1 PECTIN SUPPLEMENTATION INCREASES COLONIC SHORT CHAIN FATTY ACID (SCFA) PRODUCTION IN PATIENTS WITH SHORT BOWEL SYNDROME (SBS)
A. Atia, M. Rammohan, X. Hébuterne, F. Girard-Pipau, C. Ahn, A. Buchman Chicago, IL, Nice, France, Johnson City, TN and Dallas, TX. East Tennessee State University.
Pectin is water soluble, non-cellulose fiber that is nearly completely fermented by bacterial colonic flora to SCFAs. In animal models, SCFA promote colonic water absorption and small bowel nitrogen absorption. We hypothesized that pectin supplementation might enhance fluid and macronutrient absorption by prolonging oro-cecal transit time and by enhancing colonic fluid absorption.
We studied 6 subjects (3 M, 3 F) aged 29-67 yrs with SBS, all with jejunal-colonic anastomosis, and 4 of which had required long-term parental nutrition (PN) for 4.8 +/−3.9 yrs. At the time of the study, they received 10.0 ± 9.8 kcal/kg/d with infusion 4 ± 2.4 days/wk. Mean residual small bowel and colonic lengths were 50.3 ± 36.5 cm and 39.3 ± 5.09 cm, respectively. Subjects were admitted to the GCRC at Northwestern Memorial Hospital for 2 visits each lasting 6 days, separated by 2 weeks. During their initial visit, 25 g d-xylose test, indirect calorimetry, radioisotope gastric emptying and intestinal transit study and SmartPill© (Buffalo, NY) tests were performed. Macronutrient balance studies were performed: all stool and urine were collected for 3 days (days 3-5), weighed, and an aliquot of the pooled samples analyzed for SCFA, nitrogen, carbohydrate, fat, and energy measurements. Self-selected standardized meals were provided in duplicate, and equivalent portions consumed by the subjects were weighed and analyzed for nitrogen, fat, carbohydrate, and energy. Following completion of stool and urine collection, a custom pectin-based oral supplement (GENU® pectin type B rapid set-Z, CP Kelco, Copenhagen, Demark), that provided 6 g of citrus pectin prescribed tid in addition to usual meals. Subjects continued the pectin supplement at home and were readmitted to the GCRC after 2 weeks …