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Prediabetes is a metabolic condition associated with gut microbiome composition, although mechanisms remain elusive. We searched for fecal metabolites, a readout of gut microbiome function, associated with impaired fasting glucose (IFG) in 142 individuals with IFG and 1,105 healthy individuals from the UK Adult Twin Registry (TwinsUK). We used the Cooperative Health Research in the Region of Augsburg (KORA) cohort (318 IFG individuals, 689 healthy individuals) to replicate our findings. We linearly combined eight IFG-positively associated metabolites (1-methylxantine, nicotinate, glucuronate, uridine, cholesterol, serine, caffeine, and protoporphyrin IX) into an IFG-metabolite score, which was significantly associated with higher odds ratios (ORs) for IFG (TwinsUK: OR 3.9 [95% CI 3.02–5.02], P < 0.0001, KORA: OR 1.3 [95% CI 1.16–1.52], P < 0.0001) and incident type 2 diabetes (T2D; TwinsUK: hazard ratio 4 [95% CI 1.97–8], P = 0.0002). Although these are host-produced metabolites, we found that the gut microbiome is strongly associated with their fecal levels (area under the curve >70%). Abundances of Faecalibacillus intestinalis, Dorea formicigenerans, Ruminococcus torques, and Dorea sp. AF24-7LB were positively associated with IFG, and such associations were partially mediated by 1-methylxanthine and nicotinate (variance accounted for mean 14.4% [SD 5.1], P < 0.05). Our results suggest that the gut microbiome is linked to prediabetes not only via the production of microbial metabolites but also by affecting intestinal absorption/excretion of host-produced metabolites and xenobiotics, which are correlated with the risk of IFG. Fecal metabolites enable modeling of another mechanism of gut microbiome effect on prediabetes and T2D onset. Article Highlights: Prediabetes is a metabolic condition associated with gut microbiome composition, although mechanisms remain elusive. We investigated whether there is a fecal metabolite signature of impaired fasting glucose (IFG) and the possible underlying mechanisms of action. We identified a fecal metabolite signature of IFG associated with prevalent IFG in two independent cohorts and incident type 2 diabetes in a subanalysis. Although the signature consists of metabolites of nonmicrobial origin, it is strongly correlated with gut microbiome composition. Fecal metabolites enable modeling of another mechanism of gut microbiome effect on prediabetes by affecting intestinal absorption or excretion of host compounds and xenobiotics. [ABSTRACT FROM AUTHOR]

The Association of Stoma Care Nurses UK (2013) has stressed that it is the role of the stoma care nurse to provide education to patients, carers, prescribers and other nurses. This includes the area of medication management. Ensuring patients with an ileostomy receive their medication in a form they can absorb is of importance to every stoma care nurse. Prescribing for patients with a stoma calls for special care. Each patient with an ileostomy requires assessment of their medication regimen for the purpose of identifying potential medical absorption issues. However, from an extensive literature search, it is evident that there is very little literature published on this subject. This article looks at the considerations to take into account when prescribing medication for ileostomy patients, and examines the results of a clinical audit on medication prescribers’ knowledge of the impact of ileostomy formation on the absorption of medication. [ABSTRACT FROM AUTHOR]

Background: Instigating a patient support group for patients with pernicious anaemia (PA) revealed dissatisfaction with its current diagnosis and treatment. The authors investigated the clinical features, patient experience of diagnosis and treatment of PA in the UK. Methods: A total of 889 patients registered with the PA Society support group completed an online survey or postal questionnaire. Outcome measures included clinical features, length of time to diagnosis and patient satisfaction with current treatment Results: One-third of patients experienced symptoms for up to 1 year before diagnosis; 14% waited more than 10 years for a diagnosis. Neurological features were highly prevalent, the most common being memory loss and poor concentration. Nearly two-thirds of respondents were dissatisfied with current treatment; 10% used a non-licensed form of B12 to supplement their prescribed injections. Conclusion: The diagnosis and treatment of PA should be subject to a thorough review. This article discusses the patient survey and results and makes recommendations for how the diagnosis and treatment of PA may be evaluated. [ABSTRACT FROM AUTHOR]

Background: Recent evidence suggests that the duodenum can regulate iron absorption independently of hepcidin via the transcription factor Hif-2α acting directly on the transcription of the proteins involved in the iron transport. The current study investigates the temporal relationship between Dcytb and Hif-2α during early hypoxic stimulus in the enterocyte in vivo. Methods: Duodenal Dcytb and Hif-2α protein expression was analysed by Western blot technique while gene regulation was determined by quantitative PCR. Results: Both Dcytb and Hif-2α protein expression were increased during the first hours of hypoxic duration. A change in hepcidin expression however, was significant only at 72 h hypoxia. Increased iron absorption reported in early hypoxia could be accounted for in part by the enhancement of Dcytb expression by Hif-2α in the duodenum. Conclusion: Modulation of Hif-2α predominates over hepcidin in the regulation of intestinal iron absorption during short hypoxic duration. The intestine exerts regulatory mechanisms in the dietary absorption of iron into systemic circulation. [ABSTRACT FROM AUTHOR]

This study compared the gastrointestinal (GI) absorption characteristics and absolute bioavailability of fenofibric acid and fenofibrate (which is converted to fenofibric acid in vivo) in healthy volunteers. Treatments were delivered to the proximal small bowel, distal small bowel, and colon using a site-specific delivery system (Enterion capsule) and to the stomach by oral administration of equimolar doses. Serial blood samples were collected for 120 hours postdose and assayed for plasma fenofibric acid concentrations. The absolute bioavailability of each treatment was determined relative to 50 mg of fenofibric acid administered intravenously. Plasma exposure to fenofibric acid following fenofibric acid administration was approximately 1.5 times higher than that following fenofibrate administration for delivery to the proximal and distal small bowel and following oral administration, and it was approximately 5 times higher following colon delivery. The absolute bioavailability in the stomach, proximal small bowel, distal small bowel, and colon was approximately 81%, 88%, 84%, and 78%, respectively, for fenofibric acid and 69%, 73%, 66%, and 22%, respectively, for fenofibrate (P < .0001 and P = .033 for fenofibric acid vs fenofibrate in the colon and distal small bowel, respectively). In conclusion, fenofibric acid is well absorbed throughout the GI tract and has greater bioavailability than fenofibrate in all GI regions. [ABSTRACT FROM AUTHOR]

The pro-oxidant role of iron in neurodegenerative and chronic disease has led to concern over the danger of excessive levels posing a health risk (Kell, 2009). As the body has limited capacity to excrete iron, absorption acts as the main homeostatic mechanism (Anderson et al., 2009). Although iron stores increase with age (Liu et al., 2003), the effect of advancing age on iron regulation has not been extensively studied and age related misregulation has been implied (Levenson et al., 2004). The aim of this study was to investigate the effect of age on intestinal iron uptake in adults. Thirty-five participants (29 females and six males subdivided into three age groups) provided fasted blood samples. A second sample was taken three hours following a standard breakfast (low in iron inhibitors and enhancers) and a 200 mg iron sulphate supplement as used by Hutchinson et al. (2004). Total plasma iron, total iron binding capacity (TIBC), transferrin saturation (TSAT) and non-transferrin bound iron (NTBI) were measured. Participants completed a 52 item food frequency questionnaire, adapted from the validated EPIC-Norfolk study to be iron specific. Data was statistically analysed using and Pearson regression. Approval was granted by the University of Plymouth Ethical Committee. Total plasma iron absorption and post supplement increases in TSAT and NTBI were greatest in the 35-55 years age group (Table 1). TIBC and iron intake were similar for all groups. A weak correlation was found between iron uptake and change in NTBI ( r = 0.405, P < 0.022). This study does not support the suggestion that iron absorption is misregulated in older age (Levenson et al., 2004) but does support the 'set point' theory that iron uptake increases with age until a certain point (Garry et al., 2000). In healthy individuals the plasma concentration of NTBI is small; the elevated amount found in the 35-55 year age group is of some concern. This study examined a small, predominantly female sample and the results may have been affected by factors that were not considered such as menstruation, menopause and contraceptive use. It is possible that iron absorption is greater in the middle years of life and that this increases both stores and pro-oxidant damage, which in later years manifests into chronic disease. This study may provide new insight into iron regulation and warrants further research. Anderson, G.J., Frazer, D.M. & McLaren, G.D. (2009) Iron absorption and metabolism. Curr. Opin. Gastroenterol.,129-135. Garry, P.J., William, P.D., Hunt, C. & Baumgartner, R.N. (2000) Effects of iron intake on iron stores in elderly men and women: longitudinal and cross-sectional results. J. Am. Coll. Nutr., 262-269. Hutchinson, C., Al-Ashgar, W., Liu, D.Y., Hider, R.C., Powell, J.J. & Geissler, C.A. 2004 Oral ferrous sulphate leads to a marked increase in pro-oxidant non-transferrin bound iron. Europ. J. Clin. Invest., 782-784. Kell, D.B. (2009) Iron behaving badly: inappropriate iron chelation as a major contributor to the aetiology of vascular and other progressive inflammatory and degenerative diseases. BMC Med. Genomics, 2. Levenson, C.W. & Tassabehji, N.M. (2004) Iron and ageing: an introduction to iron regulatory mechanisms. Ageing Res. Rev., 251-63. Liu, J., Hankinson, S.E., Stampfer, M.J., Rifai, N., Willett, W.C. & Ma, J. (2003) Body iron stores and their determinants in healthy postmenopausal US women. Am. J. Clin. Nutr. , 1160-7. [ABSTRACT FROM AUTHOR]

Reports a study to measure iron absorption in humans from a stable isotope-enriched form of hydrogen-reduced iron powder added to bread. Reduced iron powder used to fortify flour in the United Kingdom; The bread and flour regulations; Bioavailability of hydrogen-reduced iron powder.