Epidemiological and clinical evidence highlight the benefit of dietary fibre consumption on body weight. This benefit is partly attributed to the interaction of dietary fibre with the gut microbiota. Dietary fibre possesses a complex food structure which resists digestion in the upper gut and therefore reaches the distal gut where it becomes available for bacterial fermentation. This process yields SCFA which stimulate the release of appetite-suppressing hormones glucagon-like peptide-1 and peptide YY. Food structures can further enhance the delivery of fermentable substrates to the distal gut by protecting the intracellular nutrients during upper gastrointestinal digestion. Domestic and industrial processing can disturb these food structures that act like barriers towards digestive enzymes. This leads to more digestible products that are better absorbed in the upper gut. As a result, less resistant material (fibre) and intracellular nutrients may reach the distal gut, thus reducing substrates for bacterial fermentation and its subsequent benefits on the host metabolism including appetite suppression. Understanding this link is essential for the design of diets and food products that can promote appetite suppression and act as a successful strategy towards obesity management. This article reviews the current evidence in the interplay between food structure, bacterial fermentation and appetite control.

Background The decision to proceed to biopsy for the diagnosis of prostate cancer in clinical practice is a difficult one. Prostate cancer risk calculators allow for a systematic approach to the use of patient information to predict a patient's likelihood of prostate cancer.Aims In this paper, we validate the two leading prostate cancer risk calculators, the prostate cancer prevention trial (PCPT) and the European Randomized Study of Screening for Prostate Cancer (ERSPC) in an Irish population.Methods Data were collected for 337 men referred to one tertiary referral center in Ireland. Calibration analysis, ROC analysis and decision curve analysis were undertaken to ascertain the performance of the PCPT and the ERSPC risk calculators in this cohort.Results Of 337 consecutive biopsies, cancer was subsequently diagnosed in 146 men (43 %), 98 (67 %) of which were high grade. The AUC for the PCPT and ERSPC risk calculators were 0.68 and 0.66, respectively for the prediction of prostate cancer. Each calculator was sufficiently calibrated in this cohort. Decision curve analysis demonstrated a net benefit via the use of the PCPT and ERSPC risk calculators in the diagnosis of prostate cancer.Conclusions The PCPT and ERSPC risk calculators achieve a statistically significant prediction of prostate cancer in this Irish population. This study provides external validation for these calculators, and therefore these tools can be used to aid in clinical decision making.

Objectives. Laryngotracheal stenosis (LTS) is an under‐recognized cause of dyspnoea and ‘wheeze’. Early treatment improves outcome while diagnostic failure leads to treatment for presumed ‘resistant’ broncho‐pulmonary pathology which increases morbidity and places the patient at ongoing risk of acute‐on‐chronic airway obstruction. The diagnostic challenge of LTS, which is an uncommon cause of a common clinical presentation lies in identifying index cases without having to subject masses of patients to unnecessary and invasive tests. We evaluated the utility of spirometry, particularly the ‘Expiratory Disproportion Index’ (EDI) in differentiating between LTS and other respiratory conditions. Methods. Diagnostic utility of EDI (FEV1/PEFR) was investigated in 9621 patients, including 3118 volunteers, 3461 patients with COPD, 1650 asthmatics, 920 patients with pulmonary fibroses, 332 patients with rare lung diseases, and 140 patients with LTS. The dataset was randomly spliced. One set was used for diagnostic rule extraction and the second for validation. Results. Area under the ROC curve for differentiating LTS from other broncho‐pulmonary diagnoses was 0.985 ± 0.011. At a threshold of 9, sensitivity of 93.4% and specificity of 96.8% were achieved. There was a significant correlation between residual tracheal cross‐section and EDI ( r = 0.61; P < 0.0001). Conclusions. EDI is a sensitive and specific spirometric test for LTS and can reliably rule in or rule out this diagnosis. It is based on PEFR‐FEV1 disproportionation, which almost exclusively occurs in patients with supra‐carinal stenosis. We recommend its use for screening defined at‐risk populations like post‐intensive‐care and Wegener's patients, and suggest more general application in evaluating patients with dyspnoea.