In vitro digestion of starches in a dynamic gastrointestinal model: an innovative study to optimize dietary management of patients with hepatic glycogen storage diseases
Uncooked cornstarch (UCCS) is a widely used treatment strategy for patients with hepatic glycogen storage disease (GSD). It has been observed that GSD-patients display different metabolic responses to different cornstarches. The objective was to characterize starch fractions and analyze the digestion of different starches in a dynamic gastrointestinal in vitro model. The following brands of UCCS were studied: Argo® and Great Value® from the United States of America; Brazilian Maizena Duryea® and Yoki® from Brazil; Dutch Maizena Duryea® from the Netherlands. Glycosade®, a modified starch, and sweet polvilho, a Brazilian starch extracted from cassava, were also studied. The starch fractions were analyzed by glycemic TNO index method and digestion analyses were determined by the TIM-1 system, a dynamic, computer-controlled, in vitro gastrointestinal model, which simulates the stomach and small intestine. The final digested amounts were between 84 and 86 % for the UCCS and Glycosade®, but was 75.5 % for sweet povilho. At 180 min of the experiment, an important time-point for GSD patients, the digested amount of the starches corresponded to 67.9–71.5 for the UCCS and Glycosade®, while it was 55.5 % for sweet povilho. In an experiment with a mixture of sweet polvilho and Brazilian Maizena Duryea®, a final digested amount of 78.4 % was found, while the value at 180 min was 61.7 %. Sweet polvilho seems to have a slower and extended release of glucose and looks like an interesting product to be further studied as it might lead to extended normoglycemia in GSD-patients.
KeywordsStarch Cornstarch Resistant Starch Glycogen Storage Disease Endogenous Glucose Production
Continuous nocturnal gastric drip feeding
- GTI method
Glycemic TNO index method
Glycogen storage disease
Rapidly available glucose
Slowly available glucose
TNO intestinal model-1
The authors thank Carlota Bussolo de Souza (TNO) for analytical help during the experiments and Marion G. Priebe (UMCG) for fruitful discussions. They also thank the CAPES Foundation/Ministry of Education of Brazil, CNPq Foundation/Ministry of Science, Technology and Innovation of Brazil, CNPq Foundation - Chamada 31/2013 – Doenças Metabólicas e Endócrinas, and FAPERGS Foundation - PPSUS/2013, and Vitaflo for their financial support.
Conflict of interest
Details of funding
CAPES Foundation/Ministry of Education of Brazil, CNPq Foundation/Ministry of Science, Technology and Innovation of Brazil, CNPq - Chamada N° 31/2013 – Doenças Metabólicas e Endócrinas, and FAPERGS Foundation - PPSUS/2013 provided grants for training and travel expenses of Tatiéle Nalin. Vitaflo provided a grant for bench fee for the laboratory studies and travel expenses of Tatiéle Nalin.
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