A Review of the Role of Soluble Fiber in Health with Specific Reference to Wheat Dextrin

leadger of outside(a) medical reticuloendothelial systemearch http//imr. sagepub. com/ A appraise of the Role of Soluble Fiber in wellness with particularized extension service to drinking straw Dextrin JL Slavin, V Savarino, A P atomic number 18des-Diaz and G Fotopoulos Journal of International Medical Research 2009 37 1 DOI 10. 1177/147323000903700hundred and one The online version of this article send away be found at http//imr. sagepub. com/ fill/37/1/1 Published by http//www. sagepublications. com Additional services and information for Journal of International Medical Research faecal matter be found at electronic mail Alerts http//imr. agepub. com/cgi/alerts Subscriptions http//imr. sagepub. com/subscriptions Reprints http//www. sagepub. com/journalsReprints. nav Permissions http//www. sagepub. com/journalsPermissions. nav Version of Record Feb 1, 2009 What is This? Downloaded from imr. sagepub. com by thickening on skirt 27, 2013 The Journal of International Med ical Research 2009 37 1 17 A Review of the Role of Soluble Fiber in Health with Specific Reference to straw Dextrin JL SLAVIN1, V SAVARINO2, A PAREDES-DIAZ3* 1 AND G FOTOPOULOS4Depart handst of solid food Science and upkeep, University of Minnesota, St Paul, Minnesota, ground forces 2 Depart custodyt of Internal music, Gastroenterology Unit, Genoa, Italy 3Novartis Consumer Health, Parsippany, refreshful Jersey, USA 4Novartis Consumer Health, Nyon, Switzerland dextrin, based on a search of PubMed. The conclusion points that dis dis meltable fictitious characters benefactor to regulate the digestive formation, whitethorn attach micro food for arche ca engross compactness, stabilize downslope glucose and put down inception serum lipids, whitethorn prevent several turgiditytro enteral disorders, and lease an accepted image in the prevention of cardiovascular disease.It is concluded that accessory with round out- alcohol- dis dissolvable graphemes (e. g. drinking straw dextrin) may be useful in individuals at assay of a visit than recommended fodderetic part breathing in. ACIDS foodetic case is wide recognized to come a beneficial use of goods and services in general wellness, exclusively only at adequate levels (25 38 g/ sidereal twenty-four hours for powerful adults). Wheat dextrin in particular is a dis meltable graphic symbol that tooshie easily be added to the victuals and is widely used in the food industry. There is around debate about whether append use of disintegrable graphemes leads to wellness benefits.This paper reviews the evidence regarding the physiological outlets and readyiveness wellness benefits of the addition of water-soluble dietetical roles, with detail reference to shuck KEY WORDS SOLUBLE FIBER WHEAT DEXTRIN SHORT-CHAIN FATTY physiological exploitS HEALTH BENEFITS PREBIOTICS Introduction Fiber, the undigested part of plants such(prenominal) as cereals, fruits and vegetabl es (Table 1), has a fundamental role in the regulation of the digestive system and may help to prevent troublesome disorders such as irregularity,1 3 diarrhea4 6 and irritable catgut syndrome. 9 Fiber may in addition help to regulate the assiduity of micro solid foods,3,10,11 stabilize glucose12 14 and cholesteroid alcohol levels,15 17 comport a role in cardiovascular health18 20 and mayhap help to prevent some forms of lavatorycer. 21 23 *Current cut through 90 Possum Way, brand-new Providence, NJ 07974, USA. Many nutrition and healthc atomic number 18 professionals use the cost soluble and insoluble personas for nutrition labeling. 24 27 Soluble cases dissolve in water and usu entirelyy form a gel.They ar generally fermented by bacteria in the subvert intestine, but they argon heavy and hence not absorbed into the ocellusstream. 24,28 Soluble fictional characters besides ferment to form short-chain plopty acids (SCFAs) such as buty finke, acetate and prop ionate (Table 2). 17,29 34 condensed-chain fatty acids generate approximately 1 2 kcal/g of ingested eccentric, so are used as an animation source by the enteric Downloaded from imr. sagepub. com by leaf node on March 27, 2013 1 JL Slavin, V Savarino, A Paredes-Diaz et al.The health benefits of soluble quality TABLE 1 Classification systems for character based on four different fictional character characteristics dietetic vulcanized references Lignin (polyphenolic compound, in booth walls of woody plants and seeds) Cellulose (glucose polymer, in all plant cellular telephone walls) ? -Glucans (glucose polymers, in oats, barley) Hemicelluloses (polysaccharides, in plant cell walls) Pectins ( embarrassing polysaccharides, in fruits and berries) Gums (saccharine polysaccharides, in seeds e. g. uar gingiva) Inulin and oligofructose (mixture of fructose chains, in plants such as onions) Resistant starch (starch in plant cell walls inaccessible to human digestive enzymes ofte n found in bananas and le gluees may in addition be formed by food processing) Soluble graphemes Wheat dextrin ? -Glucans Gums (e. g. cluster bean chewing gum, part hydrolyzed guar gum) Mucilages (e. g. fleawort) Pectins Fructo-oligosaccharides Some hemicelluloses Sources oat products, legumes (dry beans, peas, lentils) Fermentable fibers Wheat dextrin Pectins ? Glucans guar gum Partially hydrolyzed guar gum Inulin and oligofructose Sources oats, barley, fruits, vegetables Viscous fibers Pectins ? -Glucans Some gums (e. g. guar gum) Mucilages (e. g. psyllium) Functional fibers Resistant dextrins (e. g. shuck dextrin) (indigestible polysaccharides formed when starch is heated and tempered with enzymes includes resistant maltodextrins) Psyllium (viscous mucilage, isolated from husks of psyllium seeds overly known as ispaghula husk) Chitin and chitosan (nondigestible wampum from exoskeletons of crustaceans, e. . crabs, lobsters deacetylation of chitin gives chitosan, a nondige stible glucosamine polymer) Fructo-oligosaccharides (FOS, short synthetic fructose) Poly grape sugar and polyols (synthetic polysaccharides used as bulking agents and sugar substitutes in foods) Insoluble fibers Cellulose Lignin Some pectins Some hemicelluloses Sources wheat bran, some vegetables Non-fermentable fibers Cellulose Lignin Sources cereal fibers rich in cellulose (e. g. wheat bran)Non-viscous fibers Cellulose Lignin Some hemicelluloses mucosa and are absorbed through the colonic wall, where they are metabolized to produce null or hexed into the general circulation. 29 SCFAs as well as stimulate epithelial cell specialisation and proliferation. 29 Soluble fibers can also promote the crop of colonic Downloaded from imr. sagepub. com by thickening on March 27, 2013 2 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble fiberTABLE 2 Short-chain fatty acids (SCFA) produced by fermentable, soluble fiber17,29 34 Butyrate Widely recognized as the m ost significant acid in terms of its documented make in the colon The pet nutrient for the cells lining the colonic epithelium, in particular the distal colon and rectum The preferred substrate for colonocytes Positive final result on colonic mucosal harvest, crypt cell proliferation, and early-response gene expression Acetate A fuel for skeletal and cardiac muscle, kidney and the brain A substrate for fatty acid and cholesterol sub packageion Propionate Metabolized by the liver Only SCFA that can be a major(ip) source of glucose ( aft(prenominal)(prenominal) metabolism, used for vital force product) May play a role in cholesterol lowering bacterial flora (prebiotic effect). 35 37 Insoluble fibers, on the separate and, do not dissolve in water, are generally less fermentable by colonic microflora and are indigestible,26 so pass through the intestines almost intact. Insoluble fibers apply unresisting water-attr playacting properties that help to normalize large-scale bowel single-valued consumption by acting like a sponge, pulling water into the r each(prenominal) and making it easier to pass. 38 They may also decelerate intestinal transit time, increase faecal charge through bulk action, delay glucose absorption and help to visualise and balance the pH in the intestines. 39,40 In the USA, the insouciant uptake recommended by the American dietetic Association (ADA) is 20 35 g fiber/ daytimetime for healthful adults, and age plus 5 g/day for children. 6 The World Health Organization (WHO) recommends 25 g/day,41 spell the British sustainment Foundation recommends 12 24 g/day for red-blooded adults. 42 The diet and food Board of the Institute of Medicine established the Adequate Intake (AI) recommendation for fiber (both soluble and insoluble),24 which ranges from 19 to 38 g/day for children, depending on age, and from 25 to 38 g/day for thinking(a) adults. The majority of people, however, do not seem to earn the recommended d ay-to-day economic consumption of fiber, and women in general seem to consume lower amounts than men. 43,44 Wheat dextrin is a soluble fiber that has been widely used in the food industry because it has a low viscosity and so has a good consistency when added to water, beverages or soft food. 4 It is formed by heating wheat starch at high up temperature, followed by enzymatic (amylase) treatment to form a resistant starch. 24,45 It qualifies as a dietetical fiber because the non-digestible glucoside linkages (Fig. 1) lead to incomplete hydrolysation, so that only a smallish percentage of wheat dextrin is absorbed in the small intestine and the proportion is easy fermented in the large intestine. 3 This review aims to assess the evidence regarding the physiological personal effectuate and potential health benefits of supplementing the diet with soluble fibers, with specific reference to wheat dextrin. Data source The PubMed database (US National Library Downloaded from imr. sa gepub. om by customer on March 27, 2013 3 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble fiber CH2OH O OH O OH O CH2OH O OH HO O CH2 O OH O OH O OH CH2OH O OH O OH CH2OH O OH OH O OH OH O OH O OH HO 12 lodge O O CH2OH O OH CH2OH O O OH OH O OH 13 bond CH2OH O OH O CH2 O OH O HO CH2OH O OH 16 bond O CH2 O H2 C O O CH2OH O CH2OH O OH O HO OH sign 1 Chemical structure of wheat dextrin of Medicine, National Institutes of Health, Bethesda, MD, USA) was searched (to July 2007) using the terms wheat dextrin and soluble fiber, and studies were selected based on whether they evaluated the physiological or clinical effects of soluble fibers.Although this non-systematic approach limits the review in that a quantitative compend was not performed, it does allow a general and potentially useful e reallyplaceview of the effects of supplementation with soluble fibers. Physiological effects of soluble fibers FERMENTABILITY In vitro fermentation of wheat dextrin, in ulin and partly hydrolysed guar gum (PHGG), and analysis of the leaveing SCFA production over a 24-h period17 revealed that all three fibers demonstrated noticeable fermentability. Acetate was the main SCFA produced by all fibers, accounting for about 50% of the append SCFA. Over 24 h, wheat dextrin produced substantially more congeries SCFA, propionate and butyrate than PHGG, which consistently showed lower fermentability at all time points (Fig. 2A 2C).To land gas production (which can be socially undesirable and cause ill at ease(predicate) bloating), extensive fermentation at 24 h is desirable, while unwavering fermentation (e. g. high values at 4 h) may be undesirable. The shopping mall and soul amount of SCFA produced by wheat dextrin at 4 h was just over half the amount produced by glucose Downloaded from imr. sagepub. com by guest on March 27, 2013 4 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble fiber A Concentration ( counterspy/ml) 120 100 80 60 40 20 0 B Concentration ( gram molecule/ml) 16 14 12 10 8 6 4 2 0 0 4 8 12 m since start of fermentation (h) 24 0 4 8 12 Time since start of fermentation (h) 24 C Concentration (mol/ml) 45 40 35 30 25 20 15 10 5 0 0 4 8 12 Time since start of fermentation (h) 24 Wheat dextrin PHGG Inulin F97 GlucoseFIGURE 2 epitome of short-chain fatty acid (SCFA) production following in vitro fermentation of wheat dextrin, partially hydrolysed guar gum (PHGG) inulin and glucose (positive keep) over 24 h (A) bestow SCFA production (B) butyrate production and (C) propionate production17 (positive get word) and almost half the amount produced by inulin at the same time point (Fig. 2A). The fermentation of wheat dextrin, at that placefore, occurred deadeningly over 24 h, so its drug addiction was less likely to result in the gas production that can occur as a result of rapid fiber fermentation. composition towards a more beneficial distribution. 17,46 For example, the consumption of fructo-oligosaccharides led to an increase in faecal bifidobacteria,36,47,48 while ingestion of polydextroglucose resulted in a dosedependent decrease in bacteriodes and an increase in beneficial lactobacilli and bifidobacteria. 49 boldness of PHGG for 3 weeks increase the Lactobacillus spp count in feces. 0 outlay of wheat dextrin led to a lower colonic pH, an increase in the faecal concentration of glucosidases, a statistically significant increase in the beneficial lactobacilli population and a statistically significant decrease in unhealthful Clostridium perfringens. 35 In another learn, wheat dextrin increase the fecal concentration of glucosidase45,51 increase glucosidase activity is considered beneficial to the host and is think to substrate fermentation leading(p) to more SCFAs and lactic acid production. PREBIOTIC EFFECT The SCFAs produced by soluble fermentable fibers are moderately strong acids (pK 4. 8)29 and so they lower colonic pH. Lowering the pH in the l arge ntestine may support the growth of bifidobacteria and lactobacilli because they have a strong intrinsic immunity to acid and the lower pH may help to prevent the growth of pH-sensitive pathogenic bacteria such as clostridia. 30 Many soluble fermentable fibers have demonstrated a significant prebiotic effect and diverge the intestinal microflora Downloaded from imr. sagepub. com by guest on March 27, 2013 5 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble fiber EFFECT ON defecation AND REGULARITY The formation of SCFAs helps to meliorate shitting and mode by increase fecal bulk and tilt down down and increasing the waterholding capacity (and thus the hydration) of feces. 0,46 The increase in fecal bulk and system of weights results from the presence of fiber, the water that the fiber holds and the partial fermentation of the fiber, which increases the amount of bacteria in the feces. 52 Studies have confirmed that consumption of the soluble fi bers inulin or oligofructose result in an increase in fecal weight,53 while inulin helped to slenderise constipation2 and polydextrose increased fecal raft and sometimes get to absolute frequency. 49,54 Consumption of psyllium significantly increased green goddess frequency and constitute weight, increased stool water limit, mitigated stool consistency, increased the frequency of bowel movements and lessen pain on defecation. 55 59 Wheat dextrin significantly increased dry fecal product by 70% (P 0. 02) and soused fecal takings by 45% (P 0. 05) (Fig. 3). The increase in wet fecal output was due to increased dry matter output (38%) and increased water output (62%). modify NUTRIENT/MINERAL ABSORPTION Although dietetical fibers are traditionally thought to decrease mineral absorption, animal models and human studies have demonstrated that soluble fermentable fibers appear to increase the absorption of original minerals. 3,10,60 62 For example, soluble fibers may i ncrease calcium absorption through the increased production of SCFAs, with an increase in the villus crypt height, number of epithelial cells per crypt, cecal vein current and mucosal-to-serosal calcium fluxes and stimulation of the expression of calbindinD9K, thereby enhancing the active calcium transport route. 3 Soluble fibers may also increase the absorption of other minerals such as magnesium, zinc and iron. 3,10,11 Studies in rats showed that the absorption of calcium, magnesium and/or zinc may be enhanced by guar gum,64 inulin,10,65 oligofructose65 and PHGG. 11 In healthy men supplemented with both wheat dextrin or dextrose (100 g/day), ingestion of wheat dextrin significantly increased magnesium unembellished absorption (50. 9%, P = 0. 001) and retention (30. 9 mg/day, P = 0. 024) and tended 80 P 0. 02 70 60 Increase (%) 50 40 30 20 10 0 Wet fecal output FIGURE 3 act of wheat dextrin on fecal output3 change fecal output P 0. 05 45% 70% Downloaded from imr. sagepub. om by guest on March 27, 2013 6 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble fiber (not statistically significant) to increase calcium apparent absorption (37. 4%) and retention (111 mg/day) (Table 3). 3 prandial plasma glucose concentrations (13 mg, P = 0. 04) and a significant decrement in the urinary excretion of glucose (P = 0. 008) compared with the low-fiber diet. 13 In fact, the effects of fiber on glucose concentrations are most pellucid in individuals with diabetes mellitus and it has been suggested that diabetics should consume 25 50 g/day of dietetical fiber, with ? 55% of their calorie use of goods and services coming from carbohydrate. 4 To assess the effect of fiber on the luck for diabetes, more than 65 000 women (40 65 old age of age) were followed for 6 years it was found that dietary glycemic index and glycemic load were positively associated with the development of type 2 diabetes, and dietary fiber was in return associated. 75 Beyond the effects of fiber on post-prandial glucose and insulin, fiber alters the responses and actions of the gut hormones stomachal stamp downory peptide,76 glucagon-like peptide177 and cholecystokinin (CCK). 78 CCK is a peptide hormone and neurotransmitter that regulates gut motility, gall vesica contraction and pancreatic enzyme secretion and may mediate the post-prandial glycemic and insulinemic response to viscous fibers. A direct correlation has been reported amidst post-prandial CCK and subjective satiation scores following ingestion of foods with varying amounts of fiber. 79,80 DECREASED GLYCEMIA AND INSULINEMIAThrough the production of SCFAs, soluble fibers can stimulate pancreatic insulin release and affect liver ascendancy of glycogen breakdown,66,67 and so may be effective in change magnitude blood glucose and insulin levels and upward(a) glycemic and insulinemic indices. 68 Guar gum,69,70 inulin12 and dextrin71 were all found to improve postprandial glycemia. I n healthy subjects, the glycemic index of wheat dextrin was 25% compared with dextrose and the insulin response with wheat dextrin was also low at 13% compared with dextrose. 14 Resistant dextrins led to trim blood glucose concentrations and insulin secretion in rats after sucrose or maltose loading,72,73 reduced the post-prandial blood glucose concentrations in healthy men and women,13 and significantly reduced refrain blood glucose concentrations in type 2 diabetics. 6 In patients with type 2 diabetes given a diet high (25 g soluble plus 25 g insoluble fiber) or low (8 g soluble plus 16 g insoluble fiber) in keep down fiber, the high-fiber diet resulted in significantly lower pre- TABLE 3 prepare of wheat dextrin supplementation (100 g/day) on the absorption and retention of magnesium and calcium in healthy men3 Dextrose diet Calcium Apparent absorption, mean, mg/day (%) Retention, mean, mg/day Magnesium Apparent absorption, mean, mg/day (%) Retention, mean, mg/day 187 (28. 8) 39. 3 65 (30. 4) 0. 3 Wheat dextrin diet 269 (37. 4) 111 117 (50. 9) 30. 9 statistical significance (P-value) 0. 093 0. 122 0. 001 0. 024 Downloaded from imr. sagepub. com by guest on March 27, 2013 7 JL Slavin, V Savarino, A Paredes-Diaz et al.The health benefits of soluble fiber REDUCED CHOLESTEROL LEVELS The SFCAs can abrogate cholesterol synthesis by the liver and may reduce serum levels of low-density lipoprotein cholesterol (LDL-C) and triglycerides. 81 Soluble, viscous fibers are also thought to exert their hypocholesterolemic action by increasing fecal sterol excretion and stimulating hepatic rancor acid synthesis. 82,83 In a metaanalysis of 67 controlled trials, consumption of 2 10 g/day of fiber (i. e. pectin, oat bran, guar gum, psyllium) reduced total cholesterol by 4% and LDL-C by 7% compared with placebo. 15 No significant effect was observed on serum high-density lipoprotein cholesterol (HDL-C) and triacylglycerol concentrations.A greater diminution in serum tota l cholesterol and triacylglycerol concentrations was also noted in type 2 diabetics who consumed 60 g/day resistant dextrin compared with type 2 diabetics or healthy adults who consumed 30 g/day. 16 No difference was observed in the concentration of HDL-C. A diet high in total fiber (25 g soluble plus 25 g insoluble fiber) led to significantly reduced plasma total cholesterol (P = 0. 02), very-low-density lipoprotein cholesterol (VLDL-C) (P = 0. 01) and triglyceride (P = 0. 02) concentrations compared with a low-fiber diet, indicating that high fiber divine guidance, especially soluble fiber, improves plasma lipid profile. 3 It has also been proposed that soluble fermentable fibers may lead to a reduction of cholesterol levels via the increased amounts of propionate produced during their fermentation by the commensal bacteria, because propionate may inhibit cholesterol biosynthesis. 84 Fibers producing high amounts of SCFAs (particularly propionate), such as wheat dextrin, may help to sustain cholesterol levels within the normal range. 17 The cholesterol-lowering effects of wheat dextrin have been demonstrated in animal trials. 85 The findings suggest that its cholesterol-lowering effect is likely to be think to reduced cholesterol and bile salt absorption. However, not all soluble fibers are hypocholesterolemic agents for example, oat bran has been shown to lower serum lipids while wheat bran did not. 81 IMMUNE FUNCTIONIt is possible that SCFAs help to improve tolerant swear out, as they stimulate the production of T helper cells, antibodies, leukocytes and splenocyte cytokines, all of which have a crucial role in resistive protection. 86,87 In addition, SCFAs improve the barrier properties of the colonic mucosal layer, thus inhibiting inflammatory and alliance irritants. 88 90 Lactic-acid-forming bacteria competitively inhibit and/or suppress the growth of pathogenic bacteria, and may have a positive act on immune function. 91,92 WEIGHT REDUCTION Obe sity is associated with increased skill intake and decreased consumption of fiberrich foods,93 while fiber intake is inversely associated with embody weight and body fat. 94 97 Increasing unremarkable fiber intake is an effective way of providing a satiating effect. 8 dietetic fiber also decreases gastric emptying and/or slacks energy and nutrient absorption (a fiber-rich meal, which is also usually richer in micronutrients, is processed more slowly and nutrient absorption occurs over a greater period of time99), leading to lower post-prandial glucose and lipid levels. Furthermore, addition of dietary fiber to a low-calorie diet has been shown to lead to a significantly greater weight loss (8. 0 kg) compared with placebo (5. 8 kg). 100 When post-menopausal women consumed higher(prenominal) fiber diets, this was associated with significant weight loss. 101 A high Downloaded from imr. sagepub. com by guest on March 27, 2013 8 JL Slavin, V Savarino, A Paredes-Diaz et al. The heal th benefits of soluble fiber carbohydrate diet consumed ad libitum (i. e. elf-regulating), without energy restriction or change in energy intake, caused significant body weight and body fat losses in older men and women, with a significant decrease in thigh fat area (P = 0. 003). 102 A review of the effects of increased fiber (high-fiber foods or supplementation) on hunger, surfeit, energy intake and body weight revealed that controlled energy intake with increased dietary fiber led to an increase in post-meal repletion and a decrease in subsequent hunger. 103 With ad libitum energy intake, increased dietary fiber (14 g/day) resulted in an average 10% decrease in energy intake and 1. 9 kg weight loss over 3. 8 months of intervention. The effects of increasing dietary fiber were reported to be greater in heavy individuals.When evaluating the effects of 1 week of supplementation with soluble fiber (guar gum, 40 g/day) on hunger, surfeit rating and energy intake, mean passing(a) en ergy intake decreased significantly from 6. 7 to 5. 4 MJ, while hunger and satiety scores did not change. 104 Long-term (4 5 weeks) assessment of wheat dextrin (30 or 45 g/day) supplementation demonstrated a trend towards die weight maintenance compared with baseline, body weight was increased in the control group supplemented with pure absorbable maltodextrin (+0. 87 kg P = 0. 07), whereas body weight remained stable in the wheat dextrin-treated groups (+0. 0 kg). 35 sometimes stool frequency. 9,54 Psyllium significantly increased stool frequency and stool weight, increased stool water content, improved stool consistency, increased the frequency of bowel movements and reduced pain on defecation. 55 59 electric pig of PHGG for 3 weeks increased the frequency of defecation (+0. 17 /day), increased fecal moisture (+5%) and decreased fecal pH. 50 Supplementation with PHGG also helped to reduce the use of laxatives (from an average of 2. 0 to 0. 2 doses/day). 105 Wheat dextrin (100 g/day) had a positive effect on fecal output in healthy men,3 with an average 45% increase in wet fecal weight (P 0. 05) and 70% increase in dry fecal output (P 0. 02) (Fig. 3). DIARRHEA Increased intake of soluble fiber may enhance recovery and improve stool consistency in diarrhea. ,5,106 109 long-lasting diarrhea resolved in more children taking PHGG (84%) compared with those on the control diet (62%) (odds ratio 3. 12), while the duration of diarrhea was reduced and there was a trend towards reduction in daily stool weight that reached significance on days 4 7. 6 Compared with non-fiber control in children, PHGG significantly reduced the mean frequency of diarrhea (8. 8% versus 32. 0% P = 0. 001), resulted in significantly fewer days with diarrhea per total cater days (10. 8% versus 31. 5% P 0. 001) and led to a significantly lower mean diarrhea score (4. 8 versus 9. 4 P 0. 001). 110 PHGG also suppressed diarrhea caused by the ingestion of high levels of non-digestible sugar substitutes. 11 In elderly patients with diarrhea, 4-week supplementation with soluble dietary fiber (7 g/day) significantly reduced the water content of feces (P 0. 01), the fecal pH (P 0. 05) and the frequency of daily bowel movements (P 0. 05). 5 In addition, the fecal characteristics improved The role of soluble fiber in disease CONSTIPATION Increased daily fiber intake can ameliorate constipation. 40,49,52 59 Consumption of inulin or oligofructose was shown to increase fecal weight,53 inulin reduced constipation2 and polydextrose increased fecal mass and Downloaded from imr. sagepub. com by guest on March 27, 2013 9 JL Slavin, V Savarino, A Paredes-Diaz et al.The health benefits of soluble fiber and the total level of SCFAs increased significantly (P 0. 05). 5 In patients with fecal incontinence, significantly fewer incontinent stools were observed in those who consumed dietary fiber (psyllium or gum arabic) than those receiving placebo. 4 Improvements in fecal incon tinence or stool consistency did not appear to be think to unfermented dietary fiber. However, the effects of increased soluble fiber on diarrhea are inconclusive, as a meta-analysis of randomize, controlled trials found no evidence that dietary fiber was effective in treating diarrhea. 112 randomized studies would be useful to confirm the potentially beneficial effects of soluble fiber in IBS.DIVERTICULOSIS A diet low in fiber is thought to play a role in the pathogenesis of diverticular disease. 114 Increasing dietary fiber produces bulky, soft stools, facilitating defecation and cut back intracolonic compact. 114 Increased fiber also helps to promote regular bowel function and is important in controlling and minimizing diverticular disease. 115 117 Non-viscous soluble fiber is associated with a decreased run a periliness of diverticular disease and an improvement of bowel pain. 115 In patients with diverticulosis, it is recommended that patients consume 20 35 g/day of fi ber either through the diet or supplementation. 118 IRRITABLE BOWEL SYNDROME doment for irritable bowel syndrome (IBS) is aimed at alleviating symptoms. In patients with mild symptoms, fiber supplementation (particularly non-gelling soluble fibers) may help to relieve the severity and frequency of IBS symptoms, including abdominal pain, spasms or distension/tension, bowel dysfunction (e. g. fluctuation between constipation and diarrhea) and flatulence. 8,9,113 PHGG was better tolerated than wheat bran and more readily accepted by IBS patients, resulting in an improved shade of life during the treatment period. 113 PHGG also had a positive effect on evacuation frequency with a decrease in the frequency of IBS symptoms such as flatulence, abdominal tension and abdominal spasm. 13 Based on its physiological properties, wheat dextrin may also help to alleviate GI symptoms associated with IBS through increased fecal output,3 enhanced prebiotic capabilities35,45 and significant but sl ow fermentation in the lower intestine, producing high concentrations of SCFAs but lower amounts of gas, which could be an important aspect in relieving the discomfort caused by IBS. 17 However, double- finesse, HEMORRHOIDS A low-fiber diet is thought to contribute to the etiology of hemorrhoids. 119 Increasing the fiber content in the diet can have a beneficial effect in the treatment of symptomatic hemorrhoids. 120,121 A recent meta-analysis demonstrated that increased fiber reduced the run a risk of bleeding and decreased the rate of regaining of hemorrhoids,120 while a Cochrane review found that the risk of not modify hemorrhoids and having persisting symptoms decreased by 53% with increased intake of fiber, with a significant reduction in bleeding. 121CARDIOVASCULAR DISEASE A number of studies have consistently found that a fiber-enriched diet (14 g fiber/ kibibyte kcal energy) is associated with a significant reduction (16 33%) in the risk of coronary thrombosis thrombos is heart disease (CHD). 19,20,122 126 A pooled analysis of studies evaluating dietary fiber Downloaded from imr. sagepub. com by guest on March 27, 2013 10 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble fiber intake in the USA and Europe indicated that each 10 g/day increase in total fiber intake was associated with a 14% decrease in the risk of coronary events (e. g. myocardial infarction), and a 24% decrease in deaths from CHD. 9 A nurture on the descent between dietary fiber and risk of cardiovascular disease (CVD) among women over a 10-year period showed that the ageadjusted relative risk for major CVD was 0. 53 for women consuming the highest amount of fiber (22. 9 g/day) compared with those on the lowest fiber intake (11. 5 g/day). cxxv Although few interventional studies have specifically assessed fiber intake on the risk of CVD, increased fiber has been shown to ameliorate some of the risk factors for CVD (e. g. high cholesterol levels, high b lood air pressure, obesity and diabetes). For example, fiber can significantly reduce blood cholesterol levels and so may be important to cardiovascular health. 5,16,81,127 Consuming foods rich in viscous soluble fibers has been shown to reduce blood levels of LDL-C by 10 15%, with an expected reduction in CVD events of 10 15%, and it has been stated that a diet including 5 10 g/day of viscous soluble fiber reduces CVD events and death independent of baseline risk. 18 Although the cholesterol-lowering effect of soluble (especially viscous) fibers probably contributes the most to its cardioprotective effects, other mechanisms are likely to play a role. As part of a life-style adaption program, fiber can help to reduce blood pressure significantly,128 supporting research that found that highfiber intake was inversely associated with the risk of high blood pressure or hypertension. 129,130 Two intervention trials found that increased fiber intake resulted in significant reduction s in blood pressure compared with placebo. 31,132 In an analysis of the association between nutrient intake and risk of stroke, dietary fiber was inversely correlated to the relative incidence of stroke, a relationship that was stronger in hypertensive than normotensive men. 133 Fiber is also effective at reducing the risk of diabetes and, thus, the risk of developing CVD, and can improve glycemic and insulinemic indices12,14,69 71 and decrease blood glucose and insulin levels. 13,16,72 Lowfiber, high-glycemic load diets are associated with higher serum triglyceride levels and lower HDL-C levels, which are risk factors for CVD. 134,135 Increased fiber consumption may also help control body weight and support a weight reduction program by helping to reduce obesity and, possibly, the associated risk of CVD. 94 104 Safety aspects of fiber supplementationReduced absorption of trace elements has traditionally been proposed as a potential negative effect of dietary fiber intake136,137 however, it is unlikely that healthy adults who consume fiber in amounts within the recommended ranges will have problems with nutrient absorption. In fact, clinical data demonstrate that soluble fibers (e. g. inulin, fructo-oligosaccharides, wheat dextrin) may positively affect the absorption of certain minerals. 3,10,11,64,65 fermenting of dietary fiber by anaerobic bacteria in the large intestine produces gas (including hydrogen, methane and carbon dioxide), which may be related to complaints of distention or flatulence, especially with high intakes of fiber. An increase in dietary fiber should also be accompanied by an increase in silver intake, and fiber should be increased gradually to allow the GI tract time to adapt.Normal laxation may be achieved with relatively small amounts of dietary Downloaded from imr. sagepub. com by guest on March 27, 2013 11 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble fiber fiber, and the smallest intake that resu lts in normal laxation should be used. 138 Nevertheless, wheat dextrin has been shown to be well tolerated even up to the relatively high intake of 45 g/day. 51 Higher daily intakes (60 and 80 g) resulted in greater flatulence (P 0. 05) and some bloating compared with placebo, but no intake resulted in diarrhea. fiber can have beneficial effects on constipation, diarrhea and the symptoms of IBS.Soluble fiber also has additional positive effects on cardiovascular health, leading to a significant risk reduction of CHD. Thus, this review of the physiological effects and subsequent health benefits of soluble fibers suggests that daily fiber supplementation could be beneficial in those individuals who are at risk of inadequate fiber in their diet. Most servings of common foods consume between 1 and 3 g of dietary fiber so it may be difficult to consume the recommended amounts of fiber. dietetical assessment programs can estimate fiber intake for different population groups, allowing t he identification of groups that have deficient fiber intake.At an individual level, fiber intake can be generally estimated based on servings of fruits, vegetables and whole grains having 2 g of dietary fiber per serving, and servings of legumes having 5 g of dietary fiber per serving. Values from high-fiber cereals or fiber supplements can be added to these totals. Wheat dextrin is one example of a soluble fiber supplement that has been shown to help normalize bowel function and is well tolerated, even at large intakes. It is slowly but extensively fermented, leading to a significantly high production of SCFAs, while its slow fermentation profile could help minimize the undesirable effects of gas production and flatulence. Wheat dextrin has also demonstrated enhanced prebiotic capabilities when used at an intake of 30 45 g/day.Based on its physiological properties, supplementation with wheat dextrin should be useful in individuals that need to complete their dietary intake with a fiber in order to achieve the daily recommended dietary levels of fiber. Conclusion Review of the evidence indicates that soluble, fermentable fibers, including wheat dextrin, have positive physiological effects that may help to improve bowel regularity and result in some health benefits. Soluble fibers are fermented in the large intestine, leading to the production of SCFAs that lower colonic pH and result in a significant prebiotic effect in which the growth of beneficial intestinal microflora (e. g. ifidobacteria, lactobacilli) and fecal glucosidase concentrations are increased, while the growth of pH-sensitive pathogenic bacteria (e. g. clostridia) is prevented or suppressed. In this way, SCFAs could promote normal bowel regularity and may help to reduce serum glucose and cholesterol levels. SCFAs also positively influence the absorption and retention of certain micronutrients (e. g. calcium, magnesium, zinc), and may improve immune function by stimulating the production of imm unoprotective factors (e. g. T helper cells, antibodies) and improving the barrier properties of the colonic mucosal layer. Soluble fibers that are slowly barely extensively fermented in the large intestine (e. g. heat dextrin) are tolerated more easily than those that ferment quickly, as the latter can produce large amounts of gas in a shorter period of time, leading to bloating and flatulence. By improving digestive balance, regularity and hydration in the gut, soluble Downloaded from imr. sagepub. com by guest on March 27, 2013 12 JL Slavin, V Savarino, A Paredes-Diaz et al. The health benefits of soluble fiber Acknowledgments Editorial support was given by Deborah Nock, DPP-Cordell Ltd, Saxthorpe, UK. Funding for the review was provided by Novartis Consumer Health, Nyon, Switzerland. Conflicts of bet Alberto Paredes-Diaz and Grigorios Fotopoulos were Novartis Consumer Health, employees at the time of manuscript preparation.The other authors had no conflicts of interest to de clare in relation to this article. Received for publication 8 kinsfolk 2008 Accepted subject to revision 9 family line 2008 Revised accepted 11 December 2008 Copyright 2009 Field House Publishing LLP References 1 Cummings JH The effect of dietary fiber on fecal weight and composition. In CRC Handbook of dietetical Fiber in Human support (Spiller GA, ed), second edn. Boca Raton CRC Press, 1993 pp 263 349. 2 Kleessen B, Sykura B, Zunft HJ, et al set up of inulin and lactose on fecal microflora, microbial activity, and bowel habit in elderly constipated persons. 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