: Delivery mode and feeding method influenced the fecal microbiota of European infants at 6 weeks, as expected, but the effect of country of birth was more pronounced, with dominant bifidobacteria in northern countries and greater early diversification in southern European countries.

It is essential to have a thorough knowledge of the bioavailability and metabolism of dietary flavonols to understand their role in disease prevention. Lightly fried onions containing 275 mmol flavonols, principally quercetin-4 0 -glucoside and quercetin-3,4 0 -diglucoside, were fed to healthy human volunteers and plasma and urine were collected over a 24 h period. Samples were analysed by HPLC with diode array and tandem mass spectrometric detection. Five flavonol metabolites, quercetin-3 0 -sulphate, quercetin-3-glucuronide, isorhamnetin-3-glucuronide, a quercetin diglucuronide and a quercetin glucuronide sulphate, were detected in plasma in quantifiable amounts with trace quantities of six additional quercetin metabolites. Sub-micromolar peak plasma concentrations (C max ) of quercetin-3 0 -sulphate, quercetin-3-glucuronide, isorhamnetin-3-glucuronide and quercetin diglucuronide were observed 0.6 -0.8 h after ingestion. In contrast, the C max of quercetin glucuronide sulphate was 2.5 h. The elimination half-lives (t 1/2 ) of quercetin-3 0 -sulphate, quercetin-3-glucuronide and quercetin diglucuronide were 1.71, 2.33 and 1.76 h respectively, while the t 1/2 of isorhamnetin-3-glucuronide was 5.34 h and that of quercetin glucuronide sulphate was 4.54 h. The profile of metabolites excreted in urine was markedly different to that of plasma with many of the major urinary components, including quercetin-3 0 -glucuronide, two quercetin glucoside sulphates and a methylquercetin diglucuronide, absent or present in only trace amounts in the bloodstream indicative of substantial phase II metabolism. Total urinary excretion of quercetin metabolites was 12·9 mmol, corresponding to 4·7 % of intake. If these samples had been subjected to hydrolysis, as in many previous studies, only quercetin and isorhamnetin would have been detected and quantified. The bioactivity of these metabolites should be considered. Flavonols are polyphenolic C6-C3-C6 compounds which, along with other flavonoids and phenolics, occur widely in plants and plant-derived foods and beverages (Crozier et al. 2006). They have several potential nutritional and health-promoting roles in the human body but there is still much to be learnt about their bioavailability and, in particular, which metabolites appear in plasma and in what amounts. This information is essential to understanding the potential role of these compounds in reducing CHD and cancer as it is likely that the metabolites do not have the same bioactivity as the parent compounds. To gain a full picture of the absorption and metabolism of flavonols it is essential to be able to detect and quantify all the major metabolites in plasma and urine and this requires the use of appropriate analytical methodology such as HPLC with tandem MS (MS 2 ). Quercetin is the major flavonol in many foods including onions which consistently contain high levels of flavonols in the form of quercetin-3,4 0 -diglucoside (I in Fig. 1), quercetin-4 0 -glucoside (II in Fig. 1), and smaller amounts of other conjugates incl...

Although it is well established that early infant feeding has a major influence on the establishment of the gut microbiota, very little is understood about how the introduction of first solid food influences the colonization process. This study aimed to determine the impact of weaning on the faecal microbiota composition of infants from five European countries (Sweden, Scotland, Germany, Italy and Spain) which have different lifestyle characteristics and infant feeding practices. Faecal samples were collected from 605 infants approximately 4 weeks after the introduction of first solid foods and the results were compared with the same infants before weaning (6 weeks of age) to investigate the association with determining factors such as geographical origin, mode of delivery, previous feeding method and age of weaning. Samples were analysed by fluorescence in situ hybridization and flow cytometry using a panel of 10 rRNA targeted group- and species-specific oligonucleotide probes. The genus Bifidobacterium (36.5 % average proportion of total detectable bacteria), Clostridium coccoides group (14 %) and Bacteroides (13.6 %) were predominant after weaning. Similar to pre-weaning, northern European countries were associated with a higher proportion of bifidobacteria in the infant gut microbiota while higher levels of Bacteroides and lactobacilli characterized southern European countries. As before weaning, the initial feeding method influenced the Clostridium leptum group and Clostridium difficile+Clostridium perfringens species, and bifidobacteria still dominated the faeces of initially breast-fed infants. Formula-fed babies presented significantly higher proportions of Bacteroides and the C. coccoides group. The mode of birth influenced changes in the proportions of bacteroides and atopobium. Although there were significant differences in the mean weaning age between countries, this was not related to the populations of bifidobacteria or bacteroides. Thus, although the faecal microbiota of infants after first complementary foods was different to that before weaning commenced, many of the initial influences on microbiota composition were still evident

EEN impacts on gut microbiota composition and changes fecal metabolic activity. It is difficult to infer a causative association between such changes and disease improvement, but the results do challenge the current perception of a protective role for F. prausnitzii in CD.

OBJECTIVES:Exploring associations between the gut microbiota and colonic inflammation and assessing sequential changes during exclusive enteral nutrition (EEN) may offer clues into the microbial origins of Crohn's disease (CD).METHODS:Fecal samples (n=117) were collected from 23 CD and 21 healthy children. From CD children fecal samples were collected before, during EEN, and when patients returned to their habitual diets. Microbiota composition and functional capacity were characterized using sequencing of the 16S rRNA gene and shotgun metagenomics.RESULTS:Microbial diversity was lower in CD than controls before EEN (P=0.006); differences were observed in 36 genera, 141 operational taxonomic units (OTUs), and 44 oligotypes. During EEN, the microbial diversity of CD children further decreased, and the community structure became even more dissimilar than that of controls. Every 10 days on EEN, 0.6 genus diversity equivalents were lost; 34 genera decreased and one increased during EEN. Fecal calprotectin correlated with 35 OTUs, 14 of which accounted for 78% of its variation. OTUs that correlated positively or negatively with calprotectin decreased during EEN. The microbiota of CD patients had a broader functional capacity than healthy controls, but diversity decreased with EEN. Genes involved in membrane transport, sulfur reduction, and nutrient biosynthesis differed between patients and controls. The abundance of genes involved in biotin (P=0.005) and thiamine biosynthesis decreased (P=0.017), whereas those involved in spermidine/putrescine biosynthesis (P=0.031), or the shikimate pathway (P=0.058), increased during EEN.CONCLUSIONS:Disease improvement following treatment with EEN is associated with extensive modulation of the gut microbiome.

Following the ingestion of green tea, substantial quantities of flavan-3-ols pass from the small to the large intestine (Stalmach et al. Mol. Nutr. Food Res. 2009, 53, S44-S53; Mol. Nutr. Food Res. 2009, doi: 10.1002/mnfr.200900194). To investigate the fate of the flavan-3-ols entering the large intestine, where they are subjected to the action of the colonic microflora, (-)-epicatechin, (-)-epigallocatechin, and (-)-epigallocatechin-3-O-gallate were incubated in vitro with fecal slurries and the production of phenolic acid catabolites was determined by GC-MS. In addition, urinary excretion of phenolic catabolites was investigated over a 24 h period after ingestion of either green tea or water by healthy volunteers with a functioning colon. The green tea was also fed to ileostomists, and 0-24 h urinary excretion of phenolic acid catabolites was monitored. Pathways are proposed for the degradation of green tea flavan-3-ols in the colon and further catabolism of phenolic compounds passing into the circulatory system from the large intestine, prior to urinary excretion in quantities corresponding to ca. 40% of intake compared with ca. 8% absorption of flavan-3-ol methyl, glucuronide, and sulfate metabolites in the small intestine. The data obtained point to the importance of the colonic microflora in the overall bioavailability and potential bioactivity of dietary flavonoids.

BACKGROUND & AIMS: Exclusive enteral nutrition (EEN) is the only established dietary treatment for Crohn's disease (CD), but its acceptability is limited. There is a need for novel dietary treatments for CD. METHODS: We evaluated the effects of an individualized food-based diet (CD-TREAT), with similar composition to EEN, on the gut microbiome, inflammation, and clinical response in a rat model, healthy adults, and children with relapsing CD. Twenty-five healthy adults randomly received EEN or CD-TREAT for 7 days, followed by a 14-day washout period, followed by the alternate diet. Fecal microbiome and metabolome were assessed before and after each diet. HLA-B7 and HLA-B27 transgenic rats with gut inflammation received EEN, CD-TREAT, or standard chow for 4 weeks. Fecal, luminal, and tissue microbiome, fecal metabolites, and gut inflammation were assessed. Five children with active CD activity received CD-TREAT and their clinical activity and calprotectin were evaluated after 8 weeks of treatment. RESULTS: For healthy adults, CD-TREAT was easier to comply with and more acceptable than EEN. CD-TREAT induced similar effects to EEN (EEN vs CD-TREAT) on fecal microbiome composition, metabolome, mean total sulfide (increase 133.0 ± 80.5 vs 54.3 ± 47.0 nmol/g), pH (increase 1.3 ± 0.5 vs 0.9 ± 0.6), and the short-chain fatty acids (mmol/g) acetate (decrease 27.4 ± 22.6 vs 21.6 ± 20.4), propionate (decrease 5.7 ± 7.8 vs 5.2 ± 7.9), and butyrate (decrease 7.0 ± 7.4 vs 10.2 ± 8.5). In the rat model, CD-TREAT and EEN produced similar changes in bacterial load (decrease 0.3 ± 0.3 log 10 16S rRNA gene copies per gram), short-chain fatty acids, microbiome, and ileitis severity (mean histopathology score decreases of 1.25 for EEN [P ¼ .015] and 1.0 for CD-TREAT [P ¼ .044] vs chow). In children Gastroenterology 2019;156:1354-1367 CLINICAL AT receiving CD-TREAT, 4 (80%) had a clinical response and 3 (60%) entered remission, with significant concurrent decreases in fecal calprotectin (mean decrease 918 ± 555 mg/kg; P ¼ .002). CONCLUSION: CD-TREAT replicates EEN changes in the microbiome, decreases gut inflammation, is well tolerated, and is potentially effective in patients with active CD. Clinical-Trials.gov, numbers NCT02426567 and NCT03171246

The bioavailability of dietary phytochemicals may be influenced by the food matrix in which they are consumed. In this study the impact of a full-fat yogurt on the bioavailability and metabolism of orange juice flavanones was investigated. Human plasma and urine were collected over a 24 h period after the consumption of 250 mL of orange juice containing a total of 168 micromol of hesperetin-7-O-rutinoside and 12 micromol of naringenin-7-O-rutinoside, with and without 150 mL of full-fat yogurt. The juice also contained 1 g of paracetamol and 5 g of lactulose. HPLC-MS(2) analysis revealed the accumulation of hesperetin-7-O-glucuronide, and an unassigned hesperetin-O-glucuronide metabolite in plasma reached a peak concentration (C(max)) of 924 +/- 224 nmol/L, 4.4 +/- 0.5 h (T(max)) after orange juice ingestion. The T(max) is indicative of absorption in the colon. When the juice was consumed with yogurt, neither the C(max) at 661 +/- 170 nmol/L nor the T(max) at 5.1 +/- 0.4 h were significantly different from those obtained with juice alone. The two hesperetin glucuronides were also excreted in urine along with a third hesperetin-O-glucuronide, two hesperetin-O-glucuronide-O-sulfates, a hesperetin-O-diglucuronide, a naringenin-O-diglucuronide, and, tentatively identified, naringenin-7-O-glucuronide and naringenin-4'-O-glucuronide. This indicates the occurrence of substantial, postabsorption, phase II metabolism prior to urinary excretion. The quantity of flavanone metabolites excreted 0-5 h after orange juice ingestion was significantly reduced by yogurt, but over the full 0-24 h urine collection period, the amounts excreted, corresponding to ca. 7.0% of intake, were not affected by the addition of yogurt to the drink. Nor did yogurt have a significant effect on gastric emptying, as determined by plasma paracetamol levels, or on the mouth to cecum transit time of the head of the meal, assessed by measurement of lactulose-derived breath hydrogen. There is also a discussion of the merits of studies of the absorption and metabolism of flavanones based on direct analysis of metabolites by HPLC-MS and the more traditional indirect approach where samples are treated with a mollusc glucuronidase/sulfatase preparation prior to HPLC analysis of the released aglycones.