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The comparative gastrointestinal responses of children and adults following consumption of sweets formulated with sucrose, isomalt and lycasin HBC

Abstract

Objectives: To determine the gastrointestinal responses of children and adults following consumption of sucrose, isomalt and lycasin HBC and to compare these at two different dose levels in adults.

Design: Both studies were randomised, double-blind, cross-over designs.

Subjects: Fifty-one children aged 6–9 y were recruited from primary schools in the Salford area of Greater Manchester. Forty-eight children completed the study. Fifty healthy adult volunteers aged 18–24 y were recruited from the student population of the University of Salford. All subjects completed the study.

Interventions: Children consumed either 25 g of sucrose, isomalt or lycasin HBC and adults 25 and 40 g in hard boiled sweets per day for two consecutive test days. Test periods of 2 days were separated by 7 day washout periods. Children consumed sweets throughout test days and adults in no less than 30 min but no more than 90 min. Subjects reported the prevalence and magnitude of flatulence, borborygmi, bloating, colic, bowel movements and watery faeces.

Results: Consumption of 25 g isomalt provoked a mild laxative effect in children but not in adults. Consumption of 25 g isomalt significantly increased the prevalence and magnitude of gastrointestinal responses in both children and adults. Consumption of 25 g lycasin HBC significantly increased borborygml in children and adults but no other gastrointestinal responses. Consumption of 40 g lycasin HBC or isomalt by adults significantly increased the mean frequency of bowel movements and the number of subjects passing watery faeces. In adults, 40 g isomalt and lycasin HBC provoked significantly more gastrointestinal responses compared to 25 g of either product.

Conclusions: Consumption of 25 g lycasin HBC does not provoke an unacceptable laxative effect or gastrointestinal response in children or adults compared to 25 g isomalt, which is associated with a mild laxative effect and increase in gastrointestinal responses. In adults gastrointestinal responses following consumption of products were found to be dose dependent.

Sponsorship: Roquette Frères, Lestrem, France.

Introduction

Isomalt and maltitol syrups are widely used to replace sucrose in confectionery because of their cariostatic and hypocaloric properties compared to sucrose (Grenby & Saldanha, 1988; Ziesenitz & Siebert, 1987). These polyol sugars have excellent organoleptic, technological and physicochemical properties, making them ideal for formulation into ‘toothfriendly’, ‘reduced calorie’ and or ‘sugar-free’ products suitable for both adults and children (Zumbé et al, 1994, 2001; Sicard & Le Bot, 1994).

Isomalt, an equimolar mixture of the disaccharide polyols D-glucosyl-α(1→1)-D-mannitol and D-glucosyl-α(1→6)-D-glucitol is produced by the catalytic hydrogenation of isomaltulose. Lycasin 80/55 (lycasin® 80/55) is one member of the family of maltitol syrups and is produced by the catalytic hydrogenation of glucose syrup. Lycasin 80/55 typically contains 5% monosaccharides, 55% of the disaccharide maltitol, 19% maltotriitols and 21% hydrogenated oligosaccharides with the degree of polymerisation ranging from 4 to 20 sub-units (Sicard & Le Bot, 1994). The recently developed bulk sweetener ‘lycasin hard boiled candy’ (lycasin® HBC) contains a higher proportion of hydrogenated polysaccharides compared to standard lycasin 80/55. In humans, isomalt, maltitol and maltitol syrups produce low glycaemic and insulinaemic responses compared to glucose and sucrose (Pelletier et al, 1994; Thiebaud et al, 1984). It is estimated that 44 and 40% of a 20 g dose of maltitol and isomalt are unabsorbed in the upper intestine respectively (Beaugerie et al, 1991). However, the degree of upper intestinal absorption of isomalt is inversely proportional to the dose of isomalt ingested (Langkilde et al, 1994; Kruger et al, 1991). Both maltitol and lycasin 80/55 are digested to a similar extent in the upper intestine of humans (Beaugerie et al, 1990). Isomalt and maltitol are only partly hydrolysed in the upper intestine because of the low affinity of upper intestinal disaccharidases for these substrates (Nilsson & Jagerstad, 1987). Hydrolysis of maltitol results in 50% glucose and 50% sorbitol, (Ziesenitz & Siebert, 1987) and hydrolysis of isomalt, 50% glucose, 25% sorbitol and 25% mannitol (Grupp & Siebert, 1978). Thus consumption of isomalt, maltitol or a product rich in maltitol such as lycasin 80/55 or lycasin HBC results in a mixture of intact polyol molecules and their hydrolysates entering the colon where they contribute to the carbohydrate pool available for bacterial fermentation. Colonic fermentation produces short chain fatty acids, hydrogen, carbon dioxide and, in some individuals, methane (Macfarlane & Cummings, 1991). Colonic gas formation following ingestion of poorly absorbed carbohydrates may lead to increased gastrointestinal (GI) symptoms, notably flatulence and abdominal discomfort. If the fermentative capacity of the colon is exceeded, watery faeces may occur because of the osmotic effect exerted by malabsorbed low molecular weight carbohydrates (Saunders & Wiggins, 1981; Menzies, 1983). Consumption of polyol sugars has been shown to provoke dose-dependent increases in GI symptoms as well as elevated exhaled breath hydrogen profiles, indicating active colonic fermentation (Storey et al, 1998; Koutsou et al, 1996; Storey & Zumbé, 1996;Lee et al, 1994; Fritz et al, 1985; Hyams, 1983).

Although the occurrence of GI symptoms following polyol ingestion is regarded as a transient phenomenon and mitigated by reducing one's intake (Cummings et al, 2001), they are not attractive to the consumer and could be regarded as a highly sensitive issue when considering such effects in children. Little is known about the GI effects of polyol consumption in children, although studies with isomalt indicate that doses of up to 35 g are tolerated well by children (Paige et al, 1992). Because lycasin HBC contains a higher proportion of hydrogenated polysaccharides compared to mono- and disaccharide polyols and lycasin 80/55 it should exert a lower osmotic potential in the gut and reduce the potential for laxation. To date, there are no published studies concerning the GI effects of lycasin HBC in adults or children. This paper reports the comparative GI responses of 48 children aged 6–9 y following consumption of 25 g of sweets containing sucrose, isomalt or lycasin HBC and those of 50 young adults aged 18–24 following consumption of 25 or 40 g of sweets containing sucrose, isomalt or lycasin HBC.

Subjects and methods

Child study

Children were recruited from the Alder Park and Westwood Park primary schools in the Salford area of Greater Manchester, UK. Individual classes of children aged 6–9 y were chosen by the head teachers of schools for potential recruitment to the study. The purpose and nature of the study was explained to children in each class with the co-operation of teaching staff. Parents and/or guardians of children were invited by letter to allow their children to participate and discuss the study with the investigators in meetings at home or at school. Parents provided written informed consent for their children to participate in the study and could withdraw their children at any time and for any reason. Children gave verbal consent and were free to leave the study at any time and for any reason. Approval was given by Salford Local Education Authority and Head teachers of schools. Ethical approval was granted by Salford and Trafford Health Authority Local Regional Ethics Committee.

No inclusion/exclusion criteria other than parental consent, the consent of the child and screening of children were employed in selecting children for the study. Parents completed screening questionnaires for their children. Screening of children ensured that they had no history of gastrointestinal or metabolic disease, did not have any dietary restrictions or prescribed diets, did not suffer from a food allergy and did not regularly consume polyol-containing confectionery products. It was also ensured that children had not received antibiotics, steroids, laxatives or any other drugs 6 months prior to the study. Screening was based upon inclusion and exclusion criteria employed in previous studies with young adults (Lee et al, 1994; Storey et al, 1998). The prescription of medication given to children was monitored throughout the study enabling the child's suitability for continued participation to be assessed. No child was excluded from the study on such grounds.

In all, 122 children were invited to take part in the study (four classes) and 77 were given parental consent to do so. Of these, 24 did not pass the screening stage of the study and two decided not to take part. Forty-eight out of 51 children who started the study completed it satisfactorily. One child was withdrawn by their parents, who reported that the child had experienced abdominal pain following consumption of test sweets. One child consumed insufficient product and one did not consume product on the days instructed.

Twenty-three boys and 25 girls aged between 6 y 11 months and 9 y 9 months (mean±s.d.=8.40±0.9 and 8.30±0.8 y, respectively) completed the study satisfactorily. Body mass indices (mean±s.d.) were 17.08±2.49 kg/m2 and 17.57±2.67 kg/m2 for boys and girls, respectively. There were no significant differences in age or body mass index (BMI) between either boys or girls.

Adult study

Fifty healthy volunteers aged 18–24 y were recruited from the student population of the University of Salford by means of publicity posters. The purpose and nature of the studies were explained and volunteers screened for the same inclusion and exclusion criteria employed in the child study. Written consent was obtained from all volunteers, who were free to leave the study at any time and for any reason. Approval for the study was given by the University of Salford Occupational Health and Hygiene Service. Twenty-four male subjects and 26 female subjects participated in the study with body mass indices (mean±s.d.) of 23.59±3.80 kg/m2 and 20.81±1.68 kg/m2 for males and females, respectively.

Test materials

Test sweets were identical except for their carbohydrate content and were manufactured by Cadbury Dulciora, Valladolid, Spain, a subsidiary of Cadbury Schweppes plc, Bournville, Birmingham, UK. The bulk sweeteners incorporated into the sweets were lycasin® HBC (Roquette Frères, Lestrem, France), isomalt (Palatinit Sussungsmittel GmbH, Mannheim, Germany), glucose syrup and sucrose. Products for the child study were supplied as 25 g bags of hard-boiled, fruit-flavoured sweets containing 10 pieces each with an assortment of orange, lemon, strawberry and cherry flavours. Products for the adult study were supplied as 25 and 40 g bags of hard-boiled, menthol and eucalyptus flavoured sweets identical in carbohydrate content to those used for the child study. Products for each study were identified by 12 different code numbers, the identity of which was not revealed to study investigators until after both studies were completed.

Study design and restrictions

Child study

Children were tested with each product in a double-blind, controlled, cross-over study with each coded product allocated in random order determined by a Latin square design applied to each leg of the study. Children received either 25 g sucrose, isomalt or lycasin sweets per day for 2 day periods separated by 7 day washout periods (Figure 1). Children were not given 40 g of polyol based sweets to consume as in the adult study because of the risk of unacceptable GI responses and because 25 g sweets is considered a reasonable portion size for children to consume (Zumbé et al, 1994). Test products were supplied daily to avoid over-consumption. Children were instructed and encouraged to consume all the sweets in each packet given to them but they were not forced to do so. They were informed that they could consume the sweets as a snack over any period of time, but most children consumed them during school hours, allowing supervision by class teachers and/or the study investigators. Following consumption of sweets on test day 1, children were given the choice of consuming the same product for a second test day or consuming an alternative product once only. All of the children chose to consume each of the sucrose, isomalt and lycasin HBC products for a second day.

Figure 1
figure1

Child study design.

Consumption of fresh milk and fresh fruit juice by children was limited to no more than one 200 ml glass of each during test days, for the preceding 12 h of the previous day and for the first 12 h of the day thereafter. This restriction was made to avoid GI intolerance symptoms arising from malabsorption of lactose or fructose in milk and fresh fruit juice, respectively, as in Lee et al (1994).

Children were interviewed individually 24 h after consumption of each product to determine if they had adhered to study restrictions, what consumption pattern they followed and if they had experienced any GI sensations. Questions relating to the sensorial perception of the products and the incidence of the minor symptoms of thirst and loss of appetite were included in the protocol as distracter questions and as a means of building up children's confidence. Children were asked what they had eaten during test days.

Adult study

In a double-blind, controlled, cross-over study, subjects were tested with each product in randomised order determined by a Latin square design applied to each leg of the cross-over study. Subjects consumed 25 and 40 g of either sucrose, isomalt or lycasin HBC sweets during test periods separated by washout periods of one week (Figure 2). Dietary restrictions were enforced according to Lee et al (1994), and Storey et al (1998), although fasting previous to the day of product ingestion and consumption of the product at breakfast time were not prescribed. Instead, subjects were requested not to consume products at extreme times of day or as a replacement breakfast, lunch or dinner. Subjects were required to consume all of the sweets given in no less than 30 min but no more than 90 min, preferably as a mid-morning snack before lunch. Subjects were individually debriefed 24 h after product consumption according to a set protocol to determine adherence to dietary restrictions and consumption regime and to assess GI responses.

Figure 2
figure2

Adult study design.

GI responses

Child study

Questions relating to GI responses were asked after an informal discussion with the child about the school day and their sensorial perception of the sweets. Children were asked if they wanted to tell the study investigator anything about the sweets and whether they had experienced any unusual feelings in the 24 h period following consumption of sweets. Any reports of GI responses at this stage were classed as unprompted. Children were then prompted by asking them if they had experienced any GI response they had not already mentioned. Familiar terms were used to describe GI responses to children, these being ‘tummy-ache’ (colic), ‘rumbly tummy’ (borborygmi), ‘farting’ (flatulence) and ‘feeling full up and bloated’ (bloating). Children were asked how many times they had visited the toilet to open their bowels and whether their faeces were normal, ‘runny’ (watery) or hard. Children were asked to rank any positive response using the terms ‘a little’, ‘some’ or ‘lots’, which were subsequently assigned scores of 1, 2 and 3, respectively. Children had an extensive vocabulary for the description of their GI responses and, in particular, the consistency of their faeces. No child refused to answer any questions asked by the study investigators. Because of ethical considerations children could not be monitored during toilet visits and therefore information regarding faecal volume was not determined.

Adult study

Subjects were given printed sheets on which to record the incidence and magnitude of GI responses and details of their bowel movements for the 24 h period following consumption of each product. Notifiable responses were borborygmi, colic, bloating and flatulence. Each response was ranked on a hedonic scale where 0 indicated ‘normal’ function, 1 indicated ‘slightly more than usual’, 2 indicated ‘noticeably more than usual’ and 3 indicated ‘considerably more than usual’. The number of bowel movements to pass normal faeces, hard faeces and watery faeces was recorded. Information regarding faecal volume was not determined.

Statistics

GI responses for both children and adults were regarded as categorical (yes/no), and considered to be non-parametric. Products were compared by 2×2 contingency table analysis according to the methods of McNemar (1947) to test for differences in responses following product consumption but without accounting for the order of product presentation. The binomial test was used when four subjects reported GI responses or when the expected frequency in each cell of the contingency table was less than 5. A second 2×2 contingency table analysis was performed as described by Gart (1969) to test for both product effects and for any effect of the order of product presentation, thereby testing the efficacy of the cross-over design. Differences between subjects in the frequency of bowel movements and mean symptom scores were assumed to be parametric and analysed by paired t-tests after one-way ANOVA.

Results and discussion

The perceived benefits of polyol ingestion should be balanced against their potential to cause increased abdominal discomfort and laxation (Livesey, 2001). This is especially true in sensitive groups such as children, where consumption of traditional sucrose-based confectionery would not normally be expected to provoke such responses. Thus, our investigation compares the GI responses of children and adults following consumption of traditional sucrose-based confectionery with alternative confectionery containing isomalt or lycasin HBC.

Child study

There was no significant increase in the mean number of bowel movements to pass normal or watery faeces following consumption of lycasin HBC sweets compared to sucrose sweets (Table 1). Conversely, consumption of isomalt sweets was associated with a significant increase in the mean number of bowel movements to pass watery faeces (P<0.025) and in overall mean bowel movement frequency (P<0.05). Consumption of isomalt sweets was associated with a significant increase in the total number of bowel movements made by children to pass watery faeces compared to sucrose and lycasin HBC sweets (P<0.001 and P<0.05 respectively; Table 2). These results were influenced by one child who made seven bowel movements to pass watery faeces, and two children, each of whom made five bowel movements to pass watery faeces following consumption of isomalt sweets over 2 days.

Table 1 Frequency of bowel movements by children to pass hard, normal or watery faeces after consumption over two days of sweets containing 25 g sucrose, isomalt or lycasin HBC; mean±s.d. (n=48).
Table 2 Gastrointestinal responses by children after consumption over two days of sweets containing 25 g sucrose, isomalt or lycasin HBC, (total number of responses reported by children, n=48)

Table 3 partitions tolerance data in terms of grade of GI response and if children experienced responses on only 1 day, or both days of product consumption. Using the categories adopted in this study, those children experiencing grade 3 responses and on both days of product consumption could be considered as those most sensitive to the effects of polyol ingestion out of the study group. No child made more than three bowel movements to pass watery faeces on both days of consumption of any product. However, four children made three or more bowel movements to pass watery faeces following consumption of isomalt sweets on one test day compared to none for lycasin HBC. This result is not statistically significant. If laxation is defined in terms of bowel movement frequency and faecal consistency, results demonstrate that lycasin HBC is tolerated well by children with no significant increase in laxation. Where it is not possible to record faecal volume, diarrhoea (increased laxation) may be defined as ‘one or more watery stools or more than three stools per day’ (Marteau & Flourié, 2001). This study considers mild laxation to be the passage of watery faeces on only one occasion, or the passage of more than three faeces of normal consistency in 24 h following consumption of products. In this study, consumption of isomalt sweets was associated with a significant but mild laxative effect compared to sucrose controls. These observations are in keeping with those of Koutsou et al (1996), who reported no significant laxation in young adults following consumption of 30 g maltitol (the main constituent of lycasin 80/55) and only mild laxation after consumption of 30 g isomalt in milk chocolate. Conversely, Paige et al (1992) reported only one incidence of ‘diarrhoea’ following consumption of 15 and 25 g isomalt in children under 12 y.

Table 3 Number of children reporting gastrointestinal responses following consumption over two days of sweets containing 25 g sucrose, isomalt or lycasin HBC (n=48)

Consumption of isomalt sweets was associated with a significant increase in the total number of GI responses for bloating and borborygmi made by children over 2 days compared to sucrose sweets (P<0.05 and P<0.25 respectively; Table 2).

Consumption of lycasin HBC sweets was not associated with any significant increase in the total number of GI responses made by the study group over two days. Table 3 partitions data into numbers of children reporting GI responses rather than overall incidence of GI responses as shown in Table 2. Consumption of isomalt sweets was associated with a significant increase in the number of children reporting bloating, borborygmi and colic on one day or both days compared to sucrose sweets (P<0.05, P<0.005 and P<0.05, respectively). Consumption of lycasin HBC sweets was only associated with a significant increase in the number of children reporting borborygmi on one or two days compared to sucrose sweets. Borborygmi (tummy rumbling in children) could be classed as the least severe GI response in comparison to colic (tummy ache in children) and diarrhoea, which may be distressing to children. Furthermore, the total number of children reporting colic and bloating was significantly less compared to the number reporting GI responses following consumption of isomalt sweets (P<0.05 in both cases). These results presumably reflect differences in the extent of upper intestinal hydrolysis and absorption, the osmotic potential and fermentability of isomalt and lycasin HBC in the GI tract of children. Although potentially useful, breath hydrogen techniques to assess upper intestinal absorption and colonic fermentation of polyols could not be used with healthy, non-hospitalised children in this study because of ethical considerations.

Of some interest is the number of children who gave unprompted GI responses following consumption of products over two days. An unprompted GI response was one where the child volunteered information without prior definition by the study investigator of the response or its magnitude. In total there were 15 unprompted GI responses out of a possible 96 following consumption of sucrose sweets compared to 19 for lycasin HBC sweets (P>0.05) and 31 for isomalt sweets (P<0.05). This result is probably a function of the increased number of children experiencing GI responses, and of a greater magnitude, following consumption of isomalt sweets compared to sucrose and lycasin HBC sweets. Only one child was withdrawn from the study because of adverse GI responses following consumption of isomalt sweets and even in the event of children reporting responses as ‘lots’, no child wished to discontinue the study. Most children reported only grade 1 GI responses, and few grade 3 GI responses following consumption of isomalt or lycasin HBC products, the majority of GI responses occurring only after one day's consumption of product rather than on both days. Consumption of isomalt and lycasin HBC sweets was not associated with a significant number of children reporting grade 3 responses on both consumption occasions compared to controls. Every child who completed the study chose to consume products for a second day, even if GI responses were reported on the first day of consumption, indicating positive acceptance of products.

Adult study

Consumption of 25 g isomalt or lycasin HBC sweets was not associated with any significant increase in overall mean frequency of bowel movements (Table 4). However, consumption of 40 g isomalt sweets was associated with a significant increase in the overall mean frequency of bowel movements compared to the sucrose control (P<0.005). The number of subjects reporting bowel movements to pass watery faeces on one or more occasions following consumption of both 40 g isomalt and 40 g lycasin HBC sweets was significantly higher compared to sucrose sweets (P<0.005 and P<0.05, respectively; Table 5). Only consumption of 40 g isomalt sweets was associated with a greater number of subjects making bowel movements to pass watery faeces on two or more occasions compared to sucrose controls (P<0.05).

Table 4 Frequency of bowel movements by adults to pass hard, normal or watery faeces after consumption of sweets containing 25 g or 40 g sucrose, isomalt or lycasin HBC/mean+s.d.
Table 5 Gastrointestinal responses of adults after consumption of sweets containing 25 g or 40 g sucrose, isomalt or lycasin HBC (number of subjects reporting symptoms, n=50)

Consumption of 25 g isomalt sweets led to significantly more adults reporting bloating (P<0.005), borborygmi P<0.005), flatulence (P<0.05) and colic (P<0.005) compared to sucrose sweets (Table 5) and to a significant increase in the number reporting colic compared to lycasin HBC sweets (P<0.05). As with children, consumption of 25 g lycasin HBC sweets provoked only increased borborygmi (P<0.05). Forty grams of isomalt sweets provoked grades 1, 2 and 3 borborygmi and flatulence (P<0.001) and grades 2 and 3 borborygmi, flatulence and colic (P<0.001, P<0.005 and P<0.05, respectively). More subjects reported any grade of bloating, borborygmi and flatulence following consumption of lycasin HBC sweets compared to sucrose sweets (P<0.025, P<0.05 and P<0.05, respectively) and grades 2 and 3 flatulence and borborygmi (P<0.001 and P<0.05). These results are similar to those observed in children in that the majority of GI responses reported following consumption of both lycasin HBC and isomalt sweets were classed as grade 1 responses.

In this study bowel movement frequency was far higher in adults compared to children (Tables 1 and 4). Bowel movement frequency varies considerably in adults, a normal range being three bowel movements per week to three per day, with a modal frequency of one per day (Cummings et al, 2001). In children aged 3–12 y, bowel movement frequency is reported as ranging from 1 to 21 per week with a mean of 6.8+2.5 (Bloom et al, 1993). When converted to a mean of 0.971 bowel movements per day this value is still high compared to the mean bowel movement frequency of children following consumption of sucrose based sweets in this study (Table 1). This may indicate a diet low dietary fibre for schoolchildren in this study as previously indicated in other studies with schoolchildren (Johnson & Hackett, 1997; Adamson et al, 1992).

The effect of age upon GI tolerance of polyols is unclear and data based upon grams intake per kilogram body weight may give a false impression of tolerance in children compared to adults (Livesey, 2001). Previous studies with isomalt given to children suggest there is no difference in the tolerance of children aged 8–12 y and those aged up to 18 (Paige et al, 1992). In order to compare results from children and adults in this study, a mean symptom score has been calculated following consumption of products in each case. The mean symptom score for children consuming products over two days and adults consuming 25 and 40 g products on one day each were derived by summing each subject's GI responses for colic, bloating, borborygmi, flatulence and watery faeces using the hedonic, 0, 1, 2, 3 grade scales described earlier. For both children and adults, bowel movements to pass watery faeces were scored as none=0, one=1, two=2, three or more=3.

Figure 3 shows the mean symptom scores of children and adults following consumption of sucrose, isomalt and lycasin HBC sweets. In adults, the score increased significantly following consumption of 40 g isomalt and 40 g lycasin HBC sweets compared to sucrose sweets (P<0.001 in both cases). Forty grams of isomalt consumed by adults resulted in a significantly higher score compared to 25 g isomalt, (P<0.05), as did 40 g lycasin HBC compared with 25 g of lycasin HBC (P<0.005) These results are in keeping with Koutsou et al (1996), who demonstrated the dose-dependency of GI symptoms following polyol ingestion. However scores following consumption of 25 g lycasin HBC by both adults and children were not significantly different from those following consumption of sucrose sweets, whereas consumption of 25 g isomalt sweets increased the score in both children and adults (P<0.01 and P<0.005, respectively). There were no significant differences in mean symptom scores following consumption of 25 g of any product between adults and children. Considering that both double-blind studies were conducted with different groups, in different sites, at different times and the subjective nature of the data, there is a remarkable correlation in the mean symptom scores of both children and adults following consumption of sucrose based products (Figure 1). Overall, results strongly suggest that both children and adults tolerate 25 g doses of isomalt and of lycasin HBC in sweets equally well.

Figure 3
figure3

Symptom scores following consumption by children and adults of sweets containing sucrose, isomalt and lycasin® HBC/mean±s.e.m.

However, the mean symptom scores of children following consumption of 25 g lycasin HBC and isomalt sweets were slightly lower than those of adults. This is probably due to differences in the time taken to consume sweets between adults and children. Because of ethical considerations children were given the opportunity to consume sweets throughout the day rather than adhere to the strict consumption pattern enforced on adults. It is quite possible that differences in the consumption time of sweets influenced the occurrence of gastrointestinal symptoms in both study groups. A longer consumption time theoretically partitions the dose of polyol entering the colon thereby limiting the osmotic and/or fermentative effect. In studies with young adults, ingestion of up to 50 g polyol sweets has been shown to cause dose-dependent increases in GI symptoms and laxation, the response being dependent on the period of time over which products were consumed (Storey & Zumbé, 1996). Double-blind, controlled cross-over studies similar to this investigation are recommended to assess the subjective symptoms of intolerance following ingestion of poorly absorbed carbohydrates (Cummings et al, 2001; Marteau & Flourié, 2001). However, experimental conditions and inter-subject variability in GI tolerance due to differences in absorption capacity, motility pattern, colonic response and intestinal sensitivity may influence results (Marteau & Flourié, 2001).

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Acknowledgements

The investigators thank the children, parents and staff of the Alder Park and Westwood Park County Primary Schools, Salford, Greater Manchester.

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Correspondence to DM Storey.

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Lee, A., Wils, D., Zumbé, A. et al. The comparative gastrointestinal responses of children and adults following consumption of sweets formulated with sucrose, isomalt and lycasin HBC. Eur J Clin Nutr 56, 755–764 (2002). https://doi.org/10.1038/sj.ejcn.1601389

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Keywords

  • gastrointestinal responses
  • humans
  • children
  • adults
  • sucrose
  • isomalt
  • lycasin
  • polyols
  • tolerance
  • maltitol syrup

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