Protein-based oral rehydration solutions for patients with an ileostomy: A randomised, double-blinded crossover study.

Autor: Rud CL; Department of Hepatology and Gastroenterology, Aarhus University Hospital, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark. Electronic address: charru@rm.dk., Hvistendahl MK; Department of Intestinal Failure and Liver Diseases, Rigshospitalet, 2100 Copenhagen, Denmark., Langdahl B; Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark; Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark., Kraglund F; Department of Hepatology and Gastroenterology, Aarhus University Hospital, 8200 Aarhus N, Denmark., Baunwall SMD; Department of Hepatology and Gastroenterology, Aarhus University Hospital, 8200 Aarhus N, Denmark., Lal S; Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, United Kingdom., Jeppesen PB; Department of Intestinal Failure and Liver Diseases, Rigshospitalet, 2100 Copenhagen, Denmark., Hvas CL; Department of Hepatology and Gastroenterology, Aarhus University Hospital, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark.
Jazyk: angličtina
Zdroj: Clinical nutrition (Edinburgh, Scotland) [Clin Nutr] 2024 Jul; Vol. 43 (7), pp. 1747-1758. Date of Electronic Publication: 2024 May 28.
DOI: 10.1016/j.clnu.2024.05.038
Abstrakt: Background & Aim: Patients with an ileostomy are at increased risk of dehydration and sodium depletion. Treatments recommended may include oral rehydration solutions (ORS). We aimed to investigate if protein type or protein hydrolysation affects absorption from iso-osmolar ORS in patients with an ileostomy.
Methods: This was a randomised, double-blinded, active comparator-controlled 3 × 3 crossover intervention study. We developed three protein-based ORS with whey protein isolate, caseinate or whey protein hydrolysate. The solutions contained 40-48 g protein/L, 34-45 mmol sodium/L and had an osmolality of 248-270 mOsm/kg. The patients ingested 500 mL/d. The study consisted of three 4-week periods with a >2-week washout between each intervention. The primary outcome was wet-weight ileostomy output. Ileostomy output and urine were collected for a 24-h period before and after each intervention. Additionally, blood sampling, dietary records, muscle-strength tests, bioimpedance analyses, questionnaires and psychometric tests were conducted.
Results: We included 14 patients, of whom 13 completed at least one intervention. Ten patients completed all three interventions. Wet-weight ileostomy output did not change following either of the three interventions and did not differ between interventions (p = 0.38). A cluster of statistically significant improvements related to absorption was observed following the intake of whey protein isolate ORS, including decreased faecal losses of energy (-365 kJ/d, 95% confidence interval (CI), -643 to -87, p = 0.012), potassium (-7.8 mmol/L, 95%CI, -12.0 to -3.6, p = 0.001), magnesium (-4.0 mmol/L, 95%CI, -7.4 to -0.7, p = 0.020), improved plasma aldosterone (-4674 pmol/L 95%CI, -8536 to -812, p = 0.019), estimated glomerular filtration rate (eGFR) (2.8 mL/min/1.73 m 2 , 95%CI, 0.3 to 5.4, p = 0.03) and CO 2 (1.7 mmol/L 95%CI, 0.1 to 3.3, p = 0.04).
Conclusion: Ingestion of 500 mL/d of iso-osmolar solutions containing either whey protein isolate, caseinate or whey protein hydrolysate for four weeks resulted in unchanged and comparable ileostomy outputs in patients with an ileostomy. Following whey protein isolate ORS, we observed discrete improvements in a series of absorption proxies in both faeces and blood, indicating increased absorption. The protein-based ORS were safe and well-tolerated. Treatments should be tailored to each patient, and future studies are warranted to explore treatment-effect heterogeneity and whether different compositions or doses of ORS can improve absorption and nutritional status in patients with an ileostomy.
Gov Study Identifier: NCT04141826.
Competing Interests: Conflict of interest Aarhus University and Arla Foods Ingredients Group P/S financed the wages for CLR's doctoral studies, but in no way influenced the data collection, analyses, interpretation or publishing of the data. SMBD is an active member of the EurFMT alliance, a non-profit academic association, and has received a speaker honorarium from Takada on a subject unrelated to this manuscript. CLH has received lecture honoraria from Baxter and BMS on subjects unrelated to this manuscript, and is the Head of the board of the Danish Society for Clinical Nutrition. The other authors have no potential conflicts of interest to report.
(Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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