Tokumaru Toshiaki, Toyama Tadashi, Nakade Yusuke, Ogura Hisayuki, Oshima Megumi, Nakagawa Shiori, Mita Masashi, Miyagawa Taro, Kitajima Shinji, Hara Akinori, Sakai Norihiko, Shimizu Miho, Iwata Yasunori, Wada Takashi
Department of Nephrology and Rheumatology, Kanazawa University, Kanazawa, Japan.
Department of Nutrition Management, Kanazawa University Hospital, Kanazawa, Japan.
PLoS One. 2025 Jun 3;20(6):e0325482. doi: 10.1371/journal.pone.0325482. eCollection 2025.
Sake lees consumption has the potential to reduce uremic toxins by influencing the gut microbiome. To lay the groundwork for a clinical trial targeting chronic kidney disease (CKD) patients, we conducted a pilot study to explore the relationship between sake lees intake and changes in fecal uremic toxin levels among individuals with constipation. D-alanine, a renoprotective component of sake lees, was also evaluated.
This single-arm, before and after study lacked a control group. Participants met the diagnostic criteria for chronic constipation. They consumed 25 or 50 g of sake lees daily for 6 weeks. The primary endpoint was the change in fecal indole levels from baseline. Secondary endpoints included changes in plasma D-alanine, Constipation Scoring System (CSS) scores, and the composition of the fecal microbiome.
Eight participants, with a mean age of 46 years, completed the study. Percentage changes in fecal indole levels were +42%, + 52%, and -6% at weeks 2, 4, and 6, respectively. Plasma D-alanine levels showed percentage changes of +39%, + 24%, and +38% at the same time points. CSS scores improved from 9.2 to 6.8 by week 2 and remained stable after week 4. The proportion of the phylum Firmicutes in the gut microbiome increased slightly from 53% at baseline to 57% by week 6.
Sake lees intake may reduce fecal uremic toxins, elevate plasma D-alanine levels, alleviate constipation, and modify the gut microbiome. However, future studies are needed to confirm these effects in patients with CKD.
食用酒糟有可能通过影响肠道微生物群来降低尿毒症毒素。为开展针对慢性肾脏病（CKD）患者的临床试验奠定基础，我们进行了一项试点研究，以探讨便秘个体摄入酒糟与粪便尿毒症毒素水平变化之间的关系。还评估了酒糟的肾脏保护成分D-丙氨酸。
这项单臂前后对照研究没有对照组。参与者符合慢性便秘的诊断标准。他们每天食用25克或50克酒糟，持续6周。主要终点是粪便吲哚水平相对于基线的变化。次要终点包括血浆D-丙氨酸的变化、便秘评分系统（CSS）得分以及粪便微生物群的组成。
8名平均年龄为46岁的参与者完成了研究。粪便吲哚水平在第2周、第4周和第6周的百分比变化分别为+42%、+52%和-6%。血浆D-丙氨酸水平在相同时间点的百分比变化分别为+39%、+24%和+38%。到第2周时，CSS评分从9.2提高到6.8，第4周后保持稳定。肠道微生物群中厚壁菌门的比例从基线时的53%略有增加，到第6周时达到57%。
摄入酒糟可能会降低粪便尿毒症毒素，提高血浆D-丙氨酸水平，缓解便秘，并改变肠道微生物群。然而，未来需要进一步研究以在CKD患者中证实这些效果。
