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BACKGROUND: There is a lack of dedicated resources for adolescent and adult patients with phenylketonuria (PKU) and few studies have examined dietary practices within this group. METHODS: One hundred and seventy-seven PKU patients were sent questionnaires to assess dietary compliance and the preferred format for an educational resource. Seventy-one patients responded; 32 following diet were recruited to assess the resource's impact on test variables. The results were compared for the intervention group (n = 22) and control group (n = 10) at baseline, and 1 and 6 months after resource intervention. RESULTS: Most patients were aware of dietary recommendations, although this did not always result in compliance. The preferred resource format was a filofax-style folder with inserts (P < 0.05). There was a significant difference in the extent of change in knowledge score between baseline and 1 month in favour of the intervention group (P < 0.05). The improvement in knowledge was not accompanied by a significant improvement in measures of compliance. CONCLUSIONS: These findings add to the knowledge base about this patient group and support the use of patient involvement in resource development. It is likely that the test parameters used were not sensitive enough to pick up subtle and longer-term effects on compliance.

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BACKGROUND: Enteral tube feeding may impact significantly on patients' quality of life (QoL). The aim of this paper is to review studies that have measured QoL in adult patients receiving enteral tube feeding to determine the factors that are associated with feeding that impact on the patients' QoL. METHODS: An electronic search of CINAHL, MEDLINE and EMBASE was undertaken to identify articles that had measured QoL in adults receiving enteral tube feeding. RESULTS: Ten studies were included in the review. Quality of life in patients receiving enteral tube feeding generally appeared poor compared with control groups. Factors that were found to impact on patients' quality of life included symptoms such as nausea, vomiting, diarrhoea and fatigue. Issues around body image, inability to go out and discomfort while carrying out activities of daily living also impacted on QoL. CONCLUSIONS: Although the presence of underlying disease and the use of different QoL measures made comparison of the results difficult, issues requiring further consideration in clinical practice include effective symptom management, assessment of psychological and emotional issues and support for patients to enable them to cope with the resulting social isolation.

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OBJECTIVE: To develop a practical, valid and reliable chart to assist in the accurate visual characterization of fecal output in patients receiving enteral tube feeding (ETF). DESIGN: A chart incorporating verbal and pictorial descriptors of fecal output was developed. Validity and reliability were assessed by a questionnaire survey of health professionals and a clinical study of patients commencing ETF. Content validity was assessed from the results of the questionnaire, construct validity by contrasting groups analysis, concurrent validity by comparison of the chart with actual fecal weight and inter-rater reliability by independent characterization of the same fecal sample by two nurses. SETTING: St George's Hospital, London, UK. SUBJECTS: In all, 35 health professionals completed a questionnaire with respect to the chart. The chart was then used to monitor fecal output in 36 patients commencing ETF for a total of 171 patient-days, during which time nurses used the chart to characterize 269 fecal samples, of which 59 were subsequently weighed. RESULTS: The results of the questionnaire suggested good content validity. The chart demonstrated statistically significant differences in fecal frequency, fecal consistency, fecal score and incidence of diarrhea for contrasting patient groups expected to have different fecal output (P < 0.05). The inter-rater reliability was almost perfect for fecal consistency (95% agreement, kappa = 0.91) and substantial for fecal weight (83%, kappa = 0.75). In all, 83% of fecal samples were assigned to the correct weight category (kappa = 0.75). CONCLUSION: The chart has good content, construct and concurrent validity and inter-rater reliability, and is suitable for both research and clinical use. SPONSORSHIP: This research was jointly supported by King's College London and Nestlé, UK.

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INTRODUCTION: The criteria used to define diarrhoea during enteral tube feeding (ETF) and the interrater reliability of nursing staff reporting it in clinical practice has not been investigated. METHODS: A structured questionnaire was sent to a cohort of dietitians, specialist stroke nurses, intensive therapy unit (ITU) nurses and consultant gastroenterologists regarding their criteria for defining ETF diarrhoea. In a clinical study, nursing staff independently inspected faeces from patients receiving ETF and were asked whether they considered the patient to have diarrhoea. RESULTS: Thirty-five healthcare workers responded to the questionnaire. Faecal frequency, faecal consistency and faecal quantity were all considered important criteria in defining ETF diarrhoea. Faecal frequency was considered more important than consistency and quantity (P = 0.048), although not all professional groups agreed on the order of importance. In the clinical study, nursing staff agreed on the presence or absence of diarrhoea on 75% of occasions, with agreement being only fairly reliable (kappa = 0.48). CONCLUSION: Healthcare workers use a range of criteria to define ETF diarrhoea, but may not agree on the importance of each criteria. In order to prevent confusion between professional groups, healthcare workers should be encouraged to describe faecal characteristics rather than rely on the term 'diarrhoea'.

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INTRODUCTION: Diarrhoea is a common and serious complication of enteral tube feeding, and has a range of aetiologies. Manipulation of the colonic microflora may reduce the incidence of enteral tube feeding diarrhoea via suppression of enteropathogens and production of short-chain fatty acids. Probiotics and prebiotics are commonly used during enteral tube feeding to manipulate the colonic microflora; however, their efficacy is as yet uncertain. METHODS: English-language studies investigating the pathogenesis of enteral tube feeding diarrhoea and the use of probiotics and prebiotics were identified by searching the electronic databases CINAHL, EMBASE and MEDLINE from 1980 to 2001. The bibliographies of articles obtained were searched manually. RESULTS: Only two prospective, randomized, double-blind, placebo-controlled trials have investigated the effect of a probiotic on enteral tube feeding diarrhoea; however, results are conflicting. No prospective, randomized, double-blind, placebo-controlled studies have specifically addressed the effect of a prebiotic on the incidence of enteral tube feeding diarrhoea. CONCLUSION: Theoretically, probiotics and prebiotics may be of benefit in prophylaxis against enteral tube feeding diarrhoea; however, there is currently insufficient evidence to support their routine use. Prospective, randomised, double-blind, placebo-controlled studies investigating their effect on diarrhoea are required. These observations are discussed with reference to the current literature.

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INTRODUCTION: This paper presents information on the nutrient composition of commonly consumed traditional dishes eaten by the three major South Asian Muslim groups residing in Britain, namely Bangladeshi, Pakistani and East African Ismaili Muslims. METHODS: Information regarding the most common dishes consumed by South Asian Muslims originating from Bangladesh, Pakistan and East Africa (Ismailis) and living in London was obtained from 7-day menu records over two seasons. For each common dish, weighed recipes were collected in triplicate and the composition (energy and selected nutrients) was calculated from the ingredients and cooked weight of the dish. RESULTS: The three Muslim groups showed considerable variation in traditional foods commonly consumed as well as variation in fat and energy contents of similar recipes both within and between groups. Nutrient composition of commonly consumed dishes is presented calculated from the recipe nearest the average in terms of fat and energy for a particular dish. DISCUSSION AND CONCLUSIONS: The potential uses of the data, one of which would be to improve dietary compliance (especially to lower fat intakes) amongst the three diverse South Asian Muslim groups, are discussed.

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The effects of two vegetable flours, prepared from the African plants Detarium senegalense Gmelin, a legume, and Cissus rotundifolia, a shrub, on postprandial blood glucose and insulin concentrations in human subjects, were investigated. Chemical analysis indicated that these flours contained significant amounts of NSP. The detarium in particular was found to be a rich source of water-soluble NSP (SNSP). The flours were incorporated into two types of breakfast meal, a stew meal and a wheat bread meal, containing 50 g and 70 g available carbohydrate respectively. Both meals also contained 10-12 g NSP, the major fraction of which was SNSP. Control and fibre-rich meals were consumed on separate days in randomized order by two different groups of subjects (n 5, stew meals; n 10, bread meals). Venous blood samples were taken at fasting (0 min) and postprandially at 30 min intervals for 2.5 h and the plasma analysed for glucose and insulin. Compared with the controls, detarium and cissus meals elicited significant reductions (P < 0.006) in plasma glucose levels at most postprandial time points and for area-under-the-curve (AUC) values (AUC reductions 38-62%). Significant reductions (P < 0.002) in plasma insulin levels at various postprandial time points and for AUC values were also seen after detarium and cissus breads (AUC reductions 43 and 36% respectively), but not after the fibre-rich stew meals. SNSP and starch are possibly the main, but not the only, components responsible for the glucose- and insulin-lowering effects of cissus flour. The main SNSP fraction of detarium, identified as a high-molecular-weight xyloglucan, is likely to be a primary factor in determining the physiological activity of detarium flour.

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Recent human studies have shown that the physiologic effects of guar gum are not diminished by partial depolymerization of its galactomannan fraction. We evaluated the effect of depolymerized guar galactomannan on fasting plasma cholesterol and triacylglycerol concentrations in healthy volunteers with moderately raised plasma cholesterol concentrations (range: 5.2-8.0 mmol/L). This study was designed as a randomized, double-blind crossover of two 3-wk feeding periods separated by a 4-wk washout period. Control and guar wheat breads were prepared by a commercial bread-making process. Subjects (n = 11) were asked to replace their normal bread with that provided, receiving control bread for one 3-wk period and guar bread for the other period, without altering their baseline diet. Subjects recorded their intake of foods for 6 consecutive days on three occasions during the study. Fasting venous blood samples (10 mL) were taken from subjects on two consecutive mornings at the start and end of each feeding period. No significant changes in body weight or dietary intake were recorded in the control and guar bread periods. There was a significant reduction (10%) in total plasma cholesterol concentration after the guar treatment (P < 0.001), mainly because of a reduction in the low-density-lipoprotein-cholesterol fraction. No changes in plasma high-density-lipoprotein-cholesterol or triacylglycerol concentrations were seen. The cholesterol-lowering effect of partially depolymerized guar gum appears to be of a magnitude similar to that of high-molecular-weight guar gum used in earlier studies.

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Fourteen patients with non-insulin-dependent diabetes (NIDDM) attended the study centre on 4 mornings separated by at least 3 days, to receive in random order 75 g carbohydrate breakfast meals of control or guar breads with jam and butter. Guar gum flours of low, medium, and high molecular weight (MW) were incorporated into wheat bread rolls to provide 7.6 g guar per meal. Venous blood samples were taken via an indwelling cannula in a forearm vein at fasting and at eight postprandial times and then analysed for blood glucose, plasma insulin, C-peptide, and gastric inhibitory polypeptide (GIP). Guar gum bread significantly reduced the postprandial rise in blood glucose, plasma insulin, and, except for bread containing low MW guar gum, plasma GIP levels compared to the control. Thus, the partial depolymerization of guar gum does not diminish its physiological activity. No reductions in postprandial plasma C-peptide levels were seen after any of the guar bread meals. This suggests that guar gum attenuates the insulin concentration in peripheral venous blood in patients with NIDDM by increasing the hepatic extraction of insulin.

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Eight Type 2 diabetic patients ate and prepared five different meals at home, taking each meal on two separate occasions. They measured their blood glucose just before eating and 30, 60, 120, and 180 min after the meal. The meals varied in energy and dietary fibre content and in the ratio (by energy) of carbohydrate to fat. Total energy content of the meals had little effect on the postprandial glycaemic responses nor were the responses reduced by meals with high dietary fibre content. The ratio of carbohydrate to fat did not significantly affect postprandial glycaemic responses when meals were low in fibre. However, postprandial glycaemic responses were significantly greater in the meal with a high ratio of carbohydrate to fat, high in fibre and low in energy compared with those after the equicaloric meal low in carbohydrate to fat ratio and low in fibre (area under the curve 683 +/- 131 vs 306 +/- 55 mmol l-1 min-1, p < 0.05). Fat intake of 35% of energy may be compatible with improved postprandial blood glucose concentrations. Many meal combinations need to be studied in order to provide reliable information for diabetic patients. The method outlined proved producible (within patient coefficient of variation 13%), easy to perform and inexpensive.

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Fifteen adult women were given diets in which the intake of complex carbohydrates was increased from 20 to 30 g over a 12 week period. Metabolic balances were carried out, iron and zinc absorption tests performed using stable isotopes, and Fe and Zn status monitored. Although effects on bowel function were observed, the changed diet had no influence on any of the previously described variables. It was concluded that a moderate increase in cereals, fruit and vegetables did not have an adverse effect on Fe or Zn nutrition.

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Selenium concentrations were measured in the serum of 244 patients attending the Norfolk and Norwich Hospital, and 246 attending the James Paget Hospital in Gorleston, Norfolk. Both the mean and the median serum selenium concentration was lower in Gorleston than in Norwich, the difference being much greater in women than in men. Whereas the selenium concentrations were normally distributed about the mean for the Norwich area, there was a skewed distribution for the Gorleston area. The results are discussed in relation to the previously observed high risk of intestinal type gastric cancer in the Gorleston area.

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The hypocholesterolaemic effects of pectins were studied in a series of five experiments in weanling Sprague-Dawley rats. Expt A examined the effects of differing levels of dietary fat on plasma and liver lipids. Rats were given diets containing 100 g pectin, National Formulary (NF)/kg, and either 50,100, 150 or 200 g oil/kg. All diets contained 10 g cholesterol/kg. Plasma cholesterol levels were lower in all pectin-fed groups compared with rats given the control diet containing 100 g Solkafloc and 100 g oil/kg. Liver lipid and cholesterol levels increased with increasing fat content of the diet, reaching a plateau at 150 g fat/kg diet, but were still significantly lower in all pectin-fed groups compared with the control group. Expt B. The effects of molecular weight and degree of methoxylation of pectins were studied in five groups of rats given either a control diet containing 100 g Solkafloc/kg or high molecular weight, high methoxyl pectin (HMW HMP); high molecular weight, low methoxyl pectin (HMW LMP); low molecular weight, high methoxyl pectin (LMW HMP); low molecular weight, low methoxyl pectin (LMW LMP). All diets in this and subsequent experiments contained 100 g fat and 10 g cholesterol/kg. Plasma cholesterol levels were significantly lower than control values only in the HMW HMP group. Compared with controls, animals given HMW pectins had lower levels of liver lipid and liver cholesterol; on the LMW HMP diet the liver cholesterol, but not the liver lipid, was lower. Expt C. An attempt was made to clarify the possible effect of degree of methoxylation by feeding diets containing either 100 g Solkafloc/kg, 100 g pectin NF/kg or 100 g very high methoxyl pectin/kg. Plasma cholesterol levels were significantly reduced by both pectins but there was no difference in effect between the two. Both had similar viscosities suggesting that this is a more important factor than methoxyl content. Expts D and E. Effects of dose on hypocholesterolaemic effects of HMP and LMP were studied. Diets containing 50 or 100 g Solkafloc, HMP or LMP/kg were given in Expt D, and 25 g Solkafloc or HMP/kg, 50 g Solkafloc, HMP or LMP/kg and 100 g Solkafloc or LMP/kg in Expt E. Plasma cholesterol levels were significantly reduced in groups given 50 or 100 g HMP/kg and in groups given 100 g LMP/kg. HMP were found to be more effective at lowering plasma cholesterol levels than LMP. LMW pectins were not effective. This suggests that the hypocholesterolaemic effects are at least partly due to viscosity.(ABSTRACT TRUNCATED AT 400 WORDS)

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The effects on blood and faecal lipids of the addition of 15 g of either high- or low-methoxyl pectin to the habitual diets of ten healthy young adults have been studied. 2. Serum total cholesterol levels were reduced by a mean of 16% during consumption of low-methoxyl pectin and 18% during consumption of high-methoxyl pectin. High density lipoprotein cholesterol levels and triglyceride levels were unchanged. 3. There was no difference in faecal fat and steroid excretion between the two pectins. 4. The results suggest that it is the gel-forming properties of the pectins which are important in the cholesterol-lowering effect rather than differences in bile acid binding due to different methoxyl contents.

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