Nutritionally-complete formula fortified with isomalto- oligosaccharide for hemodialysis patients


  • Kridsada Keawyok Interdisciplinary Graduate School of Nutraceutical and Functional Food, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
  • Nualpun Sirinupong
  • Santad Wichienchot



Background: Recent studies have demonstrated that chronic kidney disease (CKD) is associated with dysbiotic gut microbiota. Therefore, the gut microbiota may be used as a biomarker and therapeutic agent to improve the health of CKD patients.

Objective: To study the probiotic selectivity of isomalto-oligosaccharide (IMO) produced from tapioca starch and its application in a novel nutritional formula developed for hemodialysis patients.

Methods: IMO was produced from tapioca starch in a pilot-scale reactor. The selectivity of IMO for probiotic strains was studied. Among six probiotic strains tested, two probiotic strains were selected for the development of a nutritionally-complete formula for CKD patients.The sensory attributes, probiotic survival and decapsulation, and the microbiological quality of the formula were evaluated.

Results: IMO showed prebiotic properties by promoting the growth of pure cultures of the probiotics tested. The IMO powder and the commercial probiotics, Lactobacillus paracasei and Bifidobacterium animaliswere used as ingredients to develop a nutritional formula for CKD patient with an energy distribution from protein:carbohydrate:fat of 18.43:35.29:43.27 and a total energy per 80 g serving of 400 kcal. It was found that 89.47%  of the encapsulated probiotics in the formula survived gastrointestinal tract conditions and 96.90%  of the probiotics were released after exposure to phosphate-buffered saline (pH 7.2) for 6 h. The sensory evaluation of the nutritional product showed no significant difference (p > 0.05) in its viscosity, taste, sweetness, saltiness and overall characteristics compared to a commercial product (Nepro®).The product also met relevant standards for the microbial quality of food products containing probiotics.

Conclusion: The nutritionally complete formula developed, fortified with a synbiotic combination of IMO and probiotics successfully met the requirements of the WHO and the Thai FDA regulation. This novel formula for CKD patients is the first reported with fortification by probiotics and an IMO prebiotic.

Keywords: chronic kidney disease, isomalto-oligosaccharide, hemodialysis patient, nutritional formula, probiotic





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