Neonatal jaundice in the healthy newborn:Are the guidelines conclusive?

Three cases are reported of term neonates with high serum total bilirubin levels without evident signs indicating hemolytic or other underlying disease. The three patients were treated with phototherapy and/or exchange transfusion. It is discussed that the current consensus guidelines are inconclusive with respect to 'success of phototherapy' and 'signs of underlying disease'. Recommendations are made to improve the practice guidelines.</p

Neonatal jaundice in the healthy newborn:Are the guidelines conclusive?

Three cases are reported of term neonates with high serum total bilirubin levels without evident signs indicating hemolytic or other underlying disease. The three patients were treated with phototherapy and/or exchange transfusion. It is discussed that the current consensus guidelines are inconclusive with respect to 'success of phototherapy' and 'signs of underlying disease'. Recommendations are made to improve the practice guidelines.</p

Low-dose acarbose does not delay digestion of starch but reduces its bioavailability

Aims Slowly digestible starch is associated with beneficial health effects. The glucose-lowering drug acarbose has the potential to retard starch digestion since it inhibits alpha-amylase and alpha-glucosidases. We tested the hypothesis that a low dose of acarbose delays the rate of digestion of rapidly digestible starch without reducing its bioavailability and thereby increasing resistant starch flux into the colon. Methods In a crossover study, seven healthy males ingested corn pasta (50.3 g dry weight), naturally enriched with C-13, with and without 12.5 mg acarbose. Plasma glucose and insulin concentrations, and (CO2)-C-13 and hydrogen excretion in breath were monitored for 6 h after ingestion of the test meals. Using a primed continuous infusion of D-[6,6-H-2(2)] glucose, the rate of appearance of starch-derived glucose was estimated, reflecting intestinal glucose absorption. Results Areas under the 2-h postprandial curves of plasma glucose and insulin concentrations were significantly decreased by acarbose (-58.1 +/- 8.2% and -72.7 +/- 7.4%, respectively). Acarbose reduced the overall 6-h appearance of exogenous glucose (bioavailability) by 22 +/- 7% (mean +/- SE) and the 6-h cumulative (CO2)-C-13 excretion by 30 +/- 6%. Conclusions These data show that in healthy volunteers a low dose of 12.5 mg acarbose decreases the appearance of starch-derived glucose substantially. Reduced bioavailability seems to contribute to this decrease to a greater extent than delay of digestion. This implies that the treatment effect of acarbose could in part be ascribed to the metabolic effects of colonic starch fermentation

An explorative study of in vivo digestive starch characteristics and postprandial glucose kinetics of wholemeal wheat bread

&lt;p&gt;&lt;b&gt;Background&lt;/b&gt;&lt;/p&gt; &lt;p&gt;Based on in vitro measurements, it is assumed that starch in wholemeal bread is rapidly digestible, which is considered to be less desirable for health.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Aim of the study&lt;/b&gt;&lt;/p&gt; &lt;p&gt;To evaluate the in vitro prediction, we characterized starch digestion of wholemeal wheat bread (WB) and postprandial glucose kinetics in healthy volunteers.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Methods&lt;/b&gt;&lt;/p&gt; &lt;p&gt;In a crossover study 4 healthy men ingested either intrinsically &lt;sup&gt;13&lt;/sup&gt;C-enriched WB (133 g) or glucose (55 g) in water. Plasma glucose and insulin concentrations were monitored during 6 h postprandially. Using a primed continuous infusion of D-[6,6-&lt;sup&gt;2&lt;/sup&gt;H2] glucose, the rate of systemic appearance of glucose was estimated (reflecting glucose influx) and the endogenous glucose production calculated.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Results&lt;/b&gt;&lt;/p&gt; &lt;p&gt;The glucose influx rate after WB was comparable with that after glucose in the early postprandial phase (0–2 h) (&lt;i&gt;P&lt;/i&gt; = 0.396) and higher in the late postprandial phase (2–4 h) (&lt;i&gt;P&lt;/i&gt; = 0.005). Despite the same initial glucose influx rate the 0–2 h incremental area under the curve (IAUC) of insulin after WB was 41% lower than after glucose (&lt;i&gt;P&lt;/i&gt; = 0.037). Paradoxically endogenous glucose production after WB was significantly more suppressed than after glucose (0–2 h IAUC: &lt;i&gt;P&lt;/i&gt; = 0.015, 2–4 h IAUC: &lt;i&gt;P&lt;/i&gt; = 0.018).&lt;/p&gt; &lt;p&gt;&lt;b&gt;Conclusions&lt;/b&gt;&lt;/p&gt; &lt;p&gt;Starch in WB seems to be partly rapidly and partly slowly digestible. Postprandial insulin response and endogenous glucose production after WB ingestion might not solely be determined by the digestive characteristics of starch; other components of WB seem to affect glucose homeostasis. In vitro measurements might not always predict in vivo starch digestion precisely.&lt;/p&gt

Absorption patterns of meals containing complex carbohydrates in type 1 diabetes

Successful postprandial glycaemia management requires understanding of absorption patterns after meals containing variable complex carbohydrates. We studied eight young participants with type 1 diabetes to investigate a large low-glycaemic-load (LG) meal and another eight participants to investigate a high-glycaemic-load (HG) meal matched for carbohydrates (121 g)