Objective
Lactulose/mannitol (L/M) intestinal permeability tests were completed to compare the intestinal function of severely underweight children recovering from diarrhea and other illnesses and of non-malnourished children from the same communities, and to evaluate the effects of food supplementation, with or without psychosocial stimulation, on the changes in intestinal function among the underweight children.
Methods
Seventy-seven malnourished children completed intestinal permeability studies at baseline and three months after receiving one of the following randomly-assigned treatment regimens: 1) Group-C: fortnightly follow-up at community-based follow-up units, including growth monitoring and promotion, health education, and micronutrient supplementation, n=17; 2) Group-SF: same as Group-C plus supplementary food (SF) to provide 150-300 kcal/d, n=23; 3) Group-PS: same as Group-C plus psychosocial stimulation (PS), n=17; or 4) Group-SF+PS: same as Group-C plus SF and PS, n=20. Seventeen non-malnourished children were included as comparison subjects.
Results
The malnourished children’s mean±SD initial age was 13.1±4.0 months, and their mean weight-for-age Z score was −3.82±0.61 and median (interquartile-range (IQ) urinary L/M recovery ratio was 0.16 (0.10, 0.28). 84% of the children had L/M ≥0.07, suggestive of impaired intestinal function. The median L/M of the malnourished children was significantly greater than that of 17 relatively well-nourished children (median = 0.09; IQ 0.05, 0.12, p=0.001). There were no significant differences in baseline characteristics of the severely malnourished children by treatment group. Following treatment, the L/M ratio improved in all groups (p<0.001); but there were no significant differences in these changes by treatment group. There was a significant positive association between weight gain and the magnitude of improvement in L/M ratio (r = 0.30, p=0.012).
Conclusions
Intestinal mucosal function, as measured by sugar permeability, is impaired among severely underweight children. Intestinal permeability improves in relation to weight gain, but intestinal mucosal recovery is not specifically related to the types or amount of food supplementation or psychosocial stimulation provided in this trial.