Attention to metabolic hunger and its effects on Helicobacter pylori infection

A significant decrease in the bacterial count of small intestinal mucosa ha s been observed in children with recurrent diarrhea or abdominal pain in th e time that has elapsed from the previous meal. Humans may be trained to re cognize metabolic feelings of hunger that are associated with a steady and slightly lower glycemia than baseline, between 4.7 and 3.9mmol/L (intervent ion). An eating habit associated with a decrease in preprandial glycemia pr evented diarrhea relapses, and was expected to impair intestinal microflora growth, including Helicobacter pylori in the stomach. The development of H elicobacter pylori infection might be prevented during childhood, and recov ery from infection may be expected with intervention. The improvement in at tention to metabolic feelings consisted of acquiring a predictive ability o f glycemia by distinction between unsolicited hunger feelings (metabolic hu nger) and those associated with external cues. Matching intake to the inbet ween energy needs served to predict the subsequent emergence of the metabol ic hunger. The matching was further compensated for the early or late emerg ence of metabolic hunger at the subsequent meals. Fruit and vegetables were increased to avoid abrupt glycemia lowering. This intervention was trained in 5-month periods. Subjects (209, 44, and 58) completed their training du ring 4-year periods between 1982 and 1994, and were enrolled in a prospecti ve, controlled, randomized, interventional, preventive, and cohort study. T he "prevention" hypothesis was tested in a subgroup of 86 healthy infants w ho were recalled in the years 1996 to 1998. A "recovery" study of approxima tely a 1-year intervention was investigated in 47 healthy subjects between ages 5 and 25, who were positive for anti-H. pylori and had no need for an immediate antibiotic treatment at entry. The following behavioral factors w ere recorded in a 7-day home diary and calculated: the fraction of meals in duced by metabolic hunger out of 21 main mealtimes; average preprandial gly cemia (DAP glycemia); daily intakes, activity; and bedtime hours. The decre ase in preprandial glycemia was the objective measure of compliance with th e recognition of "metabolic" hunger. Anthropometric measures and blood test s were obtained for nutritional and functional verifications. Average prepr andial glycemia was 8.5 and 8.6% lower in the intervention groups than the control groups in the "prevention" and "recovery" studies, respectively, at the end of follow-up (p < 0.05 and < 0.001, respectively). A 4.7% seroprev alence of H. pylori infection was observed in the intervention group, with 30.2% in the control group at a mean age of 10 years after approximately an 8-year follow-up in the "prevention" study (p < 0.0005). The seroprevalenc e decreased to 9 of 24 (37.5%) under intervention as opposed to 20 of 23 co ntrols (87%) in the recovery study (p < 0.002). A significant positive corr elation was found between DAP glycemia and the anti-H. pylori serum antibod y concentration (r = 0.52; p = 0.0002). A decrease in the level of immune s timulation by H. pylori infection was observed due to the intervention, whi ch may have a preventive and therapeutic role on the infection. (C) 2000 El sevier Science Inc. All rights reserved.