Lactose intolerance in children with protein-energy malnutrition

Verma, Mira; Saxena, Shakuntala

doi:10.1007/bf02831314

Cited by 5 publications

(7 citation statements)

References 11 publications

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“…This is similar to the 26% carbohydrate malabsorption in malnourished children previously reported [23]. Although we were unable to detect differences between groups, the mean fecal pH was nevertheless greater than 5.5 in our study, which supports results obtained from other studies of malnourished children [11, 22]. This may be explained by a number of things.…”

Section: Discussionsupporting

confidence: 91%

“…In low-resourced countries diarrhea is often thought to be associated with intestinal infections [7]. In addition, malnutrition itself has also been associated with impaired integrity and absorptive function of the intestine [10, 11]. Studies have indicated that carbohydrate malabsorption in general and lactose intolerance specifically is prevalent in children with SAM [13, 15, 19].…”

Section: Discussionmentioning

confidence: 99%

“…Enteric infections, the underlying malnutrition and concurrent HIV disease affect the integrity, morphology and absorptive function of the intestine [10, 11]. ‘Environmental enteropathy’ can be associated with reduced dissacharidases and subsequently lead to impaired carbohydrate absorption, especially of lactose [12–15].…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of three commonly used transition phase diets in the inpatient management of children with severe acute malnutrition: a pilot randomized controlled trial in Malawi

et al. 2017

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BackgroundThe case fatality rate of severely malnourished children during inpatient treatment is high and mortality is often associated with diarrhea. As intestinal carbohydrate absorption is impaired in severe acute malnutrition (SAM), differences in dietary formulations during nutritional rehabilitation could lead to the development of osmotic diarrhea and subsequently hypovolemia and death. We compared three dietary strategies commonly used during the transition of severely malnourished children to higher caloric feeds, i.e., F100 milk (F100), Ready-to-Use Therapeutic Food (RUTF) and RUTF supplemented with F75 milk (RUTF + F75).MethodsIn this open-label pilot randomized controlled trial, 74 Malawian children with SAM aged 6–60 months, were assigned to either F100, RUTF or RUTF + F75. Our primary endpoint was the presence of low fecal pH (pH ≤ 5.5) measured in stool collected 3 days after the transition phase diets were introduced. Secondary outcomes were duration of hospital stay, diarrhea and other clinical outcomes. Chi-square test, two-way analysis of variance and logistic regression were conducted and, when appropriate, age, sex and initial weight for height Z-scores were included as covariates.ResultsThe proportion of children with acidic stool (pH ≤5.5) did not significantly differ between groups before discharge with 30, 33 and 23% for F100, RUTF and RUTF + F75, respectively. Mean duration of stay after transitioning was 7.0 days (SD 3.4) with no differences between the three feeding strategies. Diarrhea was present upon admission in 33% of patients and was significantly higher (48%) during the transition phase (p < 0.05). There was no significant difference in mortality (n = 6) between diets during the transition phase nor were there any differences in other secondary outcomes.ConclusionsThis pilot trial does not demonstrate that a particular transition phase diet is significantly better or worse since biochemical and clinical outcomes in children with SAM did not differ. However, larger and more tightly controlled efficacy studies are needed to confirm these findings.Trial registration ISRCTN13916953 Registered: 14 January 2013.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Effectiveness of three commonly used transition phase diets in the inpatient management of children with severe acute malnutrition: a pilot randomized controlled trial in Malawi

et al. 2017

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“…(1966) 19 SAM a Yes 4 5.0 ± 0.8* 6.1 ± 1.0* 6.1 ± 1.0* – – Controls 10 6.8 ± 1.0* 7.3 ± 1.0* 7.5 ± 0.9* – – Rothman et al. (1980) 25 Kwashiorkor No 12 5.8 ± 0.2 ** – – 6.9 ± 0.2 ** <0.01 Verma & Saxena (1980) 20 Kwashiorkor Yes 2 5.7 – – – – Controls 10 6.9 – – – – Abbreviations : SD, standard deviation; SEM, standard error of the mean. a Definition of SAM is not in accordance with the current WHO definition (which includes patients with marasmus).…”

Section: Resultsmentioning

confidence: 99%

“…(1980) 25 Kwashiorkor No 12 Lactose 2 16.08 ± 9.94* – – Lifschitz et al. (1988) 31 SAM a Yes 17 [U- 13 C] glucose 0.005 – – – Dextrose 1.25 – – – Verma & Saxena (1980) 20 Kwashiorkor Yes 12 Lactose 2 19 (18–20) 36.5 (18–73) ± 10.1* – Bandsma et al. (2011) 30 SAM No 15 [U- 13 C] glucose 1.75 79.2 ± 2.12* 139 ± 2.26* – Abbreviations : SD, standard deviation; SEM, standard error of the mean.…”

Section: Resultsmentioning

confidence: 99%

Carbohydrate malabsorption in acutely malnourished children and infants: a systematic review

Kvissberg¹,

Dalvi²,

Kerac³

et al. 2015

Nutr Rev

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Context: Severe acute malnutrition (SAM) accounts for approximately 1 million child deaths per year. High mortality is linked with comorbidities, such as diarrhea and pneumonia. Objective: The aim of this systematic review was to determine the extent to which carbohydrate malabsorption occurs in children with SAM. Data Sources: The PubMed and Embase databases were searched. Reference lists of selected articles were checked. Data Extraction: All observational and controlled intervention studies involving children with SAM in which direct or indirect measures of carbohydrate absorption were analyzed were eligible for inclusion. A total of 20 articles were selected for this review. Data Synthesis: Most studies reported carbohydrate malabsorption, particularly lactose malabsorption, and suggested an increase in diarrhea and reduced weight gain in children on a lactose-containing diet. As most studies reviewed were observational, there was no conclusive scientific evidence of a causal relationship between lactose malabsorption and a worse clinical outcome among malnourished children. Conclusion: The combined data indicate that carbohydrate malabsorption is prevalent in children with SAM. Additional well-designed intervention studies are needed to determine whether outcomes of SAM complicated by carbohydrate malabsorption could be improved by altering the carbohydrate/lactose content of therapeutic feeds and to elucidate the precise mechanisms involved.

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The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance

Scrimshaw

Murray

1988

The American Journal of Clinical Nutrition

338

193

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1) Most humans, like other mammals, gradually lose the intestinal enzyme lactase after infancy and with it the ability to digest lactose, the principle sugar in milk. At some point in prehistory, a genetic mutation occurred and lactase activity persisted in a majority of the adult population of Northern and Central Europe. 2) Persistence of intestinal lactase, the uncommon trait worldwide, is inherited as a highly penetrant autosomal-dominant characteristic. Both types of progeny are almost equally common when one parent is a lactose maldigester and the other a lactose digester. 3) The incidence of lactose maldigestion is usually determined in adults by the administration in the fasting state of a 50-g dose of lactose in water, the equivalent of that in 1 L of milk. Measurement is made of either the subsequent rise in blood glucose or the appearance of additional hydrogen in the breath. It is also sometimes identified by measuring lactase activity directly in a biopsy sample from the jejunum. For children the test dose is reduced according to weight. Depending on the severity of the lactase deficiency and other factors, the test dose may result in abdominal distention, pain, and diarrhea. 4) The frequency of lactose maldigestion varies widely among populations but is high in nearly all but those of European origin. In North American adults lactose maldigestion is found in approximately 79% of Native Americans, 75% of blacks, 51% of Hispanics, and 21% of Caucasians. In Africa, Asia, and Latin America prevalence rates range from 15-100% depending on the population studied. 5) Whenever the lactose ingested exceeds the capacity of the intestinal lactase to split it into the simple sugars glucose and galactose, which are absorbed directly, it passes undigested to the large intestine. There it is fermented by the colonic flora, with short-chain fatty acids and hydrogen gas as major products. The gas produced can cause abdominal distention and pain and diarrhea may also result from the fermentation products. 6) Among individuals with incomplete lactose digestion, there is considerable variation in awareness of lactose intolerance and in the quantity of lactose that can be ingested without symptoms. A positive standard lactose test is not a reliable predictor of the ability of an individual to consume moderate amounts of milk and milk products without symptoms. In usual situations the quantity of lactose ingested at any one time is much less than in the lactose-tolerance test.(ABSTRACT TRUNCATED AT 400 WORDS)

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Lactose intolerance in children with protein-energy malnutrition

Cited by 5 publications

References 11 publications

Effectiveness of three commonly used transition phase diets in the inpatient management of children with severe acute malnutrition: a pilot randomized controlled trial in Malawi

Effectiveness of three commonly used transition phase diets in the inpatient management of children with severe acute malnutrition: a pilot randomized controlled trial in Malawi

Carbohydrate malabsorption in acutely malnourished children and infants: a systematic review

The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance

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