CONTENTS

Oligofructose

Randomized, prospective trial at the Guy's Hospital Intensive Care Group

Beneficial effect of soy protein on decreasing cardiovascular disease risk

Thai Recommended Dietary Intakes -Thai RDI

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TOP NUTRITION NEWSLETTER

VOLUME 1, NO 11: NOVEMBER 1998

Editorial

This is the eleventh issue of TOP NUTRITION NEWSLETTER in 1998.In this issue, oligofructose (fructooligosaccharides or FOS), immunonutrition, soy protein and Thai RDI are updated for your interest.

Oligofructose or FOS have received increased interest during the past 10 years, especially because they have been shown to be effective in stimulating the intestinal flora. FOS exist naturally in many kinds of plants such as onions, asparagus, banana, beer, garlic, honey, oat, rye, bacteria and yeasts. In May 1998, NIH hosted Nutritional and Health Benefits of Inulin and Oligofructose in Bethesda, Maryland. The conference, co-sponsored by several leading nutrition, academic and food organizations, reviewed the current scientific literature surrounding these food components. We could foresee the new generation enteral products will be utilizing FOS as mucosa reconditioner.

Infection is a major problem in ICU patients, contributing to increased morbidity, mortality, and healthcare costs. Thus, researchers and clinicians constantly seek new methods for decreasing infections.First-generation immune-enhancing formulas are applied in ICU patients to decrease infections and thus lower the morbidity and mortality (improved outcome).This updated randomized, prospective trial at the Guy's Hospital Intensive Care Group showed the reduction in the morbidity of their critical illness.

Although animal studies showed soy protein lowers blood cholesterol concentrations, similar studies in humans have yielded less consistent results. The presence or absence of the soybean isoflavone fraction may be a confounding factor. The proposed mechanisms for a beneficial effect of soy protein on decreasing cardiovascular disease risk is worth a look.

With the contribution from Dr.Kraisid Tontisirin, Director of Institute of Nutrition, Thailand, the new Thai Recommended Daily Intakes is provided for your interest.

Happy Reading.

Dr Shwe Win

Editor

Supercalifragilistic-OLIGOFRUCTOSE(S)

Source:HTTP://IFICINFO.HEALTH.ORG/insight/JulAug98/newsbites.htm

Even though the sound of it may be unfamiliar, oligofructose may play an important role in promoting health. Oligofructose and inulin are food components that fall into a category called oligosaccharides. Current scientific information suggests an increased consumption of oligosaccharides may be instrumental in modifying the risk of osteoporosis, heart disease, cancer and intestinal disorders. Inulin and oligofructose are carbohydrates that are found naturally in many plants. These food components are derived from chicory root or manufactured from carbohydrates, and can be used to formulate innovative, healthful food products. Oligosaccharides are used in many countries to add fiber to foods. But confirmation of their classification in the United States is still pending. Evidence is showing that their nutritional value goes beyond that of other "classical" fibers. Inulin and oligofructose may contribute to better health by increasing calcium and magnesium absorption and improving fat metabolism and function of the gastrointestinal tract. They can also act as sugar or fat replacers to make more palatable, lower-fat foods. When oligosaccharides are consumed, they travel through the gastrointestinal tract and enter the large intestine intact. Since they are not broken down, they do not increase glucose (blood sugar) levels in the blood stream, making them ideal for diabetics. Increased consumption of these components can also impact cancer risk by inhibiting tumor growth. Oligosaccharides alter microflora (beneficial bacteria that aid in digestion) in the gut to decrease carcinogens that activate tumor production. In May 1998, the National Institutes of Health (NIH) hosted Nutritional and Health Benefits of Inulin and Oligofructose in Bethesda, Maryland. The conference, co-sponsored by several leading nutrition, academic and food organizations, reviewed the current scientific literature
surrounding these food components. John Milner, Ph.D., The Pennsylvania State University, and Marcel Roberfroid, Ph.D., Catholic University of Louvain, Belgium co-chaired the NIH conference. They gave an overview of functional foods (foods that may provide health benefits beyond basic nutrition) as well as Concepts in Functional Foods: The Case of Inulin and Oligofructose, a report on oligosaccharides. Based on strong scientific research in humans, it is evident that oligosaccharides are interesting new health-promoting components. However, there needs to be additional research where results are inconclusive.

Functional food science, as recently proposed by ILSI Europe, opens new perspectives in nutrition and food sciences. The systematic investigation of the interactions between food components or food ingredients and genomic, biochemical, cellular, or physiological functions is
a unique way to improve both our knowledge and the role of nutrition in maintaining good health and in preventing disease. However, such basic knowledge is insufficient to justify claims, unless it is confirmed through relevant nutrition studies aimed at demonstrating the same effect
and its positive consequences in humans. In the first stage, this demonstration will in most cases justify functional (physiological) claims (e.g., bifidogenic effect for fructooligosaccharides, bulking effect for nondigestible carbohydrates, protection against oxidative stress for antioxidants) with no reference to any health benefit. A true health claim will require, in most cases, additional studies involving large populations and long-term trials. It is anticipated that the better we understand the mechanism of interactions between food components and specific biological functions, the more we will be able to demonstrate functional effects, and the easier it will be to accumulate convincing evidence in favor of health promotion or disease prevention. Because of both its direct contact with eaten foods and the diversity of its functions, the GI system is a potential target for many functional effects. Until now, only a limited number of these effects have been investigated so as to justify functional claims. Improvement of glucose absorption (leading to physiological glycemia and insulinemia),
modulation of GI transit time, fecal bulking, acidification of colonic content, and control of cholesterol bioavailability are all recognized effects of dietary fiber. Balanced colonic microflora and immunostimulation are attributed to the consumption of probiotics. Prebiotics selectively modify the colonic microbiota and modulate hepatic lipogenesis. According to the ILSI Europe strategy for the development of functional foods, all these effects are of interest. Their support by sound scientific arguments will be a necessary condition for their implementation in food science and nutrition for the benefit of human health.

Non-digestible oligosaccharides are complex carbohydrates of the non-a-glucan type which, because of the configuration of their osidic bonds, resist hydrolysis by salivary and intestinal digestive enzymes. In the colon they are fermented by anaerobic bacteria. Among the non-digestible oligosaccharides, the chicory fructooligosaccharides occupy a key position and, in most european countries, they are recognised as natural food ingredients. The other major products are the short chain fructooligosaccharides and galactooligosaccharides obtained by enzymatic synthesis using sucrose and lactose as substrates respectively, the soybean oligosaccharides, the xylooligosaccharides produced by partial hydrolysis of xylans and polydextrose or pyrodextrins prepared by a chemical treatment of carbohydrates. The most well known effect of most non-digestible oligosaccharides, and in particular of the fructooligosaccharides, is the selective stimulation of the growth of Bifidobacteria thus
modifying significantly the composition of the colonic microbiota. Such a modification, which has clearly been demonstrated in human volunteers, is meant to be benificial in part because it is accompanied by a significant reduction in the number of bacteria reported to have pathogenic potential. Within the framework of research and development of "functional foods", such an effect justifies a "functional claim" for fructooligosaccharides namely "bifidogenesis". They are also typical "prebiotics". Besides their bifidogenic effect, the chicory fructooligosaccharides have additional nutritional properties on digestive physiological parameters like colonic pH and stool bulking which justify their classification as dietary fibers. Moreover, in experimental models, it has also been reported that they improve the bioavailability of essentiel minerals and that they reduce serum triglyceridemia by lowering hepatic lipogenesis. Such effects demonstrate interactions between the chicory fructooligosaccharides and key functions in the body but their significance for humans still need to be proven before being used to justify additional claims.

A prospective, randomized, double-blind, controlled clinical trial of enteral immunonutrition in the critically ill. Guy's Hospital Intensive Care Group.

Source: Crit Care Med 1998 Jul;26(7):1164-72

OBJECTIVE: To assess the effects of enteral immunonutrition (IMN) on hospital mortality and length of stay in a heterogeneous group of critically ill patients. DESIGN: Prospective, randomized, double-blind, controlled clinical trial with an a priori subgroup analysis according to the volume of feed delivered in the first 72 hrs of intensive care unit (ICU) admission.

SETTING: A 13-bed adult general ICU in a London teaching hospital. PATIENTS: A total of 398 patients were enrolled and data from 390 patients (IMN = 193, control = 197) were used for an
intention-to-treat analysis. There were 369 patients (IMN = 184, control = 185) who actually received some enteral nutrition, of whom 101 patients (IMN = 50, control = 51) received >2.5 L within 72 hrs of ICU admission. This latter group was defined as the successful "early enteral
nutrition" group.

INTERVENTIONS: Within 48 hrs of ICU admission, patients were randomized to receive either the IMN Impact , an enteral feed supplemented with arginine, purine nucleotides and omega-3 fatty acids, or an isocaloric, isonitrogenous control enteral feed.

MEASUREMENTS AND RESULTS: There was no significant difference in hospital mortality rate between the two groups on an intention-to-treat analysis (Impact group 48%, control group 44%) nor in any other predefined subgroup analysis. However, patients randomized to receive the IMN had higher Acute Physiology and Chronic Health Evaluation II scores (20.1 +/- 7.1 vs. 18.7 +/- 7.1 [p = .07] intention-to-treat [n = 390]; 20.1 +/- 7.2 vs. 18.5 +/- 7.1 [p = .04] received feed [n = 369]). Of the 101 patients achieving early enteral nutrition, those patients fed with the IMN had a significant reduction in their requirment for mechanical ventilation compared with controls (median duration of ventilation 6.0 and 10.5 days, respectively, p = .007) with an associated reduction in the length of hospital stay (medians 15.5 and 20 days, respectively, p = .03).

CONCLUSION: While the administration of enteral IMN to a general, critically ill population did not affect mortality, those patients in whom it was possible to achieve early enteral nutrition with Impact had a significant reduction in the morbidity of their critical illness.

Editor's comment:

Infection is a major problem in ICU patients, contributing to increased morbidity, mortality, and healthcare costs. Thus, researchers and clinicians constantly seek new methods for decreasing infections. Dietary peptides (derived from casein, soy and other proteins), arginine, glutamine, nucleic acids, omega-3 fatty acids, vitamin C, vitamin E, and vitamin A have been found to enhance immune function.Experimental evidence also indicates that the immune-enhancing formulas can have a favorable effect on morbidity and mortality in animals. To date, 13 out of 14 prospective, randomized, clinical trials comparing an immune enteral formula with a standard formula report improved outcome (i.e., reduced complications, infections, or length of stay). The outcome benefits of the immune-enhancing formulas are found only in patients receiving critical amounts of formula. New-generation formulas, based on better knowledge of nutrient pharmacology, are on the horizon. Using an evidence-based approach, the use of immune-enhancing formulas in critically ill patients represents a level I recommendation.

Soy protein, isoflavones and cardiovascular disease risk.

Source: J Nutr 1998 Oct;128(10):1589-92

Since the early 1940s, scientists have examined the effect of soy protein on blood cholesterol concentrations. Although studies in animals have suggested that soy protein lowers blood cholesterol concentrations, similar studies in humans have yielded less consistent results. The
presence or absence of the soybean isoflavone fraction may be a confounding factor. This fraction, consisting primarily of genistein, daidzein and glycetein, has been shown to have a hypocholesterolemic effect in animals and humans. Potential mechanisms by which soy protein and/or isoflavones induce lowering of blood cholesterol concentrations include thyroid status, bile acid balance and the estrogenic effects of genistein and daidzein. Some studies have suggested that isoflavones exhibit antioxidant properties and have favorable effects on arterial compliance. In addition to the aforementioned potential beneficial effects, the increased consumption of products containing soy protein may displace foods relatively high in saturated fat and cholesterol from the diet and hence have an indirect blood cholesterol-lowering effect.

Editor's comment:

This recent advance in nutritional science is the updated information on the soy protein and the cardiovascular disease risk. Several protein components have been used for the cholesterol lowering effect in the clinical settings. Advanced isolating technology created the textured soy protein, soy flour and soy granules that retains the isoflavonoids (2.0 - 2.4 mg/g). Isolated soy protein could retain 0.62-0.99 mg/g of total isoflavonoids. In humans, incorporation of 45 g of soy flour has resulted in a 20-40 fold and 50-100 fold increase in blood and urinary phytoestrogens respectively. 45 mg of isoflavonoids, but not 23 mg isoflavonoids, resulted in a significant reduction in total and LDL cholesterol concentrations in young females. The bioavailability of isflavones is variable and is affected by the composition of the gut microflora and the fiber content of the diet. Although further studies are required to clarify the definite mechanism(s) for a beneficial effect of soy protein on decreasing cardiovascular disease risk, this is the important step to continue further exploration.

Thai Recommended Dietary Intakes -Thai RDI

Source: Ministry of Public Health, Thailand Notification Number 182/1998 on "Nutrition Labeling"

THAI RECOMMENDED DAILY INTAKES - THAI RDI

*The recommended intake of total fat, soturated fat, protein and carbohydrate are 30, 10, 10 and 60%, respectively, of total energy intake (2000 kcal) per day, (Fat 1 g = 9 kcal; Protein 1 g = 4 kcal; Carbohydrate 1 g = kcal)

Editor's comment:

This new updated recommendation reflects the importance of the total fat, saturated fat, cholesterol, dietary fiber and carbohydrate intake. Available RDI from 12 countries do not include the RDI of total fat, saturated fat, cholesterol, dietary fiber and carbohydrate but they recommended as guidelines.

Recommended dietary intakes (RDIs) or Recommended dietary allowances (RDAs) have been developed by many countries, regional and international bodies, such as the World Health Organisation (WHO) and the Food and Agriculture Organisation (FAO) of the United Nations.
These recommendations have usually been drawn-up in an effort to develop a set of nutrient intakes, which would meet the requirements of nearly all populations either at country, regional or global level to maintain health. The sets of RDIs/RDAs available in this file have been
developed by the previous IUNS Committee II/3 (1989-1993) on Dietary Recommendations for Populations and Individuals, chaired by Professor Ake Bruce of the National Food Administration of Sweden. The charge of this committee was to collect, compile and review sets of recommended nutrient intakes and dietary guidelines.

During its term, the Committee II/3 compiled the RDIs/RDAs for 12 countries and 2 regions. Professor Bruce has now forwarded these recommendations to IUNS Committee 1/1 on Food Standards, Terminology and Informatics. Because of the importance of this reference material
for both food scientists and nutritionists, Committee 1/1 has given a priority to facilitating the availability of the RDIs/RDAs on the IUNS Home Page with the technical assistance of IUNS Taskforce 1/1. The reference URL is http://www.monash.edu.au/IUNS/rdi/index.htm

Material has been included on the development and intended use of the nutrient recommendations of Australia, Canada, the United Kingdom, the USA and the Nordic countries. This material has been either excerpted from the offical reports of national or regional expert committees or is a summary of the conclusions and recommendations of the reports. Reference information is given for the other sets of recommendations.