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Calcium metabolism in children recovering from severe protein-energy malnutrition
Insights
Children with protein-energy malnutrition (PEM) absorb calcium efficiently during recovery, regardless of lactose intake. Continued calcium supplementation is recommended even after weight normalization.
Area of Science:
- Pediatric Nutrition
- Nutritional Biochemistry
- Gastroenterology
Background:
- Protein-energy malnutrition (PEM) is a critical condition in children.
- Calcium absorption is vital for recovery and bone health in malnourished children.
- The role of lactose in calcium absorption during PEM recovery requires further investigation.
Purpose of the Study:
- To evaluate intestinal calcium absorption in children with severe PEM during recovery.
- To determine the effect of lactose on calcium absorption in recovering malnourished children.
- To assess the duration of enhanced calcium absorption post-nutritional rehabilitation.
Main Methods:
- A randomized controlled trial involving 20 preschool children with severe edematous PEM.
- Comparison of intact milk formula versus lactose-free formula.
- Monitoring of calcium intake, absorption efficiency, and urinary/fecal calcium excretion during 45 days of recovery.
Main Results:
- High intestinal calcium absorption efficiency was observed in both groups, persisting post-normalization of body weight and lean mass.
- Lactose presence or absence did not significantly impact calcium absorption.
- Increased stool volume in the intact milk group did not correlate with increased fecal calcium loss.
Conclusions:
- Intestinal calcium absorption remains highly efficient in children recovering from PEM, irrespective of dietary lactose.
- Calcium supplementation should extend beyond weight normalization to ensure adequate bone mineralization.
- Lactose-free formulas are not necessary to optimize calcium absorption during PEM recovery.
Abstract:
Twenty preschool children with severe edematous protein-energy malnutrition (PEM) were studied during the first 45 days of recovery. All children received 4 g/kg/day of protein and 150 kcal/kg/day of energy from a milk-based recovery formula, providing 130-140 mg/kg/day of calcium (Ca). Children were randomized to two treatment groups, one receiving intact milk formula and the other a lactose-free preparation. Both groups showed a high efficiency of intestinal calcium absorption, sustained even after the normalization of weight for height and lean body mass. The presence or absence of lactose in the diet did not affect intestinal calcium absorption, and increased stool volume in the early period of recovery in the children receiving intact milk was not associated with higher fecal Ca losses. Urinary Ca excretion was within the range reported for healthy children under a normal diet. These results suggest that therapeutic amounts of calcium should be delivered to children with PEM well beyond the normalization of body weight and lean body mass.