Applications of Stable Isotopes to Pediatric Nutrition and Gastroenterology

Klein, Peter; Klein, E. Roseland

doi:10.1097/00005176-198502000-00004

Cited by 34 publications

(19 citation statements)

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“…20 The SBT is a noninvasive measure of small intestinal villus health based on the level of sucrase activity in the brush border of enterocytes. 20 The SBT is a noninvasive measure of small intestinal villus health based on the level of sucrase activity in the brush border of enterocytes.…”

Section: Discussionmentioning

confidence: 99%

“…20,21 We have shown previously that control children have a normal SBT of 6.1 %CD90 with 95% confidence interval of 4.8 to 7.3. Briefly, following fasting; 1-hour fast for the day 1 breath test and 6-hour fast for the day 5 breath test, the reason for the different fasting conditions was that it was deemed unethical to fast diarrhea patients for 6 hours because the subjects have not been consuming significant amount of food over the past 24 hours.…”

Section: C-sucrose Breath Test and Intestinal Permeabilitymentioning

confidence: 90%

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Zinc-Fortified Oral Rehydration Solution Improved Intestinal Permeability and Small Intestinal Mucosal Recovery

Tran

Hawkes

Graham

et al. 2014

Clin Pediatr (Phila)

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A randomized double-blind placebo-controlled study was conducted in children admitted to hospital with gastroenteritis (≥3 loose stools per day). All were treated for 5 days following admission with either zinc (Zn, 3 mg) or without Zn-fortified rice-based oral rehydration solution (ORS). (13)C-sucrose breath test (SBT) and intestinal permeability (lactulose/rhamnose or L/R ratio) were performed concurrently prior to commencement of ORS with or without Zn and at day 5 post-admission. There was a significant improvement in the SBT results in both the Zn-fortified group, median (5th-95th percentile) 2.1% (0.4% to 8.3%) versus 4.4% (0.4% to 10.4%), P < .05, and control group, 1.4% (0.1% to 5.4%) versus 4.3% (0.4% to 11.4%), P < .05, between the day of admission and day 5 post-admission. In the Zn-fortified group, there was also a significant improvement in L/R ratio between the day of admission and day 5 post-admission, 53.0 (19.5-90.6) versus 17.7 (13.4-83.2), P < .05. Low levels of Zn improved intestinal permeability but did not enhance short-term recovery following diarrheal illness.

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Section: Discussionmentioning

confidence: 99%

Section: C-sucrose Breath Test and Intestinal Permeabilitymentioning

confidence: 90%

Zinc-Fortified Oral Rehydration Solution Improved Intestinal Permeability and Small Intestinal Mucosal Recovery

Tran

Hawkes

Graham

et al. 2014

Clin Pediatr (Phila)

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“…To date, the application of 13 C-labelled substrates for diagnostic breath tests is directed to diseases of the stomach, liver, pancreas, and small bowel (Ghoos et al, 1993;Klein and Klein, 1985;McLean et al, 1983; Mundlos, Kühnelt and Adler, 1990; Murphy et al, 1990). The non-invasive lactulose H 2 -breath test is widely used for quantifying the OCTT based on the metabolic release of H 2 from the non-absorbable disaccharide lactulose in the human colon.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of oro-coecal transit time: a comparison of the lactose-[13C, 15N]ureide 13CO2- and the lactulose H2-breath test in humans

et al. 1997

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Objective:The lactulose H 2 -breath test is the most widely used non-invasive approach for evaluation of orocoecal transit time (OCTT). In the present study, doubly-labelled lactose-[ 13 C, 15 N]ureide (DLLU) was synthesized to investigate the OCTT in comparison to the conventional lactulose H 2 -breath test. Additionally, the bacterial breakdown rate (BBR) and rate of elimination and the metabolic pathways of the cleavage products of DLLU ( 13 CO 2 , [ 15 N]urea, and 15 NH 3 ) were investigated. Design and subjects: In a first study, DLLU was administered as a single oral-pulse-labelling (dosage: one gram) either without and after pretreatment of five grams of unlabelled lactoseureide (LU) on the day prior to the study to twelve healthy adult volunteers after breakfast. Breath and urine were collected in one and two hourintervals, respectively, over a one-day period. 13 C-enrichment in breath as well as 15 N-enrichment in urine fractions were measured by continuous flow-isotope ratio mass spectrometry (CF-IRMS). In a second study, lactulose was administered to the same subjects (dosage: ten grams). Breath was collected in quarter, half and one hour-intervals over a ten hour-period. Hydrogen concentration in breath was analysed using an electrochemical detector. Results:The comparison of the lactose-[ 13 C]ureide 13 CO 2 -breath test and the lactulose H 2 -breath test showed that the mean increase of the 13 C-enrichment in CO 2 occurred 1.18 h later than the mean increase of H 2 in breath. The resulting OCTTs derived from the two methods were 3.02 1.7 h (P < 0.01), respectively. The 15 N-enrichment of urinary urea and ammonia without and after pretreatment with LU started between two and three hours after DLLUadministration. The cumulative percentage urinary excretion of the 15 N-and 13 C-tracer was 29.9% and 13.6% respectively, and was slightly increased after LU-pretreatment to 32.1% and 14.6% of the dose administered. A total of 35.2% of the 13 C was found to be exhaled and remained approximately constant after LU-pretreatment (36.2%). Conclusions: The use of the lactulose H 2 -breath test for evaluation of the OCTT showed a statistically significant shortening of 1.18 h in comparison to the lactose-[ 13 C]ureide 13 CO 2 -breath test in healthy adults. The most important limitations of the lactulose H 2 -breath test are its low specificity and sensitivity due to dosedependent accelerations of OCTT, interfering H 2 -rise from malabsorbed dietary fibre and H 2 -non-producers. In contrast, our lactose-[ 13 C]ureide 13 CO 2 -breath test was confirmed to avoid these disadvantages and to yield reliable results. This test is recommended especially if higher sensitivity and specificity is required, if IRMStechnique is available and if lactulose H 2 -tests lead to insufficient results.

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“…The difference in 13C content between C, plant-derived substrates and the CO, in basal human breath is large enough to be used in metabolic studies (Lacroix et al 1973;Schoeller et al 1980;Shulman et al 1983;Klein & Klein, 1985;Hiele et al 1988aHiele et al , 6, 1989. Maize-derived glucose was obtained from Amylum, Aalst, Belgium.…”

Section: Substratesmentioning

confidence: 99%

Metabolism of erythritol in humans: Comparison with glucose and lactitol

Hiele¹,

Ghoos²,

Rutgeerts³

et al. 1993

Br J Nutr

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The metabolism of erythritol was assessed in six normal volunteers by measuring the amount of 13C02 excretion and H, excretion in breath, and erythritol in urine after intake of 25 g '3C-labelled erythritol. The results were compared with the same variables obtained after intake of 25 g I3C-labelled glucose and 13C-labelled lactitol. In addition, the H, production by faecal flora supplemented with small amounts of erythritol, glucose and lactitol was measured in vitro, as an index of bacterial metabolism of nonabsorbed substrate. In contrast to the results obtained after intake of glucose and lactitol, no increase in breath I3CO, and H, was observed after intake of erythritol, and erythritol was nearly completely recovered in urine. The in vitro experiments showed that no H, was formed by faecal flora from erythritol as compared with glucose and lactitol. It is concluded that erythritol is a substrate that is readily absorbed, and undergoes no metabolism by the host. If part of it escapes absorption, it is not metabolized by faecal flora.Erythritol metabolism: Glucose: Lactitol: Humans Recently various new sugars and sugar-alcohols have become available for nutritional and therapeutic use. They are proposed as low-energy sweeteners, less cariogenic than glucose or sucrose, but, in contrast to artificial sweeteners such as aspartame and saccharin, they provide a bulking effect to foodstuffs. Some of them, e.g. lactitol and lactulose, are also used in the treatment of constipation and portal-systemic encephalopathy. Erythritol is a C, polyol, naturally occurring in algae and mushrooms, with a pleasant taste and interesting physico-chemical characteristics (Oku & Noda, 1990). The aim of the present study was to determine the metabolic characteristics of erythritol in humans.The evaluation of the energy value of a new product is cumbersome. Feeding studies can be used in animals but are difficult to perform in man (Van Es, 1987). Another technique of evaluation is based on the measurement of the fate of a dose of radiolabelled substrate (Grimble et al. 1988). Both techniques require a number of assumptions, and the energy value obtained should be considered as approximate. In the present study we evaluated the metabolic characteristics of erythritol by comparing it with glucose and lactitol, two substrates with a well-identified metabolism, by means of the following tests: 13C0, breath tests, H, breath tests, and measurement of urinary substrate recovery. Because colonic fermentation is an important mechanism of energy salvage for non-absorbed carbohydrates, we have also compared the amount of H, formed by colonic flora in a faecal incubation system to which the different substrates were added.

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Applications of Stable Isotopes to Pediatric Nutrition and Gastroenterology

Cited by 34 publications

References 0 publications

Zinc-Fortified Oral Rehydration Solution Improved Intestinal Permeability and Small Intestinal Mucosal Recovery

Zinc-Fortified Oral Rehydration Solution Improved Intestinal Permeability and Small Intestinal Mucosal Recovery

Evaluation of oro-coecal transit time: a comparison of the lactose-[13C, 15N]ureide 13CO2- and the lactulose H2-breath test in humans

Metabolism of erythritol in humans: Comparison with glucose and lactitol

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