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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5445_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Contents
- •Editors and Contributors
- •About the Editors
- •Contributors
- •Abstract
- •1.1 Introduction
- •1.1.1 Historical Background
- •1.3.2 Pulmonary Drug Delivery
- •1.3.3 Parenteral Drug Delivery
- •1.4 Inulin Health Benefits
- •1.4.1 Prebiotic Effects
- •1.5 Inulin Industrial Applications
- •1.5.2 Pharmaceutical Uses
- •1.6.2 Regulatory Status Worldwide
- •1.7.1 Emerging Health Benefits
- •1.8 Conclusion
- •References
- •1.3 Inulin Drug Delivery Routes
- •1.3.1 Oral Drug Delivery
- •Abstract
- •2.1 Introduction
- •2.4 Physicochemical Characteristics
- •2.4.1 Chain Length
- •2.4.2 Solubility
- •2.4.3 Viscosity
- •2.4.4 Melting Temperature
- •2.4.5 Gelling
- •2.5.1 Extraction Through Hot Water
- •2.5.2 Extraction Using Ultrasound
- •2.5.3 Extraction Directed Through Microwave
- •2.7.1 Therapeutic Benefits
- •2.7.1.2 As Laxative
- •2.7.1.3 In Lipid Metabolism
- •2.7.1.5 Absorption Enhancer
- •2.8 Pharmaceutical Benefits
- •2.8.3 In PEGylation
- •2.8.5 As Gel
- •2.9 Diagnostic Benefits
- •2.10.2 Yield Variability
- •2.10.3 Purity Challenges
- •2.11 Future Scope
- •2.12 Conclusion
- •References
- •Abstract
- •3.1 Introduction
- •3.2 Inulin-Based Drug Formulations
- •3.3.1 Inulin-Based Hydrogels
- •3.3.2 Inulin-Based Micelles
- •3.3.3 Inulin-Based Liposomes
- •3.3.4 Inulin-Based Prodrugs
- •3.3.5 Inulin-Based Chelating Agents
- •3.3.6 Inulin-Based Microparticles
- •3.3.7 Inulin-Based Nanoparticles
- •3.6 Conclusions
- •References
- •Abstract
- •4.1 Introduction
- •4.3.1 Emulsifying Properties
- •4.3.3 Particle Stabilization
- •4.5.1 Solid Dosage Forms
- •4.5.3 Parenteral Formulations
- •4.5.4 Drug Delivery Systems
- •4.6.1 Skin Care Products
- •4.6.2 Hair Care Products
- •4.6.3 Personal Hygiene Products
- •4.7.2 Blood Sugar Regulation
- •4.9 Conclusion
- •References
- •Abstract
- •5.1 Introduction
- •5.5 Inulin-Based Drug Delivery Systems
- •5.5.1 Inulin Film Coating Agents
- •5.5.2 Biodegradable Inulin Coatings
- •5.5.3 Multipulse Delivery
- •5.5.4 Functional Inulin Coating Materials
- •5.5.5 Inulin Enteric Coatings/Colon Targeting
- •5.5.6 Tumor Targeting
- •5.5.7 Inulin Sustained Release Coatings
- •5.5.8 Hybrid Inulin-Based Coating Materials
- •5.5.9 Inulin Taste-Masking Coatings
- •5.5.10 Nanotechnology Using Inulin
- •5.7.1 Agriculture
- •5.7.2 Diagnosis
- •5.7.3 MRI Diagnosis
- •5.7.4 Medicine
- •5.7.5 Bioremediation
- •References
- •Abstract
- •Abbreviations
- •6.1 Introduction
- •6.1.1 Background
- •6.2 Understanding Prebiotics
- •6.4.2 Fermentation by Gut Microbiota
- •6.6.1 Bidirectional Communication
- •6.8 Future Perspective
- •6.9 Conclusion
- •References
- •7.2.2 Anti-Inflammatory Effects
- •7.3.1 Skin Whiteners
- •7.3.2 Hair Care
- •7.4 Regulatory Status
- •7.5 Conclusion
- •References
- •Abstract
- •7.1 Introduction
- •Abstract
- •8.1 Introduction
- •8.2.3 Anatomical Characteristics
- •8.2.4 Thermodynamic Stability
- •8.4.2 Formulation Strategies
- •8.5.3 Regulatory Considerations
- •8.9 Regulatory Considerations
- •8.11 Conclusion
- •References
- •Abstract
- •9.1 Introduction
- •9.2 Inulin-Based Pharmaceutical Applications
- •9.3.1.1 GIT
- •9.3.1.2 CNS
- •9.3.1.3 CVS
- •9.3.1.4 Hypersensitivity Reactions
- •9.3.1.5 Other Reported Adverse Effects
- •9.3.2 Inulin Interactions
- •9.4.1 Acceptable Daily Intake
- •9.4.3.2 Adults
- •9.4.3.3 Elderly Individuals
- •9.4.3.4 Pregnant or Lactating Women
- •9.5.1 Clinical Trial Outcome
- •9.5.2 Animal Studies
- •9.5.3 In Vitro Studies
- •9.6 Future Prospects
- •9.7 Conclusion
- •References
- •Abstract
- •Abbreviations
- •10.1 Introduction
- •10.2.2.1 Prebiotic Activity
- •10.2.2.2 Improved Gut Health
- •10.2.2.3 Anti-Inflammatory Effects
- •10.2.2.5 Enhanced Mineral Absorption
- •10.6.1 Potential Side Effects
- •10.6.2 Dosage Recommendations
- •10.7 Future Perspective
- •10.8 Conclusion
- •References
- •Abstract
- •11.19.1 Tolerance
- •11.20 Conclusion
- •References
- •Abstract
- •12.1 Introduction
- •12.5.1 Hydrogels
- •12.5.2 Microparticles
- •12.5.3 Nanoparticles
- •12.5.4 Inulin Conjugates
- •12.5.5 Miscellaneous
- •12.7 Conclusion
- •References
- •Abstract
- •13.5.1 Pharmaceutical Quality Assurance Framework
- •References
- •Abstract
- •14.1 Introduction
- •14.2.1 Prebiotic Nature
- •14.8 Immune-Modulatory Effects
- •14.9.3 Addressing Bone-Related Disorders
- •14.12 Cognitive Implications
- •14.13 Future Directions
- •14.14 Conclusion
- •References
- •Abstract
- •15.1 Introduction
- •15.3 Extraction Techniques
- •15.7.1 In Pharmaceutical Sector
- •15.7.1.4 As Vaccine Adjuvant
- •15.7.2 In Food Sector
- •References
- •Abstract
- •16.1 Introduction
- •16.1.3 Innovative Drug Delivery Systems
- •16.2 Functional Properties
- •16.2.1 Liquidity
- •16.2.2 Prebiotic Characteristics
- •16.2.3 Low Energy Density
- •16.2.5 Potential Health Benefits
- •16.3.3 Mucosal Delivery Systems
- •16.3.4 Liposomes
- •16.5 Future Perspectives
- •References

227
Larger doses of prebiotic supplements may have a neutral or detrimental effect
on symptoms; however studies on their control of gut ora and decrease of IBS
symptoms have showed some promise at low doses. Prebiotic supplementation has
not been found to be benecial for bacterial regulation or the inammatory response
in Crohn’s disease studies. Although the low-FODMAPS diet, which eliminates
some naturally occurring prebiotics from the diet, has been proven to be effective in
alleviating the symptoms of irritable bowel syndrome, it also reduces the quantity of
certain important gut bacteria. The complicated association between inulin and irri-
table bowel syndrome (IBS) varies according on the patient’s tolerance level and the
particulars of the illness (Carlson etal. 2018).
Some People’s Symptoms May Get Better: Inulin is a form of fermentable ber
that can improve gut health by encouraging the growth of good bacteria and increas-
ing bowel regularity. Because inulin can increase stool volume and encourage bowel
movements, some people with IBS, especially those with constipation-predominant
IBS (IBS-C), may see improvements in their symptoms when taking a supplement.
Possible Symptom Aggravation: However, inulin is a fermentable ber that, in
certain cases, can potentially aggravate symptoms such as gas, bloating, and pain.
This is particularly true for those with sensitive digestive systems or specic sub-
types of IBS, such as mixed IBS (IBS-M) or diarrhea-predominant IBS (IBS-D). In
these situations, increased gas production and the aggravation of symptoms like
bloating and stomach pain may result from the gut bacteria’s fermentation of inulin
(Schneider etal. 2021).
Content of FODMAPs: Inulin belongs to a class of fermentable oligosaccha-
rides, disaccharides, monosaccharides, and polyols (FODMAPs), which are a low-
absorbing category of carbohydrates that can aggravate symptoms in people with
irritable bowel syndrome (IBS). Foods and supplements high in inulin might cause
are-ups in symptoms for certain IBS sufferers. Inulin is regarded as a high-
FODMAPS food (Niness 1999).
Individual Tolerance: People with IBS can have quite different levels of toler-
ance to inulin. While some people may be able to handle small doses of inulin
without having any negative effects, others may need to completely avoid it. It is
imperative that people with IBS be mindful of their own tolerance levels and symp-
toms while ingesting meals or supplements that contain inulin.
Low-FODMAP Substitutes: Low-FODMAP substitutes may be more appropri-
ate for people with IBS whose symptoms are brought on by high-FODMAP foods
like inulin. Restricting specic types of fermentable carbohydrates, such as inulin,
is a key component of low-FODMAP dietary regimens, which aim to reduce symp-
toms of IBS (Barber etal. 2020).
Both in healthy controls and IBS, luminal bidobacteria have been found to be
inversely correlated with pain, and in IBS, bidobacteria levels have been reported
to be lower than in healthy controls. Thus, the particular prebiotic-stimulated prolif-
eration of bidobacteria represents a prospective target for therapeutics. Few ran-
domized control trials (RCTs) have examined the impact of prebiotics on IBS to yet.
The administration of 6g/day of oligofructose and 20g/day of inulin to people with
IBS in two trials failed to improve stool production or symptoms. Using 5g/day of
11 Inulin andGastrointestinal Disorders

228
short-chain fructose, a different trial’s composite symptom score improved in the
per-protocol population (Sheng etal. 2023). However, because of a signicant non-
compliance rate and the inclusion of only 50/105in the per protocol analysis, this
trial’s intention to treat was not examined. A 12-week parallel crossover trial con-
ducted at a single center using a β-GOS shown that bidobacteria were stimulated
at 3.5 and 7.0 g/day in a dose-dependent manner. Both prebiotic-treated groups
showed a signicant improvement in overall symptom relief as compared to pla-
cebo; however, when individual symptoms were evaluated and grouped, the lower
dose led to lower scores for atulence, bloating, and stool consistency. Thus, while
thinking about prebiotic use in IBS, the kind and dosage of prebiotics are probably
going to be crucial (Fatima etal. 2023).
11.7 Inulin andIts Relationship withInflammatory Bowel
Disease (IBD)
The term “inammatory bowel disease” (IBD) describes a range of complex dys-
functions that develop in the digestive tract and are characterized by severe inam-
mation of the digestive system as a result of aberrant immunological reactions. This
inammation of the gastrointestinal tract includes ulcerative colitis (UC) and
Crohn’s disease (CD). Recent research has shown that genetic, environmental, and
atypical immunological variables are the root causes of IBD complications. Disease
development is inuenced by several vulnerable endogenous factors, including gut
microbiota, lifestyle choices, and food habits (Vandeputte and Joossens 2020).
According to the study investigations, the human gut microbiota produces antigenic
components that cause the intestinal mucosa to persistently become inamed, as is
seen in CD and UC.The information provided has pointed to a newly developed
therapy strategy that uses substances such as prebiotics (inulin), which essentially
alter the microora quantitatively by promoting the growth or population of specic
bacteria. Short-chain fatty acids (SCFA) are produced when anaerobic bacteria fer-
ment prebiotics once they enter the colon. Consequently, intraluminal pH drops. A
higher concentration of bidobacteria, lactobacilli, and non-pathogenic E. coli in
the colon is responsible for antibacterial action, immunomodulation, immune
response induction, and improved barrier activity that enhances the host’s health
(van de Wiele etal. 2007).
Antibiotics, immunomodulators, and biological treatments are used in the ther-
apy of inammatory bowel disease (IBD), despite the fact that their toxicity makes
them less effective in treating ulcerative colitis (UC). Furthermore, current therapies
often target the extremely potent adaptive immune response of the host but neglect
to identify likely environmental factors, such as gut microbiota, that cause and exac-
erbate these illnesses. Additionally, in individuals with IBD, there is a microbial
imbalance between the defensive and disease-causing gut microbiota. Due to the
aforementioned disadvantage, prebiotics, probiotics, or a mix of the two (symbiotic)
are now used to treat IBD, replacing older methods. Prebiotics as a therapeutic
agent or complement to traditional therapy may be an effective way to treat a
S. K. Kadiri et al.

229
number of physiological conditions. Data from a small number of preclinical and
clinical studies have been used to examine how prebiotics affect UC and CD
(Roberfroid 2005). A versatile biopolymer, inulin nds several uses in the food and
pharmaceutical industries for targeted stimulation. Prebiotics help probiotics by
providing them with nourishment to enhance, multiply, and grow in quantity on the
intestinal microbiota. Short-chain fatty acids (acetate, propionate, and butyrate) are
the byproducts of the fermentation process by the anaerobic microora. These acids
cause a pH reduction in the colon and stop the growth of pathogenic microorgan-
isms. The type and quantity of prebiotics ingested in a diet plan, along with the
density of bidobacteria in the host’s gut, are the primary factors inuencing these
advantageous effects. Furthermore, these prebiotics have a benecial impact on the
prevention of IBD by regulating the ora’s trophic functions (Hughes etal. 2022).
11.8 Intestinal Flora’s Involvement inIBD
Although there has been progress in recent years to gain a better understanding, the
precise pathological mechanism of IBD is still unknown. According to recent
research on the etiology of IBD, the condition is caused by a conuence of immu-
nological, ecological, and genetic factors. It is commonly recognized that intestinal
microora, particularly in Crohn’s disease, plays a role in the pathophysiology of
IBD.The terminal ileum and colon, which have the highest concentration of intes-
tinal microbiota, are typically where this chronic bowel inammation manifests
itself (Mysonhimer and Holscher 2022).
The treatment for CD is antibiotics and fecal diversion; however, intestinal mate-
rials infusion into the omitted ileum or the regeneration of endurance of the bypassed
distal colon may result in a recurrence of the disease. The role of gut microora in
the initiation and maintenance of chronic intestinal inammation has been most
convincingly demonstrated in multiple rat models of chronic intestinal inamma-
tion. Transgenic rats carrying the HLA-B27 gene have colitis in the presence of
normal gut microbiota 56days after birth, but no disease is seen in non-transgenic,
antibiotic-cured, or microbe-free transgenic rats. Elevation in the concentration of
luminal Bacteroides species has been linked to worsening colitis. Bacteroides spp.
are the most common in the distal gut. Following surgical excision, postoperative
recurrence of CD is associated with an increased Bacteroides species. Most notably,
B. vulgate promotes intestinal inammation in transgenic rats after 4 weeks of
mono association, but mono association with E. coli does not indicate any illness
state. Therefore, the potential of different microorganisms to induce intestinal
inammation varies (Wang and Cheong 2023).
11.8.1 Prebiotics forConditions oftheInflammatory Bowel
Several investigations have conrmed the impact of prebiotics on gut ora and the
possibility of enhancing the intestinal ora’s metabolic activity by application of
11 Inulin andGastrointestinal Disorders

230
probiotics. For instance, a wealth of evidence from studies on humans indicates that
inulin-type fructans enhance calcium absorption. Similarly, studies on animals have
demonstrated that the fermentation of oligofructose improves hepatic lipid metabo-
lism and may prevent dysfunctions associated with metabolic syndrome and non-
alcoholic steatohepatitis. The ability of inulin-type fructans to bulk up has been
shown to improve metabolic gut processes and to help prevent and treat constipa-
tion. Treatment with prebiotics has also been demonstrated to enhance the intestinal
barrier. Prebiotics are thought to be risk-free, non-toxic, and benecial in the pre-
vention and treatment of gastrointestinal disorders because of several research on
clinical trials (Qin etal. 2023a).
11.8.2 The Effect ofInulin inAnimal Models
Prebiotics’ effects on intestinal inammation have already been investigated in a
number of animal models. Mice decient in the IL-10 gene spontaneously develop
colitis. There is one.
In addition to an increase in adherent and translocated bacteria, the newborn
colons of these mice had low levels of Lactobacillus species. It has been demon-
strated that rectal delivery of Lactobacillus reuteri causes the count of lactobacilli
in stools to normalize, hence halting the progression of colitis. In the same animal
model, oral administration of either Bidobacterium infantis or Lactobacillus sali-
varius reduces inammatory activity and mucosal lesion scores. In an IL-10 knock-
out mouse model, a genetically modied bacteria produce the anti-inammatory
cytokine IL-10, which stops the start of colitis. However, the colitis that the rats’
trinitrobenzene sulfonic acid provoked did not lessen the benets of probiotic treat-
ment with Lactobacillus plantarum. Probiotic-induced experimental results have
shown that augmenting the quantity of lactobacilli or bidobacteria in the intestinal
lumen prevents the spontaneously growing inammatory mucosal lesions in mice
lacking the IL-10 gene (Boeckner etal. 2001).
The prebiotic effect of inulin was investigated in a rat model of dextran sodium
sulfate (DSS)-induced distal colitis, which is histologically similar to human
UC.Oral inulin administration on a regular basis increases the number of native
lactobacilli in the cecum lumen and lowers the pH of the colon. The feeding of inu-
lin prolonged the saccharolytic section (exclusively in the right colon), which causes
the left colon to become acidic. Oral inulin administration reduces mucosal inam-
mation and histological damage scores in rats with colitis induced by
DSS.Furthermore, when compared to controls, the rats given inulin showed less
severe crypt damage and less mucosal damage. Treatment with oral inulin has dem-
onstrated a similar benecial effect whether it is given prior to or during DSS expo-
sure. Prebiotics have shown promise in the treatment of chronic colitis and have
been used often in animal models. In transgenic rats, a diet rich in inulin and oligo-
fructose at a rate of 5g/kg body weight reduces intestinal inammation (Anderson-
Dekkers etal. 2021). In this study, the model HLA-B27 transgenic rat is employed
to assess the mechanisms of prebiotic activity in chronic colitis. This benecial
S. K. Kadiri et al.

231
result was accompanied by an increase in lactobacilli and bidobacteria in the gut.
Prebiotic combo feeding (oligofructose and inulin) reduces mucosal proinamma-
tory cytokines and amplies growth factor-β through immunoregulatory alteration
in colitis-prone rats. Research on transgenic rats given inulin and probiotics revealed
a benecial outcome. When colitis rats fed goat’s milk oligosaccharides were
exposed to dextran sodium sulphate, they showed reduced clinical signs and
increased MUC3 manifestation in comparison to control rats. Goat’s milk oligosac-
charides also lessen intestinal inammation and necrotic lesions in rats with colitis
induced by trinitrobenzene sulfonates as compared to control rats. However, not
every study utilizing prebiotic will always demonstrate a benet. It was revealed
that oligofructose was ineffective in reducing intestinal inammation in rats caused
by dextran sodium sulfate, and that galacto-oligosaccharides were similarly
ineffective in reducing intestinal inammation caused by trinitrobenzene sulfonate
(Kaur and Gupta 2002).
In conclusion, a promising nutraceutical for a number of illnesses, including
IBD, is inulin. It is affordable and easy to consume and does not have any signicant
harmful effects could out to be a fascinating addition to the typical supplement for
IBD patients. The use of inulin in dietetics offers a potential strategy to preserve
health and well-being and control the advancement of illnesses. It has been con-
rmed that those with IBD have an overabundance of immune response to com-
mensal microorganisms. Certain bacteria have the ability to downregulate mucosal
inammation, mucosal intrinsic responses, and cytokine signaling at the local level.
Lactobacilli and bidobacteria proliferate in the large intestine because of saccha-
rolysis caused by inulin.
Experimental models demonstrate a decrease in IBD-related mucosal inamma-
tion as a result of these effects (Wan etal. 2020). Lactic acid-producing bacteria can
stop indigenous microorganisms from proliferating and can stop them from adher-
ing to surfaces and inltrating external to the body. Thus, the prebiotic effect of
inulin demonstrates a favorable inuence on the intestinal barrier function. Prebiotics
are therefore a useful addition for vulnerable populations, including individuals in
advanced stages of illness and those with long-term gastrointestinal conditions
including gut inammation and colon cancer. Although encouraging outcomes have
been seen in early clinical trials, further research is necessary to conrm that inulin
may be used therapeutically for the efcient management of IBD (Melse-Boonstra
2020). Clinical trials of prebiotics in IBD are presented in Table11.1.
11.9 The Relationship Between Inulin andtheComposition
ofGut Microbiota
Ileum bacteria can easily digest inulin, a ber made of repeated fructosyl units
joined by β (2,1) bonds, which produces a lot of short-chain fatty acids (SCFA). It
has been observed that consuming inulin signicantly increased the frequency of
stools in constipated individuals, indicating that inulin may have an effect on the
composition of the human gut microbiota. Advances in high-throughput
11 Inulin andGastrointestinal Disorders

232
technologies facilitate the evaluation of human-associated microbiomes about their
diversity and taxonomic or functional makeup. Additionally, these technologies can
detect alterations in reaction to particular supplements. Therefore, it is essential to
comprehend how inulin affects the human gut ora in order to comprehend how it
works (Hiel etal. 2019b).
Prebiotics are classied as nondigestible food ingredients that enhance health
by favorably inuencing the proliferation and/or activity of a single or small group
of bacteria in the colon. References to them date back to 1995. With its repeating
fructosyl units connected by β (2,1) bonds, inulin is an easily digested ber by gut
bacteria that produces a lot of short-chain fatty acids (SCFA). To date, it has been
observed that inulin consumption signicantly increases the frequency of stools in
constipated healthy persons. Based on a daily consumption of 12g of native chic-
ory inulin, the European Food Safety Authority reported in 2015 that inulin con-
tributes to maintenance of regular defecation by increasing stool frequency
(Roberfroid 1993a).
Serious adverse events in clinical trials evaluating prebiotics or other therapies to
modify the gut microbiome are frequently not reported or are assessed insufciently,
according to a recent systematic analysis. Additionally, advancements in high-
throughput technologies enable the evaluation of the composition and function of
human-associated microbiomes and can pinpoint particular alterations in reaction to
certain supplements. In order to comprehend the mechanisms of action of inulin, it
is crucial to comprehend its impacts on the human gut ora. Therefore, our goal was
to thoroughly examine the available data about the impact of inulin on the human
gut ora. Studies that examined the effects of inulin on the gut microbiome included
observational, prospective or retrospective, cross-sectional, case-control, cohort, or
intervention studies involving adult humans. Any participant was allowed.
Preclinical models and invitro research using feces from healthy subjects and inulin
growth media were not included in our analysis (Xiao etal. 2015).
The chemical under study, its dosage, the comparator employed, the length of
treatment exposure, the number of participants, and the microbiome evaluation
method used in the study were all listed in the rst prespecied table. Additionally,
we carried out a qualitative synthesis of the results from various published research
that were incorporated into the systematic review. We included the overall diver-
sity of gut bacteria as well as the taxonomic modications noted in the published
papers in the second prespecied table (Esmaeilnejad Moghadam etal. 2019). In
particular, alpha diversity—which is characterized as diversity within each unique
sample—was reported utilizing one or more of the following metrics: phyloge-
netic diversity, species count, operational taxonomic unit (OTU), Shannon index,
Chao1 index, and Simpson index. Crucially, an OTU is a collection of phyloge-
netically related species that are arranged according to how similar the 16S RNA
sequences are. Sequences that are similar are typically grouped into an OTU at a
similarity threshold of 97%. Using the Bray Curtis or UniFrac distances matrix,
beta diversity—which represents the inter-variability between samples and
describes how samples cluster together—was published. Relative abundance, or
the percentage composition of a particular taxon in relation to the overall number
S. K. Kadiri et al.

233
of taxa in the gut microbiome, is typically used to report taxonomy. Here, we used
the NCBI Taxonomy browser to format the ndings to universal taxonomy, going
from the phylum level to the lowest taxonomic level that was available (Giri
etal. 2021).
11.10 Utilizing Inulin forTherapeutic Purposes
A heterogeneous mixture of fructose polymers, inulin is mostly found in plants as
store carbohydrates. Furthermore, it is thought that inulin induces specic techno-
functional and related features in food systems. Due to its capacity to produce foam,
inulin has been effectively utilized as a fat substitute in a variety of items, including
dairy and baked goods. Moreover, it is recognized to have specic dietary and
medicinal advantages that go beyond enhancing well-being and lowering the likeli-
hood of numerous lifestyle-related illnesses (Tharifkhan etal. 2021).
11.11 Diet Health Linkage andFunctional Foods
Since proper diet is essential to preventive healthcare, it is the cornerstone of any
civilized society. Nowadays, consumers have a better understanding of a healthy
diet and how to see therapeutic foods as a dietary intervention. This stimulating
curiosity is connected to a deep comprehension of the ways that eating inuences
different diseases. Signicant dietary and lifestyle modications have been linked
to the beginning of multiple diseases, including hyperglycemia, hypercholesterol-
emia, colorectal malignancies, and irritable bowel syndromes. Moreover, because
80% of diabetic patients are at risk for cardiovascular diseases (CVDs), these prob-
lems are interdependent and inuence each other’s development and severity (Ballan
etal. 2020).
With no dietary recommendations for different demographic segments, these
health issues are already spreading quickly throughout emerging nations. The high
rate of illness is related to a number of causes, including poor food habits, unhealthy
lifestyle choices, and risk factors including smoking, pollution, and hypertension.
Dietary therapies, such as functional foods and nutraceuticals, dietary supplements,
and food diversity, might be benecial in the battle against chronic disorders. One
workable option for nations with extreme socioeconomic inequality is dietary treat-
ments centered on inexpensive ber supplementation. This may be accomplished by
using various soluble and insoluble bers derived from cereals and vegetables.
Diets high in ber may help healthy individuals become more peripherally insulin-
sensitive. Furthermore, soluble ber has the ability to postpone the blood’s absorp-
tion of glucose, which lowers postprandial glucose concentrations. Inulin, which
falls under the broad group of fructans, has a great deal of promise as soluble dietary
ber to reduce these health issues. Therefore, using inulin, one of the potential bio-
active molecules with a wide range of dietary uses, might be one way to make thera-
peutic foods (Delzenne etal. 2005).
11 Inulin andGastrointestinal Disorders

234
11.12 Extraction andPrecipitation ofInulin
The extraction, measurement, and application of inulin are gaining attention because
of its increasing industrial usage in nature. To increase the yield of inulin, several
studies have examined the ideal extraction parameters, such as temperature, extrac-
tion duration, and solvent/solid ratios.
Upgrading the extraction temperature signicantly increases the solubility of
inulin, which is essentially insoluble at 25°C but becomes soluble up to 35% at
90°C.Accordingly, the majority of industrial extraction uses a hot water diffusion
technique.
The basis for almost all extraction techniques is the use of hot water diffusion
with very little variation in temperature and extraction duration. To increase extrac-
tion efciency, the hot water diffusion technique can also include continuous stir-
ring (Bonnema et al. 2010a). In order to prevent inulin hydrolysis, which is a
common occurrence at pH < 6, inulin is often extracted from JA using distilled
water at 80–85°C for 1h and pH6.8. As this was seen during the extraction of
inulin from burdock roots, many factors, including temperature, sonication ampli-
tude, and duration, have recently been proposed to increase extraction by ultrasound
assistance. Without signicantly changing the temperature, the extraction efciency
was increased by increasing the sonication amplitude and extraction duration. The
sonication duration was 25min, with an amplitude of 83.22% and a temperature of
36.76°C.Because of the direct impact of ultrasounds, care must be given during
extraction to prevent inulin fragmentation. In summary, employing direct waves is
the recommended method for inulin depolymerization in order to get low molecular
weight byproducts. To get intact inulin, however, the indirect technique is more
suited (Younes etal. 2001).
11.13 Functional Health Attributes ofInulin asDietary Fiber
Dietary ber is made up of lignin, oligosaccharides, polysaccharides, and related
plant materials that may perform physiological actions in the human body, such as
reducing blood glucose or cholesterol levels and promoting bowel movements. For
those following a healthy diet plan, 30g of dietary ber is advised for those using
2500kcal per day and 25g for those using 2000kcal. The World Health Organization
suggests 16–24g of non-starch polysaccharides and 27–40g of total dietary ber
per day. Water-soluble gel and water-insoluble bers are two categories for dietary
bers. While soluble ber is found in no cellulosic portions such as mucilage, gums,
and pectin in legumes, barley, oats, fruits, and dried beans, insoluble ber is found
in the cell walls of grains and certain vegetables in the form of hemicelluloses and
cellulose. Soluble bers are associated with lipid and carbohydrate metabolism, but
insoluble bers have minimal effect on the body’s ability to metabolize glucose and
cholesterol. By means of the underlying intestinal fermentation, soluble ber may
also produce the short-chain fatty acids (acetate, propionate, and butyrate), which
are essential for lipogenesis and lipogenolysis (Tungland and Meyer 2002).
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235
11.13.1 Relationship ofInulin andBowel Habits
Due to their agreement with the majority of the dietary ber criteria, inulin and
oligofructose are classied as dietary bers worldwide. They not only enhance
bowel function but also have the capacity to ferment in the colon and specically
promote the establishment of advantageous intestinal bacteria. The fermentation
can increase the bacterial population; the resulting microora can contribute signi-
cantly to fecal biomass and water content of stool, leading to bowel peristalsis,
facilitated excretion, and increased frequency and output of stool.
Regular consumption of inulin-type fructan can enhance intestinal health and
relieve constipation because it regulates bowel function. Constipation often lasts
into old age and can be caused by dietary patterns changing, drinking more liquids,
eating a lower-ber diet less frequently, taking too many laxatives and medications,
having a smaller intestine, and not exercising. Stool weight and intestinal motility
increased in research involving healthy human volunteers fed a diet high in inulin
(Dominguez etal. 2014).
11.13.2 Nutritional Benefits ofInulin
The development and multiplication of advantageous intestinal microora as well
as the activation of the systemic response through the synthesis of SCFAs and sev-
eral other unknown metabolites are credited with the positive effects of inulin-type
fructans. Additionally, they have a favorable impact on the end products of fermen-
tation and native bacterial enzymes. Several pieces of evidence point to the bene-
cial function of bacteria called biodobacteria in the body, which increases
resistance to infections. In addition to boosting the quantity and rates of develop-
ment of biodobacteria, inulin and oligofructose can prevent the growth of danger-
ous pathogens like E. coli, Campylobacter jejuni, Salmonella enteritidis, or
Clostridium perfringens.
According to human study ndings, the gut-associated lymphoid tissues are pos-
itively impacted by fructans, such as inulin and fructo-oligosaccharides, which in
turn helps to strengthen immunity against dangerous microorganisms. The funda-
mental consequences are associated with enhanced gastrointestinal tract repair fol-
lowing disruptions, reduced symptoms of illness, and resistance to pathogen
translocation and colonization. The primary function of inulin-type fructans is to
alleviate intestinal diseases in the population, including hospitalized patients with
diarrhea (diarrhea associated with Clostridium difcile). There have been docu-
mented benets from raising bidal numbers and lowering diarrheal relapses. Apart
from its bidogenic properties, inulin has the ability to decrease the inammation
linked to ulcerative colitis.
Fermentable bers were combined with medications in a double-blind, placebo-
controlled experiment to treat colon cancer patients, with encouraging results.
Fermentable bers, such as fructans of the inulin type, can also improve the absorp-
tion of minerals (Pedersen etal. 1997).
11 Inulin andGastrointestinal Disorders

236
11.13.3 Inulin: Safety andTolerance
Two macronutrients are oligofructose and inulin. They are utilized as food additives
or as a stand-in for macronutrients. They are mostly added to meals as supplements
because of their nutritional value. The amount of dietary ber in a food is increased
by adding oligofructose or inulin. These increases typically range from 3 to 6g per
serving and, in severe circumstances, up to 10g. In other cases, oligofructose or
inulin is added to support a particular nutritional claim, such as the one about bi-
dogenic action. Typical values in these meals range from 1 to 6%, resulting in 3 to
8g per piece (Holscher etal. 2014).
Inulin and oligofructose are primarily employed as macronutrient replacements
in place of fat and sugar, respectively. Orafti developed and patented the ability of
inulin to replace fat in food in 1992. Inulin is mixed with water using a particular
processing method to mimic the mouthfeel and texture of fat. Only meals that
include water, like dairy and spreads for tables, may do this; dry foods, including
most snacks, baked goods, and confections, cannot. Generally, 0.25g of inulin is
used in place of 1g of fat. As a result, most meals that substitute fat will have inulin
quantities of 2–4g per piece. Orafti developed and patented the ability of inulin to
replace fat in food in 1992. While oligopolysaccharides have technical characteris-
tics with sugar and glucose syrups, they differ greatly in terms of their nutritional
makeup. When compared to sugar, the sweetness of (pure) oligofructose is 30%.
Because of this, it is challenging to utilize oligofructose alone as a sugar substitute;
in order to get the appropriate sweetness level, it is typically coupled with strong
sweeteners (Kruse etal. 1999). Safety of the inulinase enzyme: Partial enzymatic
hydrolysis of inulin yields oligofructose. An inulinase enzyme that was separated
from the Aspergillus niger carbohydrase complex is used in this procedure. The
manufacturer conducted toxicological testing on the enzyme and determined that it
was safe to use in food preparation.
The Joint FAO/WHO Expert Committee on Food Additives (JECFA2) believes
that using Aspergillus niger enzymes in food production poses no health risks to
humans. These enzymes are frequently employed in the food sector, such as in the
manufacturing of fruit juice.
The Aspergillus niger carbohydrase complex is protected in the United States by
an afrmation petition (GRASP 3G0016) that was led by the ad hoc Enzyme
Technical Committee in 1973 and is generally regarded as safe (GRAS). Inulinase’s
safety has been assessed by Danish authorities, who have approved its usage in the
synthesis of oligofructose. The French Council Superior d’Hygiene Public has also
assessed and suggested that the enzyme be allowed to be used in the synthesis of
several products, including oligofructose (Causey etal. 2000).
Intestinal acceptability: Two key factors determine whether nondigestible com-
ponents are accepted in the stomach. The rst is the osmotic action, which causes
the colon’s water content to rise. Greater osmotic pressure is exerted by smaller
molecules, which causes the colon to absorb more water. For example, sorbitol has
a larger laxative potential than oligofructose, which is likely due to this. The sec-
ond is the fermentation effect, which is brought on mostly by gasses and
S. K. Kadiri et al.
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