Ineffectiveness of breath methane excretion as a diagnostic test for lactose malabsorption

BACKGROUND: In clinical and field conditions, breath gas analysis has been widely used in evaluating carbohydrate digestion. A field study was performed to determine the prevalence of lactose malabsorption in Myanmar children and to evaluate the possibility of using breath methane excretion to indicate lactose malabsorption in a field situation. METHODS: The study population consisted of 118 children aged 1 to 12 years. A hydrogen breath test after a lactose meal (2 g/kg, maximum 50 g) was used as a standard test. RESULTS: Lactose malabsorption was detected in 16.7% of children aged 1 to 2.9 years, with the prevalence increasing with age from 40.5% of those aged 3 to 5.9 years to 88.5% of those aged 6 to 8.9 years and reaching 91.7% in those aged 9 to 11.9 years. Lactose malabsorption was more prevalent when children were weaned before 4 months of age (87.2 vs. 41.1%; p < 0.01). Compared with lactose-tolerant children, those with lactose malabsorption had significantly higher concentrations of breath hydrogen excretion 60 minutes after the lactose test meal. Breath methane excretion was also significantly higher in samples at 120 minutes in children with lactose malabsorption. Breath methane excretion of greater than or equal to 2 parts per million at 180 minutes as a diagnostic test for lactose malabsorption had a sensitivity of 61.5% and a specificity of 84.6%. CONCLUSION: The breath methane test for lactose malabsorption has a lower sensitivity and specificity than the breath hydrogen test and therefore does not replace the lactose breath hydrogen test.     

印度尼西亚儿童牛奶摄入与乳糖吸收不良之间的关系

目的 探讨3~12岁印度尼西亚儿童牛奶摄入与乳糖吸收不良之间的关系。 方法 该研究为横断面研究。研究对象为在印度尼西亚雅加达中部随机选取的营养状况良好的174名3~12岁健康儿童,包括72名3~5岁儿童和102名6~12岁儿童。 结果 3~5岁儿童乳糖吸收不良患病率为20.8%（15/72）,6~12岁儿童乳糖吸收不良患病率为35.3%（36/102）。牛奶或乳制品摄入与乳糖吸收不良之间无显著关联性（P>0.05）。在氢呼气试验中,51例乳糖吸收不良儿童主要表现为腹泻（62%）、腹痛（52%）和恶心（5%）。 结论 3~12岁印度尼西亚儿童牛奶摄入和乳糖吸收不良无关联,这提示遗传易感性可能比乳糖摄入的适应机制更重要。     

Abdominal pain associated with lactose ingestion in children with lactose intolerance

The causal relationship between lactose ingestion and gastrointestinal symptoms is questionable. The aim of this study was to assess symptoms associated with milk ingestion in children with lactose maldigestion. Thirty children (11 males) age 3 to 17 years with lactose maldigestion were studied. In a double-blind, crossover design, subjects ingested 240 mL daily of either lactose-hydrolyzed or lactose-containing milk for 14 days. Diaries were kept daily that recorded diet, medication use, and symptoms. There was a significant increase in abdominal pain experienced by study participants during the lactose ingestion period when compared to the lactose-free period. We conclude that ingestion of 12 g of lactose daily is associated with increased abdominal pain in susceptible children with lactose maldigestion. A trial of dietary lactose restriction may be beneficial in reducing abdominal pain in children with lactose maldigestion.     

Follow-up study of survivors of severe protein energy manlnutrition

OBJECTIVE: To evaluate the nutritional profile of survivors of severe protein energy malnutrition on follow-up at 1-3 years and 5-7 years. DESIGN: Prospective and Cross-sectional point prevalence. METHODS: Group I comprised 50 severely malnourished children dischared 5-7 years from nutritional rehabilitation center and Group II comprised 50 children discharged 1-3 years ago. The nutritional status of these 100 children was compared to the nutritional status of 35 siblings who had not suffered from severe malnutrition in their earlier life (Group III). RESULTS: All the malnourished children showed significant improvement in weight for age. More children in Group I had better height for age compared to Group II(p>0.05). Analysis of weight for height showed that study children has better nutritional status than their siblings who had not suffered from significant malnutrition. CONCLUSION: Significant improvement in nutritional status occurs with nutritional rehabilitation. However, improvement in height for age is more difficult to obtain. Interestingly, rehabilitated malnourished children on follow up had better nutritional status as compared to their siblings.     

Anthropometric measurement of malnutrition in children in Zaria, Nigeria

In a combined hospital and community study anthropometric measurements were made on 2134 children under three years of age, of whom 1445 were underweight children attending a hospital nutrition clinic, 484 were unselected village children and 205 were well nourished controls. Weight and length data were analysed to determine the prevalence of different degrees of nutritional deficit in the three groups at different ages. The U.S.A. Academy of Sciences (1976) median weight/age, length/age and weight/length were used as reference standards (1). Prevalence of nutritional deficit in the groups was estimated differently by the three anthropometric indicators, weight/age giving the highest estimate and identifying not only 89% of the "malnourished" but also 48% of "village" children as significantly underweight for age. Analysis of length measurements identified an increased prevalence of stunting with advancing age in all groups and a significant peak prevalence of wasting in village children during the second year of life. The possible reasons for this nutritional crisis during the second year of life are discussed. The operational significance of the different estimates of prevalence of nutritional deficit given by the three anthropometric indicators is also discussed. It is suggested that a combined hospital and community study of malnutrition is of value in planning nutritional intervention.     

Developmental changes of lactose malabsorption in normal Chinese children: a study using breath hydrogen test with a physiological dose of lactose

The malabsorption of a physiological dose of lactose (0.5 g/kg body weight) was studied in 726 healthy Chinese children, ranging in age from 3 to 18 years, using the breath hydrogen test. The prevalence of lactose malabsorption was found to increase with age; it occurred in less than 15% of preschool-age children and in approximately 45% of younger school-age and 60% of older school-age children. Approximately 70% of adolescents measured showed malabsorption. The critical period of change was from 6 to 7 years of age, with the lactose malabsorption rate rising abruptly from 12 to 43%. The incidence of lactose intolerance in teenagers and adolescents was 27 and 33%, respectively. The great majority of them had only dull abdominal pain. No case of lactose intolerance was seen in children less than 9 years of age. These results indicated that preschool Chinese children can absorb a physiological dose of lactose (equivalent to the average amount of milk consumed daily) without any adverse effects. In contrast, one half of school-age children and two thirds of adolescents were malabsorbers.     

Epidemiology of undernutrition

Objective. The present study was undertaken to find out the magnitude of the problem of under nutrition among the children under 5 years of age and also to identify the important factors influencing the nutritional status of the children.Methods : 30 cluster sampling technique had been applied in the study. A total of 600 children below five years of age were covered. Twenty under five children from each cluster were chosen for the study which was carried out during January to February ’97. As per IAP criteria a total of 60.29% children were undernourished and 3.92% were severely undernourished. According to NCHS standard 46.57% & 6.86% children had weight below-2SD and-3SD respectively.Results : A statistically significant relationship was found between the different age groups and nutritional status of under 5 children. Severe degree of malnutrition had highest prevalence under two years of age. The influence of variables like age, sex, religion, literacy status of parents and morbidity of the children were significantly associated with malnutrition.Conclusion : Practice of exclusive breast feeding, introduction of timely complementary feeding, education for maintaining personal hygiene, proper implementation of UIP immunization, periodic deworming, standard case management of diarrhoea and ARI as well as continuation of feeding during illness may reduce malnutrition of under-five children.     

Milk lactose malabsorption in Gabon measured by the breath hydrogen test

It is usual to consider that the greatest part of the black African population is lactose intolerant. Also, milk lactose malabsorption was studied by a breath hydrogen technique in 87 Gabonese children and 20 Gabonese adults (central Africa). The prevalence of malabsorption was 64.2% in rural schoolchildren, 65% in the urban hospitalized, and 60% in adults. Twelve children and six adults had clinical symptoms after a lactose load. All subjects were Bantus, with no tradition of consuming dairy products. These data must be considered in programs of nutritional support in Africa.     

甘肃省农村7岁以下儿童营养不良影响因素的调查研究

目的：了解甘肃省农村地区7岁以下儿童营养不良的现状及其影响因素。方法：采用分层随机整群抽样方法抽取甘肃省4个市县农村地区7岁以下9 390名儿童,进行营养状况调查;用logistic多元回归分析儿童营养不良的主要影响因素。结果：在9 390名儿童中,体重低下检出率为3.60%（338例）,生长迟缓为10.56％（992例）,5岁以下儿童消瘦检出率为2.49％（196/7 868）;性别、年龄、出生体重、生活方式、父母文化程度、家庭年收入等是营养不良发生的影响因素。结论：甘肃省农村地区7岁以下儿童的营养不良问题值得重视;要通过发展经济增加家庭年收入以及加强营养教育、提高父母亲文化水平、改善儿童生活方式等综合措施有效降低儿童营养不良患病率。［中国当代儿科杂志,2010,12(12)：950-953］     

Nutritional status of children with cancer and its effects on survival

In the present study we aimed to determine the nutritional status of our patients and to assess its relationship with survival. The nutritional status of 47 patients with cancer was evaluated at diagnosis, three months after initiation of the treatment and at the end of therapy. Weight for height, height for age, and weight for age of children were expressed as percent of standard. Values for each nutritional index were converted into standard deviation (Z) scores. Three-year overall survival (OS) and event-free survival (EFS) rates of patients were determined according to their nutritional status. The overall prevalence of malnutrition at diagnosis was 29.8%. Three months later the malnutrition ratio reached 38.3% and then decreased again to 18.5% at the end of the therapy. Although the prevalence of malnutrition at the third month of treatment was significantly higher from the prevalence at diagnosis (p: 0.001) and at the end of the therapy (p: 0.009), the mean Z scores of the nutritional indexes before and during the treatment were not significantly different. The survival rates of malnourished patients were not different from those of well nourished patients. In conclusion, malnutrition is one of the main problems in children with cancer; hovewer, nutritional status has no effect on survival.     

Influence of nutritional and haemoglobin status on malaria infection in children

Anaemia and malnutrition have been suggested to confer some degree of protection against malaria infection. Therefore, the influence of nutritional status as assessed anthropometrically and that of haemoglobin level on the incidence of malaria and the degree of parasitaemia was studied in 330 children in the age range of 1–9 years in Bisra block near Rourkela in Orissa state. Moderate to severe malnutrition as assessed from percentage of ideal weight was found in 48.8% (161/330) of children but only 8.8% (29/330) of children had some degree of malnutrition when assessed as weight for height indicating presence of chronic malnutrition. Similarly, 197 children (59.7%) had various grades of anaemia as estimated by haemoglobin level. prevalence of malaria on initial examination was 27.6% (91/330), while incidence of clinical malaria in children during the year of study was 250/1000. There was no statistical difference in the Prevalence/incidence of malaria or severity ofP. falciparum parasitaemia at different haemoglobin or nutritional levels (p>0.05). No child died or developed severe complications requiring hospitalization. Therefore, anaemia or malnutrition do not appear to provide any protection against malaria or degree of parasitaemia in the children around Rourkela.     

The status of lactose absorption in Hong Kong Chinese children

Lactose malabsorption was investigated in 169 Chinese children aged between two and 16 years using the breath hydrogen test. The challenge was either lactose solution (1 g/kg) or cow's milk (10 ml/kg). Overall, 68% of the children showed a significant increase in breath hydrogen following the lactose challenge while only 17% showed an increase after the cow's milk challenge and 13% after both challenges. The number of malabsorbers increased significantly (p less than 0.001) with age and no associated gastrointestinal symptoms or signs were found in any of the children following the challenges, suggesting a gradual and partial loss of intestinal lactase activity. We conclude that the prevalence of lactose malabsorption in Hong Kong children is very high using the standard lactose tolerance test but when a more realistic amount of lactose and a natural medium such as a glass of milk is used as the challenge, the number of malabsorbers becomes small and clinically insignificant.     

Malnutrition screening in hospitalized children: influence of the hospital unit on its management]

OBJECTIVES: The aims of this study were to assess the prevalence of malnutrition in a pediatric population hospitalized in a French regional hospital and to evaluate the influence of type of hospital unit (pediatric or not) in the screening and the management of malnutrition. PATIENTS AND METHODS: This one-day cross-sectional survey was performed in three different seasons during 2003. Every child aged 2 months to 16 years old, hospitalized for more than 48 hours was included. Weight for height, Z-score and Body Mass Index Z-score were used for nutritional assessment. Type of hospitalisation unit, date of admission, associated diagnosis, screening and treatment of malnutrition were also taken into account. RESULTS: Two hundred and eighty hospitalized children were undernourished (11%) and thirty-one children were obese (11%) with no difference in prevalence of malnutrition between pediatric and non-pediatric units. At the time of the study, malnutrition was recognized in one third of the children, at a similar rate whatever the type of hospitalized unit. The children hospitalized in pediatrics wards benefited more frequently from nutritional intervention, i.e. dietician care (43 vs. 16% P < 0.01). CONCLUSION: Prevalence of malnutrition in hospitalized children is low and the same in pediatric or non-pediatric units. Screening of malnutrition remains unsatisfactory in hospital. However, malnutrition is more frequently treated in pediatric unit compared with non-pediatric unit.     

The cut-off criterion for a positive hydrogen breath test in children: a reappraisal

Seventy-three preschool children with adequate nutritional status underwent interval-sampling, 3-hour breath-hydrogen carbohydrate absorption tests after consuming either 240 ml of intact milk (containing 12 g of lactose) or the same volume of milk with 90-95% of its lactose prehydrolyzed in vitro (containing less than 1 g lactose, with the remaining sugar as glucose and galactose). Results were examined in a reappraisal of the cut-off criterion for the rise of breath H2 concentration signifying biologically incomplete absorption. If the greater than or equal to 10-ppm criterion advocated by some investigators is used, 83% of our subjects would have been classified as incomplete lactose digesters and 30% would have their tests with the monosaccharide-rich milk classified as positive. With the greater than or equal to 20 ppm criterion used in our laboratory and others, the prevalence of lactose maldigestion in the sample becomes 60% and only 4% of subjects have apparent monosaccharide absorption, 96% having a rise below the cut-off level with prehydrolyzed milk. At least in Guatemalan preschoolers, the 20-ppm criterion for a positive breath H2 test provides a superior specificity-sensitivity balance and more reasonable diagnostic conclusions.     

National immunization day to assess nutritional status of underfives in chandigarh

National Immunization Days (NIDs) are an additional opportunity to reach a large number of children and can be used to undertake additional activities beside immunization. This study highlights an attempt to assess nutritional status of under five children by using a NID. Seven thousand four hundred and thirteen underfives were selected randomly from urban, rural and slums areas of Chandigarh. Nutritional status was assessed by using weight for age criteria. Prevalence of protein energy malnutrition (PEM) was found to be about 42% while 22.7%, 14.5%, 4.1% and 0.7% children had grade I, II, III and IV PEM respectively. The prevalence of PEM was significantly higher among females (47.6%), in 1–3 years age group (53.80%), in slum area (67%) and children of labour class (60.5%) (p < 0.001). With increase in family size, the prevalence of malnutrition also significantly increased, and decreased with high literacy rate in parents (p < 0.001). The prevalence of PEM in present study (42%) was comparable to a community based survey (51.6%) among pre-school children of an ICDS block of Chandigarh. National immunization days can be successfully used to assess nutritional status of children. This approach can be used by others for screening common childhood problems, preparing normogram for a region or country, administering Vitamin A and educating mothers.     

Late-onset hypolactasia in Hong Kong school children.

Three hundred and twenty Chinese school children aged between 6 and 19 years from six schools in Hong Kong were tested for their lactose digestion status. After an overnight fast, the children were challenged with cow's milk, 5 ml/kg bodyweight (i.e. lactose approximately 0.25 g/kg). Malabsorption was assessed by measuring hydrogen concentration from end-expiratory breath samples taken in duplicate before and at 90 and 180 minutes after the challenge. On average, 10% of the children showed an increase in breath hydrogen excretion within 3 h after the challenge, indicating malabsorption of lactose. None of the children complained of gastro-intestinal symptoms or showed any clinical sign of intolerance to the milk. The number of malabsorbers increased significantly (p less than 0.001) with age, starting at about 3% at the age of 8 and reaching about 27% at the age of 18 years. The sharpest rise occurred between 14 and 15 years. It is concluded that, despite the high prevalence of hypolactasia, Hong Kong Chinese children can consume normal amounts of milk without developing any untoward clinical symptom or sign.     

Lactose malabsorption and intolerance in Uruguayan population by breath hydrogen test (H2)

This study of 200 Uruguayans between 0 and 86 years old was designed to determine the prevalence of lactose malabsorption. Lactose intolerance is defined as a clinical syndrome of abdominal pain, diarrhea, flatulence, and bloating after the ingestion of a standard lactose tolerance test dose (2 g of lactose per kilogram of body weight or 50 g/m2 of body surface area, maximum 50 g in a 20% water solution). Lactose malabsorption refers to the state in which dietary lactose remains unhydrolyzed and subsequently unabsorbed from the gastrointestinal tract; symptoms may or may not result from lactose malabsorption. The technique of breath hydrogen (H2) was used after ingestion of 2 g/kg body weight to a maximum of 50 g in a 20% solution. There was no lactose malabsorption in children younger than 5 years old. The prevalence increases progressively after the age of 5, and in adolescence the percentage of malabsorption is similar to that in adults, who show 65% lactose malabsorption, with 25% asymptomatic and 40% intolerant. In 109 white adults, the prevalence of lactose malabsorption is 63%, with 24% asymptomatic and 39% intolerant. In 11 black adults, lactose malabsorption is 82%, with 27% asymptomatic and 55% intolerant. The difference between white and black adults is statistically significant (p less than 0.05). The H2 test is simple, reliable, noninvasive, and appropriate to study large populations.     

Malabsorption of different lactose loads in children with human immunodeficiency virus infection.

Thirty children infected with human immunodeficiency virus (HIV) (18 P1 and 12 P2, according to the classification system of the Centers for Disease Control) and 54 noninfected children were evaluated for lactose malabsorption with use of the hydrogen breath test after different lactose loads. Lactose malabsorption after load of 2 g/kg occurred in 75% of P2, 67% of P1, and in 46% of noninfected children. With a lower lactose load (1 g/kg), the prevalence of malabsorption was significantly higher among P2 children than P1 and noninfected cases. A similar figure was obtained after the lowest load (0.5 g/kg). Infected children with lactose malabsorption were significantly younger than noninfected malabsorbers (mean age +/- SD; 50.3 +/- 22 vs. 63.5 +/- 20.9 months) when the load of 2 g/kg was used. The use of lower lactose loads seems to be helpful in finding the dose that can be tolerated. This finding could have nutritional importance and could lead to better dietary management.     

Changes in nutritional status and morbidity over time among pre-school children from slums in Pune, India

OBJECTIVE:To investigate changes in nutritional status and morbidity over time among pre-school slum children. DESIGN: Longitudinal. METHODS: Children in the age group of 0-5 years from three slums in Pune (n = 845) were studied for a period of two years. Measurement of weight (up to 20 g) and height (up to 0.1 cm), morbidity (in last 7 days) and clinical assessment was undertaken once every four months. RESULTS: Peak prevalence of malnutrition was observed around 18 months and shorter period (3.5 months) of exclusive breastfeeding was probably responsible. Morbidity was generally higher in rainy season and was associated with wasting but not stunting. Gastrointestinal illness and fever contributed 50% of total morbidity days. Higher morbidity affected significantly growth velocities in weight throughout pre-school age. Height velocities were significantly low upto three years of age but there appeared no scope for catch-up growth as velocities remained similar thereafter. Higher morbidity in younger children (less than 2 years) led to deterioration of nutritional status over time in 30% to 50% children. CONCLUSION: Shorter period of exclusive breastfeeding results in undernutrition at an early age among slum children. Morbidity further deteriorates the nutritional status     

Malnutrition improvement for infants under 18 months old of Dai minority in Luxi, China

BACKGROUND: Child malnutrition and thiamine deficiency remain a matter of public concern in Dai children under 5 years old in Southwest areas of China. The aim of the present study was to understand the status and correlates of malnutrition and thiamine deficiency in Dai children under 18 months old in Yunnan, China, and to explore an effective intervention for improving their nutritional status and decreasing the prevalence of malnutrition and thiamine deficiency in Dai children. METHODS: Well-trained investigators completed a baseline evaluation survey, including questionnaire survey by maternal interviews, child physical measurements, lab examination of thiamine, and group discussions in a cross-sectional study. An intervention plan was constructed by a group consisting of the city governor, government officers, maternal and child health workers, community leaders, and villagers etc. A comprehensive community-based intervention was carried out for 352 children born after July 2001 and their mothers or caregivers in half of the baseline survey villages by the end of 2003. The intervention included participatory intervention, community nutrition education, child growth monitoring and distributing thiamine to new mothers just before or after delivery. RESULTS: The baseline evaluation survey in 2000 indicated that the prevalence of moderate and severe protein-energy malnutrition was 19.5% for underweight, 16.4% for stunting, and 6.7% for wasting, respectively. With increasing age, the prevalence increased, peaking at 12-15 months. The prevalence of underweight in girls was higher than in boys. A total of 10.5% of children suffered from thiamine deficiency, and 5.7% of the children were insufficient in thiamine supply. Low Kaup target (<25%) was significantly associated with lack of guidance by doctors, lack of nutrition knowledge, lack of knowledge of causes of malnutrition and local culture food taboos. The status of child nutrition has been improved significantly since the intervention measure implementation. The change of prevalence of underweight children aged 6-17 months prior to and after the intervention was significant: 20.5% before and 13.7% after the intervention in infants aged 6-11 months, and 39.0% before and 26.4% after the intervention in young children aged 12-17 months. Prevalence of girls was higher than that of boys. Some women began to eat vegetables and pork from the market, which were forbidden by the culture food taboos. There is no case report of child thiamine deficiency in project villages. CONCLUSION: The prevalence of moderate and severe protein-energy malnutrition is high in Dai infants and young children. However, based on the local situation, participatory community-based comprehensive nutrition intervention effectively reduces the prevalence of child malnutrition and thiamine deficiency. It is highlighted that population nutritional intervention can produce better results with participation at a community level.