Christine A. Edwards

Intestinal microbiota of 6-week-old infants across Europe: geographic influence beyond delivery mode, breast-feeding, and antibiotics

Objectives: There are many differences in diet and lifestyle across Europe that may influence the development of the infant gut microbiota. This work aimed to assess the impact of geographic area, mode of delivery, feeding method, and antibiotic treatment on the fecal microbiota of infants from 5 European countries with different lifestyle characteristics: Sweden, Scotland, Germany, Italy, and Spain. Patients and Methods: Fecal samples from 606 infants (age 6 weeks) recruited within the European project INFABIO were analyzed by fluorescent in situ hybridization combined with flow cytometry using a panel of 10 rRNA targeted group- and species-specific oligonucleotide probes. Information on factors potentially affecting gut microbiota composition was collected with questionnaires and associations were evaluated with multivariate analyses. Results: The Bifidobacterium genus was predominant (40% average proportion of total detectable bacteria), followed by Bacteroides (11.4%) and enterobacteria (7.5%). Northern European countries were associated with higher proportions of bifidobacteria in infant feces, whereas a more diverse microbiota with more bacteroides characterized southern countries. Bifidobacteria dominated the microbiota of breast-fed infants, whereas formula-fed babies had significantly higher proportions of Bacteroides and members of the Clostridium coccoides and Lactobacillus groups. Newborns delivered by cesarean section or from mothers treated with antibiotics perinatally had lower proportions of Bacteroides and members of the Atopobium cluster. Conclusions: Delivery mode and feeding method influenced the fecal microbiota of European infants at 6 weeks, as expected, but the effect of country of birth was more pronounced, with dominant bifidobacteria in northern countries and greater early diversification in southern European countries.

Intestinal flora during the first months of life: new perspectives.

Increasing awareness that the human intestinal flora is a major factor in health and disease has led to different strategies to manipulate the flora to promote health. The complex microflora of the adult is difficult to change in the long term. There is greater impact of diet on the infant microflora. Manipulation of the flora particularly with probiotics has shown promising results in the prevention and treatment of diarrhoea and allergy. Before attempting to change the flora of the infant population in general, a greater understanding of the gut bacterial colonisation process is required. The critical stages of gut colonisation are after birth and during weaning. Lactic acid bacteria dominate the flora of the breast-fed infant. The formula-fed infant has a more diverse flora. The faeces of the breast-fed infant contain mainly acetic and lactic acid whereas the formula fed-infant has mainly acetic and propionic acid. Butyric acid is not a significant component in either group. The formula-fed infant also has higher faecal ammonia and other potentially harmful bacterial products. The composition of the microflora diversifies shortly before and particularly after weaning. The flora of the formula-fed infant develops more quickly than that of the breast-fed infant. Before embarking on any strategy to change the flora, the following questions should be considered: Should we retain a breast-fed style flora with limited ability to ferment complex carbohydrates? Can pro- and prebiotics achieve a flora with adult characteristics but with more lactic acid bacteria in weaned infants? Are there any health risks associated with such manipulations of the flora?

Determinants of the human infant intestinal microbiota after the introduction of first complementary foods in infant samples from five European centres

Although it is well established that early infant feeding has a major influence on the establishment of the gut microbiota, very little is understood about how the introduction of first solid food influences the colonization process. This study aimed to determine the impact of weaning on the faecal microbiota composition of infants from five European countries (Sweden, Scotland, Germany, Italy and Spain) which have different lifestyle characteristics and infant feeding practices. Faecal samples were collected from 605 infants approximately 4 weeks after the introduction of first solid foods and the results were compared with the same infants before weaning (6 weeks of age) to investigate the association with determining factors such as geographical origin, mode of delivery, previous feeding method and age of weaning. Samples were analysed by fluorescence in situ hybridization and flow cytometry using a panel of 10 rRNA targeted group- and species-specific oligonucleotide probes. The genus Bifidobacterium (36.5 % average proportion of total detectable bacteria), Clostridium coccoides group (14 %) and Bacteroides (13.6 %) were predominant after weaning. Similar to pre-weaning, northern European countries were associated with a higher proportion of bifidobacteria in the infant gut microbiota while higher levels of Bacteroides and lactobacilli characterized southern European countries. As before weaning, the initial feeding method influenced the Clostridium leptum group and Clostridium difficile+Clostridium perfringens species, and bifidobacteria still dominated the faeces of initially breast-fed infants. Formula-fed babies presented significantly higher proportions of Bacteroides and the C. coccoides group. The mode of birth influenced changes in the proportions of bacteroides and atopobium. Although there were significant differences in the mean weaning age between countries, this was not related to the populations of bifidobacteria or bacteroides. Thus, although the faecal microbiota of infants after first complementary foods was different to that before weaning commenced, many of the initial influences on microbiota composition were still evident.

Green tea flavan-3-ols: colonic degradation and urinary excretion of catabolites by humans.

Following the ingestion of green tea, substantial quantities of flavan-3-ols pass from the small to the large intestine (Stalmach et al. Mol. Nutr. Food Res. 2009, 53, S44-S53; Mol. Nutr. Food Res. 2009, doi: 10.1002/mnfr.200900194). To investigate the fate of the flavan-3-ols entering the large intestine, where they are subjected to the action of the colonic microflora, (-)-epicatechin, (-)-epigallocatechin, and (-)-epigallocatechin-3-O-gallate were incubated in vitro with fecal slurries and the production of phenolic acid catabolites was determined by GC-MS. In addition, urinary excretion of phenolic catabolites was investigated over a 24 h period after ingestion of either green tea or water by healthy volunteers with a functioning colon. The green tea was also fed to ileostomists, and 0-24 h urinary excretion of phenolic acid catabolites was monitored. Pathways are proposed for the degradation of green tea flavan-3-ols in the colon and further catabolism of phenolic compounds passing into the circulatory system from the large intestine, prior to urinary excretion in quantities corresponding to ca. 40% of intake compared with ca. 8% absorption of flavan-3-ol methyl, glucuronide, and sulfate metabolites in the small intestine. The data obtained point to the importance of the colonic microflora in the overall bioavailability and potential bioactivity of dietary flavonoids.

Butyrate production from oligofructose fermentation by the human faecal flora: what is the contribution of extracellular acetate and lactate?

Butyrate is an important substrate for maintenance of colonic health and oligofructose fermentation by human faecal bacteria can increase butyrate production in vitro. However, oligofructose appears to be fermented by mainly acetate and lactate-producing bacteria rather than butyrate-producing bacteria. Isotope labelling studies using [U-(13)C(6)]glucose were used to show that (13)C(2) and (13)C(4) were the major labelled butyrate species produced from glucose fermentation, via [(13)C(2)]acetate-acetyl CoA as intermediate. Bacterial interconversion reactions were quantified and acetate conversion to butyrate and lactate conversion to acetate, propionate and butyrate were observed. Addition of oligofructose to faecal batch cultures significantly increased butyrate production. Of the newly synthesised butyrate from oligofructose fermentation, 80 % was derived from interconversion of extracellular acetate and lactate, with acetate being quantitatively more significant. Carbohydrates, such as oligofructose, have prebiotic properties. In addition, oligofructose selectively stimulates the bacterial conversion of acetate and lactate to butyrate. Carbohydrates with similar properties represent a refinement of the prebiotic definition, termed butyrogenic prebiotics, because of their additional functionality.

Bioavailability of Pelargonidin-3-O-glucoside and Its Metabolites in Humans Following the Ingestion of Strawberries with and without Cream

Plasma and urine were collected over a 24 h period after the consumption by humans of 200 g of strawberries, containing 222 micromol of pelargonidin-3- O-glucoside, with and without cream. The main metabolite, a pelargonidin- O-glucuronide, reached a peak plasma concentration ( C max) of 274 +/- 24 nmol/L after 1.1 +/- 0.4 h ( t max) when only strawberries were ingested. When the strawberries were eaten with cream, the C max was not statistically different but the t max at 2.4 +/- 0.5 h was delayed significantly ( p < 0.001). The pelargonidin- O-glucuronide, along with smaller quantities of other metabolites, was also excreted in urine in quantities corresponding to ca. 1% of anthocyanin intake. The quantities excreted over the 0-24 h collection period were not influenced significantly by cream. However, the 0-2 h excretion of anthocyanin metabolites was significantly lower when the strawberries were eaten with cream, whereas the reverse occurred during with the 5-8 h excretion period. In keeping with these observations, measurement of plasma paracetamol and breath hydrogen revealed that cream delayed gastric emptying and extended mouth to cecum transit time.

The relative contribution of the small and large intestine to the absorption and metabolism of rutin in man

Tomato juice containing rutin (quercetin-3-rutinoside) was ingested by healthy volunteers and ileostomists. Blood and urine collected over 24 h were analysed by HPLC with photodiode array (PDA) and tandem mass spectrometric detection. Low concentrations of isorhamnetin-3-glucuronide (Cmax = 4.3 ± 1.5 nmoles/l) and quercetin-3-glucuronide (Cmax = 12 ± 2 nmoles/l) were detected in plasma of healthy subjects. Metabolites appeared in blood after 4 h indicating absorption from the large intestine. Nine metabolites of rutin were detected in urine but with considerable variation in total amount (40 ± 1–4981 ± 115 nmoles over 24 h). No metabolites were detected in plasma or urine of ileostomists and 86 ± 3% of the ingested rutin was recovered in ileal fluid. In subjects with an intact large intestine, but not ileostomists, rutin was catabolised with the appearance of 3,4-dihydroxyphenylacetic acid, 3-methoxy-4-hydroxyphenylacetic acid and 3-hydroxyphenylacetic acid in urine accounting for 22% of rutin intake.

Antioxidant flavonols from fruits, vegetables and beverages: measurements and bioavailability

Flavonols are polyphenolic secondary plant metabolites that are present in varying levels in commonly consumed fruits, vegetables and beverages. Flavonols have long held an interest for nutritionists, which has increased following a Dutch study in the early 1990s showing that dietary intake of flavonols was inversely correlated with the incidence of coronary heart disease. The main factors that have hindered workers in the field of flavonol research are (i) the accurate measurement of these compounds in foods and biological samples, and (ii) a dearth of information on their absorption and metabolism. This review aims to highlight the work of the authors in attempting to clarify the situation. The sensitive and selective HPLC procedure to identify and quantify common flavonols and their sugar conjugates is described. In addition, the results of an on-going screening program into the flavonol content of common produce and beverages are presented. The bioavailability of dietary flavonols is discussed with reference to an intervention study with onions, as well as pilot studies with tea, red wine and cherry tomatoes. It is concluded that flavonols are absorbable and accumulate in plasma and that consuming high flavonol-containing varieties of fruits and vegetables and particular types of beverages could increase their circulatory levels.

Milk decreases urinary excretion but not plasma pharmacokinetics of cocoa flavan-3-ol metabolites in humans

BACKGROUND Cocoa drinks containing flavan-3-ols are associated with many health benefits, and conflicting evidence exists as to whether milk adversely affects the bioavailability of flavan-3-ols. OBJECTIVE The objective was to determine the effect of milk on the bioavailability of cocoa flavan-3-ol metabolites. DESIGN Nine human volunteers followed a low-flavonoid diet for 2 d before drinking 250 mL of a cocoa beverage, made with water or milk, that contained 45 micromol (-)-epicatechin and (-)-catechin. Plasma and urine samples were collected for 24 h, and flavan-3-ol metabolites were analyzed by HPLC with photodiode array and mass spectrometric detection. RESULTS Milk affected neither gastric emptying nor the transit time through the small intestine. Two flavan-3-ol metabolites were detected in plasma and 4 in urine. Milk had only minor effects on the plasma pharmacokinetics of an (epi)catechin-O-sulfate and had no effect on an O-methyl-(epi)catechin-O-sulfate. However, milk significantly lowered the excretion of 4 urinary flavan-3-ol metabolites from 18.3% to 10.5% of the ingested dose (P = 0.016). Studies that showed protective effects of cocoa and those that showed no effect of milk on bioavailability used products that have a much higher flavan-3-ol content than does the commercial cocoa used in the present study. CONCLUSIONS Most studies of the protective effects of cocoa have used drinks with a very high flavan-3-ol content. Whether similar protective effects are associated with the consumption of many commercial chocolate and cocoa products containing substantially lower amounts of flavan-3-ols, especially when absorption at lower doses is obstructed by milk, remains to be determined.

Colonic Catabolism of Ellagitannins, Ellagic acid and Raspberry Anthocyanins: In Vivo and In Vitro Studies

Red raspberries contain principally anthocyanins and ellagitannins. After ingestion of raspberries by humans, trace levels of anthocyanins, absorbed in the upper gastrointestinal tract, are excreted in urine in amounts corresponding to <0.1% of intake. Urine also contains urolithin-O-glucuronides derived from colonic metabolism of the ellagitannins. Raspberry feedings with ileostomists show that substantial amounts of the anthocyanin and ellagitannin intake are excreted in ileal fluid. In subjects with an intact functioning colon, these compounds would pass to the large intestine. The aim of this study was to identify raspberry-derived phenolic acid catabolites that form in the colon and those that are subsequently excreted in urine. In vitro anaerobic incubation of ellagitannins with fecal suspensions demonstrated conversion to ellagic acid and several urolithins. Fecal suspensions converted 80% of added ellagic acid to urolithins. In vivo, urolithins are excreted in urine as O-glucuronides, not aglycones, indicating that the colonic microflora convert ellagitannins to urolithins, whereas glucuronidation occurs in the wall of the large intestine and/or postabsorption in the liver. Unlike ellagitannins, raspberry anthocyanins were converted in vitro to phenolic acids by anaerobic fecal suspensions. Urinary excretion of phenolic acids after ingestion of raspberries indicates that after formation in the colon some phenolic acids undergo phase II metabolism, resulting in the formation of products that do not accumulate when anthocyanins are degraded in fecal suspensions. There is a growing realization that colonic catabolites such as phenolic acids and urolithins may have important roles in the protective effects of a fruit- and vegetable-rich diet.