Double-balloon jejunal perfusion to compare absorption of vitamin E and vitamin E acetate in healthy volunteers under maldigestion conditions

• Published in: European journal of clinical nutrition Vol. 67; no. 2; pp. 202 - 206
• Main Authors: Nagy, K, Ramos, L, Courtet-Compondu, M-C, Braga-Lagache, S, Redeuil, K, Lobo, B, Azpiroz, F, Malagelada, J-R, Beaumont, M, Moulin, J, Acquistapache, S, Sagalowicz, L, Kussmann, M, Santos, J, Holst, B, Williamson, G
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.02.2013; Nature Publishing Group
• Subjects: 692/699/1503; 692/700/1421/164; 692/700/459/1994; Absorption; Absorption (Physiology); Acetates - metabolism; Acetates - pharmacokinetics; Acetic acid; Acetylation; Adult; alpha-Tocopherol - analogs & derivatives; alpha-Tocopherol - metabolism; alpha-Tocopherol - pharmacokinetics; Balloons; Bioavailability; Biological and medical sciences; Blood; Clinical Nutrition; Digestion; Digestive enzymes; Digestive system; Dyspepsia - metabolism; Effluents; Enteral nutrition; Enzymes; Epidemiology; Esterification; Feeding. Feeding behavior; Fundamental and applied biological sciences. Psychology; Health aspects; Humans; Internal Medicine; Intestinal Absorption; Intestine; Jejunum; Jejunum - enzymology; Jejunum - metabolism; Liquid chromatography; Male; Mass spectrometry; Mass spectroscopy; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Nutrition; original-article; Perfusion; Public Health; Reference Values; Salts; Small intestine; Subtraction; Tocopherol; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vitamin E; Vitamin E - analogs & derivatives; Vitamin E - metabolism; Vitamin E - pharmacokinetics; United Kingdom; bioavailability; jejunal segmental perfusion; pancreas; vitamin E; Human; Digestive system; Volunteer; Metabolic diseases; Acetate; Bioavailability; Small intestine; Absorption; Jejunum; Perfusion; Vitamin E; Sounding balloon; Pancreas; Comparative study
• ISSN: 0954-3007; 1476-5640
• DOI: 10.1038/ejcn.2012.183

Background/Objectives: The vitamin E derivative, α-tocopheryl acetate, is often included in formulations used in enteral nutrition. In this respect, we compared α-tocopherol and α-tocopheryl acetate absorption under ‘maldigestion’ conditions, such as occurring during enteral tube feeding, using differentially labeled RRR -[5,7-methyl-( 2 H 6 )]-α-tocopherol and RRR -[5-methyl- 2 H 3 ]-α-tocopheryl acetate allowing direct comparison between free and esterified forms. Subjects/Methods: The two derivatives were given together in a single dose to six volunteers directly into the jejunum using a double-balloon perfusion system. Perfusion lasted for 1 h, and the collected blood and effluent samples were analyzed by liquid chromatography–mass spectrometry. Results: In the isolated 20-cm length of exposed jejunum, on average ∼6% of the two vitamin E forms were absorbed >1 h based on subtraction of effluent from influent. There was substantial difference in the absolute absorbed quantity between individuals, but no significant differences were observed in the absorption between the two labeled forms as assessed in the plasma. 2 H 3 -α-tocopherol was not present in the influent, but appeared in the effluent, indicating that the acetylated form of vitamin E is cleaved by brush border enzymes in the small intestine. Conclusions: This study shows that even in the absence of digestive enzymes and bile salts, the appropriately solubilized acetylated form of α-tocopherol exhibits the same bioavailability as free α-tocopherol. This suggests that both forms can be absorbed equally under maldigestion conditions such as present clinically during enteral tube feeding.