Carbohydrate malabsorption may increase daily energy requirements in infants

OBJECTIVE: Carbohydrate malabsorption in infants has been found to increase nutrient losses. However, the effect of this alteration on daily metabolic rate is unknown. We assessed daily metabolic rates in infants with asymptomatic carbohydrate malabsorption (ACM) after a single fruit juice load. METHODS: Sixteen healthy infants with ACM (63.3 +/- 5.6 cm, 7.5 +/- 1.0 kg, 5.6 +/- 0.8 mo, peak breath hydrogen [BH2] = 39.1 +/- 22.4 ppm) and 16 without ACM (64.3 +/- 3.9 cm, 7.8 +/- 1.0 kg, 5.0 +/- 0.8 mo, BH2 = 9.4 +/- 4.7 ppm), after a single fruit juice load, had 24-h energy expenditure (24-h EE; kcal x kg(-1) x d(-1)), resting (RMR; kcal x kg(-1) x d(-1)) and sleeping (SMR; kcal x kg(-1) x d(-1)) metabolic rates extrapolated from 3.5-h assessments in the Enhanced Metabolic Testing Activity Chamber. Furthermore, RMR was calculated with the World Health Organization (WHO), Schofield weight-based and weight- and height-based equations. Carbohydrate absorption was determined by BH2. Differences (P < 0.05) were determined by t test. RESULTS: All infants with ACM had greater (P < 0.05) extrapolated 24-h EE (91.2 +/- 24.8 versus 78.0 +/- 6.8) and RMR (71.8 +/- 15.2 versus 59.5 +/- 5.9). This represented an increase of 15-18.5%, respectively, in energy expenditures. Carbohydrate malabsorption was a significant determinant of EE, RMR, and SMR. However, the WHO (53.8 +/- 1.0 versus 54.1 +/- 0.9) and both Schofield equations (54.7 +/- 0.9 versus 54.9 +/- 1.0 and 50.6 +/- 7.5 versus 47.3 +/- 6.7) failed to detect any differences in RMR. There was a 20 percentile reduction in growth performance in infants with carbohydrate malabsorption. CONCLUSIONS: Infants with ACM following fruit juice ingestion may have increased daily energy expenditure leading to increased metabolic requirements.