Karin C Wu1,2, Sisi Cao3,4, Connie M Weaver3, Nicole J King2, Sheena Patel5, Hillary Kingman2, Deborah E Sellmeyer6, Kathryn McCauley1, Danny Li1, Susan V Lynch1, Tiffany Y Kim1,2, Dennis M Black7, Martin M Shafer8, Mustafa Özçam1, Din L Lin1, Stanley J Rogers9, Lygia Stewart9,10, Jonathan T Carter9, Andrew M Posselt9, Anne L Schafer1,2,7. 1. Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA. 2. Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA. 3. Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA. 4. Department of Human Sciences, the Ohio State University, Columbus, OH 43210, USA. 5. California Pacific Medical Center Research Institute, San Francisco, CA 94107, USA. 6. Department of Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA. 7. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA. 8. Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA. 9. Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA. 10. Surgical Services, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA.
Abstract
CONTEXT: The adverse skeletal effects of Roux-en-Y gastric bypass (RYGB) are partly caused by intestinal calcium absorption decline. Prebiotics, such as soluble corn fiber (SCF), augment colonic calcium absorption in healthy individuals. OBJECTIVE: We tested the effects of SCF on fractional calcium absorption (FCA), biochemical parameters, and the fecal microbiome in a post-RYGB population. METHODS: Randomized, double-blind, placebo-controlled trial of 20 postmenopausal women with history of RYGB a mean 5 years prior; a 2-month course of 20 g/day SCF or maltodextrin placebo was taken orally. The main outcome measure was between-group difference in absolute change in FCA (primary outcome) and was measured with a gold standard dual stable isotope method. Other measures included tolerability, adherence, serum calciotropic hormones and bone turnover markers, and fecal microbial composition via 16S rRNA gene sequencing. RESULTS: Mean FCA ± SD at baseline was low at 5.5 ± 5.1%. Comparing SCF to placebo, there was no between-group difference in mean (95% CI) change in FCA (+3.4 [-6.7, +13.6]%), nor in calciotropic hormones or bone turnover markers. The SCF group had a wider variation in FCA change than placebo (SD 13.4% vs 7.0%). Those with greater change in microbial composition following SCF treatment had greater increase in FCA (r2 = 0.72, P = 0.05). SCF adherence was high, and gastrointestinal symptoms were similar between groups. CONCLUSION: No between-group differences were observed in changes in FCA or calciotropic hormones, but wide CIs suggest a variable impact of SCF that may be due to the degree of gut microbiome alteration. Daily SCF consumption was well tolerated. Larger and longer-term studies are warranted. Published by Oxford University Press on behalf of the Endocrine Society 2021.
CONTEXT: The adverse skeletal effects of Roux-en-Y gastric bypass (RYGB) are partly caused by intestinal calcium absorption decline. Prebiotics, such as soluble corn fiber (SCF), augment colonic calcium absorption in healthy individuals. OBJECTIVE: We tested the effects of SCF on fractional calcium absorption (FCA), biochemical parameters, and the fecal microbiome in a post-RYGB population. METHODS: Randomized, double-blind, placebo-controlled trial of 20 postmenopausal women with history of RYGB a mean 5 years prior; a 2-month course of 20 g/day SCF or maltodextrin placebo was taken orally. The main outcome measure was between-group difference in absolute change in FCA (primary outcome) and was measured with a gold standard dual stable isotope method. Other measures included tolerability, adherence, serum calciotropic hormones and bone turnover markers, and fecal microbial composition via 16S rRNA gene sequencing. RESULTS: Mean FCA ± SD at baseline was low at 5.5 ± 5.1%. Comparing SCF to placebo, there was no between-group difference in mean (95% CI) change in FCA (+3.4 [-6.7, +13.6]%), nor in calciotropic hormones or bone turnover markers. The SCF group had a wider variation in FCA change than placebo (SD 13.4% vs 7.0%). Those with greater change in microbial composition following SCF treatment had greater increase in FCA (r2 = 0.72, P = 0.05). SCF adherence was high, and gastrointestinal symptoms were similar between groups. CONCLUSION: No between-group differences were observed in changes in FCA or calciotropic hormones, but wide CIs suggest a variable impact of SCF that may be due to the degree of gut microbiome alteration. Daily SCF consumption was well tolerated. Larger and longer-term studies are warranted. Published by Oxford University Press on behalf of the Endocrine Society 2021.
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