Effect of Unripe Banana Flour on Gut-Derived Uremic Toxins in Individuals Undergoing Peritoneal Dialysis: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial

Author(s)

de Andrade, Laila Santos ^[1] ; Sarda, Fabiana Andrea Hoffmann ^{[2, 3]} ; Pereira, Natalia Barros Ferreira ^[1] ; Teixeira, Renata Rodrigues ^[1] ; Rodrigues, Silvia Daniele ^[4] ; de Lima, Jordana Dinora ^[5] ; Dalboni, Maria Aparecida ^[6] ; Aoike, Danilo Takashi ^[7] ; Nakao, Lia Sumie ^[4] ; Cuppari, Lilian ^{[1, 7, 8]}

Affiliation

^[1] Univ Fed Sao Paulo UNIFESP, Nutr Program, BR-05508000 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Pharmaceut Sci, Dept Food & Expt Nutr, BR-05508000 Sao Paulo - Brazil

^[3] Univ Coll Cork, APC Microbiome Ireland, Cork T12 K8AF - Ireland

^[4] Univ Fed Parana UFPR, Dept Basic Pathol, BR-81531980 Curitiba, Parana - Brazil

^[5] Univ Fed Parana UFPR, Dept Cell Biol, BR-81531980 Curitiba, Parana - Brazil

^[6] Univ Nove Julho UNINOVE, Postgrad Program Med, BR-01504001 Sao Paulo - Brazil

^[7] Univ Fed Sao Paulo UNIFESP, Div Nephrol, Rua Botucatu 720-740, BR-04023062 Sao Paulo - Brazil

^[8] Hosp Rim, Fundacao Oswaldo Ramos, Dialysis Dept, BR-04038002 Sao Paulo - Brazil

• Document type: Journal article
• Source: NUTRIENTS; v. 13, n. 2 FEB 2021.
• Web of Science Citations: 0

Abstract

In chronic kidney disease (CKD), the accumulation of gut-derived metabolites, such as indoxyl sulfate (IS), p-cresyl sulfate (pCS), and indole 3-acetic acid (IAA), has been associated with the burden of the disease. In this context, prebiotics emerge as a strategy to mitigate the accumulation of such compounds, by modulating the gut microbiota and production of their metabolites. The aim of this study was to evaluate the effect of unripe banana flour (UBF-48% resistant starch, a prebiotic) on serum concentrations of IS, pCS, and IAA in individuals undergoing peritoneal dialysis (PD). A randomized, double-blind, placebo-controlled, crossover trial was conducted. Forty-three individuals on PD were randomized to sequential treatment with UBF (21 g/day) and placebo (waxy corn starch-12 g/day) for 4 weeks, or vice versa (4-week washout). The primary outcomes were total and free serum levels of IS, pCS, and IAA. Secondary outcomes were 24 h urine excretion and dialysis removal of IS, pCS, and IAA, serum inflammatory markers {[}high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-alpha (TNF-alpha)], serum lipopolysaccharide LPS, and dietary intake. Of the 43 individuals randomized, 26 completed the follow-up (age = 55 +/- 12 years; 53.8% men). UBF did not promote changes in serum levels of IS (p = 0.70), pCS (p = 0.70), and IAA (p = 0.74). Total serum IS reduction was observed in a subgroup of participants (n = 11; placebo: median 79.5 mu mol/L (31-142) versus UBF: 62.5 mu mol/L (31-133), p = 0.009) who had a daily UBF intake closer to that proposed in the study. No changes were observed in other secondary outcomes. UBF did not promote changes in serum levels of IS or pCS and IAA; a decrease in IS was only found in the subgroup of participants who were able to take 21g/day of the UBF. (AU)

• FAPESP's process: 18/12122-7 - Effect of unripe banana flour on intestinal micribiota and on uremic toxins in patients on peritoneal dialysis.
• Grantee: Lilian Cuppari
• Support Opportunities: Regular Research Grants
• FAPESP's process: 13/07914-8 - FoRC - Food Research Center
• Grantee: Bernadette Dora Gombossy de Melo Franco
• Support Opportunities: Research Grants - Research, Innovation and Dissemination Centers - RIDC