Henrik Andersson

Intake of dietary plant sterols is inversely related to serum cholesterol concentration in men and women in the EPIC Norfolk population: a cross-sectional study

Objective: We examined the relation between intake of natural dietary plant sterols and serum lipid concentrations in a free-living population.Design, setting and participants: Cross-sectional population-based study of 22 256 men and women aged 39–79 y resident in Norfolk, UK, participating in the European Prospective Investigation into Cancer (EPIC-Norfolk).Main exposure and outcome measures: Plant sterol intake from foods and concentrations of blood lipids.Results: Mean concentrations of total cholesterol and low-density lipoprotein cholesterol, adjusted for age, body mass index and total energy intake, decreased with increasing plant sterol intake in men and women. Mean total serum cholesterol concentration for men in the highest fifth of plant sterol intake (mean intake 463 mg daily) was 0.25 mmol/l lower and for low-density lipoprotein cholesterol 0.14 mmol/l lower than those in the lowest fifth of plant sterol consumption (mean intake 178 mg daily); the corresponding figures in women were 0.15 and 0.13 mmol/l. After adjusting for saturated fat and fibre intakes, the results for total cholesterol and low-density lipoprotein cholesterol were similar, although the strength of the association was slightly reduced.Conclusions: In a free-living population, a high intake of plant sterols is inversely associated with lower concentrations of total and low-density lipoprotein serum cholesterol. The plant sterol content of foods may partly explain diet-related effects on serum cholesterol concentration.

Cholelithiasis and Urolithiasis in Crohn's Disease

In a consecutive series of 107 patients operated on for Crohns disease involving the distal ileum, the overall incidence of gallstones was 17% and of renal stones 12%. Whereas the frequency of gallstone disease was 9% in patients with minor resections, patients with more than 100 cm diseased or resected small bowel had a frequency of 35%. The probability of gallstone development in both sexes was calculated to be approximately 50% after 20 years of distal ileopathy. The frequency of renal stone disease in patients with minor resection was comparable to that of a population in Sweden but was significantly commoner in patients with resection of more than 100 cm (28%), provided they were not colectomized. The high frequency of stone disease after resection of distal ileum is attributed to metabolic disturbances due to steatorrhea and bile salt malabsorption.

Oat bran rapidly increases bile acid excretion and bile acid synthesis: an ileostomy study

Objective:To study whether oat bran with native β-glucans increases bile acid excretion and bile acid synthesis as measured by serum concentrations of 7α-hydroxy-4-cholesten-3-one (7α-HC).Design:Short-term interventional crossover study evaluating cholesterol absorption, ileal excretion of cholesterol and bile acids, and serum levels of cholesterol and bile acid metabolites. Differences between diets evaluated with Wilcoxons signed rank-sum test.Setting:Outpatients at a metabolic-ward kitchen.Subjects:Nine volunteers with conventional ileostomies.Methods:Two 3-day-diet periods, with controlled, blinded basal diet including 75 g extruded oat bran breakfast cereal daily, with either 11.6 g native or hydrolysed β-glucans.Results:Native oat bran increased median excretion of bile acids by 144% (P=0.008). Cholesterol excretion remained unchanged, cholesterol absorption decreased by 19% (P=0.013), whereas the sum of bile acid and cholesterol excretion increased by 40% (P=0.008) compared with hydrolysed oat bran. 7α-HC reflecting bile acid synthesis increased by 57% (P=0.008) within 24 h of consumption, whereas serum lathosterol concentration reflecting cholesterol synthesis increased by 12% (P=0.015).Conclusions:Oat bran with native β-glucans increases bile acid excretion within 24 h of consumption and this increase can also be detected by rising serum concentrations of 7α-HC. Thus, 7α-HC could be used for rapid detection of dietary effects on bile acid metabolism. These effects could possibly be explained by entrapment of whole micelles in the gut owing to higher viscosity.

Extrusion cooking of a high-fibre cereal product 2. Effects on apparent absorption of zinc, iron, calcium, magnesium and phosphorus in humans

1. The effect of extrusion cooking, using mild conditions, of a high-fibre cereal product on apparent small bowel absorption of zinc, iron, calcium, magnesium and phosphorus was studied. 2. Seven ileostomy subjects were studied during two periods (each of 4 d), on a constant low-fibre diet supplemented with either 54 g/d of a bran-gluten-starch mixture or the corresponding extruded product. 3. The apparent absorption of Zn, Mg and P was significantly decreased (P less than 0.05) during the period with extruded product compared with the period with bran-gluten-starch. No difference was found for Fe and Ca. 4. The negative effect of extrusion cooking of a product containing phytic acid on availability of Zn, Mg and P was small but could be of nutritional relevance in foodstuffs that are consumed frequently and in infant formulas.

Food sources of plant sterols in the EPIC Norfolk population

Objective:To investigate the intake of plant sterols and identify major dietary sources of plant sterols in the British diet.Subjects:A total of 24 798 men and women recruited during 1993–1997, participating in the European Prospective Investigation into Cancer (EPIC-Norfolk).Interventions:A database of the plant sterol (campesterol, β-sitosterol, stigmasterol, campestanol and β-sitostanol) content in foods, based on gas-liquid chromatography (GLC) analyses, was linked to nutritional intake data from food frequency questionnaires in the EPIC-Norfolk population.Results:The mean (s.d.) intake of total plant sterols was 300 (108) mg/d for men and 293 (100) mg/d for women. Bread and other cereals, vegetables and added fats were the three major food sources of plant sterols representing 18.6 (8.9), 18.4 (8.5) and 17.3 (10.4)% of the total plant sterol intake respectively. Women had a higher plant sterol density than men (36.4 vs 32.8 mg/1000 kJ, P<0.001) and in relation to energy intake higher intakes of plant sterols from vegetables, bread and other cereals, added fats, fruits and mixed dishes (all P<0.001), whilst men had higher intakes of plant sterols from cakes, scones and chocolate, potatoes (all P<0.001) and other foods (P<0.01).Conclusions:The intake of plant sterols in UK, mainly from bread, cereals, fats and vegetables, is much higher than previously reported but comparable to recent European studies.

Substrates available for colonic fermentation from oat, barley and wheat bread diets. A study in ileostomy subjects

Nutrients not absorbed in the small bowel will form substrates for microbial growth in the colon which may have implication for the development of colon cancer. The aim of the present study was to investigate whether fibre-rich oat and barley diets increase the excretion of energy-supplying nutrients from the small bowel compared with a low-fibre wheat diet, and whether a possible increase could be related to the beta-glucan content. Nine ileostomy subjects were served four types of bread together with a low-fibre basal diet (12 g dietary fibre/d). The breads were based on either wheat flour (W diet, 7 g dietary fibre/d), oat bran (OB diet, 29 g dietary fibre/d), the same amount of oat bran with addition of beta-glucanase (EC 3.2.1.4) (OBE diet, 19 g dietary fibre/d) or a fibre-rich barley fraction (B diet, 35 g dietary fibre/d). An increased ileal excretion of starch was observed with the barley diet but no effect of the oat beta-glucan on starch recovery was found. The NSP + Klason lignin in the ileostomy effluents accounted only for 24, 31, 24 and 35% of the gross energy excretion in the W, OB, OBE and B diet periods respectively. A large part of the dry weight and energy (30, 21, 28 and 27%, in the W, OB, OBE and B diets respectively) in the effluents could not be identified as fat, protein, total starch or NSP + Klason lignin. This unidentified part was probably made up of oligosaccharides, endogenous losses and nutrient complexes. Methods for identifying and analysing these components should be developed and their role as substrates for colonic fermentation and colon cancer development ought to be investigated.

Sugar-beet fibre increases cholesterol and reduces bile acid excretion from the small bowel

The effect of addition of sugar-beet fibre to the diet on sterol excretion from the small intestine was studied in nine ileostomy subjects. A constant low-fibre diet was given in two 3 d periods with and without 32 g sugar-beet fibre/d in random order. Care was taken to minimize bacterial alteration of the ileostomy contents. The addition of sugar-beet fibre increased net cholesterol excretion by 52 (SE 9)% (P < 0.01), from 294 (SE 99) to 451 (SE 124) mg/d, and decreased bile acid excretion by 26 (SE 15)% (P < 0.01), from 764 (SE 118) to 567 (SE 96) mg/d. The increased cholesterol and decreased bile acid excretion found with sugar-beet fibre addition is different from the pattern associated with fibre sources such as pectin and oat fibre. The interaction between dietary fibre and sterol metabolism may be mediated, therefore, by different mechanisms depending on the fibre source.

Factors regulating sodium balance in proctocolectomized patients with various ileal resections.

Patients subjected to proctocolectomy together with an ileal resection will lose increased amounts of sodium with the ileostomy excreta and may develop sodium and water depletion. Studies of sodium balance and measurements of renin activity, aldosterone, and arginine vasopressin in plasma were made in 23 such patients, 8 of them under metabolic-ward conditions while receiving various salt loads. Salt loss never resulted in subnormal sodium levels in serum. The earliest sign of salt depletion was a nearly total inhibition of renal sodium excretion, which could precede activation of the renin-aldosterone axis in these patients. Secretion of vasopressin remained unaffected by sodium-water depletion and by activation of the renin system. The routine monitoring of these patients should include measurements of renal sodium excretion. Measurement of renin and aldosterone levels should be used for evaluation of the severity of a sodium deficiency.

Determination of the Faecal Excretion of Labelled Bile Salts after i.v. Administration of 14C-cholic Acid: An Evaluation of the Bile Salt Malabsorption before and after Surgery in Patients with Crohn's Disease

By measuring total faecal radioactivity, correlated to 24-hour enterohepatic circulation, following i.v. administration of 14C-cholic acid, bile salt malabsorption was evaluated before and/or after surgery in 80 patients with Crohns disease localized to the ileum and/or the colon and the results related to the length of ileum diseased or resected. Before operation bile salt malabsorption was observed only in patients with inflammation of the terminal ileum, but no significant correlation was found between bile salt excretion and the extent of ileal disease. In patients subjected to ileal resection with sacrifice of the ileocaecal valve, bile salt malabsorption correlated strongly to the length of ileum resected. This correlation was about the same in ileostomy patients and in patients subjected to restorative operation. We concluded that determination of 14C in faeces is a more sensitive test than the Schilling test and the faecal fat excretion test in reflecting ileal dysfunction, at least in patients with ileal resections.

Balance studies in patients with intestinal resection: how long is enough?

1. Results from two independent metabolic balance studies in patients with ileal resection with or without a remaining colon were examined to assess the precision of the mineral, protein and fat balances obtained. 2. Low day-to-day variation in balances was found in patients with ileostomy/jejunostomy, irrespective of formula diet composition. In contrast, patients with a remaining colon showed considerable variation, with reliable cumulative balances often not reached for many weeks. 3. In conclusion, short-term cumulative balances can be performed with good precision in patients with ileostomy or jejunostomy.