Aktuelle Ernährungsmedizin 2006; 31: 61-67
DOI: 10.1055/s-2005-915363
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Schwer verdauliche Saccharide

Low-Digestible SaccharidesW.  Scheppach1
  • 1Schwerpunkt Gastroenterologie, Medizinische Klinik und Poliklinik II, Julius-Maximilians-Universität Würzburg
Further Information

Publication History

Publication Date:
14 February 2006 (online)

Zusammenfassung

Schwer verdauliche Saccharide sind enzymresistente Zucker bzw. deren Oligo- oder Polymere, die im Magen-Darm-Trakt des Menschen spezifische Wirkungen entfalten. Im Dünndarm beeinflussen sie die Digestion und Resorption von Energieträgern mit Rückwirkungen auf den Glukose- und Fettstoffwechsel. Hierdurch vermindern sie die bekannten Risikofaktoren von Gefäßkrankheiten. Im proximalen Kolon werden die Saccharide von den anaeroben Bakterien der Mikroflora abgebaut. Die Fermentation von Kohlenhydraten ist für das innere Milieu des Dickdarms von Bedeutung. Durch Stimulation des bakteriellen Teilungsstoffwechsels wird Stickstoff in der Bakterienfraktion fixiert und so zur Ausscheidung über den Stuhl gebracht; dieser Effekt kann bei Patienten mit Leberzirrhose zur Prävention oder Therapie der hepatischen Enzephalopathie genutzt werden. Butyrat, ein Endprodukt der bakteriellen Kohlenhydratfermentation, hat antiinflammatorische Eigenschaften und kann möglicherweise in der Therapie bestimmter Kolitisformen (Colitis ulcerosa, Pouchitis, Strahlenproktitis) eingesetzt werden. Diese kurzkettige Fettsäure regelt auch die Expression zahlreicher Gene, die mit der Karzinogenese im Zusammenhang stehen; insofern könnte sie in der Primärprävention des kolorektalen Karzinoms eine Rolle spielen. Nicht fermentierte Kohlenhydrate steigern die Stuhlmasse, wodurch die funktionelle chronische Obstipation und die symptomatische Divertikulose gelindert werden können. Hingegen ist ihre Rolle beim Reizdarmsyndrom noch nicht endgültig geklärt. Zusammenfassend gibt es Belege für die Annahme, dass schwer verdauliche Saccharide für zahlreiche Teilaspekte des physiologischen Verdauungsprozesses von großer Bedeutung sind.

Abstract

Low-digestible saccharides represent a class of enzyme-resistant sugars (or their oligomers/polymers) which have specific effects on the human gastrointestinal tract. In the small bowel, they affect nutrient digestion and absorption, glucose and lipid metabolism and, thus, reduce known risk factors of cardiovascular disease. In the proximal colon they are fermented by the anaerobic bacteria of the indigenous microflora. The fermentation of carbohydrates has a major impact on the luminal environment of the large gut. By stimulating bacterial proliferation, nitrogen is fixed in bacterial matter and, thus, nitrogen excretion is enhanced; this effect can be used to prevent or treat hepatic encephalopathy in patients with liver cirrhosis. Butyrate, an end product of bacterial carbohydrate fermentation, exhibits anti-inflammatory properties and may be used to treat distinct forms of colitis (ulcerative colitis, pouchitis, radiation proctitis). This short chain fatty acid also regulates the expression of numerous genes involved in the promotion of carcinogenesis and may have a role in the prevention of colorectal cancer. Unfermented carbohydrates increase faecal bulk which is important in the treatment of functional chronic constipation and symptomatic diverticulosis; however, their role in the management of the irritable bowel syndrome is not quite clear. In conclusion, there is evidence that low-digestible saccharides play a role in the maintenance of human digestive health.

Literatur

  • 1 Theander O. Chemistry of dietary fibre components.  Scand J Gastroenterol. 1986;  129 S21-28
  • 2 Englyst H, Wiggins H S, Cummings J H. Determination of the non-starch polysaccharides in plant foods by gas-liquid chromatography of constituent sugars as alditol acetates.  Analyst. 1982;  107 307-318
  • 3 Scheppach W, Fabian C, Ahrens F, Spengler M, Kasper H. Effect of starch malabsorption on colonic function and metabolism in humans.  Gastroenterology. 1988;  95 1549-1555
  • 4 Cummings J H, Englyst H N. Measurement of starch fractions in the human large intestine.  Can J Physiol Pharmacol. 1991;  69 121-129
  • 5 Blackburn N A, Redfern J S, Jarjis H, Holgate A M, Hanning I, Scarpello J HB, Johnson I T, Read N W. The mechanism of action of guar gum in improving glucose tolerance in man.  Clin Sci. 1984;  66 329-336
  • 6 Jenkins D JA, Wolever T MS, Taylor R H, Barker H, Fielden H, Baldwin J M, Bowling A C, Newman H C, Jenkins A L, Goff D V. Glycemic index of foods: a physiological basis for carbohydrate exchange.  Am J Clin Nutr. 1981;  34 362-366
  • 7 Chandalia M, Garg A, Lutjohann D, Bergmann K von, Grundy S M, Brinkley L J. Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus.  N Engl J Med. 2000;  342 1392-1398
  • 8 Lafrance L, Rabasa-Lhoret R, Poisson D, Ducros F, Chiasson J L. Effects of different glycaemic index foods and dietary fibre intake on glycaemic control in type 1 diabetic patients on intensive insulin therapy.  Diabet Med. 1998;  15 972-978
  • 9 Lindström J, Eriksson J G, Valle T T, Aunola S, Cepaitis Z, Hakumäki M, Hämäläinen H, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Martikkala V, Moltchanov V, Rastas M, Salminen V, Sundvall J, Uusitupa M, Tuomilehto J. Prevention of diabetes mellitus in subjects with impaired glucose tolerance in the Finnish diabetes prevention study: Results from a randomized clinical trial.  J Am Soc Nephrol. 2003;  14 S108-S113
  • 10 Bosaeus I, Carlsson N G, Sandberg A S, Andersson H. Effect of wheat bran and pectin on bile acid and cholesterol excretion in ileostomy patients.  Hum Nutr Clin Nutr. 1986;  40 429-440
  • 11 Chen W J, Anderson J W, Jennings D. Propionate may mediate the hypocholesterolemic effects of certain soluble plant fibers in cholesterol-fed rats.  Proc Soc Exp Biol Med. 1984;  175 215-218
  • 12 Jenkins D JA, Kendall C WC, Marchie A, Faulkner D A, Wong J MW, Souza R de, Emam A, Parker T L, Vidgen E, Trautwein E A, Lapsley K G, Josse R G, Leiter L A, Singer W, Connelly P W. Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants.  Am J Clin Nutr. 2005;  81 380-387
  • 13 Ascherio A, Rimm E B, Giovannucci E L, Colditz G A, Rosner B, Willett W C, Sacks F, Stampfer M J. A prospective study of nutritional factors and hypertension among US men.  Circulation. 1992;  86 1475-1484
  • 14 Ascherio A, Hennekens C, Willett W C, Sacks F, Rosner B, Manson J, Witteman J, Stampfer M J. Prospective study of nutritional factors, blood pressure, and hypertension among US women.  Hypertension. 1996;  27 1065-1072
  • 15 Bagger M, Andersen O, Nielsen J B, Ryttig K R. Dietary fibres reduce blood pressure, serum total cholesterol and platelet aggregation in rats.  Br J Nutr. 1996;  75 483-493
  • 16 Jacobs D R, Meyer K A, Kushi L H, Folsom A R. Whole-grain intake may reduce the risk of ischemic heart disease death in postmenopausal women: The Iowa Women's Health Study.  Am J Clin Nutr. 1998;  68 248-257
  • 17 Wolk A, Manson J E, Stampfer M J, Colditz G A, Hu F B, Speizer F E, Hennekens C H, Willett W C. Long-term intake of dietary fiber and decreased risk of coronary heart disease among women.  JAMA. 1999;  281 1998-2004
  • 18 Liu S, Buring J E, Sesso H D, Rimm E B, Willett W C, Manson J E. A prospective study of dietary fiber intake and risk of cardiovascular disease among women.  J Am Coll Cardiol. 2002;  39 49-56
  • 19 Cummings J H. The large intestine in nutrition and disease. Brüssel; Institut Danone 1997
  • 20 Bowling T E, Raimundo A H, Grimble G K, Silk D BA. Reversal by short-chain fatty acids of colonic fluid secretion induced by enteral feeding.  Lancet. 1993;  342 1266-1268
  • 21 Ramakrishna B S, Venkataraman S, Srinivasan P, Dash P, Young G P, Binder H J. Amylase resistant starch plus oral rehydration solution for cholera.  N Engl J Med. 2000;  342 308-313
  • 22 Gibson G R, Beatty E R, Wang X, Cummings J H. Selective stimulation of bifidobacteria in the human colon by oligofructose and inulin.  Gastroenterology. 1995;  108 975-982
  • 23 Bouhnik Y, Vahedi K, Achour L, Attar A, Salfati J, Pochart P, Marteau P, Flourie B, Bornet F, Rambaud J C. Short-chain fructo-oligosaccharide administration dose-dependently increases fecal bifidobacteria in healthy humans.  J Nutr. 1999;  129 113-116
  • 24 Gostner A, Blaut M, Schaeffer V, Kozianowski G, Theis S, Klingeberg M, Dombrowski Y, Martin D, Luehrs H, Melcher R, Schauber J, Kudlich T, Dorbath D, Menzel T, Scheppach W. Colonic effects of the polyol isomalt in humans.  Gastroenterology. 2004;  126 A 400 (Abstr.)
  • 25 Lewis S, Burmeister S, Brazier J. Effect of the prebiotic oligofructose on relapse of Clostridium difficile-associated diarrhea: A randomized, controlled study.  Clin Gastroenterol Hepatol. 2005;  3 442-448
  • 26 Chacko A, Cummings J H. Nitrogen losses from the human small bowel: obligatory losses and the effect of physical form of food.  Gut. 1988;  29 809-815
  • 27 Weber F L, Banwell J G, Fresard K M, Cummings J H. Nitrogen in fecal bacterial, fiber, and soluble fractions of patients with cirrhosis: effects of lactulose and lactulose plus neomycin.  J Lab Clin Med. 1987;  110 256-263
  • 28 Bircher J, Muller J, Guggenheim P, Haemmerli U P. Treatment of chronic portal-systemic encephalopathy with lactulose.  Lancet. 1966;  1 890-892
  • 29 Liu Q, Duan Z P, Ha D K, Bengmark S, Kurtovic J, Riordan S M. Symbiotic modulation of gut flora: Effect on minimal hepatic encephalopathy in patients with cirrhosis.  Hepatology. 2004;  39 1441-1449
  • 30 Roediger W EW. The starved colon - diminished mucosal nutrition, diminished absorption, and colitis.  Dis Colon Rectum. 1990;  33 858-862
  • 31 Lührs H, Gerke T, Müller J, Melcher R, Schauber J, Boxberger F, Scheppach W, Menzel T. Butyrate inhibits NF-κB activation in lamina propria macrophages of patients with ulcerative colitis.  Scand J Gastroenterol. 2002;  37 458-466
  • 32 Breuer R I, Soergel K H, Lashner B A, Christ M L, Hanauer S B, Vanaguas A, Harig J M, Keshavarzian A, Robinson M, Sellin J H, Weinberg D, Vidican D E, Flemal K L, Rademaker A W. Short chain fatty acid rectal irrigation for left-sided ulcerative colitis: a randomised, placebo controlled trial.  Gut. 1997;  40 485-491
  • 33 Scheppach W. German-Austrian SCFA Study Group . Treatment of distal ulcerative colitis with short-chain fatty acid enemas. A placebo-controlled trial.  Dig Dis Sci. 1996;  41 2254-2259
  • 34 Kanauchi O, Mitsuyama K, Homma T, Takahama K, Fujiyama Y, Andoh A, Araki Y, Suga T, Hibi T, Naganuma M, Asakura H, Nakano H, Shimoyama T, Hida N, Haruma H, Koga H, Sata M, Tomiyasu N, Toyanaga A, Fukuda M, Kojima A, Bamba T. Treatment of ulcerative colitis patients by long-term administration of germinated barley foodstuff: Multi-center open trial.  Int J Mol Med. 2003;  12 701-704
  • 35 Hanai H, Kanauchi O, Mitsuyama K, Andoh A, Takeuchi K, Takayuki I, Araki Y, Fujiyama Y, Toyanaga A, Sata M, Kojima A, Fukuda M, Bamba T. Germinated barley foodstuff prolongs remission in patients with ulcerative colitis.  Int J Mol Med. 2004;  13 643-647
  • 36 Seidner D L, Lashner B A, Brzezinski A, Banks P LC, Goldblum J, Fiocchi C, Katz J, Lichtenstein G R, Anton P A, Kam L Y, Garleb K A, Demichele S J. and the enteral nutrition in ulcerative colitis study group . An oral supplement enriched with fish oil, soluble fiber, and antioxidants for corticosteroid sparing in ulcerative colitis: A randomized, controlled trial.  Clin Gastroenterol Hepatol. 2005;  3 358-369
  • 37 Hallert C, Kaldma M, Petersson B G. Ispaghula husk may relieve gastrointestinal symptoms in ulcerative colitis in remission.  Scand J Gastroenterol. 1991;  26 747-750
  • 38 Fernandez-Banares F, Hinojosa J, Sanchez-Lombrana J L, Navarro E, Martinez-Salmeron J F, Garcia-Puges A, Gonzalez-Huix F, Riera J, Gonzalez-Lara V, Dominguez-Abascal F, Gine J J, Moles J, Gomollon F, Gassull M A. Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Spanish Group for the Study of Crohn's Disease and Ulcerative Colitis (GETECCU).  Am J Gastroenterol. 1999;  94 427-433
  • 39 Welters C F, Heineman E, Thunnissen F B, Bogaard A E van den, Soeters P B, Baeten C G. Effect of dietary inulin on inflammation of pouch mucosa in patients with an ileal pouch-anal anastomosis.  Dis Colon Rectum. 2002;  45 621-627
  • 40 Potter J D. Food, nutrition and cancer: a global perspective. Washington DC; World Cancer Research Fund/American Institute for Cancer Research 1997
  • 41 Howe G R, Benito E, Castelleto R. et al . Dietary intake of fiber and decreased risk of cancers of the colon and rectum: evidence from the combined analysis of 13 case-control studies.  J Natl Cancer Inst. 1992;  84 1887-1896
  • 42 Fuchs C S, Giovannucci E L, Colditz G A, Hunter D J, Stampfer M J, Rosner B, Speizer F E, Willett W C. Dietary fiber and the risk of colorectal cancer and adenoma in women.  N Engl J Med. 1999;  340 169-176
  • 43 Bingham S A, Day N E, Luben R, Ferrari P, Slimani N, Norat T, Clavel-Chapelon F, Kesse E, Nieters A, Boeing H, Tjonneland A, Overvad K, Martinez C, Dorronsoro M, Gonzalez C A, Key T J, Trichopoulou A, Naska A, Vineis P, Tumino R, Krogh V, Bueno-de-Mesquita H B, Peeters P HM, Berglund G, Hallmans G, Lund E, Skeie G, Kaaks R, Riboli E. Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition: an observational study.  Lancet. 2003;  361 1496-1501
  • 44 Scheppach W, Bartram H P, Richter F. Role of short-chain fatty acids in the prevention of colorectal cancer.  Eur J Cancer. 1995;  31A 1077-1080
  • 45 Schatzkin A, Lanza E, Corle D, Lance P, Iber F, Caan B, Shike M, Weissfeld J, Burt R, Cooper M R, Kikendall J W, Cahill J. and the Polyp Prevention Trial Study Group . Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas.  N Engl J Med. 2000;  342 1149-1155
  • 46 Alberts D S, Martinez M E, Roe D J, Guillen-Rodriguez J M, Marshall J R, Leeuven J B Van, Reid M E, Ritenbaugh C, Vargas P A, Bhattacharyya A B, Earnest D L, Sampliner R E. and the Phoenix Colon Cancer Prevention Physicians' Network. . Lack of effect of a high fiber cereal supplement on the recurrence of colorectal adenomas.  N Engl J Med. 2000;  342 1156-1162
  • 47 Cummings J H, Branch W, Jenkins D JA, Southgate D AT, Houston H, James W PT. Colonic response to dietary fibre from carrot, cabbage, apple, bran, and guar gum.  Lancet. 1978;  i 5-9
  • 48 Stephen A M, Cummings J H. Mechanism of action of dietary fibre in the human colon.  Nature. 1980;  284 283-284
  • 49 Voderholzer W A, Schatke W, Mühldorfer B E, Klauser A G, Birkner B, Müller-Lissner S A. Clinical response to dietary fiber treatment of chronic constipation.  Am J Gastroenterol. 1997;  92 95-98
  • 50 Aldoori W H, Giovannucci E L, Rimm E B, Wing A L, Trichopoulos D V, Willett W C. A prospective study of diet and the risk of symptomatic diverticular disease in men.  Am J Clin Nutr. 1994;  60 757-764
  • 51 Fisher N, Berry C S, Fearn T, Gregory J A, Hardy J. Cereal dietary fibre consumption and diverticular disease: a lifespan study in rats.  Am J Clin Nutr. 1985;  42 788-804
  • 52 Drossman D A, Whitehead W E, Camillieri M. American Gastroenterological Association medical position statement: irritable bowel syndrome.  Gastroenterology. 1997;  112 2118-2137
  • 53 Cook I J, Irvine E J, Campbell D, Shannon S, Reddy S N, Collins S M. Effect of dietary fiber on symptoms and rectosigmoid motility in patients with irritable bowel syndrome.  Gastroenterology. 1990;  98 66-72
  • 54 Parisi G C, Zilli M, Miani M P, Carrara M, Bottona E, Verdianelli G, Battaglia G, Desideri S, Faedo A, Marzolino C, Tonon A, Ermani M, Leandro G. High-fiber diet supplementation in patients with irritable bowel syndrome (IBS). A multicenter, randomized, open trial comparison between wheat bran diet and partially hydrolyzed guar gum (PHGG).  Dig Dis Sci. 2002;  47 1697-1704

Prof. Dr. med. Wolfgang Scheppach

Schwerpunkt Gastroenterologie · Medizinische Klinik und Poliklinik II · Julius-Maximilians-Universität Würzburg

Josef-Schneider-Straße 2

87080 Würzburg

Phone: 0931/201-36183

Fax: 0931/201-36534

Email: scheppach_w@klinik.uni-wuerzburg.de

    >