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Carbohydrate malabsorption in children with severe protein energy malnutrition
Insights
Severe Protein-Energy Malnutrition (PEM) in Basotho children is linked to increased carbohydrate malabsorption, especially lactose malabsorption. This suggests careful lactose use during PEM treatment is advisable.
Area of Science:
- Nutritional Science
- Pediatric Gastroenterology
- Public Health Nutrition
Background:
- Severe Protein-Energy Malnutrition (PEM) poses significant health challenges in children.
- Understanding nutrient malabsorption is crucial for effective PEM treatment strategies.
- Lactose malabsorption is a common concern in pediatric malnutrition.
Purpose of the Study:
- To investigate the incidence of carbohydrate malabsorption, specifically lactose malabsorption.
- To assess malabsorption in Basotho children with severe PEM during treatment.
- To evaluate the impact of a dry skim milk (DSM)-sucrose-oil mixture on malabsorption.
Main Methods:
- A Hydrogen Breath Test (HBT) was administered to 105 children with PEM.
- Children received a dry skim milk (DSM)-sucrose-oil mixture.
- Lactose-free challenges were used to confirm lactose malabsorption.
Main Results:
- Carbohydrate malabsorption was more frequent in children with kwashiorkor (48%) compared to marasmus (15%), marasmic kwashiorkor (20%), and controls (24%).
- Lactose malabsorption accounted for at least two-thirds of carbohydrate malabsorption cases in kwashiorkor.
- Carbohydrate malabsorption onset was earlier in PEM children (approx. 13 months) than in controls (approx. 22 months).
- Diarrhea was more prevalent in PEM children with carbohydrate malabsorption.
Conclusions:
- Severe PEM is associated with a higher incidence of carbohydrate and lactose malabsorption.
- Lactose malabsorption in PEM children occurs earlier than in healthy children.
- Findings support the cautious use of physiological lactose doses in severe PEM treatment.
Abstract:
To determine the incidence of carbohydrate malabsorption, particularly lactose malabsorption in Basotho children with severe PEM during treatment with a dry skim milk (DSM)-sucrose-oil mixture, 105 children with PEM were submitted to a Hydrogen Breath Test (HBT) after administration of the mixture. Carbohydrate malabsorption occurred more frequently in children with kwashiorkor (28/58) than in those with marasmus (5/33), marasmic kwashiorkor (3/15) and healthy controls (8/34). The positive HBT appeared to be due to lactose malabsorption in at least two thirds of the children with kwashiorkor as it turned negative when the challenge was repeated with a lactosefree mixture. In controls malabsorption of carbohydrate (usually lactose) appeared at the age of 22 months, nearly a year later than in PEM. Diarrhoea occurred in 23 children with PEM and particularly in those with carbohydrate malabsorption. In 20 children Giardia was found in the stools without any observable effect on carbohydrate malabsorption, however. The findings support the cautious use of physiological doses of lactose in the treatment of severe PEM.