Effect of Unripe Banana Flour on Gut-Derived Uremic Toxins in Individuals Undergoing Peritoneal Dialysis: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial
In chronic kidney disease (CKD), the accumulation of gut-derived metabolites, such as indoxyl sulfate (IS), p-cresyl sulfate (pCS), and indole 3-acetic acid (IAA), has been associated with the burden of the disease. In this context, prebiotics emerge as a strategy to mitigate the accumulation of suc...
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MDPI AG
2021-02-01
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| Series: | Nutrients |
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| Online Access: | https://www.mdpi.com/2072-6643/13/2/646 |
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| author | Laila Santos de Andrade Fabiana Andréa Hoffmann Sardá Natalia Barros Ferreira Pereira Renata Rodrigues Teixeira Silvia Daniéle Rodrigues Jordana Dinorá de Lima Maria Aparecida Dalboni Danilo Takashi Aoike Lia Sumie Nakao Lilian Cuppari |
| author_facet | Laila Santos de Andrade Fabiana Andréa Hoffmann Sardá Natalia Barros Ferreira Pereira Renata Rodrigues Teixeira Silvia Daniéle Rodrigues Jordana Dinorá de Lima Maria Aparecida Dalboni Danilo Takashi Aoike Lia Sumie Nakao Lilian Cuppari |
| author_sort | Laila Santos de Andrade |
| collection | DOAJ |
| description | In chronic kidney disease (CKD), the accumulation of gut-derived metabolites, such as indoxyl sulfate (IS), p-cresyl sulfate (pCS), and indole 3-acetic acid (IAA), has been associated with the burden of the disease. In this context, prebiotics emerge as a strategy to mitigate the accumulation of such compounds, by modulating the gut microbiota and production of their metabolites. The aim of this study was to evaluate the effect of unripe banana flour (UBF—48% resistant starch, a prebiotic) on serum concentrations of IS, pCS, and IAA in individuals undergoing peritoneal dialysis (PD). A randomized, double-blind, placebo-controlled, crossover trial was conducted. Forty-three individuals on PD were randomized to sequential treatment with UBF (21 g/day) and placebo (waxy corn starch—12 g/day) for 4 weeks, or vice versa (4-week washout). The primary outcomes were total and free serum levels of IS, pCS, and IAA. Secondary outcomes were 24 h urine excretion and dialysis removal of IS, pCS, and IAA, serum inflammatory markers [high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-α (TNF-α)], serum lipopolysaccharide LPS, and dietary intake. Of the 43 individuals randomized, 26 completed the follow-up (age = 55 ± 12 years; 53.8% men). UBF did not promote changes in serum levels of IS (<i>p</i> = 0.70), pCS (<i>p</i> = 0.70), and IAA (<i>p</i> = 0.74). Total serum IS reduction was observed in a subgroup of participants (<i>n</i> = 11; placebo: median 79.5 μmol/L (31–142) versus UBF: 62.5 μmol/L (31–133), <i>p</i> = 0.009) who had a daily UBF intake closer to that proposed in the study. No changes were observed in other secondary outcomes. UBF did not promote changes in serum levels of IS or pCS and IAA; a decrease in IS was only found in the subgroup of participants who were able to take 21g/day of the UBF. |
| first_indexed | 2024-03-09T00:48:57Z |
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| issn | 2072-6643 |
| language | English |
| last_indexed | 2024-03-09T00:48:57Z |
| publishDate | 2021-02-01 |
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| series | Nutrients |
| spelling | doaj.art-ca3b4d0ef8104cc2b7f289bb22b593e02023-12-11T17:20:07ZengMDPI AGNutrients2072-66432021-02-0113264610.3390/nu13020646Effect of Unripe Banana Flour on Gut-Derived Uremic Toxins in Individuals Undergoing Peritoneal Dialysis: A Randomized, Double-Blind, Placebo-Controlled, Crossover TrialLaila Santos de Andrade0Fabiana Andréa Hoffmann Sardá1Natalia Barros Ferreira Pereira2Renata Rodrigues Teixeira3Silvia Daniéle Rodrigues4Jordana Dinorá de Lima5Maria Aparecida Dalboni6Danilo Takashi Aoike7Lia Sumie Nakao8Lilian Cuppari9Nutrition Program, Universidade Federal de São Paulo—UNIFESP, São Paulo 05508-000, BrazilDepartment of Food and Experimental Nutrition, Faculty of Pharmaceutical Sciences, Universidade de São Paulo—USP, São Paulo 05508-000, BrazilNutrition Program, Universidade Federal de São Paulo—UNIFESP, São Paulo 05508-000, BrazilNutrition Program, Universidade Federal de São Paulo—UNIFESP, São Paulo 05508-000, BrazilDepartment of Basic Pathology, Universidade Federal do Paraná—UFPR, Curitiba 81531-980, BrazilDepartment of Cell Biology, Universidade Federal do Paraná—UFPR, Curitiba 81531-980, BrazilPost-Graduate Program in Medicine, Universidade Nove de Julho—UNINOVE, São Paulo 01504-001, BrazilDivision of Nephrology, Universidade Federal de São Paulo—UNIFESP, Rua Botucatu, 720/740, São Paulo 04023-062, BrazilDepartment of Basic Pathology, Universidade Federal do Paraná—UFPR, Curitiba 81531-980, BrazilNutrition Program, Universidade Federal de São Paulo—UNIFESP, São Paulo 05508-000, BrazilIn chronic kidney disease (CKD), the accumulation of gut-derived metabolites, such as indoxyl sulfate (IS), p-cresyl sulfate (pCS), and indole 3-acetic acid (IAA), has been associated with the burden of the disease. In this context, prebiotics emerge as a strategy to mitigate the accumulation of such compounds, by modulating the gut microbiota and production of their metabolites. The aim of this study was to evaluate the effect of unripe banana flour (UBF—48% resistant starch, a prebiotic) on serum concentrations of IS, pCS, and IAA in individuals undergoing peritoneal dialysis (PD). A randomized, double-blind, placebo-controlled, crossover trial was conducted. Forty-three individuals on PD were randomized to sequential treatment with UBF (21 g/day) and placebo (waxy corn starch—12 g/day) for 4 weeks, or vice versa (4-week washout). The primary outcomes were total and free serum levels of IS, pCS, and IAA. Secondary outcomes were 24 h urine excretion and dialysis removal of IS, pCS, and IAA, serum inflammatory markers [high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-α (TNF-α)], serum lipopolysaccharide LPS, and dietary intake. Of the 43 individuals randomized, 26 completed the follow-up (age = 55 ± 12 years; 53.8% men). UBF did not promote changes in serum levels of IS (<i>p</i> = 0.70), pCS (<i>p</i> = 0.70), and IAA (<i>p</i> = 0.74). Total serum IS reduction was observed in a subgroup of participants (<i>n</i> = 11; placebo: median 79.5 μmol/L (31–142) versus UBF: 62.5 μmol/L (31–133), <i>p</i> = 0.009) who had a daily UBF intake closer to that proposed in the study. No changes were observed in other secondary outcomes. UBF did not promote changes in serum levels of IS or pCS and IAA; a decrease in IS was only found in the subgroup of participants who were able to take 21g/day of the UBF.https://www.mdpi.com/2072-6643/13/2/646unripe banana floururemic toxinsgutprebioticchronic kidney disease |
| spellingShingle | Laila Santos de Andrade Fabiana Andréa Hoffmann Sardá Natalia Barros Ferreira Pereira Renata Rodrigues Teixeira Silvia Daniéle Rodrigues Jordana Dinorá de Lima Maria Aparecida Dalboni Danilo Takashi Aoike Lia Sumie Nakao Lilian Cuppari Effect of Unripe Banana Flour on Gut-Derived Uremic Toxins in Individuals Undergoing Peritoneal Dialysis: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial Nutrients unripe banana flour uremic toxins gut prebiotic chronic kidney disease |
| title | Effect of Unripe Banana Flour on Gut-Derived Uremic Toxins in Individuals Undergoing Peritoneal Dialysis: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial |
| title_full | Effect of Unripe Banana Flour on Gut-Derived Uremic Toxins in Individuals Undergoing Peritoneal Dialysis: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial |
| title_fullStr | Effect of Unripe Banana Flour on Gut-Derived Uremic Toxins in Individuals Undergoing Peritoneal Dialysis: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial |
| title_full_unstemmed | Effect of Unripe Banana Flour on Gut-Derived Uremic Toxins in Individuals Undergoing Peritoneal Dialysis: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial |
| title_short | Effect of Unripe Banana Flour on Gut-Derived Uremic Toxins in Individuals Undergoing Peritoneal Dialysis: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial |
| title_sort | effect of unripe banana flour on gut derived uremic toxins in individuals undergoing peritoneal dialysis a randomized double blind placebo controlled crossover trial |
| topic | unripe banana flour uremic toxins gut prebiotic chronic kidney disease |
| url | https://www.mdpi.com/2072-6643/13/2/646 |
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