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Assessment of small-intestine permeability in healthy Nigerian children is altered by urinary volume and voiding
Ibukun Afolami1,2, Folake Olukemi Samuel1, Martin Mwangi2
1Department of Human Nutrition, University of Ibadan, Ibadan, Nigeria.
Insights
Urinary volume significantly impacts small intestine permeability tests in children. Higher urinary volume correlates with altered sugar recovery, suggesting volume is a key factor in test interpretation.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Biomedical Research
Background:
- Small intestine permeability is a crucial indicator of gut health.
- Multi-sugar tests are commonly used to assess intestinal permeability.
- Factors influencing test accuracy, such as urinary volume, require investigation.
Purpose of the Study:
- To investigate the effect of voided urinary volume on small intestine permeability ratios in healthy children.
- To determine if urinary volume influences the interpretation of multi-sugar permeability tests.
Main Methods:
- Assessed small intestine permeability in 155 healthy Nigerian children (3-5 years) using a multi-sugar test (lactulose, sucrose, mannitol, rhamnose).
- Categorized children into low (LV) and high (HV) urinary volume groups based on percentile rankings.
- Compared sugar recovery ratios and permeability indices between LV and HV groups, and between voiding (VC) and non-voiding (NVC) children.
Main Results:
- Higher urinary volume (HV) was associated with significantly increased mannitol and rhamnose recovery compared to low urinary volume (LV).
- Lactulose recovery was lower in HV children, though not statistically significant (p=0.071).
- Lactulose-mannitol, lactulose-rhamnose, and sucrose-rhamnose ratios were significantly higher in the LV group, indicating altered permeability.
Conclusions:
- Total urinary volume is a significant variable affecting small intestine permeability measurements in multi-sugar tests.
- Voiding status before testing may independently influence specific sugar recovery and permeability ratios.
- Recommendations for conducting multi-sugar small intestine permeability tests should consider and account for variations in urinary volume.
Objective:
This study aimed to uncover the effect of voided urinary volume on small intestine permeability ratios in healthy children.
Methods:
We assessed small intestine permeability in 155 apparently healthy children, aged 3-5 years old, without any visible symptoms of disease, in a rural, malaria-endemic setting in Nigeria, using a multi-sugar test solution, comprising lactulose, sucrose, mannitol, and rhamnose. Children were categorized into low urinary volume (LV) and high urinary volume (HV), based on the volume of urine voided per kg body weight per hour. LV children voided less than 25th percentile of the total population, while HV children voided greater than 75th percentile of the total population. Urinary volume excreted over a 90-minute period after administration of the test solution was measured, and differences in sugar ratios were compared between children with high (HV) and low urinary volumes (LV), as well as between children who voided (VC) or who were not able to void (NVC) before administration of the test solution.
Results:
Urinary mannitol and rhamnose recovery were 44% (p = 0.002) and 77% (p<0.001) higher in HV children compared to LV children respectively, while urinary lactulose recovery was 34% lower (p = 0.071). There was no difference in urinary sucrose recovery between groups (p = 0.74). Lactulose-mannitol ratio, lactulose-rhamnose ratio and sucrose-rhamnose ratio were all significantly higher in children in the LV group compared to children in the HV group (p<0.001). In a multiple regression analysis, urinary volume and voiding status combined, explained 13%, 23% and 7% of the variation observed in lactulose-mannitol, lactulose-rhamnose and sucrose-rhamnose ratios, respectively.
Conclusion:
Sugar permeability ratios vary significantly with total urinary volume in multi-sugar small-intestine permeability tests. Voiding status before sugar administration appears to influence lactulose recovery, lactulose-rhamnose and sucrose-rhamnose ratios independently of total urinary volume. Evidence from this study suggests the need to take urinary volume into account when conducting multi-sugar small-intestine permeability tests.
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