RESUMO
BACKGROUND: Environmental enteropathy (EE) is a common intestinal condition among children living in low- and middle-income countries and is associated with diminished enteric immunity to gastrointestinal pathogens, and possibly to oral vaccine antigens. The goal of this study was to examine associations between biomarkers of EE and immunogenicity to the pentavalent rotavirus vaccine (RV5). METHODS: Infants were recruited 1 day before their first RV5 immunization in León, Nicaragua, from public health rosters. Infants provided a preimmunization blood and stool sample, and a second blood sample 1 month after receipt of RV5. We measured immunoglobin A (IgA) seroconversion to the first dose of RV5 and concentrations of 4 previously identified fecal biomarkers of EE (alpha-1 antitrypsin, neopterin, myeloperoxidase and calprotectin). We then assessed associations between concentrations of these biomarkers, both individually and as combined scores, and seroconversion to the first dose of RV5. RESULTS: Of the 43 enrolled infants, 24 (56%) seroconverted after the first dose of RV5. As compared with infants who seroconverted, those who did not seroconvert had higher median concentrations of both myeloperoxidase (3.1 vs. 1.1 µg/mL, P = 0.002) and calprotectin (199.1 vs. 156.2 µg/mL, P = 0.03). Further, those who did not seroconvert had a higher median combined score of the 4 biomarkers as compared with those who seroconverted (6.5 vs. 4.5, P = 0.017). CONCLUSIONS: We found an association between biomarkers of EE and seroconversion to the first dose of RV5. It is possible that interventions that prevent or ameliorate EE may also improve oral rotavirus vaccine response.
Assuntos
Anticorpos Antivirais/sangue , Biomarcadores/análise , Diarreia Infantil/epidemiologia , Fezes/química , Vacinas contra Rotavirus/imunologia , Biomarcadores/metabolismo , Estudos de Coortes , Diarreia Infantil/metabolismo , Feminino , Humanos , Imunoglobulina A/sangue , Lactente , Complexo Antígeno L1 Leucocitário/análise , Masculino , Nicarágua , Peroxidase/análise , Rotavirus/imunologiaRESUMO
Tufting enteropathy (TE) is an uncommon disease causing intractable diarrheas starting in early childhood and resulting in failure to thrive, dependence on total parenteral nutrition, and eventually requiring transplantation for treatment. The diagnosis has been based on histology showing the presence of epithelial "tufts" in the small bowel and colonic mucosa and variable villus alterations with mild to no inflammatory changes and preserved brush border. The gene for TE has been identified to be the EpCAM gene on chromosome 2p21. With Institutional Review Board approval, all cases of intractable diarrhea in children in whom TE was suspected or diagnosed were retrieved from the pathology files (17 patients). Other cases of infantile, neonatal, and childhood diarrhea were also retrieved to serve as controls for the staining studies (total 37 patients). EpCAM/MOC31 antibody staining was performed on all cases. The study cohort comprised 17 patients (13 boys, 4 girls) with a diagnosis of TE ranging in age at diagnosis from 3 months to 9 years, all presenting with protracted diarrhea and/or failure to thrive, usually since birth. Staining with MOC31 was carried out in all but 2 patients (both consults) and was completely negative in the epithelium irrespective of the site of biopsy or resection. In contrast, MOC31 was positive in all other cases tested, giving a sensitivity and specificity of 100% for loss of staining. MOC31 is a diagnostic stain for TE and should be included in the panel in any case of prolonged diarrhea in children to exclude this possibility.
Assuntos
Antígenos de Neoplasias/análise , Moléculas de Adesão Celular/análise , Colo/química , Diarreia Infantil/metabolismo , Imuno-Histoquímica , Mucosa Intestinal/química , Intestino Delgado/química , Síndromes de Malabsorção/metabolismo , Fatores Etários , Biomarcadores/análise , Biópsia , Criança , Pré-Escolar , Colo/patologia , Diarreia Infantil/patologia , Regulação para Baixo , Molécula de Adesão da Célula Epitelial , Insuficiência de Crescimento/metabolismo , Insuficiência de Crescimento/patologia , Feminino , Humanos , Lactente , Mucosa Intestinal/patologia , Intestino Delgado/patologia , Síndromes de Malabsorção/patologia , Masculino , Valor Preditivo dos Testes , Prognóstico , Estudos RetrospectivosRESUMO
BACKGROUND AND OBJECTIVE: Postpartum vitamin A supplementation is a strategy used to combat vitamin A deficiency and seems to reduce maternal/infant morbidity and mortality. However, studies have shown that a dose of 200 000 IU (World Health Organization [WHO] protocol) does not seem to provide adequate retinol levels in maternal breast milk, infant serum, and infant tissue. The objective of this study was to compare the effect of postpartum maternal supplementation with 400 000 IU (International Vitamin A Consultative Group protocol) compared with 200 000 IU of vitamin A on infant morbidity. METHODS: This was a randomized controlled, triple-blinded clinical trial conducted at 2 public maternity hospitals in Recife in northeastern Brazil. There were 276 mother-child pairs that were allocated to 2 treatment groups: 400 000 IU or 200 000 IU of vitamin A. They were followed up for >6 months to evaluate infant morbidity. RESULTS: Fever (rate ratio [RR]: 0.92 [95% confidence interval (CI): 0.75-1.14]), diarrhea (RR: 0.96 [95% CI: 0.72-1.28]), otitis (RR: 0.94 [95% CI: 0.48-1.85]), acute respiratory infection (RR: 1.03 [95% CI: 0.88-1.21]), the need for intravenous rehydration (RR: 2.08 [95% CI: 0.64-2.07]), and the use of antibiotic treatment (RR: 0.80 [95% CI: 0.43-1.47]) did not differ significantly between the 2 treatment groups. CONCLUSIONS: Our findings suggest that postpartum maternal supplementation with 400 000 IU of vitamin A does not provide any additional benefits in the reduction of illness in children aged <6 months; therefore, we do not support the proposal to increase the standard vitamin A dose in the existing WHO protocol.
Assuntos
Diarreia Infantil/prevenção & controle , Suplementos Nutricionais , Deficiência de Vitamina A/tratamento farmacológico , Vitamina A/administração & dosagem , Administração Oral , Adulto , Brasil/epidemiologia , Diarreia Infantil/epidemiologia , Diarreia Infantil/metabolismo , Relação Dose-Resposta a Droga , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Leite Humano/química , Morbidade/tendências , Período Pós-Parto , Resultado do Tratamento , Vitamina A/farmacocinética , Deficiência de Vitamina A/epidemiologia , Vitaminas/administração & dosagem , Vitaminas/farmacocinética , Adulto JovemRESUMO
A series of studies have shown that the heavy burdens of diarrheal diseases in the first 2 formative years of life in children living in urban shanty towns have negative effects on physical and cognitive development lasting into later childhood. We have shown that APOE4 is relatively common in shanty town children living in Brazil (13.4%) and suggest that APOE4 has a protective role in cognitive development as well as weight-for-height in children with heavy burdens of diarrhea in early childhood (64/123; 52%), despite being a marker for cognitive decline with Alzheimer's and cardiovascular diseases later in life. APOE2 frequency was higher among children with heaviest diarrhea burdens during the first 2 years of life, as detected by PCR using the restriction fragment length polymorphism method, raising the possibility that ApoE-cholesterol balance might be critical for growth and cognitive development under the stress of heavy diarrhea burdens and when an enriched fat diet is insufficient. These findings provide a potential explanation for the survival advantage in evolution of genes, which might raise cholesterol levels during heavy stress of diarrhea burdens and malnutrition early in life.
Assuntos
Apolipoproteínas E/genética , Diarreia Infantil/genética , Polimorfismo Genético/genética , Apolipoproteínas E/metabolismo , Brasil , Desenvolvimento Infantil , Pré-Escolar , Cognição , Estudos de Coortes , Diarreia Infantil/complicações , Diarreia Infantil/metabolismo , Feminino , Frequência do Gene , Genótipo , Humanos , Lactente , Recém-Nascido , Masculino , Mucosa Bucal/citologia , Reação em Cadeia da Polimerase , Fatores SocioeconômicosRESUMO
A series of studies have shown that the heavy burdens of diarrheal diseases in the first 2 formative years of life in children living in urban shanty towns have negative effects on physical and cognitive development lasting into later childhood. We have shown that APOE4 is relatively common in shanty town children living in Brazil (13.4 percent) and suggest that APOE4 has a protective role in cognitive development as well as weight-for-height in children with heavy burdens of diarrhea in early childhood (64/123; 52 percent), despite being a marker for cognitive decline with Alzheimers and cardiovascular diseases later in life. APOE2 frequency was higher among children with heaviest diarrhea burdens during the first 2 years of life, as detected by PCR using the restriction fragment length polymorphism method, raising the possibility that ApoE-cholesterol balance might be critical for growth and cognitive development under the stress of heavy diarrhea burdens and when an enriched fat diet is insufficient. These findings provide a potential explanation for the survival advantage in evolution of genes, which might raise cholesterol levels during heavy stress of diarrhea burdens and malnutrition early in life.
Assuntos
Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Apolipoproteínas E/genética , Diarreia Infantil/genética , Polimorfismo Genético/genética , Apolipoproteínas E/metabolismo , Brasil , Desenvolvimento Infantil , Cognição , Estudos de Coortes , Diarreia Infantil/complicações , Diarreia Infantil/metabolismo , Frequência do Gene , Genótipo , Mucosa Bucal/citologia , Reação em Cadeia da Polimerase , Fatores SocioeconômicosAssuntos
Diarreia Infantil/genética , Poli-Hidrâmnios/epidemiologia , Abdome , Antiporters/genética , Antiportadores de Cloreto-Bicarbonato , Cloretos/metabolismo , Consanguinidade , Diarreia Infantil/metabolismo , Diarreia Infantil/fisiopatologia , Feminino , Humanos , Hiponatremia/etiologia , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/fisiopatologia , Masculino , Peristaltismo , Gravidez , Transportadores de SulfatoRESUMO
Se realizó un estudio prospectivo en el servicio de pediatría del Hospital de la Victoria en el que se consideraron las siguientes variables en 44 pacientes con enfermedad diarreica: sexo, edad, características clínicas de la enfermedad diarreica, medición del pH, electrólitos en materia fecal y azúcares reductores, las cuales se consideran fundamentales para poder hacer dignóstico etiológico de la diarrea y su respectivo tratamiento
Assuntos
Humanos , Criança , Diarreia Infantil/diagnóstico , Diarreia Infantil/epidemiologia , Diarreia Infantil/etiologia , Diarreia Infantil/metabolismo , Diarreia Infantil/fisiopatologia , Diarreia Infantil/terapia , Eletrólitos , Eletrólitos/químicaRESUMO
A diarréia persistente, uma condiçäo altamente prevalente em países em desenvolvimento, ocasiona diferentes alteraçöes morfológicas e funcionais na mucosa do intestino delgado, incluindo aumento da permeabilidade a diversas moléculas de prova. Investiga-se, pela primeira vez, a permeabilidade intestinal ao Cr-EDTA em crianças brasileiras com diarréia persistente. O teste de absorçäo do Cr-EDTA foi realizado em 13 crianças controle e em 14 com diarréia persistente, oferecendo-se 50 µCi da substância teste, por via oral, com posterior detecçäo da radioatividade excretada na urina de 24 horas. Houve diferença estatisticamente significante entre o grupo controle (mediana = 1,26 variaçäo = 0,20-3,31 por cento) e com diarréia persistente (mediana = 4,68; variaçäo = 1,40-10,29 por cento). Estabelecendo como padräo de referência de normalidade para o teste de absorçäo urinária de Cr-EDTA os valores mínimo e máximo encontrados no grupo controle, observaram-se que 61,5 por cento dos pacientes com diarréia persistente apresentaram resultado alterados. Nos pacientes com diarréia persistente, a excreçäo do Cr-EDTA foi significativamente maior no grupo que fez uso de dieta à base de hidrolisado protéico e/ou nutriçäo parenteral total, em comparaçäo com o que näo fez, demonstrando sua possível utilidade como indicador de gravidade. Em quatro pacientes com diarréia persistente, o teste foi realizado após a recuperaçäo clínica, sendo que houve queda nos valores de excreçäo em todos os casos. A partir destes dados, pode-se concluir que: 1) na diarréia persistente deve haver alteraçäo na permeabilidade intestinal, que permitiria a entrada aumentada de antígenos alimentares locais, com subseqüente sensibilizaçäo e enteropatia alérgica, contribuindo para a perpetuaçäo do ciclo de diarréia, má absorçäo e desnutriçäo; 2) o teste do Cr-EDTA pode ser útil como indicador de gravidade na diarréia persistente; 3) a alteraçäo da permeabilidade intestinal é um fenômeno secundário na diarréia persistente e, com a reconstruçäo da barreira intestinal, ocorre normalizaçäo da mesma.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Diarreia Infantil/metabolismo , Ácido Edético/farmacocinética , Intestino Delgado/metabolismo , Permeabilidade , Absorção , Radioisótopos de Cromo/farmacocinética , Radioisótopos de Cromo/urinaRESUMO
Persistent diarrhea, a condition highly prevalent in developing countries, causes different morphological and functional alterations of the mucosa of the small intestine, including increased permeability to different test molecules. In the present study we investigate for the first time the intestinal permeability to 51Cr-EDTA of Brazilian children with persistent diarrhea. The test of 51Cr-EDTA absorption was performed in 13 control children and in 14 children with persistent diarrhea by offering 50 microCi of the test substance by the oral route, with later detection of radioactivity excreted in 24-hour urine. There was a statistically significant difference between the control group (median = 1.26; range = 0.20-3.31%) and the group with persistent diarrhea (median = 4.68; range = 1.40-10.29%). Using the minimum and maximum values detected in the control group as the normal reference standard for the test of urinary 51Cr-EDTA absorption, we observed that 61.5% of the patients with persistent diarrhea showed altered results. Among the patients with persistent diarrhea, 51Cr-EDTA excretion was significantly higher in the group fed a protein hydrolysate diet and/or total parenteral nutrition than in the group that did not receive this diet. In four patients with persistent diarrhea, the test was performed after clinical recovery, with a fall in the excretion levels in all cases. On the basis of these data, we may conclude that: 1) in persistent diarrhea there must be alteration of intestinal permeability that might permit an increased entry of local alimentary antigens, with subsequent sensitization and allergic enteropathy, contributing to the perpetuation of the diarrhea, malabsorption and malnutrition cycle; 2) the 51Cr-EDTA test may be useful as an indicator of severity in persistent diarrhea; 3) alteration of intestinal permeability is a secondary phenomenon in persistent diarrhea, with normalization occurring after reconstruction of the intestinal barrier.
Assuntos
Diarreia Infantil/metabolismo , Ácido Edético/farmacocinética , Intestino Delgado/metabolismo , Absorção , Criança , Pré-Escolar , Radioisótopos de Cromo/farmacocinética , Radioisótopos de Cromo/urina , Doença Crônica , Feminino , Humanos , Lactente , Masculino , PermeabilidadeRESUMO
Recently we reported on the application of a method for protein determination which measures nitrogen in Kjeldahl digests colorimetrically. This procedure has the advantage of eliminating the distillation and titration steps of the Kjeldahl method and it is ideal for nutritional studies, since many samples can be run in a single day. Accordingly, the purpose of the present report was to extend the application of this method to the determination of the protein content of commercially available foods such as dairy products, dry cereals or cereal based products and legumes and also to evaluate this method in the determination of the protein content of the mixtures of cooked foods served during lunch at the cafeteria of the Universidad Simón Bolívar, Caracas. In both cases the results of the colorimetric nitrogen agreed very well with those obtained by the macro Kjeldahl, indicating that the colorimetric method may be used in monitoring the protein content of commercial foods and in evaluating the protein offered in institutional food services. Finally, to further demonstrate the value of this method in clinical trials, we used it to monitor the daily nitrogen intake and nitrogen losses in 43 male young children with acute diarrhoea, and 15 with persistent diarrhoea fed liquid formulae, and showed that protein digestibility and retention were higher in persistent than in acute diarrhoea. The severity of acute diarrhoea affected negatively (r = -0.62) the percentage of protein absorbed, whereas the protein absorbed (r = 0.70) and retained (r = 0.55) correlated positively with protein consumption.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Diarreia Infantil/metabolismo , Proteínas Alimentares/análise , Análise de Alimentos/métodos , Alimentos Formulados/análise , Nitrogênio/análise , Colorimetria/métodos , Laticínios/análise , Grão Comestível/química , Fabaceae/química , Humanos , Lactente , Masculino , Nitrogênio/metabolismo , Plantas MedicinaisRESUMO
1. Daily fecal loss and daily clearance of alpha-1-antitrypsin were determined in 30 infants without intestinal disorders and in 21 with persistent diarrhea. 2. Stools were collected during a 48-h period and a randomly obtained single sample was also collected. Blood samples were also collected from the infants, and alpha-1-antitrypsin was measured by radial immunodiffusion in both stool and serum. 3. No difference in daily fecal loss (mg/d) of alpha-1-antitrypsin was detected between the control group and the group with persistent diarrhea (11 +/- 9.3 vs 18.5 +/- 20 mg/d). No difference in daily alpha-1-antitrypsin clearance (ml/d) was detected between the control group and the group with persistent diarrhea (4.3 +/- 3.6 vs 5.2 +/- 4.8 ml/d). 4. There was a strong correlation between daily fecal loss and daily clearance of alpha-1-antitrypsin (N = 50). There was a weak correlation between the concentrations of alpha-1-antitrypsin in randomly obtained single samples and daily fecal loss of the antiprotease (N = 25; r = -0.183; P < 0.01). 5. We conclude that: a) there is no increased fecal loss of alpha-1-antitrypsin persistent in diarrhea; b) fecal alpha-1-antitrypsin clearance is not necessary to estimate the enteric loss of the antiprotease; c) the determination of alpha-1-antitrypsin in random samples of feces is not a reliable method.
Assuntos
Diarreia Infantil/metabolismo , Fezes/química , alfa 1-Antitripsina/análise , Diarreia Infantil/sangue , Humanos , Imunodifusão , Lactente , Recém-Nascido , Enteropatias Perdedoras de Proteínas/metabolismo , Fatores de TempoRESUMO
A double-masked clinical trial was conducted to assess the effects of inclusion of beans in a mixed diet for young Peruvian children with acute diarrhea. Dietary treatment consisted of either rice, beans, and vegetable oil (group RB, n = 25) or rice, soy-protein isolate, corn syrup solids, and vegetable oil (group RS, n = 21), each given in amounts up to 150 kcal/kg body weight per day immediately following rehydration therapy. The groups were generally similar at the time of admission, and there were no differences in the rates of treatment failure (8% in group RB, 14% in group RS; P = .65). Mean stool outputs were 83 +/- 46 (SD) g/kg body weight in group RB and 71 +/- 43 g/kg body weight in group RS on day 1, and these outputs consistently ranged from 25% to 40% greater in group RB than in group RS (P = .058). By contrast, the median duration of liquid stool excretion was substantially less in group RB than in group RS (60 vs 121 hours, P = .01). The fractional absorption of carbohydrate, fat, and total energy was significantly greater by children in group RS, but there were no differences in net apparent absorption of these nutrients because the children in group RB consumed significantly more of their assigned diet. Children in group RS gained significantly more weight during the whole period of observation (194 g vs 1 g, P = .047), but these differences could be entirely explained by the weight (and presumably fluid) changes on day 1. There were no consistent differences by dietary group in any of the other anthropometric indicators.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Diarreia Infantil/dietoterapia , Fabaceae , Plantas Medicinais , Doença Aguda , Diarreia Infantil/metabolismo , Carboidratos da Dieta/metabolismo , Gorduras na Dieta/metabolismo , Método Duplo-Cego , Fabaceae/metabolismo , Fezes , Humanos , Lactente , Absorção Intestinal , Nitrogênio/metabolismo , Peru , Resultado do TratamentoRESUMO
To determine whether rice cereal could be used to complement a cow milk-based diet in the nutritional management of infants with acute diarrhea, we assessed its digestion and absorption in eight affected male infants, 69 to 131 days of age. They received cow milk formula with 5.4% lactose (diluted 1:1 with water and precooked rice cereal) 5 to 22 hours after admission and rehydration. The first feeding consisted of milk diluted with carbon 13-enriched rice cereal. A 48-hour fecal collection and balance study was performed. Rice cereal was reasonably well absorbed (84.0% to 95.8%) by seven of the eight infants. The study was repeated in seven of the infants after they had recovered. Our results indicated that rice cereal is well absorbed by young infants with acute diarrhea and that it is an adequate nutrient supplement for this patient population.
Assuntos
Gastroenterite/metabolismo , Alimentos Infantis , Absorção Intestinal , Oryza , Doença Aguda , Animais , Isótopos de Carbono , Diarreia Infantil/metabolismo , Diarreia Infantil/terapia , Ingestão de Alimentos , Fezes , Humanos , Lactente , Masculino , LeiteRESUMO
A randomized clinical trial was completed to study the severity, duration, and nutritional outcome of acute diarrhea in 85 Peruvian children between 5 and 24 months of age who received a soy-protein-isolate, lactose-free formula (group SF) or one of two mixtures of home-available foods, all in amounts up to 110 kcal/kg of body weight/day. The mixed diets contained either wheat flour, pea flour, carrot flour, sucrose, and vegetable oil (group WP) or potato flour, dried whole milk, carrot flour, sucrose, and oil (group PM). The characteristics of the children in each group were generally similar initially. There were no differences in treatment failure rate by diet group. Fecal outputs were similar in all groups during the first day of treatment, averaging 60 to 65 g/kg/day. However, stool outputs were greater for the PM group than for other groups on days 3 and 4, and were less for the SF group than the other groups on days 5 and 6. The estimated median durations of diarrhea in the WP group (52 h) and PM group (53 h) were significantly less than in the SF group (154 h, p = 0.005). Energy intakes, energy absorption, and nitrogen retention (% of intake) were generally similar in all dietary groups, although there were minor differences in the absorption of specific macronutrients. Children in all groups gained weight during hospitalization, and there were no significant differences by diet group in the change in anthropometric status during treatment. We conclude that these locally available, low-cost staple food mixtures offer a safe and nutritionally adequate alternative to a commercially produced lactose-free formula for the dietary management of young children with acute diarrhea in this setting.
Assuntos
Diarreia Infantil/dietoterapia , Alimentos Formulados , Glycine max , Lactose , Proteínas de Vegetais Comestíveis , Doença Aguda , Análise de Variância , Diarreia Infantil/metabolismo , Diarreia Infantil/fisiopatologia , Assistência Domiciliar , Humanos , Lactente , Masculino , Estado Nutricional , Proteínas de SojaRESUMO
We studied urinary acidification daily during the hospital course of 16 infants with acute gastroenteritis and metabolic acidosis. Urine pH value on admission was higher than 5.5 in 14 (87%) patients. We hypothesized that inappropriate urinary acidification was due to sodium deficiency and inadequate sodium delivery to the distal nephron. Forty-one urinary samples were collected during metabolic acidosis. The mean pH of 24 urine samples with sodium concentration less than 10 mmol/L was significantly higher than the pH of 17 samples with sodium concentration greater than 10 mmol/L (6.04 +/- 0.06 vs 5.19 +/- 0.1; p less than 0.001). The urine ratios of titratable acid to creatinine and of total acidity to creatinine were significantly higher in urine samples containing more sodium (p less than 0.02), whereas the ammonium/creatinine ratio was not. After administration of furosemide or correction of the sodium deficit, appropriate acidification was observed. We conclude that impaired urinary acidification is frequently found during metabolic acidosis in infants with acute gastroenteritis and results from a sodium deficit rather than from transient distal renal tubular acidosis.
Assuntos
Acidose Tubular Renal/etiologia , Diarreia Infantil/complicações , Sódio/urina , Doença Aguda , Fatores Etários , Diarreia Infantil/metabolismo , Diarreia Infantil/terapia , Hidratação , Furosemida/administração & dosagem , Furosemida/farmacologia , Humanos , Concentração de Íons de Hidrogênio , Lactente , Injeções Intravenosas , Sódio/deficiência , Sódio/metabolismo , Fatores de TempoRESUMO
To determine how the carbohydrate (CHO) content of "semielemental" formulas affects tolerance and macronutrient absorption, we enrolled 12 infants with severe diarrhea in two successive metabolic balance studies. The infants received, in random order, one of two isocaloric formulas that differed mainly in their CHO and fat concentrations. No significant differences were found between the two feeding periods for peak breath hydrogen levels and fecal osmolality. The low-CHO formula was tolerated better than the high-CHO formula, as indicated by a significantly lower stool output (mean +/- SD 387 +/- 230 vs 764 +/- 443 gm, respectively; p less than 0.05), and higher fecal pH (5.9 +/- 0.7 vs 4.9 +/- 0.5; p less than 0.05). Macronutrient absorption was greater during the ingestion of the low-CHO formula, as indicated by a significantly higher coefficient of fat absorption (p less than 0.005) and lower total fecal energy (mean +/- SD for high- vs low-CHO formula, 372 +/- 205 vs 207 +/- 102 kcal; p less than 0.05), which resulted from a lower CHO excretion (p less than 0.05). A correlation coefficient between the energy derived from CHO in feces and the total stool output was significant for both the high-CHO formula (r = 0.83; p less than 0.001) and the low-CHO formula (r = 0.7; p = 0.01). The CHO concentration of the special infant formula that we tested had an overriding effect on stool output and on fat and energy absorption.
Assuntos
Diarreia Infantil/dietoterapia , Carboidratos da Dieta/administração & dosagem , Alimentos Infantis/efeitos adversos , Doença Crônica , Diarreia Infantil/metabolismo , Carboidratos da Dieta/metabolismo , Carboidratos da Dieta/farmacologia , Gorduras na Dieta/administração & dosagem , Gorduras na Dieta/metabolismo , Ingestão de Energia , Fezes/análise , Humanos , Lactente , Absorção Intestinal/efeitos dos fármacos , Masculino , Distribuição AleatóriaRESUMO
Because rice remains the most available carbohydrate in developing countries, where chronic diarrhea is most prevalent, we compared the in vitro hydrolysis and clinical tolerance of rice glucose polymer with those of corn glucose polymer. Rice glucose polymer hydrolysis to D-glucose and short-chain polymers (polymers with two to four glucose units and those with five or more units) was similar to that for corn glucose polymers during incubation with saliva or duodenal aspirates. However, rice glucose polymers yielded more short-chain products than corn glucose polymers during incubation with pooled mucosal homogenates (p less than 0.01). In vivo tolerance testing of 16 infants with chronic diarrhea confirmed that rice glucose polymers were well tolerated and, compared with corn glucose polymers, achieved a higher maximal increase of serum glucose concentration (36.6 +/- 7.3 vs 27.6 +/- 10.3 mg/dl; p less than 0.02), a shorter time to peak serum glucose concentration (34.0 +/- 10.2 vs 52.5 +/- 25.7 minutes; p less than 0.02), and a greater area under the serum glucose response curve at 30 minutes (538 +/- 131 vs 1035 +/- 501 cm; p less than 0.02). We conclude that rice glucose polymers are rapidly hydrolyzed in vitro and in vivo and are more rapidly absorbed than are corn glucose polymers in children with chronic diarrhea.
Assuntos
Diarreia Infantil/metabolismo , Glucose/metabolismo , Oryza , Zea mays , Absorção , Amilases/metabolismo , Glicemia/análise , Doença Crônica , Duodeno/enzimologia , Nutrição Enteral , Glucose/farmacocinética , Humanos , Hidrólise , Lactente , Mucosa Intestinal/enzimologia , Pâncreas/enzimologia , Distribuição Aleatória , Saliva/enzimologiaRESUMO
Se estudiaron 50 lactantes con diarrea de menos de cinco días de evolución, de los cuales la mitad se realimentó con una leche con bajo contenido de lactosa (grupo experimental) y los restantes con una fórmula láctea en polvo (grupo control). Durante un seguimiento de 2 meses evaluaron el curso clínico, los cambios antropométricos y la tolerancia a los prodctos. La evolución clínica, las etiologías y la duración promedio de los episodios (3,6 + ou - 1,9 y 3,9 + ou - 1,9 días en experimentales y controles, respectivamente) fueron comparables en ambos grupos. No se observó deterioro nutricional durante ni después del episodio. En 2 niños (8,3%) del grupo control fue necesario administrar la leche sin lactosa para que remitieran los sintomas. La aceptabilidad a ambos productos fue satisfactoria. Estos resultados sugieren que la utilización de productos con bajo contenido de lactosapuede ser ventajosa en el manejo clínico de lactantes con diarrea aguda y evidencia de intolerancia por lactosa
Assuntos
Lactente , Humanos , Diarreia Infantil/dietoterapia , Lactose/administração & dosagem , Leite , Doença Aguda , Infecções Bacterianas , Diarreia Infantil/etiologia , Diarreia Infantil/metabolismo , Alimentos Infantis , Intolerância à Lactose/complicações , Lactose/metabolismo , Estado NutricionalRESUMO
Fifty infants with acute diarrhea (less than or equal to 5 days of duration) were refed with either a low-lactose formula (experimental group, N = 25) or whole powdered cow's milk (control group, N = 25). During a two-month follow up etiology, clinical course, changes of anthropometric parameters and tolerance to the milk products were evaluated. The etiology of diarrhoea, the mean duration of the episodes (3.6 +/- 1.9 and 3.9 +/- 1.9 days in the experimental and control group, respectively) and the clinical course were comparable in both groups. Nutritional parameters remained unchanged during and after the episode. In two children (8.3%) of the control group stools continued to be liquid, fecal pH was 5 and reducing substances were positive. They had to be refed with the low-lactose product to induce remission of the symptoms. Both products were well tolerated. These findings suggest that availability of low-lactose formulae may be advantageous in the clinical management of infants with acute diarrhea and evidence of lactose intolerance.