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Effect of age on fructose malabsorption in children presenting with gastrointestinal symptoms
Hilary F Jones1, Esther Burt, Kate Dowling
1Cell Biology of Disease Research Group and PERI Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
Insights
Children under 10 absorb fructose poorly, leading to more positive fructose malabsorption breath hydrogen tests (BHTs). This absorption capacity improves with age, unlike lactose malabsorption BHT results.
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Clinical Diagnostics
Background:
- Fructose malabsorption is a common cause of chronic diarrhea and abdominal pain.
- Breath hydrogen testing (BHT) is used to diagnose carbohydrate malabsorption.
- The impact of patient age on BHT results for fructose and lactose malabsorption requires clarification.
Purpose of the Study:
- To investigate the effect of patient age on the clinical application of the fructose breath hydrogen test (BHT).
- To compare the age-related performance of the fructose BHT with the lactose BHT.
Main Methods:
- Retrospective review of BHT results from a gastroenterology clinic (2003-2008).
- Patients underwent BHT after consuming either fructose (0.5 g/kg, max 10 g) or lactose (2 g/kg, max 20 g).
- Test results were analyzed for correlations with patient age.
Main Results:
- Age significantly affected fructose BHT results (P < 0.001) in 1093 patients.
- Positive fructose malabsorption rates decreased with age: 88.2% (<1 yr), 66.6% (1-5 yrs), 40.4% (6-10 yrs), 27.1% (10-15 yrs).
- No significant age-related effect was observed for lactose BHT results (P = 0.115) in 3073 patients.
Conclusions:
- Infants and young children exhibit a lower threshold for fructose absorption, with capacity increasing up to age 10.
- Age-specific interpretation of fructose BHT results is crucial for accurate diagnosis in pediatric patients.
- Dietary recommendations for fructose intake in infants with gastrointestinal symptoms should consider age-related absorption capacity.
Objectives:
Fructose malabsorption can produce symptoms such as chronic diarrhoea and abdominal pain. Here, we retrospectively review breath hydrogen test (BHT) results to determine whether age has an effect on the clinical application of the fructose BHT and compare this with the lactose BHT.
Patients And Methods:
Patients were referred to a gastroenterology breath-testing clinic (2003-2008) to investigate carbohydrate malabsorption as a cause of gastrointestinal symptoms. Patients received either 0.5 g/kg body weight of fructose (maximum of 10 g) or 2 g/kg of lactose (maximum of 20 g), in water, and were tested for 2.5 hours.
Results:
Patient age showed a significant effect on the fructose BHT results (P < 0.001, 0.1-79 years old, n = 1093). The odds of testing positive for fructose malabsorption in paediatric patients (15 years old or younger, n = 760) decreased by a factor of 0.82/year (95% confidence interval 0.79-0.86, P < 0.001). There were 88.2% positive in younger than 1-year-olds, 66.6% in 1- to 5-year-olds, 40.4% in 6- to 10-year-olds, and 27.1% in 10- to 15-year-olds. In contrast, 39.3% of lactose BHTs were positive, with no significant relation between patient age and test result (P = 0.115, 0.1-89 years old, n = 3073).
Conclusions:
The majority of infants with gastrointestinal symptoms exhibited fructose malabsorption, but the capacity to absorb fructose increased with patient age up to 10 years old. The low threshold for fructose absorption in younger children has significant implications for the performance and interpretation of the fructose BHT and for the dietary consumption of fructose in infants with gastrointestinal symptoms.
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