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Objectives: To examine the perspectives of patients and healthcare professionals of self-administration of subcutaneous (SC) injection of Bortezomib in the homes of patients with Multiple Myeloma (MM), and to assess organizational aspects., Methods: A prospective, clinical, parallel mixed-method design with a qualitative core and a quantitative supplementary component was conducted at a single hematological centre in Denmark. Qualitative data were obtained from individual, semi-structured interviews with patients (n = 10) and a focus group interview with healthcare professionals (n = 5); data were analyzed using a hermeneutic approach. Quantitative data were acquired from time registrations performed by patients and nurses and descriptively analyzed applying a micro-costing approach, using cost data per individual., Results: In general, patients and healthcare professionals were pleased with self-administration as patient empowerment increased. Qualitative findings yielded three themes: "Home is best", "Everyone is different", and "Safety first". Quantitative data were confirmative and revealed self-administration to be time saving for patients and nurses. In a Danish context, delivery of the medicine to the patient's home was slightly more expensive than administration at the hospital., Conclusions: Self-administration of SC Bortezomib in the homes of patients with MM is advantageous for patients and healthcare professionals. It is feasible, safe, and timesaving. These advantages come with a negligible increase in expenses., Competing Interests: Declaration of competing interest None declared., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Technological advances have made it possible to offer home-based chemotherapy to patients without health care professionals being present. Prior studies on effects of home-based treatment lack inclusion of patients with hematologic malignancies. We present data from a multicenter single-arm feasibility and safety study of home-based intensive chemotherapy in patients with newly diagnosed acute myeloid leukemia and their quality of life and psychological wellbeing. This national study included patients from six sites in Denmark who received intensive chemotherapy on programmed CADD Solis infusion pumps through a central venous catheter and were also managed as outpatients during treatment-induced pancytopenia. Data are presented from 104 patients, receiving 272 treatments with 1.096 (mean 4.57, SD 3.0) home infusion days out of 1.644 treatment days (67 %). Sixty-two of 168 (36.9 %) reinduction and consolidation treatment cycles ensuing pancytopenia phases were solely handled in the outpatient clinic. Patients reported high satisfaction with home-based treatment, which had a positive influence on their ability to be involved in their treatment and be socially and physically active. No unexpected events occurred during the intervention. Overall, patients improved in all quality of life outcomes over time. Home-based intensive chemotherapy treatment was feasible and safe in this population. ClinicalTrials.gov identifier: NCT04904211., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Consumption of a large amount of dietary fructose induces gastrointestinal intolerance, and glucose has been known as an enhancer of fructose absorption. Erythritol is a nonglycemic sugar alcohol, and it has been suggested that erythritol is absorbed paracellularly. It was hypothesized that paracellular absorption of erythritol could also enhance paracellular absorption of fructose in healthy adults. This is one of the proposed pathways for how additional glucose enhances the absorption of fructose. Thirty-seven nondiabetic, healthy adults participated in a randomized, double-masked, controlled crossover study. After an overnight fast, participants consumed beverages containing either 50 g fructose and 50 g glucose, 50 g fructose and 33.3 g erythritol (an equimolar concentration of fructose), or 50 g fructose alone. Breath hydrogen response was determined for 8 hours postprandially. Gastrointestinal intolerance symptoms and the number and consistency of bowel movements were recorded for 24 hours postprandially. The breath hydrogen area under the curve (AUC) of the fructose and erythritol beverage was 2 times the AUC of the fructose beverage and 8.75 times the AUC of the fructose and glucose beverage (P < .001, respectively). Compared with fructose and glucose beverage and fructose alone, frequency of watery stools increased (P < .05) and gastrointestinal tolerance worsened (P < .05) when participants consumed fructose and erythritol. These data suggest that coingestion of equimolar concentrations of fructose and erythritol increased carbohydrate malabsorption., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Genetic heterogeneity of Turkish ruminant pestiviruses was investigated by phylogenetic analysis of complete N(pro) encoding nucleotide sequences. A total of 30 virus isolates obtained from 15 provinces around the country between 1997 and 2005 were included in the phylogenetic analysis. Virus isolates mostly originated from cattle with one isolate from sheep. The bovine isolates all belonged to BVDV-1, the sheep isolate to BVDV-2. Fifteen isolates formed a new subgroup within BVDV-1, tentatively named BVDV-1l. The remaining bovine isolates were typed as BVDV-1a (n=4), BVDV-1b (n=4), BVDV-1d (n=3), BVDV-1f (n=2) and BVDV-1h (n=1). The isolates allocated to BVDV-1l originated from various geographical regions in different years. There was no correlation between genetic grouping and locations where isolates were obtained. Viruses originating from one farm in most cases belonged to the same subgroup (n=5). This study indicates that the newly detected subgroup BVDV-1l is predominant and widespread in Turkey. Moreover, an ovine virus isolate was identified as the first member of BVDV-2 reported in Turkey. A serological survey using samples from western Turkey indicated that BVDV-2 is also present in cattle.

Objectives: Our aims were to investigate the pituitary volume in patients with seasonal winter depression and healthy volunteers in winter and summer, and to assess the effects of phototherapy in these patients., Method: The pituitary volume of 12 patients with winter depression and 12 healthy controls, paired according gender, age and menstrual cycle, were obtained from magnetic resonance imaging in winter and summer. Eight patients were submitted to phototherapy (10000 vs. 2500 lux) in a double-blind crossover fashion during the winter, and reassessed (symptoms and magnetic resonance imaging) after treatment., Results: There were no significant differences in pituitary volume between controls and patients in winter or summer. Exposure to phototherapy (10000 lux) decreased the depressive symptoms (p = 0.004), but the glandular volume did not change (p = 0.5). However, the pituitary volume in winter showed a positive correlation with the severity of depression in these patients (r = 0.69, p = 0.04)., Conclusions: The results suggest that neither winter depression nor the change of seasons is associated with significant change in the pituitary volume. Despite the fact that this study was performed in a tropical area, phototherapy with 10000 lux showed to be an efficient treatment in this SAD patients sample.

Objective: Preliminary in vitro and animal studies have shown that gamma-cyclodextrin (GCD) is a slowly and completely digestible carbohydrate. The objective of this study was to determine the glycemic and insulinemic responses to GCD in humans. Breath hydrogen excretion was measured simultaneously to evaluate carbohydrate malabsorption., Methods: Healthy adult subjects (N = 32) received 50 g of carbohydrate from GCD or a rapidly digested maltodextrin (MD) in a double-masked, randomized, crossover design. Plasma glucose (fingerstick) and serum insulin (venous) concentrations were measured at baseline and at 15, 30, 45, 60, 90, 120, 150, and 180 min postprandially. Breath hydrogen excretion was monitored hourly for 8 h postprandially. The severity of gastrointestinal symptoms (nausea, cramping, distension, flatulence) was rated by the subjects on a ranked scale for two 24-h periods postprandially., Results: The mean baseline-adjusted peak plasma glucose concentration was 47% lower (P < 0.001), and the mean baseline-adjusted peak serum insulin concentration was decreased by 45% (P < 0.001) after subjects consumed GCD compared with MD. Positive incremental area under the curve (0-120 min) was reduced 45% for plasma glucose and 49% for serum insulin by GCD compared with MD (P < 0.001 in each case). There were no differences between GCD and MD in the proportion of positive breath hydrogen tests and both carbohydrates were equally well tolerated., Conclusions: GCD effectively lowers postprandial glycemia and insulinemia compared with MD, without resulting in appreciable carbohydrate malabsorption or gastrointestinal intolerance.

Pullulan and gamma-cyclodextrin are incompletely digestible, glucose-based, nonstructural carbohydrates synthesized by microorganisms. To determine their effect when incorporated into a complete liquid diet on ileal and total tract nutrient digestibility, ileal cannulated dogs (n = 8) were used in a repeated 4 x 4 Latin-square design. Twice daily, diets were offered containing 30% (DMB) maltodextrin, high-molecular-weight (MW) pullulan (MW 100,000), low-MW pullulan (MW 6300), or gamma-cyclodextrin. Fecal and ileal samples were collected for the last 4 d of each 10-d period. Dogs consuming high-MW pullulan had lower (P < 0.05) dry matter, organic matter, crude protein, fat, carbohydrate ileal and total tract digestibilities, and fecal DM, and higher (P < 0.05) fecal output and fecal scores (indicating looser stools). To evaluate glycemic and insulinemic responses to pullulans, food-deprived dogs consumed 25 g maltodextrin, high-MW pullulan, or low-MW pullulan in a repeated 3 x 3 Latin-square design. Glucose and insulin responses were determined for 180 min. Consumption of 25 g alpha-, beta-, and gamma-cyclodextrin resulted in regurgitation within 60 min. High-MW pullulan reduced (P < 0.05) blood glucose concentration at 15, 30, 45, and 60 min. Compared with maltodextrin, low-MW pullulan and gamma-cyclodextrin did not alter nutrient digestibilities or fecal characteristics to any extent, and low MW pullulan did not affect glycemic response. Although high MW pullulan decreased glycemic response, consumption of large amounts negatively affected nutrient digestibility and fecal characteristics.

Objective: This study evaluated the postprandial glycemic, insulinemic, and breath hydrogen responses to a liquid nutritional product containing Salacia oblonga extract, an herbal alpha-glucosidase inhibitor, and two insulinogenic amino acids., Methods: In a randomized, double-masked, crossover design, 43 healthy subjects were fed the following meals on separate days after overnight fasting: control (C; 480 mL of a study beverage containing 82 g of carbohydrate, 20 g of protein, and 14 g of fat), control plus 3.5 g each of phenylalanine and leucine (AA), control plus 1000 mg of S. oblonga extract (S), and control plus S and AA (SAA). Postprandially, fingerstick capillary plasma glucose and venous serum insulin levels were measured for 180 min, and breath hydrogen excretion was measured for 480 min., Results: The baseline-adjusted peak glucose response was not different across meals. However, changes in plasma glucose areas under the curve (0 to 120 min and 0 to 180 min, respectively) compared with C were -9% and -11% for AA (P>0.05 each), -27% and -24% for S (P=0.035 and 0.137), and -27% and -29% for SAA (P<0.05 each). Changes in insulin areas under the curve were +5% and +5% for AA (P>0.05 each), -35% and -36% for S (P<0.001 each), and -6% and -7% for SAA (P>0.05 each). Breath hydrogen excretion was 60% greater (P<0.001) in the S-containing meals than in the C- and AA-containing meals and was associated with mild flatulence., Conclusions: Salacia oblonga extract is a promising nutraceutical ingredient that decreased glycemia in this study. Supplementation with amino acids had no significant additional effect on glycemia.

A novel induced viscosity fiber (IVF) crispy bar was formulated with the viscous dietary fibers alginate and guar gum. To evaluate the glycemic response and gastrointestinal tolerance to IVF crispy bars, nondiabetic healthy adult subjects (n = 48) were studied in a randomized, double-masked, crossover design. The control crispy bars and IVF crispy bars were identical except for the 2 dietary fibers contained in the experimental (IVF) bars. After an overnight fast, subjects consumed test bars containing 50 g carbohydrate. Their capillary blood glucose response was determined for 180 min postprandially. When subjects consumed IVF, the incremental blood glucose excursions were reduced (P < 0.05) at 15, 30, 45, and 120 min. At 180 min, the subjects' blood glucose concentration was maintained above the basal blood glucose concentration for both bars. Compared with controls, the incremental peak blood glucose concentration was reduced (P < 0.001) 30% when subjects consumed IVF. When subjects consumed IVF, the positive incremental area under the curve for glucose was reduced (P < 0.01) by 33% compared with controls. In the 24-h postprandial period after each treatment, the frequency and intensity of gastrointestinal tolerance symptoms did not differ. In conclusion, compared with a control crispy bar, the IVF crispy bar attenuated the postprandial glycemic excursion without gastrointestinal intolerance in healthy adult subjects.

Objective: Dietary supplementation with guar gum or fructose has been reported to reduce the postprandial glycemic response to an oral glucose challenge. As a result of the poor palatability of most foods containing guar gum, a novel low-viscosity beverage with guar gum was developed that becomes viscous in vivo through an enzymatic induction. The primary study objective was to determine the effect of an amylase-induced viscosity (I-V) product, with or without supplemental fructose, on the postprandial glycemic response to a high glycemic index test meal in healthy nondiabetic subjects., Design: The study was a four-treatment, placebo-controlled, double-blind, randomized block protocol., Setting: The study was performed at Glycaemic Index Testing, Inc., Toronto, Ontario, Canada., Subjects: A total of 30 healthy nondiabetic volunteers (13 male, 17 female, mean+/-s.e.m. age of 51+/-3 y and body mass index of 24.2+/-0.4 kg/m(2)) participated in the study., Intervention: In the morning after an overnight fast, subjects participated in four 3-h meal glucose tolerance tests on separate occasions. The test meals contained 50 g of available carbohydrate from maltodextrin and white bread (control) or the same meal with either 5 g of guar gum (3.6 g galactomannan), 5 g of fructose, or 5 g of guar gum +5 g of fructose., Results: Treatments containing guar gum had a reduced (P<0.01) baseline-adjusted peak glucose response and incremental area under the glucose curve. In contrast to previous studies, fructose increased (P<0.05) the baseline-adjusted peak glucose concentration., Conclusions: Guar gum incorporated into an amylase I-V product provided a means to stabilize blood glucose levels by reducing the early phase excursion and then by appropriately maintaining the later phase excursion in healthy nondiabetic humans.

The objectives of this study were as follows: 1) to determine the rate and extent of starch disappearance from the small intestine of the rat fed selected starch sources, 2) to determine the ratios of the major starch fractions [rapidly digestible starch (RDS), slowly digestible starch (SDS), and resistant starch (RS)] in those starch sources using two in vitro methods and 3) to compare the two data sets to determine the accuracy of the in vitro methods. Diets were prepared using cornstarch, potato starch, amylomaize, maltodextrin, modified maltodextrin or pullulan. Starch sources and diets were analyzed for starch fractions by two in vitro methods. Diets were fed to rats, intestinal contents were collected and the ethanol-induced precipitate from the contents was analyzed to obtain a digestion curve that was mathematically modeled for comparison to results obtained using the two in vitro methods. Only the cornstarch diet had a defined amount of RDS, SDS and RS. The RDS concentration obtained from the intestinal contents of the rats fed the cornstarch diet differed (P < 0.05) from that determined by one in vitro method but was consistent with the value obtained using the other in vitro method. All other digestible starch values obtained differed (P < 0.05) among methods except for that of amylomaize. Starch fractions in starch sources obtained using in vitro procedures differed (P < 0.05) from values obtained for diets. The rate of disappearance differed (P < 0.05) between in vivo and in vitro procedures. There was minimal agreement between in vitro methods tested, and there was also minimal agreement between in vitro and in vivo results. Classification of starch into RDS and SDS components cannot be accomplished for a variety of starch sources, with cornstarch being the major exception.

Plant extracts from the Salacia genus have been found to have intestinal alpha-glucosidase inhibitor activity, which may have application to the development of medical foods for people with diabetes. We evaluated the safety of a hot water extract of S. oblonga (salacinol extract) supplemented to or processed into a medical food. Thirty male Sprague-Dawley rats were assigned among one of three treatments: (1) EN-0178 (control, liquid diet), (2) EN-0178+salacinol (as 1 plus 500 mg of salacinol extract per 253 g diet, which was added to product immediately prior to feeding), (3) EN-0195 (as 1 plus 500 mg of salacinol extract per 253 g diet, which was added during product manufacture). After 14 days of free access to dietary treatments, rats were sacrificed, blood collected and organs weighed. Rats consuming salacinol extract had reduced (P <0.05) weight gain and feed intake. The relative (% of body weight) testicular weight was higher (P<0.05) for rats consuming salacinol extract, whereas, the relative liver and spleen weight was lower (P<0.05) for rats consuming salacinol extract. Of the serum chemistries analyzed, blood urea nitrogen and alkaline phosphatase was lower (P<0.05) for rats consuming salacinol extract. No differences in blood hematology were found. We conclude that salacinol extract, in a medical food consumed for 2 weeks in amounts estimated at 10-fold greater than proposed for human intake, did not result in clinical chemistry or histopathologic indications of toxic effects in male Sprague-Dawley rats.

Pullulan is an extracellular polysaccharide excreted by the fungus Aureobasidium pullulans. To evaluate the glycemic and breath hydrogen responses and gastrointestinal tolerance to pullulan, nondiabetic healthy adult subjects (n = 28) were studied in a randomized, double-masked, crossover design. After an overnight fast, subjects consumed beverages containing 50 g of carbohydrate from either maltodextrin (control) or pullulan. Capillary blood glucose response was determined for 180 min postprandially. Breath hydrogen response was determined for 8 h postprandially. Compared with control, incremental peak blood glucose concentration was reduced (P < 0.01) when subjects consumed pullulan (4.24 +/- 0.35 vs. 1.97 +/- 0.10 mmol/L). In addition, pullulan reduced (P < 0.01) the positive incremental area under the glucose curve by 50%. When subjects consumed pullulan, the incremental blood glucose excursions were reduced (P < 0.01) at 15, 30, 45, 60 and 90 min, but were maintained above basal glucose concentrations at 150 and 180 min. At 180 min, the blood glucose concentration was higher (P < 0.05) when subjects consumed pullulan compared with control, supporting the hypothesis that pullulan is digested slowly. Breath hydrogen concentrations were increased (P < 0.01) at 3, 4, 5, 6, 7 and 8 h postprandially when subjects consumed pullulan. In the first 24-h postprandial period, the frequency and intensity of flatulence was higher (P < 0.05) after subjects consumed pullulan compared with control. In conclusion, pullulan attenuated the postprandial glycemic excursion compared with an equivalent maltodextrin challenge. Pullulan also increased breath hydrogen excretion and the incidence of gastrointestinal intolerance symptoms, indicating that a portion of pullulan was malabsorbed.

The objective of this research was to determine whether fructooligosaccharides (FOS) and (or) Lactobacillus acidophilus (LAC) affected concentrations of gut microbial populations, fermentative end products and nutrient digestibilities in healthy adult dogs. Two experiments were performed using 40 adult dogs (20 dogs/experiment). Dogs in each experiment were randomly assigned to one of 4 treatments. Twice daily, treatments were given orally via gelatin capsules: 1) 2 g sucrose + 80 mg cellulose; 2) 2 g FOS + 80 mg cellulose; 3) 2 g sucrose + 1 x 10(9) colony forming units (cfu) LAC; or 4) 2 g FOS + 1 x 10(9) cfu LAC. Data were analyzed by the General Linear Models procedure of SAS. In Experiment 1, FOS resulted in lower (P = 0.08) Clostridium perfringens and greater fecal butyrate (P = 0.06) and lactate (P < 0.05) concentrations. In Experiment 2, FOS supplementation increased (P < 0.05) bifidobacteria, increased lactobacilli (P = 0.08), increased fecal lactate (P = 0.06) and butyrate (P < 0.05), and decreased (P < 0.05) fecal ammonia, isobutyrate, isovalerate and total branched-chain fatty acid concentrations. Dogs fed LAC had the highest fecal concentrations of hydrogen sulfide and methanethiol in Experiment 1 and dimethyl sulfide in Experiment 2, whereas dogs fed FOS had the lowest concentrations of these compounds. Overall, FOS appeared to enhance indices of gut health by positively altering gut microbial ecology and fecal protein catabolites, whereas LAC was more effective when fed in combination with FOS rather than fed alone.

The objective of this experiment was to determine whether supplementation with fructooligosaccharides (FOS) and (or) Lactobacillus acidophilus (LAC) affected bowel function and fermentative end-product concentrations in feces of healthy humans. Subjects (n = 68) were enrolled in a randomized, double-blind, placebo-controlled, parallel study design. After a 4-wk baseline period, subjects consumed one of the following treatments twice daily for 4 wk: 1) 3 g sucrose + 80 mg cornstarch; 2) 3 g FOS + 80 mg cornstarch; 3) 3 g sucrose + 1 x 10(9) colony-forming units (cfu) LAC; or 4) 3 g FOS + 1 x 10(9) cfu LAC. Subjects completed 7-d bowel function forms and 3-d dietary records before collection of fresh stool samples at wk 4, 6 and 8. Statistical analyses were performed on differences from baseline using the General Linear Models procedure of SAS. Fructooligosaccharides decreased fecal ammonia (P = 0.07) and isovalerate (P = 0.12) concentrations at wk 6. At wk 8, FOS tended (P = 0.11) to increase fecal putrescine concentrations. Lactobacillus decreased fecal organic matter percentage at wk 6 (P < 0.05) and 8 (P = 0.07). At wk 6 and 8, LAC increased (P < 0.05) fecal 2-methylindole, total indole, and total indole and phenol concentrations. At wk 8, LAC decreased fecal agmatine (P = 0.08) and phenylethylamine (P < 0.05) concentrations. In conclusion, FOS and LAC modified several metabolites associated with gut health, with FOS tending to be beneficial (decreased fecal protein catabolites) and LAC being negative (increased fecal protein catabolites).

The study objective was to determine whether a small dose of fructose administered before or simultaneously with a high glycemic index, starchy food decreases postprandial glycemic response. Nondiabetic healthy adults (n = 31; mean +/- SEM: age, 26 +/- 1 y; weight, 66.1 +/- 2.6 kg; body mass index, 23.3 +/- 0.6 kg/m(2)) were studied in a randomized crossover design. Treatments consisted of 50 g available carbohydrate from instant mashed potatoes fed alone (control) or with 10 g fructose fed 60, 30 or 0 min before the potato meal. Capillary finger-stick blood samples were analyzed for glucose concentration at -60, -30, 0, 15, 30, 45, 60, 90 and 120 min relative to the ingestion of the potato meal. Compared with the control, the positive incremental area under the glucose curve was reduced 25 and 27% (P < 0.01) when fructose was fed either 60 or 30 min before the meal, respectively. In contrast to previous studies demonstrating that immediate administration of a small amount of fructose lowers the glycemic response to a glucose solution, we found that fructose must be consumed before a starchy food to reduce postprandial glycemia.

Objective: An acid-induced-viscosity (I-V) complex containing alginate, citrate, and insoluble calcium was incorporated into a glucose-based beverage. We hypothesized that the acid I-V beverage would become viscous in the stomach (due to the solubilization of calcium and its interaction with alginate and citrate) and would blunt glycemia., Methods: Thirty subjects were used in a double-masked, placebo-controlled crossover study evaluating the acid I-V complex. The placebo was a glucose-based beverage that had a similar total dietary fiber level and initial viscosity (Control). After a 12-h overnight fast, serum glucose and insulin were monitored over a 3-h postprandial period., Results: The postprandial mean peak incremental change from baseline in serum glucose tended (P < 0.06) to be lower for the acid I-V product. The net incremental area under the curve (AUC) for serum glucose was reduced 75% (P < 0.01) by the acid I-V product, which was due mainly to an increased undershoot. The mean peak incremental change from baseline in serum insulin was higher (P < 0.05) for the acid I-V product. Net incremental AUC for serum insulin did not differ (P > 0.20) between products., Conclusions: Results of this study suggested that the acid I-V complex may attenuate the postprandial glycemic response to a glucose challenge in healthy subjects.

Experiments were conducted to evaluate the effects of supplemental fructose on postprandial glycemia. After overnight food deprivation, Zucker fatty fa/fa rats were given a meal glucose tolerance test. Plasma glucose response was determined for 180 min postprandially. At a dose of 0.16 g/kg body, fructose reduced (P < 0.05) the incremental area under the curve (AUC) by 34% when supplemented to a glucose challenge and by 32% when supplemented to a maltodextrin (a rapidly digested starch) challenge. Similarly, sucrose reduced (P = 0.0575) the incremental AUC for plasma glucose when rats were challenged with maltodextrin. Second-meal glycemic response was not affected by fructose supplementation to the first meal, and fructose supplementation to the second meal reduced (P < 0.05) postprandial glycemia when fructose had been supplemented to the first meal. In a dose-response study (0.1, 0.2, and 0.5 g/kg body), supplemental fructose reduced (P < 0.01) the peak rise in plasma glucose (linear and quadratic effects). In the final experiment, a low dose of fructose (0.075 g/kg body) reduced (P < 0.05) the incremental AUC by 18%. These data support the hypothesis that small amounts of oral fructose or sucrose may be useful in lowering the postprandial blood glucose response.

To evaluate the glycemic response to a food starch esterified by 1-octenyl succinic anhydride (OSA), 30 healthy nondiabetic adult subjects were studied in a double-blind crossover design. After an overnight fast, subjects consumed a product containing either 25 g of glucose or 25 g of OSA-substituted starch. Finger-prick capillary blood was obtained at baseline and 15, 30, 45, 60, 90, and 120 min postprandial for glucose measurement. After OSA treatment, the rise in blood glucose was reduced (P < 0.05) at 15 and 30 min and tended (P < 0.08) to be lower at 45 min. Mean peak rise in glucose was reduced 19% (P < 0.01) by OSA (3.30 +/- 0.19 versus 2.66 +/- 0.16 mmol/L) compared to glucose, but time to peak did not differ between treatments. Net incremental area under the curve was also lower (P < 0.05) on OSA compared to glucose. Minimal effects on gastrointestinal symptoms (intensity and frequency of nausea, cramping, distention, and flatulence) were noted for both products, with no clinically significant difference between products. In conclusion, starch substitution with OSA attenuated the postprandial glycemic excursion compared to an equivalent glucose challenge and was well tolerated by fasting healthy adult subjects.

Fructooligosaccharides (FOS) are short-chain sugars that occur naturally and have dietary benefits for humans. They are widely distributed in nature and are a natural part of the human diet. The objective of this study was to determine the concentrations of 1-kestose (GF(2)), nystose (GF(3)), and 1(F)-beta-fructofuranosylnystose (GF(4)) in a variety of common processed and prepared foods. An ion chromatographic method was developed for this purpose in which the sugar concentrations were measured using integrated amperometry. The samples were simply prepared by blending with water and filtering the suspensions through a 10000 Da cutoff centrifugal filter. These samples were then injected into the ion chromatograph, which had been programmed for gradient elution, and the areas of the sugar peaks obtained compared to those of standard sugars on a calibration curve. Selected samples were prepared both with and without standard spikes in order to assess the efficiency of the determination. Of the vegetables investigated, artichokes contained by far the most FOS, followed by onions; bananas contained more FOS than other fruits investigated. The method was shown to be simple, convenient, and relatively fast for the quantitation of FOS in processed and prepared food products.

To evaluate the potential of indigestible oligosaccharides (OS) to serve as "dietary fiber-like" ingredients, it is necessary to determine their extent of indigestibility. In vitro fermentation characteristics of two novel OS, alpha-glucooligosaccharides (GOS) and a maltodextrin-like OS (MD), were compared to those of fructooligosaccharides (FOS), gum arabic (GA), guar gum (GG) and guar hydrolysate (GH). Total short-chain fatty acid (SCFA) production (micromol/g dry matter) as a result of MD fermentation was higher initially compared with GA (P<0.01), but GA was more extensively fermented at 24 h (P<0.01). Total SCFA production for GOS was similar to that for FOS, GG, GH and GA. In the second experiment, GOS and MD were added at 6% to an enteral formula control diet (Control) and fed to ileal-cannulated dogs in a 3x3 replicated Latin-square design. Ileal digestibility of glucose was lower (P<0.05) and carbohydrate (CHO) numerically lower (P = 0.08) for both GOS and MD compared with the Control. Total tract digestibility of CHO and glucose was lower only for MD (P<0.01) compared with the Control. Total fecal weights were higher (P<0.01) for both GOS and MD treatments. Fecal concentration of bifidobacteria was numerically increased by GOS and MD supplementation (P = 0.13 and 0.23, respectively). Thus, GOS and MD are indigestible yet fermentable OS, and may act as "dietary fiber-like" ingredients.

In situ and in vivo digestibility experiments were conducted to determine the acceptability, digestibility, and safety of a return chewing gum/packaging (G/P) material mixture when fed to steers. In the in situ experiment, both ruminal and intestinal disappearances were measured. Two ruminally and duodenally cannulated steers, which were given free access to alfalfa hay (AH), were used in this study. Duplicate Dacron bags containing the G/P were incubated in the rumen for 0, 3, 6, 12, 24, and 48 h. After ruminal incubation, the 12-, 24-, and 48-h bags were placed in the duodenum and collected in the feces to determine intestinal disappearance. In situ ruminal DM disappearance was greater than 70% for all substrates tested at 0 h, indicating high solubility of the substrates in water, and began to reach a plateau after 12 h of incubation. Intestinal in situ disappearance was not different (P>.25) from zero. In the digestion trial, four ruminally cannulated steers (337+/-21.3 kg BW; mean +/- SD) were used in a 4x4 Latin square design with the following treatments: 0) 50% corn (C), 50% AH; 10) 45% C, 45% AH, 10% G/P; 20) 40% C, 40% AH, 20% G/P; 30) 35% C, 35% AH, 30% G/P. Steers fed G/P-containing diets had greater (P<.01) DMI than the control steers. Increasing the G/P resulted in a linear (P<.05) increase in DMI. Apparent DM digestibility tended to be higher (P<.10) for the G/P-containing diets than for the control. A quadratic effect (P<.05) on digestible DMI was observed, with greater (P<.01) digestible DMI values for G/P-containing diets (4.8 vs. 5.8 kg/d). Digestible organic matter and total nonstructural carbohydrate intakes followed trends similar to those of DM. Apparent aluminum digestibility of G/P-containing diets was not different (P>.13) from zero. The level of G/P in the diet had no effect (P>.2) on total VFA concentration or ruminal pH. There was a linear decrease (P<.01) in the molar percentage of isobutyrate and isovalerate in addition to a linear increase (P<.01) in butyrate and valerate with increasing levels of G/P. There was a quadratic effect (P<.01) on molar proportions of acetate and propionate and on the acetate:propionate ratio. Results of both experiments suggest that G/P may be fed to safely replace up to 30% of corn-alfalfa hay diets for growing steers with advantages in improving DMI and digestibility.

Differences in glycemic and insulinemic responses to dietary starch are directly related to the rate of starch digestion. Chemical modification of starch may allow for the production of a slowly digested starch that could be used for the treatment of certain medical modalities. An in vitro method was utilized to evaluate the effects of chemical modification on the rate and extent of raw and cooked starch digestion. The extent of starch digestion was significantly reduced by dextrinization, etherification, and oxidation. However, the rate of starch digestion was not significantly affected by chemical modification. For most modified starches, as the degree of modification increased, the extent of digestion decreased, suggesting an increase in the amount of resistant starch. The results of this study suggest that chemically modified starch has a metabolizable energy value of <16.7 kJ/g. Chemically modified starch ingredients may serve as a good source of resistant starch in human and animal diets.

The effect of L. acidophilus supplementation to reduce fecal shedding of Cryptosporidium parvum oocysts was compared to L. reuteri using C57BL/6 female mice immunosuppressed by murine leukemia virus (strain LP-BM5) inoculation. After 12 weeks post LP-BM5 inoculation, 15 immunosuppressed mice each were randomly assinged to one of the following treatment groups: historical control (group A), LP-BM5 control (group B), C. parvum (group C), L. reuteri plus C. parvum (group D) or L. acidophilus plus C. parvum (group E). Mice were pre-fed the L. reuteri or L. acidophilus bacteria strains daily for 13 days, challenged with C. parvum oocysts and thereafter fed the specified Lactobacillus regimens daily during the experimental period. Animals supplemented with L. reuteri shed fewer (p<0.05) oocysts on day-7 post C. parvum challenge compared to controls. Mice supplemented with L. acidophilus also shed fewer (p<0.05) oocysts on days 7 and 14 post-challenge compared to controls. Overall, Lactobacillus supplementation reduced C. parvum shedding in the feces but failed to suppress the production of T-helper type 2 cytokines [interleukin-4 (IL-4), IL-8)] which are associated with immunosuppression. Additionally, Lactobacillus supplementation did not restore T-helper type 1 cytokines (interleukin-2 (IL-2) and gamma interferon (IFN-gamma), which are required for recovery from parasitic infections. Altered T-helper types 1 and 2 cytokine production as a consequence of immunodysfunction permitted the development of persistent cryptosporidiosis while mice with intact immune system were refractory to infection with C. parvum. Reduction in shedding of oocysts observed in the Lactobacillus supplemented mice during deminished IL-2 and IFN-gamma production may be mediated by factors released into the intestinal lumen by the Lactobacillus and possibly other host cellular mechanisms. These observations suggest that L. reuteri or L. acidophilus can reduce C. parvum parasite burdens in the intestinal epithelium during cryptosporidiosis and may serve potential benefits as probiotics for host resistance to intestinal parasitic infections. L. acidophilus was more efficacious in reducing fecal shedding than L. reuteri and therefore may also have implication in the therapy of cryptosporidiosis during immunosuppressive states including human AIDS.

The purpose of this study was to evaluate the apparent digestibility and postprandial glycaemic responses of ileal-cannulated dogs when fed an experimental induced viscosity dietary fibre (IVF) incorporated into a liquid enteral formula. Dietary treatments were: (1) control; (2) Glucerna; (3) Glytrol; (4) IVF; and (5) Jevity. Diets varied in concentrations of crude protein (CP), fat, starch and total dietary fibre (TDF). Dry matter and starch intakes by dogs fed the Glucerna and Glytrol treatments were lower (P<0.05) than for those consuming the other diets. However, daily intakes of CP and fat followed a reverse trend. Digestibility of nutrients at the ileum was high (>80%) for all dietary treatments. Mineral absorption proximal to the ileum and from the total tract was not significantly different among treatments. Mean incremental area under the serum glucose response curves for dogs fed Glytrol, Glucerna, and IVF treatments were lower (P<0.05) than the control treatment. Induced viscosity fibre appears to have no negative effects on nutrient digestion throughout the gastrointestinal tract. Its ability to moderate serum glucose concentrations would make it a potentially good choice for a diabetic liquid formula.

Probiotic supplementation may provide health benefits, especially for individuals with an underlying disease state that makes them more susceptible to infections. The purpose of this experiment was to evaluate the safety and tolerance of Lactobacillus reuteri ingestion by subjects infected with the human immunodeficiency virus (HIV). Thirty-nine subjects consumed a freeze-dried preparation of L. reuteri or a placebo for 21 days in a double-masked, parallel design experiment. Serum chemistry, haematology, immune profile, urinalysis, physical examination, gastrointestinal tolerance and faecal microbiota data were collected. No clinically significant changes were noted in any of the safety parameters measured. Overall, tolerance was good in both groups. Consumption of L. reuteri tended to increase faecal levels of L. reuteri on days 7, 14 and 21 of treatment feeding (P < 0.06, P < 0.11 and P = 0.05, respectively). However, faecal levels of L. reuteri and total Lactobacillus species were lower than levels previously observed in healthy male adults. Overall, this study documents that L. reuteri may be fed to HIV-positive individuals at 1 x 10(10) colony forming units/day without any clinically significant safety or tolerance problems.

The purpose of this study was to evaluate apparent digestibility in ileal-cannulated dogs fed enteral diets containing a debranched amylopectin-lipid complex (V-complex) or resistant starch. Six ileal-cannulated dogs were randomized into a replicated 3 x 3 Latin square design for determination of digestibility of three experimental treatments. Dietary treatments were as follows: 1) control; 2) V-complex; and 3) resistant starch. Diets were similar in chemical composition. Apparent digestibility of dry matter (DM), organic matter (OM) and carbohydrate by dogs fed the control diet was higher (P < 0.05) than for dogs consuming the other diets. Mean apparent digestibilities of carbohydrate for the control, V-complex and resistant starch diets were 89, 76 and 43%, respectively. Both DM and carbohydrate digestibility were lower (P < 0.05) for resistant starch compared with V-complex. Fecal dry and wet weights for dogs fed the control diet were lower (P < 0.05) than for those receiving either the resistant starch or V-complex treatments. Dogs fed the V-complex diet produced approximately 90 g less feces per day than dogs fed resistant starch. Dietary incorporation of V-complex to replace traditional carbohydrates may be beneficial for diabetic patients because of the decreased digestibility and subsequent glucose absorption rate. Furthermore, incorporation of resistant starch into enteral formulas may improve gastrointestinal tract health status as a result of increased fecal bulk, potential dilution of toxins in the intestinal lumen and greater production of short-chain fatty acids.

Certain indigestible oligosaccharides may benefit gastrointestinal tract health via fermentation and proliferation of desirable bacterial species. The purpose of this study was to elucidate effects of selected oligosaccharides on cecal and fecal short-chain fatty acid (SCFA) concentration, pH, total large bowel wet weight and wall weight, and gut microbiota levels in rats. Fifty male Sprague-Dawley rats were randomly assigned to one of five treatments: 1) control diet; 2) control diet + 5% microcrystalline cellulose (5% CC); 3) control diet + 5% CC + 6% fructooligosaccharides; 4) control diet + 5% CC + 6% oligofructose; or 5) control diet + 5% CC + 6% xylooligosaccharides. The control diet consisted of (dry matter basis) 20% protein, 65% carbohydrate, 10.5% fat, vitamin and mineral mixes. The duration of the study was 14 d. The oligofructose- and fructooligosaccharide-containing diets resulted in higher cecal butyrate concentrations compared with the control, cellulose and xylooligosaccharide diets. Generally, total cecal SCFA pools were higher while pH was lower from ingesting oligosaccharide-containing diets compared with control or cellulose diets. Cecal total weight and wall weight were higher from oligosaccharide consumption, whereas colonic total wet weight was higher for rats consuming xylooligosaccharides compared with other treatments; colon wall weight was unaffected by treatments. Cecal bifidobacteria and total anaerobes were higher whereas total aerobes were lower in rats fed oligosaccharide diets compared with those fed the control diet. Cecal lactobacilli levels were unaffected by treatment. Dietary incorporation of fermentable, indigestible oligosaccharides, by providing SCFA, lowering pH, and increasing bifidobacteria, may be beneficial in improving gastrointestinal health.

Efficacy of Lactobacillus reuteri as a probiotic for the control of Cryptosporidium parvum infection was evaluated in C57BL/6 female mice that were immunosuppressed by intraperitoneal inoculation with the LP-BM5 leukemia virus. Four months after inoculation, mice developed lymphadenopathy, splenomegaly, and susceptibility to C. parvum infection. After daily prefeeding with L. reuteri (10(8) cfu/day) for 10 days, mice were challenged with 6.5 x 10(6) C. parvum oocysts and fed L. reuteri during the entire study. Mice supplemented with L. reuteri and challenged with C. parvum cleared parasite loads from the gut epithelium. However, unsupplemented animals developed persistent cryptosporidiosis and shed high levels of oocysts in the feces. L. reuteri feeding increased its colonization of the intestinal tract, which was inversely related to the fecal shedding of oocysts. These findings suggest that L. reuteri may help prevent C. parvum infection in immunodeficient subjects.

Seventy-two Simmental-cross growing steers (219 +/- 2.4 kg initial BW) were used in a randomized complete block design to evaluate the effects of feeding a return chewing gum/packaging material mixture (G/P) on feedlot performance, carcass characteristics, sensory attributes of meat, and mineral content of beef liver and muscle. Animals were allotted by weight to 12 pens (six/pen). Each pen was assigned one of three dietary treatments: 1) 0% G/P (control), 2) 20% G/P, or 3) 30% G/P (% G/P on a DM basis). Steers were fed their respective diets for an 84-d growing phase and a 112-d finishing phase. The G/P replaced corn silage and corn in the growing and finishing phases, respectively. Eighteen steers (six/treatment) were randomly selected for slaughter at the end of the finishing phase, and carcass measurements, sensory attributes of meat, and mineral content of liver and longissimus muscle were measured. During the growing phase, steers fed G/P-containing diets had improved (P < .01) daily DMI, ADG, and gain:feed ratios (G:F) compared with controls. However, due to compensatory gain and the fact that G/P replaced corn in the finishing phase, control steers had increased (P < .01) ADG and improved (P < .05) G:F vs steers fed G/P-containing diets. Over the entire study (growing and finishing phases) steers fed diets containing G/P and the control had similar performance. Amount of G/P in the diet had no effect (P > .05) on carcass characteristics. Steaks from steers fed 20% G/P had improved (P < .01) juiciness compared with steaks from steers fed 30% G/P; no other sensory attributes were affected. Aluminum, zinc, and barium content of longissimus muscle and liver were within the normal expected ranges for all treatments. These data indicate that G/P can safely replace at least 30% of growing and finishing diets without impairing feedlot performance or carcass merit.

Cobalt glucoheptonate as a source of Co to enhance ruminal fiber digestion was evaluated in two in vitro digestibility experiments. In Experiment 1, Co supplementation (0, 5, and 10 ppm) of five substrates (leaf and stem fractions of alfalfa and orchardgrass hays and ground corn) was evaluated under two dietary conditions (ruminal fluid taken from steers fed alfalfa hay or a high concentrate diet) for 24 or 48 h of fermentation in a 3 x 5 x 2 x 2 factorial arrangement. In Experiment 2, four concentrations of Co (0, 10, 20, and 30 ppm) were added to five substrates (alfalfa hay, orchardgrass hay, corn cobs, recycled newsprint treated with HCl, and cellulose casings) and were incubated with ruminal fluid from steers fed alfalfa hay for 24 or 48 h of fermentation in a 4 x 5 x 2 factorial arrangement. No interactions among treatments were observed for digestibilities of DM, OM, or NDF in both experiments or for VFA concentrations in Experiment 1. Supplementation with Co did not increase digestibilities of DM, OM, or NDF in either experiment or concentrations of VFA in Experiment 1. In Experiment 1, in vitro digestibilities of DM, OM, and NDF were higher for inoculum from steers fed alfalfa versus concentrate. In Experiment 2, digestibilities of DM, OM, and NDF were highest for alfalfa hay and lowest for recycled newsprint treated with HCl. Cobalt concentrations that were above minimum requirements did not improve digestion of DM, OM, or fiber.

In situ experiments and two lamb digestion trials were conducted to evaluate the effects of chemically treating recycled newsprint (NP). Treatment of NP with 2% HCl (percentage of NP DM) followed by autoclaving for 4 h was most efficacious and was used in an in vivo digestion trial with 25 ram and wether lambs in a randomized complete block design (RCB). On a DM basis treatment diets were: 1) control, 95% alfalfa hay (AH); 2) 75% AH, 20% HCl-treated NP (HCl-NP); 3) 55% AH, 40% HCl-NP; 4) 75% AH, 20% untreated NP; and 5) 55% AH, 40% untreated NP on a DM basis. Lambs fed Treatments 2 and 3 had ad libitum DMI (1,043 and 1,036 g/d, respectively) similar to the DMI of those fed the control treatment (1,024 g/d); however, lambs fed Treatments 4 and 5 had lower (P < .05) ad libitum DMI (578 and 426 g/d, respectively) than lambs fed Treatments 1, 2, and 3. Apparent DM digestibilities were lower (P < .05) by lambs consuming Treatments 2, 3, 4, and 5 (52.6, 44.5, 52.0, and 48.2%, respectively) than by those consuming Treatment 1 (60.7%). Apparent OM, CP, NDF, and ADF digestibilities followed trends similar to DM. In the second digestion trial, 15 ram and wether lambs were used in a RCB to compare Treatments 1, 2, and 3. For this second digestion study, NP was treated with 4% HCl (percentage of NP DM), autoclaved for 4 h, and diets were fed at 2% of BW. As in Trial 1, apparent nutrient digestibilities decreased (P < .05) with increasing amounts of HCl-NP. Our results suggest that HCl-NP can be fed to sheep at 40% of the diet without a decrease in DMI; however, apparent nutrient digestibility decreases with increasing levels of HCl-NP.