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Carbohydrate malabsorption in acutely malnourished children and infants: a systematic review
Matilda A Kvissberg1, Prasad S Dalvi1, Marko Kerac1
1M.A. Kvissberg and R.H. Bandsma are with the Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University Medical Centre Groningen, University of Groningen, The Netherlands. P.S. Dalvi and R.H. Bandsma are with the Physiology and Experimental Medicine Program, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada. P.S. Dalvi is with the Center for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada. M. Kerac is with the Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. W. Voskuijl is with the College of Medicine, University of Malawi, Blantyre, Malawi. J.A. Berkley is with the Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom. J.A. Berkley is with the KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya. M.G. Priebe is with the Centre for Medical Biomics, University Medical Centre of Groningen, University of Groningen, The Netherlands. R.H. Bandsma is with the Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada.
Insights
Carbohydrate malabsorption, especially lactose malabsorption, is common in children with severe acute malnutrition (SAM). Further research is needed to confirm if dietary changes can improve clinical outcomes in these children.
Area of Science:
- Pediatric Nutrition
- Gastroenterology
- Global Child Health
Background:
- Severe acute malnutrition (SAM) causes approximately 1 million child deaths annually.
- Comorbidities like diarrhea and pneumonia contribute to high SAM mortality rates.
Purpose of the Study:
- To systematically review the prevalence of carbohydrate malabsorption in children diagnosed with SAM.
- To assess the impact of carbohydrate malabsorption on clinical outcomes in SAM.
Main Methods:
- Systematic review of observational and controlled intervention studies.
- Searched PubMed and Embase databases, including reference lists of selected articles.
- Included 20 articles analyzing direct or indirect measures of carbohydrate absorption in children with SAM.
Main Results:
- Most studies indicated carbohydrate malabsorption, particularly lactose malabsorption, in children with SAM.
- Evidence suggests a link between lactose malabsorption and increased diarrhea and reduced weight gain in children consuming lactose.
- Observational nature of studies limits conclusive evidence of a causal relationship between lactose malabsorption and worse clinical outcomes.
Conclusions:
- Carbohydrate malabsorption is prevalent in children suffering from SAM.
- Well-designed intervention studies are required to investigate if modifying carbohydrate/lactose content in therapeutic diets improves SAM outcomes.
- Further research is needed to understand the mechanisms involved in carbohydrate malabsorption and its impact on SAM.
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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