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Poor intestinal permeability in mildly stunted Nepali children: associations with weaning practices and Giardia lamblia infection

Published online by Cambridge University Press:  09 March 2007

Rie Goto ,
Catherine Panter-Brick ,
Christine A. Northrop-Clewes ,
Renu Manahdhar  and
Nhuchhe R. Tuladhar
Rie Goto
Affiliation:
Department of Anthropology, University of Durham, Durham, UK
Catherine Panter-Brick*
Affiliation:
Department of Anthropology, University of Durham, Durham, UK
Christine A. Northrop-Clewes
Affiliation:
Northern Ireland Centre for Diet and Health, University of Ulster, Coleraine, UK
Renu Manahdhar
Affiliation:
Department of Clinical Microbiology, Tribhuvan University, Kathmandu, Nepal
Nhuchhe R. Tuladhar
Affiliation:
Department of Clinical Microbiology, Tribhuvan University, Kathmandu, Nepal
*
*Corresponding author: Dr Catherine Panter-Brick, fax +44 191 374 7527, email Catherine.Panter-Brick@durham.ac.uk
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Abstract

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Studies in the Gambia, using the lactulose–mannitol dual-sugar intestinal permeability test (lactulose:mannitol ratio) as a non-invasive way of investigating mucosal damage, have shown that food malabsorption is significantly associated with early growth retardation. In this cross-sectional study, 210 poor urban Nepali children, 0–60 months old, were recruited and measured for height or length and weight, 167 were examined for intestinal permeability and 173 for parasite infection. Weaning and morbidity data were collected from 172 caretakers. Children were mildly stunted (mean height-for-age Z-score −1·45) and underweight (mean weight-for-age Z-score −1·62). The lactulose:mannitol ratio (0·26) was poorer than that of UK children (0·12), but similar to that found in Bengali children of the same age (0·24). Two stages of weaning, the onset supplementary feeding (6 months) and the cessation of breast-feeding (23 months), were shown to have differential impact. In children currently breast-feeding, the duration of supplementation was negatively related to lactose (P<0·001) and lactose:lactulose values (P<0·0001), indicating lactose maldigestion. In children who had ceased breast-feeding, a longer period of lactation was associated with poorer intestinal permeability (P=0·031), and poorer height-for-age (P=0·024), which was an unexpected result. No significant relationships were found between intestinal permeability and growth, or with morbidity and helminth infection, except in children with Giardia lamblia who had worse lactulose:mannitol ratios than those without (0·43 v. 0·25 respectively, P=0·014). It is likely that insults to the gut (e.g. Giardia) and challenges to the immune system (weaning) have a different impact in early and late infancy.

Keywords

Fat intakeEnergy expenditureEnergy balanceRespiratory quotientDietary induced thermogenesis
Type
Research Article
Information
British Journal of Nutrition , Volume 88 , Issue 2 , August 2002 , pp. 141 - 149
Copyright
Copyright © The Nutrition Society 2002

References

Almedom, AM (1991) Infant feeding in urban low-income households in Ethiopia: Determinants of weaning. Ecology of Food and Nutrition 25, 111–121.CrossRefGoogle Scholar
Behrens, RH, Lunn, PG, Northrop, CA, Hanlon, PW & Neale, G (1987) Factors affecting the integrity of the intestinal mucosa of Gambian children. American Journal of Clinical Nutrition 45, 1433–1441.CrossRefGoogle ScholarPubMed
Blood, J, Ingle, AR, Allison, N, Davies, GR & Hill, PG (1991) Rapid enzymic method for the measurement of mannitol in urine. Annals of Clinical Biochemistry 28, 401–406.CrossRefGoogle ScholarPubMed
Costello, AM (1989) Growth velocity and stunting in rural Nepal. Archives of Disease in Childhood 64, 1478–1482.CrossRefGoogle ScholarPubMed
Farthing, MJ (1984) Giardiasis: pathogenesis of chronic diarrhea and impact on child growth and development. In Chronic Diarrhea in Children, pp. 253–267 [Lebenthal, E, editor]. Vevey and New York, NY: Nestlé and Raven Press.Google Scholar
Gartoulla, RP (1998) Therapy Pattern of Conventional Medicine with Other Alternative Medicines – a Study in Medical Anthropology in Nepal. Kathmandu: RECID/NEPAL.Google Scholar
Goto, K, Chew, F, Torun, B, Peerson, JM & Brown, KH (1999) Epidemiology of altered intestinal permeability to lactulose and mannitol in Guatemalan infants. Journal of Pediatric Gastroenterology and Nutrition 28, 282–290.Google ScholarPubMed
Hamill, PW (1977) NCHS Growth Curves for Children, Birth–18 Months. Hyattsville, MD: National Center for Health Statistics, DHEW, (PHS), 78–1650.Google Scholar
Katz, J, West, KP Jr., LeClerq, SC, Thapa, MD, Khatry, SK, Shresta, SR, Pradhan, EK & Pohkrel, RP (1998) Agreement between clinical examination and parental morbidity histories of four children in Nepal. Journal of Tropical Pediatrics 44, 225–229.CrossRefGoogle Scholar
Kroeger, A (1983) Health interview surveys in development countries: a review of the methods and results. International Journal of Epidemiology 12, 465–481.CrossRefGoogle ScholarPubMed
Lohman, TG, Roche, AF & Martorell, R (1988) Anthropometric Standardization Reference Manual. Champaign, IL: Human Kinetics Books.Google Scholar
Lunn, PG (2000) The impact of infection and nutrition on gut function and growth in childhood. Proceedings of the Nutrition Society 59, 147–154.CrossRefGoogle ScholarPubMed
Lunn, PG, Erinoso, HO, Northrop-Clewes, CA & Boyce, SA (1998) Giardia intestinalis is unlikely to be a major cause of the poor growth of rural Gambian infants. Journal of Nutrition 129, 872–877.CrossRefGoogle Scholar
Lunn, PG, Northrop, CA & Northrop, AJ (1989) Automated enzymatic assays for the determination of intestinal permeability probes in urine. 2. Mannitol. Clinica Chimica Acta 183, 163–170.CrossRefGoogle ScholarPubMed
Lunn, PG & Northrop-Clewes, CA (1992) Intestinal permeability: update on the enzymatic assay of mannitol. Clinica Chimica Acta 205, 151–152.CrossRefGoogle ScholarPubMed
Lunn, PG, Northrop-Clewes, CA & Downes, RM (1991) Recent development in the nutritional management of diarrhoea, 2. Chronic diarrhoea and malnutrition in The Gambia: studies in intestinal permeability. Transactions of the Royal Society of Tropical Medicine and Hygiene 85, 8–11.CrossRefGoogle ScholarPubMed
Martorell, R, Kettek Khan, L & Schroeder, DG (1994) Reversibility of stunting: epidemiological findings in children from developing countries. European Journal of Clinical Nutrition 48, Suppl. 1, S45–S57.Google ScholarPubMed
Moffat, T (1998) Urbanization and child growth in Nepal. American Journal of Human Biology 10, 307–315.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
Moffat, T (2001) A biocultural investigatiom of the weanling's dilema in Kathmandu, Nepal: do universal recommendations for weaning practices make sense? Journal of Biosocial Science 33, 321–338.CrossRefGoogle Scholar
Molbak, K, Gottschau, A, Aaby, P, Hojlyng, N, Ingholt, L & Da Silva, APJ (1994) Prolonged breast feeding, diarrhoeal disease, and survival of children in Guinea-Bissau. British Medical Journal 308, 1403–1406.CrossRefGoogle ScholarPubMed
Noone, C, Menzies, IS, Banatvala, JE & Scopes, JW (1986) Intestinal permeability and lactose hydrolysis in human rotaviral gastroenteritis assessed simultaneously by non-invasive differential sugar permeation. European Journal of Clinical Investigation 16, 217–225.CrossRefGoogle ScholarPubMed
Northrop, CA, Lunn, PG & Behrens, RH (1990) Automated enzymatic assays for the determination of intestinal permeability probes in urine. 1. Lactulose and lactose. Clinica Chimica Acta 187, 79–88.CrossRefGoogle ScholarPubMed
Northrop-Clewes, CA, Rousham, EK, Mascie-Taylor, CGN & Lunn, PG (2001) Anthelmintic treatment of rural Bangladeshi children: effects on host physiology, growth and biochemical status. American Journal of Clinical Nutrition 73, 53–60.CrossRefGoogle ScholarPubMed
Northrop-Clewes, CA, Lunn, PG & Downes, RM (1997) Lactose maldigestion in breast-feeding Gambian infants. Journal of Pediatric Gastroenterology and Nutrition 24, 257–263.Google ScholarPubMed
Panter-Brick, C (1992) Women's work and child nutrition: the food intake of 0–4 year old children in rural Nepal. Ecology of Food and Nutrition 29, 11–24.CrossRefGoogle Scholar
Panter-Brick, C (1997) Seasonal growth patterns in rural Nepali children. Annals of Human Biology 24, 1–8.CrossRefGoogle ScholarPubMed
Panter-Brick, C (1998) Biological anthropology and child health: context, process and outcome. In Biosocial Perspective on Children, pp. 66–101 [Panter-Brick, C, editor]. Cambridge: Cambridge University Press.Google Scholar
Panter-Brick, C, Todd, A & Baker, R (1996) Growth status of homeless Nepali boys: do they differ from rural and urban controls? Social Science and Medicine 43, 441–451.CrossRefGoogle ScholarPubMed
Ross, DA & Vaughan, JP (1986) Health interview surveys in developing countries: a methodological review. Studies in Family Planning 17, 78–94.CrossRefGoogle ScholarPubMed
Rousham, EK, Northrop-Clewes, CA & Lunn, PG (1998) Maternal reports of child illness and the biochemical status of the child: the use of morbidity interviews in rural Bangladesh. British Journal of Nutrition 80, 451–456.CrossRefGoogle ScholarPubMed
Solomons, NW (1982) Giardias: nutritional implications. Reviews of Infectious Disease 4, 859–869.CrossRefGoogle ScholarPubMed
Strickland, SS & Tuffrey, VR (1997) Form and Function – a Study of Nutrition, Adaptation and Social Inequality in Three Gurung Villages of the Nepal Himalayas. London: Smith-Gordon and Company Ltd.Google Scholar
Tanner, JM (1986) Use and abuse of growth standards. In Human Growth, 2nd edition, pp. 95–109 [Falkner, F and Tanner, JM, editors]. New York, NY: Plenum Press.Google Scholar
Ulijaszek, SJ & Kerr, DA (1999) Anthropometric measurement error and the assessment of nutritional status. British Journal of Nutrition 82, 165–177.CrossRefGoogle ScholarPubMed
United Nations Children's Fund (1996) Children and Women of Nepal – a Situation Analysis. Kathmandu, Nepal: UNICEF.Google Scholar