Digestive Diseases and Sciences

, Volume 51, Issue 8, pp 1331–1338 | Cite as

Effects of Posture on Gastric Emptying, Transpyloric Flow, and Hunger After a Glucose Drink in Healthy Humans

  • Karen L. Jones
  • Deirdre O’Donovan
  • Michael Horowitz
  • Antonietta Russo
  • Yong Lei
  • Trygve Hausken
Original Paper

Abstract

Previous studies suggest that posture has relatively little effect on gastric emptying of high-nutrient liquids; these studies have, however, only assessed overall rates of gastric emptying, whereas gastric emptying is known to be predominantly a pulsatile phenomenon. In healthy subjects perceptions of appetite, such as hunger, are inversely related to antral area and content; hence, changes in intragastric meal distribution induced by posture may affect appetite. Gastric emptying is a major determinant of postprandial glycemia. The aims of this study were to evaluate the effects of posture on patterns of transpyloric flow (TF), gastric emptying (GE), antral area (AA), hunger, and the glycemic response to oral glucose. Eight healthy young subjects (five males, three females; mean age, 24.0 ± 2.4 years; BMI, 21.2 ± 0.6 kg/m2) were studied twice in random order, once in the sitting position and once in the lying (supine) position. After consuming 600 ml water with 75 g glucose, labeled with 20 MBq 99mTc-sulfur colloid, subjects had simultaneous measurements of (i) TF during consumption of the drink by Doppler ultrasonography, (ii) GE with scintigraphy, (iii) AA at t = −5 and t = 30 min by ultrasonography, and (iv) perceptions of appetite with a visual analogue scale. During drink ingestion TF was greater in the sitting, compared with the lying, position (586 ± 170 vs. 177 ± 65 [cm/sec]×sec; P < 0.05). Posture affected intragastric distribution; more of the drink was retained in the distal stomach in the sitting position (e.g., at 30 min: sitting, 29 ± 3%, vs. lying, 12 ± 3%; P < 0.0001) but had no effect on the overall rate of GE or the blood glucose response. AA at t = 30 min (P < 0.005) was greater in the sitting position; there was an inverse relationship between hunger and AA at 30 min (r = −0.53, P < 0.05). We conclude that posture influences initial TF and intragastric distribution, but not the overall rate of GE of, or the glycemic response to, a large-volume nutrient liquid. The increases in AA and content in the sitting position are associated with a reduction in hunger.

Keywords

Gastric emptying Transpyloric flow Posture 

References

  1. 1.
    Burn-Murdoch R, Fisher MA, Hunt JN (1980) Does lying on the right side increase the rate of gastric emptying? J Physiol 302:395–398PubMedGoogle Scholar
  2. 2.
    Hunt JN, Knox MT, Oginski A (1965) The effect of gravity on gastric emptying with various test meals. J Physiol 178:92–97PubMedGoogle Scholar
  3. 3.
    Tothill P, McLoughlin GP, Holt S, Heading RC (1980) The effect of posture on errors in gastric emptying measurements. Phys Med Biol 25:1071–1077PubMedCrossRefGoogle Scholar
  4. 4.
    Anvari M, et al. (1995) Effects of posture on gastric emptying of nonnutrient liquids and antropyloroduodenal motility. Am J Physiol 268:G868–G871PubMedGoogle Scholar
  5. 5.
    Doran S, Jones KL, Andrews JM, Horowitz M (1998) Effects of meal volume and posture on gastric emptying of solids and appetite. Am J Physiol 275:R712–R7186Google Scholar
  6. 6.
    Hausken T, Gilja OH, Ødegaard S, Berstad A (1998) Flow across the human pylorus soon after the ingestion of food, studied with duplex sonography: effect of glyceryl trinitrate. Scand J Gastroenterol 33:484–490PubMedCrossRefGoogle Scholar
  7. 7.
    Hausken T, Ødegaard S, Matre K, Berstad A (1992) Antroduodenal motility and movements of luminal contents studied by duplex sonography. Gastroenterology 102:1583–1590PubMedGoogle Scholar
  8. 8.
    Malbert CH, Mathis C (1994) Antropyloric modulation of transpyloric flow of liquids in pigs. Gastroenterology 107:302–306Google Scholar
  9. 9.
    King PM, Adam RD, Pryde A, McDicken WN, Heading RC (1984) Relationships of human antroduodenal motility and transpyloric fluid movement: non-invasive observations with real-time ultrasound. Gut 25:1384–1391PubMedCrossRefGoogle Scholar
  10. 10.
    Collins PJ, et al. (1991) Role of the proximal and distal stomach in mixed solid and liquid meal emptying. Gut 32:615–619PubMedCrossRefGoogle Scholar
  11. 11.
    Jones KL, et al. (1997) Relation between postprandial satiation and antral area in normal subjects. Am J Clin Nutr 66:127–132PubMedGoogle Scholar
  12. 12.
    Sturm K, et al. (2004) Energy intake and appetite are related to antral area in healthy young and older subjects. Am J Clin Nutr 80:656–667PubMedGoogle Scholar
  13. 13.
    Santangelo A, Peracchi M, Conte D, Fraquelli M, Porrini M (1998) Physical state of meal affects gastric emptying, cholecystokinin release and satiety. Br J Nutr 80:521–527PubMedGoogle Scholar
  14. 14.
    Feinle C, et al. (2003) Effects of fat digestion on appetite, APD motility, and gut hormones in response to duodenal fat infusion in humans. Am J Physiol Gastrointest Liver Physiol 284:G798–G807PubMedGoogle Scholar
  15. 15.
    MacIntosh CG, et al. (2001) Effect of small intestinal nutrient infusion on appetite, gastrointestinal hormone release, and gastric myoelectrical activity in young and older men. Am J Gastroenterol 96:997–1007PubMedCrossRefGoogle Scholar
  16. 16.
    Hausken T (2003) The effect of body position on gastric emptying and postprandial symptoms. Neurogastroenterol Motil 15:46Google Scholar
  17. 17.
    Horowitz M, Edelbroek MA, Wishart JM, Straathof JW (1993) Relationship between oral glucose tolerance and gastric emptying in normal healthy subjects. Diabetologia 36:857–862Google Scholar
  18. 18.
    Jones KL, et al. (1996) Gastric emptying in “early” noninsulin-dependent diabetes mellitus relationship to oral glucose tolerance and appetite. J Nucl Med 37:1643–1648PubMedGoogle Scholar
  19. 19.
    O’Donovan DG, et al. (2004) Effect of variations in small intestinal glucose delivery on plasma glucose, insulin, and incretin hormones in healthy subjects and type 2 diabetes. J Clin Endocrinol Metab 89:3431–3435PubMedCrossRefGoogle Scholar
  20. 20.
    Beckoff K, et al. (2001) Effects of glucose supplementation on gastric emptying, blood glucose homeostasis, and appetite in the elderly. Am J Physiol Regul Integr Comp Physiol 280:R570–R576PubMedGoogle Scholar
  21. 21.
    Sievenpiper JL, Vuksan V, Wong EYY, Mendelson RA, Bruce-Thompson C (1998) Effect of meal dilution on the postprandial glycemic response. Implications for glycemic testing. Diabetes Care 21:711–716PubMedCrossRefGoogle Scholar
  22. 22.
    Collins PJ, Horowitz M, Cook DJ, Harding PE, Shearman DJ (1983) Gastric emptying in normal subjects—a reproducible technique using a single scintillation camera and computer system. Gut 24:1117–1125PubMedCrossRefGoogle Scholar
  23. 23.
    Collins PJ, Horowitz M, Shearman DJ, Chatterton BE (1984) Correction for tissue attenuation in radionuclide gastric emptying studies: a comparison of a lateral image method and a geometric mean method. Br J Radiol 57:689–695PubMedCrossRefGoogle Scholar
  24. 24.
    Sepple CP, Read NW (1989) Gastrointestinal correlates of the development of hunger in man. Appetite 13:183–191PubMedCrossRefGoogle Scholar
  25. 25.
    Jones KL, et al. (2001) Guar gum reduces postprandial hypotension in older people. J Am Geriatr Soc 49:162–167PubMedCrossRefGoogle Scholar
  26. 26.
    Urbain JL, Charkes ND (1995) Recent advances in gastric emptying scintigraphy. Semin Nucl Med 25:318–325PubMedCrossRefGoogle Scholar
  27. 27.
    Moore JG, Datz FL, Christian PE, Greenberg E, Alazraki N (1988) Effect of body posture on radionuclide measurements of gastric emptying. Dig Dis Sci 33:1592–1595PubMedCrossRefGoogle Scholar
  28. 28.
    Boulby P, Gowland P, Adams V, Spiller RC (1987) Use of echo planar imaging to demonstrate the effect of posture on the intragastric distribution and emptying of an oil/water meal. Neurogastroenterol Motil 9:41–47CrossRefGoogle Scholar
  29. 29.
    Spiegel TA, et al. (2000) Effects of posture on gastric emptying and satiety ratings after a nutritive liquid and solid meal. Am J Physiol Regul Integr Comp Physiol 279:R684–R694PubMedGoogle Scholar
  30. 30.
    Horowitz M, Jones K, Edelbroek MAL, Smout AJPM, Read NW (1993) The effect of posture on gastric emptying and intragastric distribution of oil and aqueous meal components and appetite. Gastroenterology 105:382–390PubMedGoogle Scholar
  31. 31.
    McHugh PR, Moran TH (1979) Calories and gastric emptying: a regulatory capacity with implications for feeding. Am J Physiol 236:R254–R260PubMedGoogle Scholar
  32. 32.
    Brener W, Hendrix TR, McHugh PR (1983) Regulation of the gastric emptying of glucose. Gastroenterology 85:76–82PubMedGoogle Scholar
  33. 33.
    Hunt JN, Smith JL, Jiang CL (1985) Effect of meal volume and energy density on the gastric emptying of carbohydrates. Gastroenterology 89:1326PubMedGoogle Scholar
  34. 34.
    Lin HC, Doty JE, Reedy TJ, Meyer JH (1989) Inhibition of gastric emptying by glucose depends on length of intestine exposed to nutrient. Am J Physiol 256:G404–G411PubMedGoogle Scholar
  35. 35.
    Lin HC, Doty JE, Reedy TJ, Meyer JH (1990) Inhibition of gastric emptying by sodium oleate depends on the length of intestine exposed to nutrient. Am J Physiol 259:G1031–G1036PubMedGoogle Scholar
  36. 36.
    Kaplan JM, Spector AC, Grill HJ (1992) Dynamics of gastric emptying during and after stomach fill. Am J Physiol 263:R813–R819PubMedGoogle Scholar
  37. 37.
    Carney BI, et al. (1995) Gastric emptying of oil and aqueous meal components in pancreatic insufficiency: effects of posture and on appetite. Am J Physiol 268:G925–G932PubMedGoogle Scholar
  38. 38.
    Meyer JH, et al. (1994) Control of canine gastric emptying of fat by lipolytic products. Am J Physiol 266:G1017–G1035PubMedGoogle Scholar
  39. 39.
    Meyer JH, et al. (1996) Gastric emptying of oil from solid and liquid meals: effect of human pancreatic insufficiency. Dig Dis Sci 41:1691–1699PubMedCrossRefGoogle Scholar
  40. 40.
    Edelbroek MAL, et al. (1994) Effects of duodenal distention on fasting and postprandial antropyloroduodenal motility in humans. Gastroenterology 106:583–592PubMedGoogle Scholar
  41. 41.
    Sanaka M, Kuyama Y, Yamanaka M (1998) Right lateral position reduces intra-individual variation during oral glucose tolerance tests. Diabet Med 15:706–707PubMedCrossRefGoogle Scholar
  42. 42.
    Nisell O (1957) The effect of posture and intragastric gas administration on the oral glucose tolerance test. Acta Med Scand 157:445–449PubMedCrossRefGoogle Scholar
  43. 43.
    Holdsworth CD, Hulme-Moir I, Thirumalai C (1972) Effect of posture on glucose tolerance after gastric surgery. Br Med J 4:198–200PubMedCrossRefGoogle Scholar
  44. 44.
    Sievenpiper JL, Jenkins DJ, Josse RG, Vuksan V (2000) Dilution of the 75-g oral glucose tolerance test increases postprandial glycemia: implications for diagnostic criteria. CMAJ 162:993–996PubMedGoogle Scholar
  45. 45.
    Jones K, et al. (2005) Effects of drink volume and glucose load on gastric emptying and postprandial blood pressure in healthy older subjects. Am J Physiol 289: 6240–6248Google Scholar
  46. 46.
    Horowitz M, et al. (1991) Relationships between oesophageal transit and solid and liquid gastric emptying in diabetes mellitus. Eur J Nucl Med 18:229–234PubMedCrossRefGoogle Scholar
  47. 47.
    Jones KL, et al. (1995) Relationships between gastric emptying, intragastric meal distribution and blood glucose concentrations in diabetes mellitus. J Nucl Med 36:2220–2228PubMedGoogle Scholar
  48. 48.
    Geliebter A (1988) Gastric distension and gastric capacity in relation to food intake in humans. Physiol Behav 44:665–668PubMedCrossRefGoogle Scholar
  49. 49.
    Greenberg D, Smith GP, Gibbs J (1990) Intraduodenal infusions of fats elicit satiety in sham-feeding rats. Am J Physiol 259:R110–R118PubMedGoogle Scholar
  50. 50.
    Welch I, Saunders K, NW R (1985) Effect of ileal and intravenous infusions of fat emulsions on feeding and satiety in human volunteers. Gastroenterology 89:1293–1297PubMedGoogle Scholar
  51. 51.
    Wirth JB, McHugh PR (1983) Gastric distension and short-term satiety in the rhesus monkey. Am J Physiol 245:R174–R180PubMedGoogle Scholar
  52. 52.
    Pappas TN, Melendez RL, Debas HT (1989) Gastric distension is a physiologic satiety signal in the dog. Dig Dis Sci 34:1489–1493PubMedCrossRefGoogle Scholar
  53. 53.
    Santangelo A, Peracchi M, Conte D, Fraquelli M, Porrini M (1998) Physical state of meal affects gastric emptying, cholecystokinin release and satiety. Br J Nutr 80:521–527PubMedGoogle Scholar
  54. 54.
    Meshkinpour H, Hsu D, Farivar S (1988) Effect of gastric bubble as a weight reduction device: a controlled, crossover study. Gastroenterology 95:589–592PubMedGoogle Scholar
  55. 55.
    Benjamin SB, et al. (1988) Double-blind controlled trial of the Garren-Edwards gastric bubble: an adjunctive treatment for exogenous obesity. Gastroenterology 95:581–588PubMedGoogle Scholar
  56. 56.
    Hogan RB, et al. (1989) A double-blind, randomized, sham-controlled trial of the gastric bubble for obesity. Gastrointest Endosc 35:381–385PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Karen L. Jones
    • 1
  • Deirdre O’Donovan
    • 1
  • Michael Horowitz
    • 1
  • Antonietta Russo
    • 1
  • Yong Lei
    • 1
  • Trygve Hausken
    • 2
  1. 1.Department of MedicineUniversity of Adelaide, Royal Adelaide Hospital, North TerraceAdelaideAustralia
  2. 2.Division of GastroenterologyMedical Department, Haukeland University HospitalBergenNorway

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