In vitro digestion of starches in a dynamic gastrointestinal model: an innovative study to optimize dietary management of patients with hepatic glycogen storage diseases
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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.
- Anderson GH, Cho CE, Akhavan T, Mollard RC, Luhovyy BL, Finocchiaro ET (2010) Relation between estimates of cornstarch digestibility by the Englyst in vitro method and glycemic response, subjective appetite, and short-term food intake in young men. Am J Clin Nutr 91:932–939CrossRefPubMedGoogle Scholar
- Bali DS, Chen Y, Goldstein JL (2010) Glycogen storage disease type I. Available from http://www.ncbi.nlm.nih.gov/books/NBK1312/
- Bellmann S, Minekus M, Zeijdner E et al (2010) TIM-Carbo: a rapid, cost-efficient and reliable in vitro method for glycemic response after carbohydrate ingestion. In:JKamp JW, McCleary BV, Topping DL, eds. Dietary fibre: new frontiers for food and health. Wageningen Academic, Wageningen, pp 467-473Google Scholar
- Laforêt P, Weinstein DA,. Smit GPA (2012) The glycogen storage diseases and related disorders. In: Saudubray JM, van den Berghe G, Walter JH, eds. Inborn metabolic dDiseases: diagnosis and treatment. Springer, HeidelbergGoogle Scholar
- Minekus M, Marteau P, Havenaar R, Veld JHJ HI’T (1995) A multicompartmental dynamic computer-controlled model simulating the stomach and small intestine. ATLA Altern Lab Anim 23:197–209Google Scholar
- WHO - World Health Organization (2003) Adherence to long term therapies. Evidence for action. Switzerland. Available from http://whqlibdoc.who.int/publications/2003/9241545992.pdf