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Abstract: PO2039

High-Amylose Resistant Starch (RS) Cookies Supplementation Does Not Decrease Trimethylamine N-Oxide (TMAO) Plasma Level in Hemodialysis (HD) Patients

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Authors

  • Mafra, Denise, Federal University Fluminense, Rio de Janeiro, RJ, Brazil
  • Kemp, Julie ann, Federal University Fluminense, Rio de Janeiro, RJ, Brazil
  • Santos, Henrique Fragoso dos, Federal University Fluminense, Rio de Janeiro, RJ, Brazil
  • de Jesus, Hugo E., Federal University Fluminense, Rio de Janeiro, RJ, Brazil
  • Esgalhado, Marta, Federal University Fluminense, Rio de Janeiro, RJ, Brazil
  • Paiva, Bruna, Federal University Fluminense, Rio de Janeiro, RJ, Brazil
  • Lindholm, Bengt, Karolinska Institutet, Stockholm, Stockholm, Sweden
  • Bergman, Peter, Karolinska Institutet, Stockholm, Stockholm, Sweden
  • Stenvinkel, Peter, Karolinska Institutet, Stockholm, Stockholm, Sweden
Background

TMAO is generated from dietary nutrients by the gut bacteriome and it is associated with cardiovascular mortality in HD patients. Thus, to reduce its generation, nutritional strategies have been proposed. The aim of this study was to analyze the TMAO levels and potential changes in TMA-associated bacterial taxa in HD patients after RS supplementation.

Methods

This is a randomized, double-blind, placebo-controlled trial with HD patients that were allocated to RS or placebo group to receive alternately 9 cookies/d (dialysis days) and 1 sachet/d (non-dialysis days) containing 16g/d of RS (Hi-Maize 260, Ingredion®) or manioc flour as the placebo, during 4 weeks. Plasma TMAO, choline, and betaine levels were measured with LC-MS/MS. Fecal bacteriome composition was evaluated by high-throughput sequencing of 16S ribosomal RNA gene V1–V3 region, followed by a search for TMA-associated taxa.

Results

Thirty-one participants finished the study, 15 in RS group (53.3% ♀; 56.0±7.5 yrs; 50.0±36.5 months on HD and BMI 26.1±5.0 kg/m2) and 16 in the placebo group (31.2% ♀; 53.5±11.4 yrs; 44.3±26.4 months on HD and BMI 26.6±5.2 kg/m2). After four weeks of supplementation no significant changes in TMAO, choline and betaine plasma levels were observed (Table 1). Notably, after the RS supplementation, TMA-producing bacterial taxa such as Ruminococcus torques group [(0.026 (0.023 - 0.04) vs. 0.017 (0.017 - 0.02), p=0.06)] and Streptococcus had decreased the relative abundance, while Prevotellaceae family and Enterococcus increased their relative abundance in placebo group. However, the differences did not reach statistical significance. Additionally, the relative abundance of TMA-producing bacterial taxa was low in both groups.

Conclusion

RS supplementation did not influence TMAO plasma levels nor fecal taxa potentially linked to TMAO in HD patients, suggesting that RS did not modify the composition of gut bacteriome that convert its precursors into TMAO.

Effects of RS supplementation or placebo on plasma TMAO, choline and betaine levels
 RS group
(n=13)
p valuesPlacebo group
(n=12)
p values
 BeforeAfter BeforeAfter 
TMAO (ng/µl)4.1 (3.0 - 8.2)4.4 (2.6 - 6.3)0.893.3 (2.5 - 5.2)4.6 (3.1 - 5.6)0.49
Choline (ng/µl)12.3 (10.8 - 13.6)12.5 (10.2 - 14.3)0.9710.8 (9.95 - 13.9)11.2 (9.7 - 19.9)0.21
Betaine (ng/µl)5.0 (3.4 - 7.1)5.7 (3.2 - 7.3)0.995.2 (3.9 - 7.2)5.6 (4.2 - 6.1)0.57

Funding

  • Government Support - Non-U.S.