News Round-up
Group of International Scientists Align on a Definition for ‘Synbiotic’
New definition provides a foundation for science-based claims about the health benefits of synbiotics.
The word ‘synbiotic’ appears on a growing number of food and supplement products, with synbiotic ingredients showing promise for modulating the community of microbes living in the human gut, while providing a health benefit. Synbiotics are generally understood to be a combination of a probiotic and a prebiotic – but experts have deemed this description too limiting for innovation in this field and too ambiguous to allow for a clear understanding of synbiotic health benefits.
To address the scientific ambiguity around synbiotics, a group of 11 leading international scientists formed a panel to create a consensus definition and to clarify the evidence required to show synbiotics are safe and effective.
In a paper published in Nature Reviews Gastroenterology & Hepatology, the authors advance a new definition of synbiotics, which is informed by the latest scientific developments in the field: “a mixture comprising live microorganisms and substrate(s) selectively utilised by host microorganisms that confers a health benefit on the host.” The experts on the panel emphasise that the definition is designed to be inclusive – many different combinations of live microorganisms and selectively utilised substrates could qualify as synbiotics, as long as a human study demonstrates the health benefits of any particular combination. Furthermore, synbiotics need not be limited to the gut; they could potentially target any part of the human body that harbours a community of microorganisms.
“We hope the publication of this definition will mark a shift in people’s understanding of synbiotics,” says first author Kelly Swanson, Professor in the Department of Animal Sciences and Division of Nutritional Sciences, University of Illinois at Urbana-Champaign. “We can begin discussing synbiotics in a more scientifically accurate way, giving everyone a shared vocabulary for understanding what they do, how they work, and what evidence is needed to meet the definition.”
In the publication, the group also makes a distinction between ‘complementary synbiotics’, in which a probiotic and prebiotic are combined but work separately, and ‘synergistic synbiotics’, in which the selectively utilised substrate specifically feeds the microorganisms that accompany it.
The expert panel was convened by the International Scientific Association for Probiotics and Prebiotics (ISAPP), the non-profit organisation that previously led the scientific consensus definitions of both probiotics and prebiotics.
“Creating a definition of synbiotic is a first step,” says Mary Ellen Sanders, ISAPP’s Executive Science Officer. “From here, the scientific community can focus on designing and carrying out studies to test the health effects of these products.”
Surveys indicate that consumers increasingly look for evidence that products on the market provide the benefits they claim to provide. Sanders says: “We expect that the scientific data on synbiotic health benefits will increase over time, alongside an increase in general awareness about synbiotics.”
NEW Nutrison Peptisorb Plus HEHP – a high energy, high protein peptide-based tube feed, designed to improve intolerance1
When malnutrition occurs as a result of a disease affecting the gastrointestinal (GI) tract, patients can suffer from debilitating symptoms such as vomiting, diarrhoea and abdominal distension.2
Tube feeds containing whole proteins/fats are often poorly tolerated in patients with GI disorders.2 Peptide-based tube feeds have been shown to improve tolerance.2
Nutrison Peptisorb Plus HEHP is a high energy, high protein formulation designed to improve GI tolerance and increase nutritional intake in patients with impaired GI function:1
- Peptide-based, 100% whey protein
- High protein tube feed 7.5 g/100ml
- High levels of readily absorbed MCT; 60% fat as MCT
- High levels of sodium and potassium*
In a 28-day UK clinical study in tube-fed adults with complex conditions, Nutrison Peptisorb Plus HEHP improved GI tolerance, increased energy and protein intake and increased compliance. Additionally, 86% of dietitians felt patients tolerated the feed and/or exceeded tolerance expectations.1
For more information on Nutrison Peptisorb Plus HEHP, please visit: www.nutriciaHCP.com
*197 mg/100ml, 340 mg/100ml respectively.References: 1. Nutricia ACBS trial, data on file 2020.; 2. Alexander DD, et al. World J Gastrointest Pharmacol Ther. 2016;7(2):306-19. Nutrison Peptisorb Plus HEHP is a Food for Special Medical Purposes for the dietary management of disease related malnutrition in patients with malabsorption and/or maldigestion and must be used under medical supervision.
Information intended for Healthcare Professionals only.
NEW Framework from the National Post-Intensive Care Rehabilitation Collaborative
In the aftermath of COVID-19, there is a need to ensure that the rehabilitation needs of those who required critical care are met.
To address the needs of patients, the National Post-Intensive Care Rehabilitation Collaborative have created the ICS Framework to assess and guide timely rehabilitation post-ICU.
With collective expertise from nursing; physiotherapy; dietetics; occupational therapy; speech and language therapy; clinical psychology; sports medicine; ear, nose and throat surgery; intensive care; neuro-intensive care; plastic surgery; respiratory medicine; rehabilitation medicine; and renal medicine, the framework makes practical recommendations for early post-intensive care rehabilitation assessment and support from the multidisciplinary team.
The Collaborative has worked hard to bring together a comprehensive pathway for the rehabilitation of patients in and leaving intensive care and the framework includes a new Post ICU Presentation Screening (PICUPS) tool and rehabilitation prescription that can be applied to Trusts straight away.
Due the rapid nature of producing this document in the COVID-19 pandemic, it is likely that iterations will be required to refine the content of the framework and the associated tools, hence feedback is essential and encouraged.
With nutrition playing a key part in recovery for many, this new exciting framework is of relevance to BAPEN members. We would encourage you to discuss and share this guidance with colleagues, representative organisations, your networks and throughout appropriate channels to ensure that care post-ICU supports our patients to the standards required to optimise recovery and improve quality of life.
https://bit.ly/ICSRehab
How Vitamin C Could Help Over 50s Retain Muscle Mass
Vitamin C could be the key to better muscles in later life – according to new research from the University of East Anglia (UEA).
A study shows that older people who eat plenty of vitamin C – commonly found in citrus fruits, berries and vegetables – have the best skeletal muscle mass. This is important because people tend to lose skeletal muscle mass as they get older – leading to sarcopenia (a condition characterised by loss of skeletal muscle mass and function), frailty and reduced quality of life.
Lead researcher Prof Ailsa Welch, from UEA’s Norwich Medical School said: “As people age, they lose skeletal muscle mass and strength.
People over 50 lose up to one per cent of their skeletal muscle mass each year, and this loss is thought to affect more than 50 million people worldwide. It’s a big problem, because it can lead to frailty and other poor outcomes such as sarcopenia, physical disability, type-2 diabetes, reduced quality of life and death.
We know that Vitamin C consumption is linked with skeletal muscle mass. It helps defend the cells and tissues that make up the body from potentially harmful free radical substances. Unopposed these free radicals can contribute to the destruction of muscle, thus speeding up age-related decline.
But until now, few studies have investigated the importance of Vitamin C intake for older people. We wanted to find out whether people eating more Vitamin C had more muscle mass than other people.
The research team studied data from more than 13,000 people aged between 42-82 years, who are taking part in the EPIC (European Prospective Investigation into Cancer and Nutrition) Norfolk Study.
They calculated their skeletal muscle mass and analysed their vitamin C intakes from a seven-day food diary. They also examined the amount of vitamin C in their blood.
Dr Richard Hayhoe, also from UEA’s Norwich Medical School, said: “We studied a large sample of older Norfolk residents and found that people with the highest amounts of vitamin C in their diet or blood had the greatest estimated skeletal muscle mass, compared to those with the lowest amounts.
We are very excited by our findings as they suggest that dietary vitamin C is important for muscle health in older men and women and may be useful for preventing age-related muscle loss.
This is particularly significant as Vitamin C is readily available in fruits and vegetables, or supplements, so improving intake of this vitamin is relatively straightforward. We found that nearly 60 per cent of men and 50 per cent of women participants were not consuming as much Vitamin C as they should, according to the European Food Safety Agency recommendations.
We’re not talking about people needing mega-doses. Eating a citrus fruit, such as an orange, each day and having a vegetable side to a meal will be sufficient for most people.”
The research was led by the University of East Anglia, in collaboration with the University of Cambridge and Strangeways Research Laboratory in Cambridge, and developed from a UEA medical student project by Lucy Lewis.
The EPIC-Norfolk study was supported by grant funding from the Medical Research Council and Cancer Research UK.
Paper: Lower dietary and circulating vitamin C in middle and older aged men and women are associated with lower estimated skeletal muscle mass. Journal of Nutrition.
PENG Award 2020
Recent COVID-19 events have been challenging on both a personal and professional level. We have all had to examine what we do and how we can do things differently to meet the needs of patients and the dietetic profession to deliver evidence based, patient centred, nutritional support. The Parenteral and Enteral Nutrition Group (PENG) and Critical Care Specialist (CCSG) Group of the British Dietetic Association (BDA) are collaborating to plan an event in March 2021 (COVID-19 permitting), to provide a platform for dietitians to share learning from recent times.
PENG members* are invited to submit abstracts of audit/research, service development and innovative practice in relation to recent COVID-19 events.
Supportive educational grant: Abbott, Fresenius Kabi and Nutricia Advanced Life Transforming Nutrition have very kindly offered to jointly provide 6 supportive educational grants of £250 to enable 6 PENG members to present their work at the PENG/CCSG event March 2021.
How to apply: Using guidance from the BDA (www.bda.uk.com/uploads/assets/db946ae2-b02d-45ac-a8b1921b97eb322f/Write-a-conference-abstract2020.pdf), prepare an abstract on audit/research/innovation/service development on the topic of nutrition support in relation to COVID-19. To enter the PENG Award 2020 please submit your abstract to education.peng@bda.uk.com by Monday 30th November 2020.
Abstracts for PENG Award will be judged by members of PENG and Industry representatives. The award winners will be announced in January 2021.
PENG mentoring scheme: If you are unsure how to start writing an abstract, have a question about analysing your data, or wish some peer support, please contact: JJones@qmu.ac.uk for further information.
*Not a PENG member? Please go to the PENG website www.peng.org.uk and join today.
Oat and Rye Bran Fibres Alter Gut Microbiota, Reducing Weight Gain and Hepatic Inflammation
In a newly published experimental study, the consumption of dietary fibre from oat and rye brans supported the growth of beneficial gut microbiota, which in turn ameliorated cholesterol metabolism, enhanced gut barrier function and reduced hepatic inflammation. In addition, diets enriched with oat or rye bran were shown to attenuate weight gain. The effects of oat and rye were partly different, but both were beneficial for health.
The study was conducted within the research collaboration between the Institute of Public Health and Clinical Nutrition of the University of Eastern Finland, VTT Technical Research Centre of Finland and the School of Biological Sciences of The University of Hong Kong.
The health benefits of oat, rye and other whole grain products have been widely studied, and their use has been associated with decreased inflammation and improved glucose, lipid and adipose tissue metabolism in human and animal experimental research. In addition, they have been linked to a decreased risk of obesity, metabolic syndrome, cardiovascular diseases and type 2 diabetes. Different dietary fibres are also known to have differing health effects.
Until recently, the mechanisms underlying the health effects or oat and rye bran fibres have not been well understood. Dietary fibre is known to induce changes in gut microbiota function and to thus modulate gut environment in a beneficial manner. How this modulation is associated with metabolic pathways is, however, largely unclear. The aim of this experimental study was to investigate differences in metabolites produced by gut microbiota and their interactions with host metabolism in response to supplementation with oat and rye bran fibres.
The study was an animal experiment during which mice were fed a high-fat Western diet for 17 weeks. Two groups were fed the same diet enriched with 10% of either oat or rye bran. Among the various gut microbial metabolites, this study focused on those especially relevant to the development of fatty liver disease, which is often associated with obesity. Thus, microbial metabolites were assessed by measuring caecal short chain fatty acids (SCFAs), ileal and faecal bile acids, and the expression of genes related to tryptophan metabolism.
The findings suggest that both brans have the capacity to create a favourable environment in the gut by supporting the growth of beneficial microbes. The abundance of Lactobacillus genera was increased in the oat group, whereas Bifidobacterium genera was increased in the rye group. Via these microbiota changes, oats modified bile acid-related receptor function and rye modified bile acid production, which led to an improved cholesterol metabolism. Both bran fibres enhanced the production of SCFAs, leading to improved gut integrity, reduced liver inflammation, and diversion of tryptophan metabolism to a more beneficial pathway, that is, from serotonin synthesis to microbial indole production. In addition, both oat and rye supplementation were shown to attenuate weight gain associated with a high-fat diet.
Paper: Kundi ZM, et al. (2020). Dietary Fiber from Oat and Rye Brans Ameliorate Western Diet–Induced Body Weight Gain and Hepatic Inflammation by the Modulation of Short‐Chain Fatty Acids, Bile Acids, and Tryptophan Metabolism. Mol. Nutr. Food Res.; https://doi.org/10.1002/mnfr.201900580