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An adequate fiber intake is recommended for pregnant women, with or without gestational diabetes, similarly to the general population. Due to the lack of precise data on the composition of fiber in foods, dietary advices are not specific. Their objective is to increase the overall fiber consumption, ideally up to a daily consumption of 28g. Fiber intake has diverse effects and it is predominantly the intake of the viscous soluble fibers that improves the glycemic profile. In the case of gestational diabetes, supplementation with fiber products can be of interest in addition to the dietary recommendations to improve the postprandial glycemic profiles. More precise information on the impact of foods according to their fiber composition is needed to optimize the dietary advice.

An adequate fiber intake is recommended for pregnant women, with or without gestational diabetes, similarly to the general population. Due to the lack of precise data on the composition of fiber in foods, dietary advices are not specific. Their objective is to increase the overall fiber consumption, ideally up to a daily consumption of 28g. Fiber intake has diverse effects and it is predominantly the intake of the viscous soluble fibers that improves the glycemic profile. In the case of gestational diabetes, supplementation with fiber products can be of interest in addition to the dietary recommendations to improve the postprandial glycemic profiles. More precise information on the impact of foods according to their fiber composition is needed to optimize the dietary advice.Une consommation suffisante de fibres fait partie des recommandations pour les femmes enceintes, avec ou sans diabète gestationnel, tout comme pour la population générale. Par manque de données précises sur la composition des fibres des aliments, les conseils alimentaires se trouvent être peu spécifiques, avec pour objectif d’augmenter la consommation de manière générale à 28 g par jour. Les fibres ont des effets divers, et ce sont surtout les fibres solubles visqueuses qui améliorent le profil glycémique. En cas de diabète gestationnel, une supplémentation est intéressante pour limiter les élévations glycémiques, en plus des conseils pour majorer les fibres de manière générale dans l’alimentation. Plus de détails sur l’impact des aliments en fonction de leur composition en fibres sont nécessaires pour optimiser les conseils alimentaires.

Intestinal gluconeogenesis (IGN) is a regulatory function of energy homeostasis. IGN-produced glucose is sensed by the gastrointestinal nervous system and sends a signal to regions of the brain regulating food intake and glucose control. IGN is activated by dietary protein and dietary fibre, and by gastric bypass surgery of obesity. Glutamine, propionate and succinate are the main substrates used for glucose production by IGN. Activation of IGN accounts for the well-known satiety effect of protein-enriched diets and the anti-obesity and anti-diabetes effects associated with fibre feeding and gastric bypass surgery. Genetic activation of IGN in mice shows the same beneficial effects, independently of any nutritional manipulation, including a marked prevention of hepatic steatosis under hypercaloric feeding. The activation of IGN could thus be the basis for new approaches to prevent or correct metabolic diseases in humans.La néoglucogenèse intestinale : une fonction insulinomimétique.La néoglucogenèse intestinale (NGI) est une fonction régulatrice de l’homéostasie énergétique. Le glucose qu’elle produit est détecté par le système nerveux gastrointestinal et envoie un signal aux régions du cerveau régulant la prise alimentaire et le contrôle glycémique. L’activation de la NGI par les protéines et les fibres alimentaires et par la chirurgie de type by-pass gastrique permet d’expliquer les effets anti-obésité et anti-diabète des régimes enrichis en protéines et/ou en fibres et de la chirurgie bariatrique. L’activation génétique de la NGI chez la souris présente les mêmes effets bénéfiques, indépendamment de toute manipulation nutritionnelle. L’activation de la NGI pourrait ainsi être la base de nouvelles approches préventives ou correctives des maladies métaboliques chez l’homme.

Problématique et hypothèse : L’incidence du diabète de type 2 (DT2), ainsi que de la morbidité et mortalité associées, est en augmentation constante dans le monde. La perte de poids par diète hypocalorique réduit les facteurs de risque et l’incidence du DT2 chez les sujets obèses. Cependant, il existe une grande variabilité dans la réponse des sujets obèses à ce type d’interventions pour des raisons inconnues. La dysfonction du tissu adipeux blanc (TAB), l’hypertriglycéridémie post-prandiale, la résistance à l’insuline (RI) et l’hyperinsulinémie sont des facteurs de risque majeurs du DT2 chez l’humain. Des travaux de notre laboratoire ont démontré que les lipoprotéines porteuses d’apoB prédisent et promeuvent la dysfonction du TAB et les facteurs de risque associés chez des sujets obèses. Notre hypothèse était qu’un taux élevé d’apoB plasmatique au début de l’étude identifie les sujets obèses qui réduiront le plus les facteurs de risque de DT2 après une diète hypocalorique de 6 mois. Nous avons également exploré si le changement d’apport en fibres après l’intervention était prédictif de l’amélioration des facteurs de risque de DT2 indépendamment de la perte de poids. Méthodologie : Cinquante-neuf participants (33 femmes, 26 hommes, 45-74 ans, IMC ≥27 kg/m2, sans maladies chroniques) ont complété l’intervention de diète hypocalorique (-500 calories/jour) d’une durée de 6 mois. La fonction du TAB ex vivo a été mesurée par sa capacité d’hydrolyse et d’entreposage de lipoprotéines riches en triglycérides synthétiques marquées au 3H-trioléine. Le métabolisme post-prandial des lipides a été mesuré durant 6 heures après l’ingestion d’un repas riche en gras marqué au 13C-trioléine. La sensibilité à l’insuline (SI) et la sécrétion d’insuline induite par le glucose (SIIG) ont été mesurées par clamp Botnia, qui combine un test de tolérance au glucose intraveineux de 1 heure et un clamp hyperinsulinémique-euglycémique de 3 heures. Les apports alimentaires ont été évalués par journaux alimentaires de 3 jours. Résultats : Après la diète hypocalorique, les participants ont réduit leur apport calorique de 11,1±22,6% et lipidique de 19,9±31,0%, et ont perdu en moyenne 5,40±4,76% de leur poids initial. L’augmentation moyenne de la SI était de 33,7±56,2% et la diminution de la SIIG de -17,7±27,6%. L'apoB au début de l'étude prédit l'augmentation de la fonction du tissu adipeux (p=0,002, r=0,63-0,68) et une diminution de la sécrétion d'insuline (p=0,006, r=0,59) après l'intervention, indépendamment du sexe, du changement d'IMC, de masse grasse androïde et du ratio gras androïde/gynoïde. L’augmentation de l’apport en fibres prédit la diminution de la 2e phase de SIIG (p=0,040, r=-0.49) et de SI mesurée durant le TTGIV (p=0,026, r=0,48), indépendamment du sexe et du changement d’IMC, d’apport énergétique et d’apport en macronutriments. Conclusion : Un taux élevé d'apoB plasmatique avant l'intervention ainsi qu’un apport élevé en fibres post-intervention identifie les sujets qui réduisent le plus la dysfonction du TAB, la RI et l’hyperinsulinémie après une diète hypocalorique. Cibler les sujets avec taux d’apoB élevé par une diète hypocalorique riche en fibres pourrait maximiser les bénéfices de la diète hypocalorique pour réduire l’incidence du DT2 chez les sujets obèses., Background and hypothesis: The incidence of type 2 diabetes (T2D) and associated morbidity and mortality is constantly on the rise worldwide. Weight loss using behaviour modification programs, such as hypocaloric diets, reduce the risk factors for, and incidence of, T2D in obese subjects. However, there is a large inter-subject variability in the metabolic response of obese subjects to these interventions, the reasons for which are unclear. White adipose tissue (WAT) dysfunction, postprandial hypertriglyceridemia, insulin resistance (IR), and hyperinsulinemia are major risk factors for T2D in humans. Work from our lab demonstrated that apoB lipoproteins, measured in plasma as apoB, promote and predict WAT dysfunction and related risk factors in obese subjects. Our hypothesis was that elevated baseline plasma apoB identify obese subjects who best reduce the risk factors for T2D following a 6-month hypocaloric dietary intervention. We also explored whether the change in fiber intake following the intervention was most predictive of the amelioration in the risk factors for T2D independent of weight-loss. Methods: Fifty-nine subjects (33 women, 26 men, 45-74 years, BMI ≥27 kg/m2, without chronic diseases) completed a hypocaloric dietary intervention (-500 kcal/day) over 6 months. Ex vivo WAT function was measured as the hydrolysis and storage of synthetic 3H-triolein-labeled triglyceride-rich lipoproteins. Postprandial fat metabolism was measured over 6-hours after the ingestion of a 13C-triolein-labeled high fat meal. Insulin sensitivity (IS) and glucose-induced insulin secretion (GIIS) were measured by a Botnia clamp, which is a combination of 1-hour intravenous glucose tolerance test followed by 3-hour hyperinsulinemic euglycemic clamp. Dietary intakes were evaluated using 3-days food recalls. Results: Following the hypocaloric diet, subjects decreased caloric intake by 11.1±22.6% and fat intake by 19.9±31.0% and lost an average weight of 5.40±4.76%. They also had an increase in IS by 33.7±56.2% and a decrease in GIIS by -17.7±27.6%. Baseline apoB predicted the post-intervention increase in WAT function (p=0.002, r=0.63-0.68) and decrease in GIIS (p=0.006, r=0.59), independently of sex, change in BMI, android fat mass and android/gynoid fat mass ratio. The increase in fiber intake predicted the decrease in 2nd GIIS (p=0.040, r=-0.49) and IS (p=0.026, r=0.48) measured during the IVGTT independent of sex and changes in BMI and energy intake or other macronutrients. Conclusions: Elevated baseline plasma apoB and increased post-intervention fiber intake identifies subjects who best reduce WAT dysfunction, IR and hyperinsulinemia after a hypocaloric diet. Targeting subjects with high plasma apoB with fiber-enriched hypocaloric diet may maximize the benefit of hypocaloric diets to reduce the incidence of T2D in obese subjects.

Patients often use dietary supplements for cardiovascular prevention. An US study showed that 75% of patients with cardiovascular disease used dietary supplements. Red yeast rice, phytosterols and fibers can significantly decrease LDL. The level of monacolin in red yeast rice can vary between products and toxins can sometimes be found. Prospective studies showed that fibers could decrease cardiovascular risk. Others substances, like guggul, soy and artichoke leaf extracts, did not show a clear benefit for cardiovascular prevention. Measurements of cholesterol levels can help the physician to discuss with his patient about the effects of some dietary supplements.

Chronic constipation is one of the most common chronic gastrointestinal complaints and a frequent reason for consultation. Lifestyle modification and dietary advice attract a lot of patients, often dissatisfied with a long-term drug intake. These behavioral modifications are recommended as a first-line approach in the treatment of chronic mild constipation in the majority of current guidelines despite a low level of evidence. Fiber supplementation is probably the most relevant measure because of a satisfactory level of proof. It improves stool frequency and consistency. It has a positive effect on excessive straining and colonic transit time. The recommended daily fiber intake is at least 20 to 25g. To avoid side effects like bloating and abdominal pain, it must be gradually adjusted after a several days period. The benefice of increasing water intake or daily physical exercise in the treatment of chronic constipation have a lack of evidence, except specific situations such as elderly, hospitalized, institutionalized, dehydrated people or people consuming fluids less than 500mL/day. Change in environmental defecation conditions or bowel habits are probably anecdotal recommendations.

Acute diverticulitis is a common disease with increasing incidence. In most of cases, diagnosis is made at an uncomplicated stage offering a curative attempt under medical treatment and use of antibiotics. There is a risk of diverticulitis recurrence. Uncomplicated diverticulitis is opposed to complicated forms (perforation, abscess or fistula). Recent insights in the pathophysiology of diverticulitis, the natural history, and treatments have permitted to identify new treatment strategies. For example, the use of antibiotics tends to decrease; surgery is now less invasive, percutaneous drainage is preferred, peritoneal lavage is encouraged. Treatments of the diverticulitis are constantly evolving. In this review, we remind the pathophysiology and natural history, and summarize new recommendations for the medical and surgical treatment of acute diverticulitis.

Pain, Fibres, Sel, Dominance Temporelle des Sensations, Temps-Intensité. Bread, Dietary fiber, Salt, Temporal Dominance of Sensations, Time-Intensity; In France, consumption of dietary fiber is insufficient (18.8 g/day) and salt intake is higher compared to the recommendations of authorities (6 g/day). However, bread is a major source of these two ingredients in the French diet. It is therefore essential that industrial bakeries consider a reduction in salt content of bread, parallel to a fiber enrichment, to meet these recommendations. In this context, the objective of this study is the assessment of perceptions of texture and taste of fiber-enriched and salt reduced breads, containing leaven or not. To know the evolution of these sensory properties in mouth, temporal methods have been implemented: Temporal Dominance of Sensations (TDS) and Time-Intensity (TI). A sensory panel of 19 people was recruited, trained in these methods, and selected to participate in the evaluation sessions. Four fiber-enriched breads (9.2% of wheat bran, flour wet basis (wb)) were made with different salt contents (1.4% -1.8% wb) and with (breads to 1.4% salt) or without leaven (breads to 1.8% salt). Each bread was evaluated using seven texture attributes and four taste attributes for TDS, and two attributes (salty and leaven) for TI. Results indicate that wheat bran particles are perceived in the four breads in the end of tasting. Breads to 1.4% salt containing leaven are less pasty than those to 1.8% salt, even if the evolution of texture during tasting is similar for the four breads. Significant differences in salt perception are also seen between these same breads. In fact, breads to 1.8% salt are characterized by a dominant perception of salty attribute during tasting. In contrast, this same attribute “salty” does not attract or little the attention of the panel for breads to 1.4% salt and seems to be masked by the dominant perception of leaven aromatic notes. These breads appeared bland for short periods in the middle and/or end of tasting. These two sensory methods show that a 22% salt reduction in breads could be compensated by the aromatic typicity of leaven for French bread rich in fiber.; En France, la consommation de fibres alimentaires est insuffisante (18,8 g/jour) et l’apport en sel est supérieur aux recommandations des pouvoirs publics (6 g/jour). Or, le pain est une source majeure de ces deux ingrédients dans l’alimentation des français. Il est donc essentiel que les boulangers, artisans ou industriels, envisagent une diminution de la teneur en sel parallèlement à un enrichissement en fibres pour atteindre ces recommandations. Dans ce cadre, l’objectif de cette étude est d'évaluer les perceptions de texture et de goût de pains enrichis en fibres et à teneurs réduites en sel, en présence ou non de levain. Pour connaître l'évolution de ces propriétés sensorielles en bouche, des méthodes temporelles ont été mises en œuvre: la Dominance Temporelle des Sensations (DTS) et le Temps-Intensité (TI). Un panel de 19 personnes a été recruté, formé à ces méthodes, et sélectionné pour participer aux séances d’évaluation. Quatre pains enrichis en fibres (9,2% de sons base farine) ont été fabriqués à différentes teneurs en sel (1,4%-1,8% base farine) en présence (pains à 1,4% sel) ou non (pains à 1,8% sel) de levain de blé. Chaque pain a été évalué selon 7 attributs de texture et 4 attributs de goût pour la DTS, et 2 attributs (salé et levain) pour le TI. Les résultats indiquent que les particules de son sont perçues dans les quatre pains en fin de dégustation. Les pains à 1,4% de sel contenant du levain sont moins pâteux que ceux à 1,8% sel, même si l’évolution de la texture au cours de la dégustation est similaire pour les quatre pains. Des différences significatives de perception salée sont aussi perçues entre ces mêmes pains. En effet, les pains à 1,8% de sel sont caractérisés par une perception dominante de l’attribut « salé » au cours de la dégustation. A l’inverse, ce même attribut « salé » n’attire pas ou peu l’attention du panel pour les pains à 1,4% de sel, et semblerait masqué par la perception dominante de notes « levain ». Ces pains apparaissent fades pour de courtes durées en milieu et/ou fin de dégustation. Ces deux méthodes ont mis en évidence qu’une réduction de 22% de la teneur en sel pourrait être compensée par la typicité aromatique du levain pour des pains français riches en fibres céréalières.

Acute diverticulitis is defined by diverticular and peridiverticular inflammation and infection and is efficiently treated medically in most of the cases. For most patients, outpatient treatment is possible and hospitalization is only indicated if the patient is unable to eat, suffers from an acute attack, has diverticulitis related complications or if symptoms fail to improve despite adequate outpatient therapy The treatment of acute uncomplicated diverticulitis usually consists of broad-spectrum antibiotics covering both aerobic and anaerobic bacteria. Antibiotic therapy is usually administrated for 7 to 10 days but its duration can be longer if any complications occur. If there is no clinical improvement within 2 or 3 days, repeat CT imaging is needed, as this may reveal an abscess, phlegmon or fistula, which may require percutaneous drainage or surgery. The published literature does not support the recommendation of any prophylactic diet or medical treatment for reducing the risk of first or recurrent diverticulitis in patients with diverticulosis.

The functional colopathies are frequent in digestive pathology and are particularly badly felt by African patients. The authors, after the determination of the masticatory efficiency score (classification of Verkindere) of 100 subjects affected by colopathies and diagnosed in the service of gastroenterology of Cocody University Hospital (Abidjan), attempt to determine the importance of the masticatory deficiency in functional colopathies. Among the toothless subjects with functional colopathies, the restoration of the masticatory efficiency by functional prosthetic rehabilitation constitutes an essential therapeutic act in the reduction of the symptoms of the functional colopathies and the improvement of the comfort of the patients. Patients' global care raises the interest of collaboration between odontologists and gastroenterologists for an efficient treatment.

Dietary recommendations are the first step of children hypercholesterolemia's management, whatever its level and its mechanism. The authors review the scientific justifications for these recommendations, and particularly the effects on plasma LDL-cholesterol of the different dietary fatty acids, of fibers and plant sterols. They point out the diet's aim and principles and they give consumption indicators and practical advice.

Wheat bioactive compounds (fibres, minerals, vitamins, antioxidants) are concentrated in grain outer layers, which constitute the bran fraction obtained after the milling process leading to the white flour. In order to improve the health value of the flours, whole grains can be processed or alternatively, bran fractions can be added to white flours. In the bran, bio-actives compounds are poorly bio-accessible as they are trapped in resistant cell-wall. Dry fractionation of wheat bran takes advantage from differences in compositional and mechanical properties between grain tissues. Both ultrafine milling and electrostatic separation can be used to prepare bran fractions with different degrees of micronization and/or enriched in compounds of interest. In vitro digestion studies of bran-enriched breads have shown that the bio-accessibility of phenolic acids and minerals improves with decreasing particle size and also with increasing concentration of micronized aleurone material. © 2010 Sociét é française de nutrition. Published by Elsevier Masson SAS. All rights reserved.

Wheat bioactive compounds (fibres, minerals, vitamins, antioxidants) are concentrated in grain outer layers, which constitute the bran fraction obtained after the milling process leading to the white flour. In order to improve the health value of the flours, whole grains can be processed or alternatively, bran fractions can be added to white flours. In the bran, bio-actives compounds are poorly bio-accessible as they are trapped in resistant cell-wall. Dry fractionation of wheat bran takes advantage from differences in compositional and mechanical properties between grain tissues. Both ultrafine milling and electrostatic separation can be used to prepare bran fractions with different degrees of micronization and/or enriched in compounds of interest. In vitro digestion studies of bran-enriched breads have shown that the bio-accessibility of phenolic acids and minerals improves with decreasing particle size and also with increasing concentration of micronized aleurone material. © 2010 Sociét é française de nutrition. Published by Elsevier Masson SAS. All rights reserved.

Obesity is a multifactorial disease and often considered as an imbalance between energy intake and energy expenditure. However, the gut microbiota could have an impact on the development of excess body weight. According to the type of diet, this black box of the bowel could contribute to modifications of both the caloric extraction and the energy expenditure. The gut microbiota is linked with intermediary metabolism and inflammation, and could be involved in physiopathogenesis of type 1 and 2 diabetes, metabolic syndrome and obesity. Fiber enriched diet and Mediterranean type of diet could induce gut microbiota modifications with consecutive weight loss and improvement of both metabolic syndrome and diabetes.

In irritable bowel syndrome, the main objectives of the treatment are the relief of abdominal pain then the improvement of bowel disturbances. Spasmolytic agents, or clays remain routinely the first line pharmacological options. The efficacy of dietary recommendations is not validated in most of the cases while dietary fibers, mainly insoluble fibers, may even worsen abdominal discomfort. In C-IBS, osmotic laxatives or macrogol are effective to improve colonic transit while loperamide and also colestyramine can be prescribed to reduce the number of stools of D-IBS patients. When the first line treatment fails to improve symptoms, antidepressants (tricyclic rather than SSRs) can be prescribed at lower doses than that recommended for depression. In meta-analysis, the odds ratio for pain relief varies from 2 to 4 and strongly depends on the patient's compliance to the treatment. Probiotics, pregabalin and even antibiotics (i.e neomycin, metronidazole or rifaximin), are possible new therapeutic options. Few clinical trials suggest that ramosetron (a new 5HT3 antagonist), octreotide, melatonin, or lidocain could be also discussed in the future. A non pharmacological therapeutic approach has to be considered, particularly in patients with severe symptoms, in combination with pharmacological treatment.

During the past few decades, considerable attention has been given to the impact of nutrition on kidney disease. Although most dietary attempts to treat chronic renal failure (CRF) and to decrease uremia recommend a protein restriction, another dietetic approach, based on dietary fibers (DF), can lead to the same urea-lowering effect by increasing urea-nitrogen (N) excretion in stool with a concomitant decrease of the total N quantity excreted in urine. In fact, feeding DF results in a greater rate of urea N transfer from blood to large bowel, where it will be hydrolyzed by bacterial ureases before subsequent microflora metabolism and proliferation. Because elevated concentration of serum urea N have been associated with adverse clinical symptoms of CRF, these results suggested a possible usefulness of combining DF with a low protein diet to increase N excretion via the fecal route. These results have been shown in animal models of experimental renal failure and in CRF patients. Further investigations in this population of patients are currently in progress to study whether DF may be beneficial on CRF progression and on CRF terminal stage tolerance. A part of this work is financed by the French Society of Nephrology.

How the epidemic obesity appeared in the United States during the eighties. Respective intake of fats, proteins and saccharides in the diet is notified. Sugars such as sucrose provide pleasure and reward specially by infants and children. Lactose occurs in the life of the newborn with a peculiar situation; its sweetening effect is weak and devoid of any neurochemical stimulation. The amounts of lipids and sugars in the daily diet are frequently excessive if physical activity is inappropriate. TV dinners are specially endangered. Eating too much snacks disrupts the physiological rhythm of the digestive economy. The carbonated soft beverages' are used instead of water, affording large amounts of inapparent sugars. Ice creams are often too rich in sugars and lipids. Fruits and vegetable fibers fail in the diet.

Postprandial hyperglycaemia depends on the amount and type of ingested carbohydrates and/or the degree of inhibition of hepatic glucose output following a meal. The kinetics of carbohydrate absorption is directly influenced by the type of food (carbohydrates with variable glycaemic indices, fibre content of the meal) and by the speed of gastric emptying. Hepatic glucose output is remarkably inhibited by insulin and strongly stimulated by glucagon. It remains abnormally high after a meal in diabetic patients because of insufficient portal insulin concentrations, hepatic insulin resistance and/or hyperglucagonaemia. In diabetic patients, postprandial hyperglycaemia contributes to the aggravation of chronic hyperglycaemia, and thus to the increase of glycated haemoglobin levels. Furthermore, it has been recently demonstrated that postprandial hyperglycaemia increases the cardiovascular risk, even in nondiabetic subjects, probably by inducing endothelial dysfunction. Appropriate dietary counselling plays a key-role in the control of postprandial hyperglycaemia. Generally speaking, it includes a selection of carbohydrates with low glycaemic index and a higher fibre intake. Pharmacological interventions may also be considered when necessary.

Degradation ruminale et digestion intestinale de la graine de pois: effets de l'extrusion ou d'un ajout de tannins de châtaignier. L'effet de differents traitements visant a diminuer la degradabilite ruminale des proteines du pois a ete evalue par des mesures in situ et in vivo de la digestion ruminale et intestinale. Quatre moutons fistules ont ete utilises. La graine de pois constituait 50 % de la matiere azotee totale (MAT) de la ration. Le pois a ete distribue cru (RP), avec des tannins de châtaignier (RPT2, 2 % de la MAT du pois; RPT3, 3 % de la MAT du pois) ou extrude. La degradabilite theorique du pois a diminue sous l'effet du traitement d'extrusion (83,3 % vs. 90,8 %), mais n'a pas ete affectee par l'ajout de tannins. In vivo, l'addition de tannin n'a eu aucun effet sur les parametres de la digestion de la matiere organique (MO) et de l'N. L'extrusion a diminue la digestion apparente de la MO dans le rumen, mais celle-ci a augmente dans l'intestin grele. Ainsi la digestibilite de la MO dans l'ensemble du tube digestifn'a pas ete modifiee. Le flux duodenal de NAN a augmente de 27 % entre les regimes RP et EP. Cette augmentation s'explique essentiellement par une augmentation du flux de NAN non-microbien. La digestibilite intestinale apparente n'a pas ete modifiee par l'extrusion et la quantite de NAN apparemment digeree dans l'intestin grele a augmente de 23 % entre les regimes RP et EP. Une legere diminution de la digestibilite totale de l'N a ete observee avec le traitement d'extrusion. L'efficacite de la synthese de proteines microbiennes a ete superieure avec le regime EP. La quantite d'acides amines apparemment digeree dans l'intestin grele a ete plus elevee avec le regime EP qu'avec le regime RP, mais le profil des acides amines apparemment absorbes n'a pas ete modifie. Cette etude montre que des faibles doses de tannins (jusqu'a 3 % de la MAT du pois, ou 1,5 % de la MAT de la ration) sont inefficaces pour diminuer la degradabilite ruminale de la graine de pois, par contre l'extrusion peut largement ameliorer la valeur azotee de ce proteagineux.

This review is a summary of three reference books and of the final report of a European concerted action. The data have been updated by an analysis of recent publications, according to the same methodological criteria as those used in the reference books: sample size, quality of questionnaire and statistical methods. Mechanistic hypothesis are considered for each microcompounds, the effect of which is situated along the natural history of cancer. Few studies have considered folates effect on breast cancer, and they observed an interaction with the risk related to alcohol consumption, which is decreased with a high intake of folates. Many studies considered the effect of vitamin C and E, and carotenoids, but results are inconsistent. Conflicting results were also observed in studies on fibre and breast cancer. However, although only half of the studies showed a protective effect, the strength of the biological mechanisms give support to the hypothesis of a protection provided by fibre. The situation is comparable with phyto-estrogens: epidemiological studies are scarce and few of them show significant protection, but several plausible biological mechanisms are proposed, either related to the negative modulation of estrogen receptor by phyto-estrogen, or to the inhibition of proliferation by action on various enzymes. At the present time, caution in the interpretation of the results and in the use of plant microcompounds in prevention or therapy is strongly recommended.

Several dietary components increase the risk of ischemic cardiovascular disease: excess dietary cholesterol and fats (especially saturated fats with low mono- and polyunsaturated fatty acid content), deficiency of antioxidants, fibers. These dietary factors modify the levels and the physicochemical structure of plasma lipoproteins and consequently their metabolic activities. Some of them also modify platelet aggregation and endothelial function. To reduce the cardiovascular risk, different nutritional schemes have been proposed and applied in prevention studies. Mediterranean-type diet, or traditional Asian food provide a very favorable cost/effectiveness ratio. These diets must be associated with the usual measures for improving lifestyle (increased physical activity, reduction of smoking) and with drug treatment of major risk factors (dyslipidemia, hypertension, diabetes).

Diet prescription is a fundamental first-line element in the management of patients with dyslipidemia. Weight loss should be a primary goal for all overweight patients. A 5 to 10% weight loss is often sufficient to obtain a significant improvement in lipid levels. Dietary fat should not provide more than 30% of total calorie intake. Saturated fatty acids should not exceed 7% and polyunsaturated fatty acids should also be limited to 7 to 10%. For monounsaturated fatty acids the dietary allowance can be a bit wider, up to 15% of total calorie intake. Carbohydrates, particularly complex carbohydrates, should replace the fat calories. Dietary fiber (more than 20g/d) as well as soy protein or phyto-sterols can be helpful in reducing LDL-cholesterol by about 10%. Consumption of fruits and vegetables should also be encouraged because they provide antioxidants that have effects on other cardiovascular risk factors. Long-term education is needed to encourage the patient to comply with this type of diet. Psycho-behavioral strategies can be useful here.

FIBERS: A group of vegetarian subjects have been shown to have a lower risk of cancer of the prostate than a control group. But the exact role of food fiber remains to be determined because plant foods also have an antioxidant effect on their own. PLANT PRODUCTS AND EXTRACTS: A compound called PD SPEC has been showed to have antitumor effects both in vitro and in vivo. Evaluated in patients with a cancer escaping hormone control, the clinical response was a lower level of prostate specific antigen (PSA). SOYBEANS: Several studies have demonstrated the interesting properties of soybeans. No study has however been able to demonstrate the optimal dose per day. A prospective study is currently under way using a 40 g/day dose. OVERALL NUTRITIONAL APPROACH: Several studies are being conducted using a proposed diet where 15% of the total energy intake comes from fat (associated with a low saturated/unsaturated ratio), high fiber content (18 g/100 kcal) and 40 g daily soybean protein. Although large-scale studies with rigorous methodology are lacking, an overall nutritional approach could be an interesting strategy for the management of cancer of the prostate.

Large epidemiological studies have shown a reduced incidence of cardiovascular diseases in relation to dietary intake of micronutrients such as n-3 fatty acids (FA), folic acid, and vitamin E. The meaning of such results has been extended to promote the consumption of several vitamin supplements. Such supplementation, which represents a huge market, is generally taken as self-medication, with no medical prescription or control. Recent prospective trials confirm the efficacy of n-3 fatty acids in the secondary prevention of cardiovascular diseases. N-3 FA markedly affect cell metabolism by interacting at different levels. Increased intake of folic acid, either through changes in dietary habits or via supplements, also appears to positively affect cardiovascular prevention. Folic acid acts, both as an antioxidant and by reducing serum homocysteine concentration. While increased dietary intakes of vitamin E are associated with a reduced cardiovascular risk, the clinical results of recent studies evaluating the effect of vitamin E supplementation have generally been disappointing and contrast with the demonstration of potent antioxidant properties, as well as protective effects on endothelial and immune functions.

Although diet has always been recognized as the cornerstone in the management of diabetes, dietary recommendations are evolving continuously. There is now some consensus that the goals of medical nutrition therapy should be to attain and/or maintain a reasonable body weight, to ensure the best possible glycemic control and to reduce cardiovascular risk factors but the means to achieve these goals are still under discussion. Apart from caloric restriction which is, without any doubt, highly efficient but hardly applied in obese diabetic patients, the clinical benefits of the traditional measures to alleviate postprandial hyperglycemia (increasing meal frequency, consumption of carbohydrates with a low glycemic index and/or rich in fibers) are not unanimously acknowledged. The hotly debated issue regarding the ideal proportions of carbohydrates and fat advisable for diabetic individuals has lapsed progressively into disuse, all the arguments having run out. At the present time, there remain many unanswered important questions related to nutrition and diabetes because of the lack of long-term randomized studies evaluating the impact of a diet modification on morbidity and mortality. Considering the difficulties of changing our usual feeding patterns on a long term basis, these uncertainties will not readily be solved.