropic Polypeptide and Glucagon-like Peptide 1 in Healthy Individuals.

The incretin hormones glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) are secreted postprandially and contribute importantly to postprandial glucose tolerance. In this study, we assessed the individual and combined contributions of endogenous GIP and GLP-1 to the postprandial changes in glucose and glucoregulatory hormones using the novel GIP receptor antagonist GIP(3-30)NH2 and the well-established GLP-1 receptor antagonist exendin(9-39)NH2 During 4-h oral glucose tolerance tests (75 g) combined with an ad libitum meal test, 18 healthy men received on four separate days in randomized, double-blinded order intravenous infusions of A) GIP(3-30)NH2 (800 pmol/kg/min) plus exendin(9-39)NH2 (0-20 min: 1,000 pmol/kg/min; 20-240 min: 450 pmol/kg/min), B) GIP(3-30)NH2, C) exendin(9-39)NH2, and D) saline, respectively. Glucose excursions were significantly higher during A than during B, C, and D, while glucose excursions during B were higher than during C and D. Insulin secretion (assessed by C-peptide/glucose ratio) was reduced by 37 ± 16% (A), 30 ± 17% (B), and 8.6 ± 16% (C) compared with D (mean ± SD). A and C resulted in higher glucagon levels and faster gastric emptying. In conclusion, endogenous GIP affects postprandial plasma glucose excursions and insulin secretion more than endogenous GLP-1, but the hormones contribute additively to postprandial glucose regulation in healthy individuals.

Acute Effects of Substitution, and Addition, of Carbohydrates and Fat to Protein on Gastric Emptying, Blood Glucose, Gut Hormones, Appetite, and Energy Intake.

Whey protein, when ingested on its own, load-dependently slows gastric emptying and stimulates gut hormone concentrations in healthy young men. The aim of this study was to determine the effects of substitution, and addition, of carbohydrate (dextrose) and fat (olive oil) to whey protein. In randomized, double-blind order, 13 healthy young men (age: 23 ± 1 years, body mass index: 24 ± 1 kg/m2) ingested a control drink (450 mL; ~2 kcal/‘control’) or iso-volumetric drinks containing protein/carbohydrate/fat: (i) 14 g/28 g/12.4 g (280 kcal/‘M280′), (ii) 70 g/28 g/12.4 g (504kcal/‘M504′), and (iii) 70 g/0 g/0 g (280 kcal/‘P280′), on 4 separate study days. Gastric emptying (n = 11, 3D-ultrasonography), blood glucose, plasma insulin, ghrelin, cholecystokinin (CCK) and glucagon-like peptide-1 (GLP-1) concentrations (0–180 min), appetite (visual analogue scales), and ad-libitum buffet-meal energy intake (180–210 min) were determined. Substitution of protein with carbohydrate and fat was associated with faster gastric emptying (lower 50% emptying time (T50)), reduced suppression of ghrelin, and stimulation of GLP-1 (all P < 0.001); while the addition of carbohydrate and fat to protein did not affect gastric emptying or gut hormone responses significantly. Total energy intake (i.e., drink plus meal) was greater after all caloric drinks than control (P < 0.001). In conclusion, substitution of whey protein with dextrose and olive oil accelerated gastric emptying. Higher protein content of a mixed macronutrient drink increased gut hormone and insulin responses.