Effect of dietary fiber and growth hormone on colonic adaptation in short bowel syndrome treated by enteral nutrition.
BACKGROUND
Colon adaptation can partially compensate for the reduced capacity of nutrient absorption in patients with short bowel syndrome (SBS).


OBJECTIVE
The aim of this study was to assess the effect of combined treatment with enteral nutrition (EN), dietary fiber, and recombinant human growth hormone (rhGH) on promoting colonic adaptation.


METHODS
A group of 40 male Sprague-Dawley rats undergoing up to 80% to 85% small intestine resection were randomly assigned to four groups of 10 rats each: enteral nutrition (EN, the control); enteral nutrition/dietary fiber (EF); enteral nutrition/rhGH (EG); and enteral nutrition/dietary fiber/rhGH (EFG). All groups received isonitrogenous, isocaloric enteral feeding for 21 days. Body weight, daily nitrogen balance, colonic morphology, DNA, insulin-like growth factor-1/IGF-1 receptor (IGF-1)/IGF-1R) expression were determined.


CONCLUSIONS
Morphologic adaptation of the colon (including increased mucosal thickness and plica height, enlarged surface area, increased hyditloid cells) was observed on postoperative day 21. GH is superior to fiber in several aspects: increasing colon diameters (0.46 +/- 0.03 vs. 0.38 +/- 0.02 cm, P < 0.05), villous height (356 +/- 23 vs. 307 +/- 21 microm, P < 0.05) and total surface area (15,222 +/- 1344 vs. 13,178 +/- 1727 microm(2), P < 0.05). Increased DNA content-1.66 +/- 0.13 (EG) and 1.71 +/- 0.13 (EGF) vs. 1.28 +/- 0.11(EF), P < 0.05-in the colon was also found in the EG and EGF groups. GH administration led to a significant increase in plasma IGF-1 (439.6 +/- 88.3 ng/ml in the EG group, 455.4 +/- 107.4 ng/ml in the EGF group) and growth hormone (9.29 +/- 6.49 ng/ml in the EG group, 9.68 +/- 3.26 ng/ml in the EGF group) as compared to the EN group (IGF-1, 328.7 +/- 68.1 ng/ml; GH, 5.81 +/- 2.41 ng/ml) and the EF group (IGF-1, 356.4 +/- 52.1 ng/ml; GH, 6.51 +/- 4.66 ng/ml). Analysis of IGF-1 and IGF-1 receptor mRNA also demonstrated a significantly higher IGF-1 mRNA in the EG and EFG groups than in the EN and EF groups. Colon functional adaptation was also associated with accelerated absorptive function of water in the EF, EG, and EGF groups. Improved nutritional status (body weight, nitrogen retention, plasma protein) were seen in the EG and EGF groups. Dietary fiber, in combination with growth factor, synergistically promoted colon adaptation in the SBS animal model and facilitated maintenance of daily nutritional needs in rodents.
Xu
Jianmin
J
Department of General Surgery, Zhongshan Hospital, Shanghai, People's Republic of China. xujmin@yahoo.com.cn
Zhong
Yunshi
Y
Jin
Dayong
D
Zhang
Hongwei
H
Wu
Zhaohan
Z
D000222:Adaptation, Physiological; D000704:Analysis of Variance; D000818:Animals; D015152:Blotting, Northern; D001835:Body Weight; D002851:Chromatography, High Pressure Liquid; D003106:Colon / Q000378:metabolism* / Q000502:physiology*; D004043:Dietary Fiber / Q000008:administration & dosage*; D004750:Enteral Nutrition; D008401:Gas Chromatography-Mass Spectrometry; D013006:Growth Hormone / Q000008:administration & dosage*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D012778:Short Bowel Syndrome / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy*
D004043:Dietary Fiber; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone