TY - JOUR
T1 - Infant nutritional status, feeding practices, enteropathogen exposure, socioeconomic status, and illness are associated with gut barrier function as assessed by the lactulose mannitol test in the MAL-ED birth cohort
AU - Lee, Gwenyth O.
AU - McCormick, Benjamin J.J.
AU - Seidman, Jessica C.
AU - Kosek, Margaret N.
AU - Haque, Rashidul
AU - Olortegui, Maribel Paredes
AU - Lima, Aldo A.M.
AU - Bhutta, Zulfiqar A.
AU - Kang, Gagandeep
AU - Samie, Amidou
AU - Amour, Caroline
AU - Mason, Carl J.
AU - Ahmed, Tahmeed
AU - Yori, Pablo Peñataro
AU - Oliveira, Domingos B.
AU - Alam, Didar
AU - Babji, Sudhir
AU - Bessong, Pascal
AU - Mduma, Estomih
AU - Shrestha, Sanjaya K.
AU - Ambikapathi, Ramya
AU - Lang, Dennis R.
AU - Gottlieb, Michael
AU - Guerrant, Richard L.
AU - Caulfield, Laura E.
PY - 2017
Y1 - 2017
N2 - The lactulose mannitol (LM) dual sugar permeability test is the most commonly used test of environmental enteropathy in developing countries. However, there is a large but conflicting literature on its association with enteric infection and host nutritional status. We conducted a longitudinal cohort using a single field protocol and comparable laboratory procedures to examine intestinal permeability in multiple, geographically diverse pediatric populations. Using a previously published systematic review to guide the selection of factors potentially associated with LM test results, we examined the relationships between these factors and mucosal breach, represented by percent lactulose excretion; absorptive area, represented by percent mannitol excretion; and gut barrier function, represented by the L/M ratio. A total of 6,602 LM tests were conducted in 1,980 children at 3, 6, 9, and 15 months old; percent lactulose excretion, percent mannitol excretion, and the L/M ratio were expressed as age- and sex-specific normalized values using the Brazil cohort as the reference population. Among the factors considered, recent severe diarrhea, lower socioeconomic status, and recent asymptomatic enteropathogen infections were associated with decreased percent mannitol excretion and higher L/M ratios. Poorer concurrent weight-for-age, infection, and recent breastfeeding were associated with increased percent lactulose excretion and increased L/M ratios. Our results support previously reported associations between the L/M ratio and factors related to child nutritional status and enteropathogen exposure. These results were remarkably consistent across sites and support the hypothesis that the frequency of these exposures in communities living in poverty leads to alterations in gut barrier function
AB - The lactulose mannitol (LM) dual sugar permeability test is the most commonly used test of environmental enteropathy in developing countries. However, there is a large but conflicting literature on its association with enteric infection and host nutritional status. We conducted a longitudinal cohort using a single field protocol and comparable laboratory procedures to examine intestinal permeability in multiple, geographically diverse pediatric populations. Using a previously published systematic review to guide the selection of factors potentially associated with LM test results, we examined the relationships between these factors and mucosal breach, represented by percent lactulose excretion; absorptive area, represented by percent mannitol excretion; and gut barrier function, represented by the L/M ratio. A total of 6,602 LM tests were conducted in 1,980 children at 3, 6, 9, and 15 months old; percent lactulose excretion, percent mannitol excretion, and the L/M ratio were expressed as age- and sex-specific normalized values using the Brazil cohort as the reference population. Among the factors considered, recent severe diarrhea, lower socioeconomic status, and recent asymptomatic enteropathogen infections were associated with decreased percent mannitol excretion and higher L/M ratios. Poorer concurrent weight-for-age, infection, and recent breastfeeding were associated with increased percent lactulose excretion and increased L/M ratios. Our results support previously reported associations between the L/M ratio and factors related to child nutritional status and enteropathogen exposure. These results were remarkably consistent across sites and support the hypothesis that the frequency of these exposures in communities living in poverty leads to alterations in gut barrier function
UR - http://www.scopus.com/inward/record.url?scp=85024385744&partnerID=8YFLogxK
U2 - 10.4269/ajtmh.16-0830
DO - 10.4269/ajtmh.16-0830
M3 - Article
C2 - 28719336
AN - SCOPUS:85024385744
SN - 0002-9637
VL - 97
SP - 281
EP - 290
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
IS - 1
ER -