Effect of enteral administration of insulin on intestinal development and feeding tolerance in preterm infants: a pilot study

Shulman, Robert J.

doi:10.1136/fn.86.2.f131

Cited by 40 publications

(32 citation statements)

References 25 publications

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“…Available animal data, the presence of insulin in human milk (18,28), and the observation that oral administration of insulin to preterm infants (26-29 weeks of gestational age) increases lactase activity and reduces feeding intolerance (29) suggest that it is time to investigate the role of oral insulin supplementation in humans and its possible clinical implications.…”

Section: Discussionmentioning

confidence: 96%

Intestinal and Systemic Effects of Oral Insulin Supplementation in Rats After Weaning

et al. 2005

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Oral insulin has intestinal trophic effects in suckling animals. In mice, lower glucose and lipid levels may be seen when oral insulin is given after the weaning period. The purpose of the present study is to examine local and systemic effects of oral insulin supplementation in rats in the postweaning period. Immediately after weaning, Sprague-Dawley rats received either drinking water (controls) or oral insulin in their drinking water (1 U/ml) for either 1 week or 6 weeks. Intestinal mucosal parameters (bowel and mucosal weight, mucosal DNA and protein) and histological changes were examined in all study groups. Glucose levels were monitored weekly, and at the end of the study, blood levels of glucose, lipids, and insulin were measured in the fasting state. After 1 week of insulin supplementation, mucosal weight in duodenum and jejunum as well as jejunal DNA content were significantly higher in insulin-supplemented rats compared to controls. Duodenal circumference and villus height in jejunum were significantly higher in insulin-supplemented rats compared to controls on both day 7 and day 42. Total cholesterol levels were significantly lower in the study group compared with the controls. We conclude that oral insulin supplementation exerts intestinal trophic effects, as well as systemic effects in the postweaning period in rats.

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Section: Discussionmentioning

confidence: 96%

Intestinal and Systemic Effects of Oral Insulin Supplementation in Rats After Weaning

et al. 2005

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“…The evidence that oral INS has a trophic effect on intestinal mucosa comes from experiments by Shulman et al, who have demonstrated that oral INS stimulates an increase in ileal mass and disaccharidase activity (12) and increases ileal lactase activity (13) in the newborn miniature pig. In a recent clinical trial, Shulman showed that enteral administration of INS to preterm infants (26-29 weeks of gestational age) leads to higher lactase activity and less feed intolerance (22).…”

Section: Discussionmentioning

confidence: 99%

Oral Insulin Enhances Intestinal Regrowth Following Massive Small Bowel Resection in Rat

et al. 2005

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Experimental studies have suggested that insulin (INS) plays an important role in small intestinal growth and development. In the present study we investigated the effect of oral INS on structural intestinal adaptation and enterocyte proliferation and loss via apoptosis in a rat model of short bowel syndrome (SBS). Male Sprague-Dawley rats were divided into three experimental groups: sham rats underwent bowel transection, SBS rats underwent 75% small bowel resection, and SBS-INS rats underwent bowel resection and were treated with oral INS given in the drinking water from the 3rd to the 15th postoperative day. Parameters of intestinal adaptation (bowel and mucosal weight, mucosal DNA and protein, villous height, and crypt depth), enterocyte proliferation, and apoptosis were determined on day 15. SBS-INS rats demonstrated a significant increase (vs SBS rats) in jejunal and ileal overall bowel and mucosal weight, ileal mucosal DNA and protein, ileal villous height, and crypt depth. SBS-INS rats also showed an increased cell proliferation index in jejunum and ileum and decreased apoptotic index in jejunum compared to SBS animals. In conclusion, in a rat model of SBS, oral INS strongly enhances intestinal adaptation. Possible mechanisms may include increased cell proliferation and decreased enterocyte loss via apoptosis.

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“…Subcutaneous administration of interleukin-10 was used with variable outcomes in a small number of adults with refractory celiac disease [35]. In premature neonates, a single study involving 8 newborns evaluated the effects of enterally administered insulin on intestinal development and feeding intolerance and suggested that insulin might be of benefit in reducing feeding intolerance [36]. However, the minimal amounts and composition of growth factors as well as the routes of administration necessary to maintain specific intestinal functions in adults and neonates remain to be established.…”

Section: Discussionmentioning

confidence: 99%

Abnormal Intestinal Histology in Neonates with Congenital Anomalies of the Gastrointestinal Tract

Condino

Barleycorn

et al. 2004

Neonatology

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In animal models, when swallowing is experimentally prevented in utero, bowel length and weight are reduced, and villus height, crypt depth, and villus function are retarded. Little is known about the intestinal histology in infants with gastrointestinal (GI) tract anomalies. We examined the histological architecture of the intestine in neonates with GI anomalies in comparison to that of normal fetuses. Villus height, area, and length and crypt depth of normal fetuses were quantified in the proximal small bowel (n = 11) and measurements compared to those of surgical specimens of neonates with congenital anomalies of the GI tract (n = 16). Villus height and area and lamina propria height and area increased linearly from 8 to 24 weeks of gestation. In infants with anomalies of the GI tract, the villi were blunted and lacked normal histological architecture, the crypts were disorganized, and the crypt depth was significantly decreased (p = 0.004). Enterocyte height and area were significantly greater in neonates with congenital anomalies of the GI tract. The intestinal histology in neonates with congenital anomalies of the GI tract differs significantly from that of normal fetuses.

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Effect of enteral administration of insulin on intestinal development and feeding tolerance in preterm infants: a pilot study

Abstract: These preliminary data suggest that enteral insulin administration may be of benefit in reducing feed intolerance in preterm infants. A randomised, blinded trial is warranted.

Cited by 40 publications

References 25 publications

Intestinal and Systemic Effects of Oral Insulin Supplementation in Rats After Weaning

Intestinal and Systemic Effects of Oral Insulin Supplementation in Rats After Weaning

Oral Insulin Enhances Intestinal Regrowth Following Massive Small Bowel Resection in Rat

Abnormal Intestinal Histology in Neonates with Congenital Anomalies of the Gastrointestinal Tract

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