Fructose Malabsorption in Children With Functional Digestive Disorders

Abstract

-Context -Fructose is a monosaccharide frequently present in natural and artificial juice fruits. When the concentration of fructose in certain food is present in excess of glucose concentration some individuals may develop fructose malabsorption. Objectives -To report the frequency of fructose malabsorption utilizing the hydrogen breath test in children with gastrointestinal and/ or nutritional disorders. Methods -Between July 2011 and July 2012, 43 patients with gastrointestinal and/or nutritional disorders, from both sexes, were consecutively studied, utilizing the hydrogen breath test with loads of the following carbohydrates: lactose, glucose, fructose and lactulose. Fructose was offered in a 10% aqueous solution in the dose of 1 g/kg body weight. Samples were collected fasting and at every 15 minutes after the intake of the aqueous solution for a 2 hour period. Malabsorption was considered when there was an increase of >20 ppm of hydrogen over the fasting level, and intolerance was diagnosed if gastrointestinal symptoms would appear. Results -The age of the patients varied from 3 months to 16 years, 24 were boys. The following diagnosis were established: irritable bowel syndrome with diarrhea in 16, functional abdominal pain in 8, short stature in 10, lactose intolerance in 3, celiac disease in 1, food allergy in 1 and giardiasis in 1 patient. Fructose malabsorption was characterized in 13 (30.2%) patients, and intolerance in 1 (2.3%) patient. The most frequent fructose malabsorption was characterized in 7 (16.3%) patients with irritable bowel syndrome and in 4 (9.3%) patients with functional abdominal pain. Conclusions -Patients with irritable bowel syndrome and functional abdominal pain were the main cause of fructose malabsorption.

Hereditary Fructose Intolerance in a Pediatric Context

“…However, a negative result does not exclude a satisfactory response to fructose restriction, therefore, hydrogen breath testing is not an appropriate diagnostic medium to predict diet response (Lozinsky et al, 2013). This test is based on the fact that normal intestinal flora metabolizes these sugars into short chain fatty acids and hydrogen.…”

“…Some eating disorders present similar treatment to HFI, such as fructose malabsorption, which is a functional problem of the small intestine, triggered by a decrease in fructose absorption capacity, and may be caused by the excessive intake of fructose and consequent disorders in the intestinal microbiota or even to be secondary to an underlying intestinal disease such as celiac disease (Canani et al, 2016). Its symptoms are like those of the HFI, but with a lower intensity, being more related to emetic episodes, abdominal pain, bloating, abdominal distension and diarrhea after ingestion of foods rich in fructose, sucrose or sorbitol (Lozinsky et al, 2013). The test of expiratory hydrogen can be used to aid in the diagnosis, but the therapeutic test with the suspension of foods rich in fructose presents a greater diagnostic and therapeutic accuracy (Yüce et al, 2016;Canani et al, 2016).…”

“…The intestinal absorption of fructose presents two main mechanisms, the first being a facilitated transport mediated by the Glut-5 protein (glucose transporter protein 5), which shows high affinity for fructose and low affinity for glucose, not depending on the action of insulin. The second mechanism has glucose-dependent co-transport, optimizing the absorption of fructose by up to 29%, when it is ingested as sucrose (disaccharide formed by the junction of fructose with glucose) or when ingested together with glucose (Tran, 2017) (Lozinsky et al, 2013) (Chumpitazi and Shulman, 2016).…”

“…After intestinal absorption, the fructose is transported through the basolateral enterocyte membrane with the aid of the Glut-2 protein (glucose transporter protein 2), reaching the bloodstream and then the liver through the portal circulation (Canani et al 2016) (Lozinsky et al, 2013).…”

Functional abdominal pain: an integrative review study from a biopsychosocial view

“…To Horst et al 11 , somatic intestinal symptoms and depression in children with FAP were relevant for the maintenance of the abdominal pain from childhood into the adult life. The influence of physiological symptoms and digestive processes was presented by Lozinsky et al 12 , who found a poor fructose absorption in 30.2% of the subjects diagnosed with irritable bowel syndrome and FAP. Children in the FAP group presented greater response of the parasympathetic system 13 , which means more difficulty in reaching the homeostasis state than in children in the painless group, as well as the deregulation of the autonomic system against the FAP mechanism.…”