Yao C K, Tan H-L, van Langenberg D R, Barrett J S, Rose R, Liels K, Gibson P R, Muir J G
Departments of Gastroenterology, Eastern Health and Central Clinical Schools, Monash University, Melbourne, Victoria, Australia.
J Hum Nutr Diet. 2014 Apr;27 Suppl 2:263-75. doi: 10.1111/jhn.12144. Epub 2013 Aug 3.
Sorbitol and mannitol are naturally-occurring polyol isomers. Although poor absorption and induction of gastrointestinal symptoms by sorbitol are known, the properties of mannitol are poorly described. We aimed to expand data on food composition of these polyols, and to compare their absorptive capacities and symptom induction in patients with irritable bowel syndrome (IBS) and healthy individuals.
Food samples were analysed for sorbitol and mannitol content. The degree of absorption measured by breath hydrogen production and gastrointestinal symptoms (visual analogue scales) was evaluated in a randomised, double-blinded, placebo-controlled study in 21 healthy and 20 IBS subjects after challenges with 10 g of sorbitol, mannitol or glucose.
Certain fruits and sugar-free gum contained sorbitol, whereas mannitol content was higher in certain vegetables. Similar proportions of patients with IBS (40%) and healthy subjects (33%) completely absorbed sorbitol, although more so with IBS absorbed mannitol (80% versus 43%; P = 0.02). Breath hydrogen production was similar in both groups after lactulose but was reduced in patients with IBS after both polyols. No difference in mean (SEM) hydrogen production was found in healthy controls after sorbitol [area-under-the-curve: 2766 (591) ppm 4 h(-1) ] or mannitol [2062 (468) ppm 4 h(-1) ] but, in patients with IBS, this was greater after sorbitol [1136 (204) ppm 4 h(-1) ] than mannitol [404 (154) ppm 4 h(-1) ; P = 0.002]. Overall gastrointestinal symptoms increased significantly after both polyols in patients with IBS only, although they were independent of malabsorption of either of the polyols.
Increased and discordant absorption of mannitol and sorbitol occurs in patients with IBS compared to that in healthy controls. Polyols induced gastrointestinal symptoms in patients with IBS independently of their absorptive patterns, suggesting that the dietary restriction of polyols may be efficacious.
山梨醇和甘露醇是天然存在的多元醇异构体。虽然已知山梨醇吸收差并会引发胃肠道症状，但甘露醇的特性描述较少。我们旨在扩充这些多元醇的食物成分数据，并比较它们在肠易激综合征（IBS）患者和健康个体中的吸收能力及症状诱发情况。
对食物样本进行山梨醇和甘露醇含量分析。在一项随机、双盲、安慰剂对照研究中，对21名健康受试者和20名IBS受试者分别给予10克山梨醇、甘露醇或葡萄糖进行激发试验后，通过呼气氢气产生量测量吸收程度，并评估胃肠道症状（视觉模拟评分）。
某些水果和无糖口香糖含有山梨醇，而某些蔬菜中的甘露醇含量较高。IBS患者（40%）和健康受试者（33%）中完全吸收山梨醇的比例相似，不过IBS患者吸收甘露醇的比例更高（80%对43%；P = 0.02）。两组在服用乳果糖后呼气氢气产生量相似，但在服用两种多元醇后IBS患者的呼气氢气产生量均降低。健康对照者服用山梨醇[曲线下面积：2766（591）ppm 4小时⁻¹]或甘露醇[2062（468）ppm 4小时⁻¹]后，平均（标准误）氢气产生量无差异，但在IBS患者中，服用山梨醇后的氢气产生量[1136（204）ppm 4小时⁻¹]高于甘露醇[404（154）ppm 4小时⁻¹；P = 0.002]。仅IBS患者在服用两种多元醇后总体胃肠道症状显著增加，尽管这些症状与两种多元醇的吸收不良无关。
与健康对照者相比，IBS患者中甘露醇和山梨醇的吸收增加且不一致。多元醇在IBS患者中诱发胃肠道症状，与它们的吸收模式无关，这表明限制多元醇的饮食可能有效。
