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Kvissberg MA, Dalvi PS, Kerac M, Voskuijl W, Berkley JA, Priebe MG, Bandsma RHJ. Carbohydrate malabsorption in acutely malnourished children and infants: a systematic review. Nutr Rev 2015; 74:48-58. [PMID: 26578625 PMCID: PMC4684688 DOI: 10.1093/nutrit/nuv058] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 07/12/2015] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Severe acute malnutrition (SAM) accounts for approximately 1 million child deaths per year. High mortality is linked with comorbidities, such as diarrhea and pneumonia. OBJECTIVE The aim of this systematic review was to determine the extent to which carbohydrate malabsorption occurs in children with SAM. DATA SOURCES The PubMed and Embase databases were searched. Reference lists of selected articles were checked. DATA EXTRACTION All observational and controlled intervention studies involving children with SAM in which direct or indirect measures of carbohydrate absorption were analyzed were eligible for inclusion. A total of 20 articles were selected for this review. DATA SYNTHESIS Most studies reported carbohydrate malabsorption, particularly lactose malabsorption, and suggested an increase in diarrhea and reduced weight gain in children on a lactose-containing diet. As most studies reviewed were observational, there was no conclusive scientific evidence of a causal relationship between lactose malabsorption and a worse clinical outcome among malnourished children. CONCLUSION The combined data indicate that carbohydrate malabsorption is prevalent in children with SAM. Additional well-designed intervention studies are needed to determine whether outcomes of SAM complicated by carbohydrate malabsorption could be improved by altering the carbohydrate/lactose content of therapeutic feeds and to elucidate the precise mechanisms involved.
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Affiliation(s)
- Matilda A Kvissberg
- M.A. Kvissberg and R.H. Bandsma are with the Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University Medical Centre Groningen, University of Groningen, The Netherlands. P.S. Dalvi and R.H. Bandsma are with the Physiology and Experimental Medicine Program, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada. P.S. Dalvi is with the Center for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada. M. Kerac is with the Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. W. Voskuijl is with the College of Medicine, University of Malawi, Blantyre, Malawi. J.A. Berkley is with the Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom. J.A. Berkley is with the KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya. M.G. Priebe is with the Centre for Medical Biomics, University Medical Centre of Groningen, University of Groningen, The Netherlands. R.H. Bandsma is with the Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
| | - Prasad S Dalvi
- M.A. Kvissberg and R.H. Bandsma are with the Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University Medical Centre Groningen, University of Groningen, The Netherlands. P.S. Dalvi and R.H. Bandsma are with the Physiology and Experimental Medicine Program, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada. P.S. Dalvi is with the Center for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada. M. Kerac is with the Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. W. Voskuijl is with the College of Medicine, University of Malawi, Blantyre, Malawi. J.A. Berkley is with the Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom. J.A. Berkley is with the KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya. M.G. Priebe is with the Centre for Medical Biomics, University Medical Centre of Groningen, University of Groningen, The Netherlands. R.H. Bandsma is with the Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
| | - Marko Kerac
- M.A. Kvissberg and R.H. Bandsma are with the Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University Medical Centre Groningen, University of Groningen, The Netherlands. P.S. Dalvi and R.H. Bandsma are with the Physiology and Experimental Medicine Program, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada. P.S. Dalvi is with the Center for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada. M. Kerac is with the Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. W. Voskuijl is with the College of Medicine, University of Malawi, Blantyre, Malawi. J.A. Berkley is with the Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom. J.A. Berkley is with the KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya. M.G. Priebe is with the Centre for Medical Biomics, University Medical Centre of Groningen, University of Groningen, The Netherlands. R.H. Bandsma is with the Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
| | - Wieger Voskuijl
- M.A. Kvissberg and R.H. Bandsma are with the Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University Medical Centre Groningen, University of Groningen, The Netherlands. P.S. Dalvi and R.H. Bandsma are with the Physiology and Experimental Medicine Program, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada. P.S. Dalvi is with the Center for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada. M. Kerac is with the Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. W. Voskuijl is with the College of Medicine, University of Malawi, Blantyre, Malawi. J.A. Berkley is with the Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom. J.A. Berkley is with the KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya. M.G. Priebe is with the Centre for Medical Biomics, University Medical Centre of Groningen, University of Groningen, The Netherlands. R.H. Bandsma is with the Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
| | - James A Berkley
- M.A. Kvissberg and R.H. Bandsma are with the Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University Medical Centre Groningen, University of Groningen, The Netherlands. P.S. Dalvi and R.H. Bandsma are with the Physiology and Experimental Medicine Program, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada. P.S. Dalvi is with the Center for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada. M. Kerac is with the Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. W. Voskuijl is with the College of Medicine, University of Malawi, Blantyre, Malawi. J.A. Berkley is with the Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom. J.A. Berkley is with the KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya. M.G. Priebe is with the Centre for Medical Biomics, University Medical Centre of Groningen, University of Groningen, The Netherlands. R.H. Bandsma is with the Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
| | - Marion G Priebe
- M.A. Kvissberg and R.H. Bandsma are with the Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University Medical Centre Groningen, University of Groningen, The Netherlands. P.S. Dalvi and R.H. Bandsma are with the Physiology and Experimental Medicine Program, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada. P.S. Dalvi is with the Center for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada. M. Kerac is with the Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. W. Voskuijl is with the College of Medicine, University of Malawi, Blantyre, Malawi. J.A. Berkley is with the Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom. J.A. Berkley is with the KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya. M.G. Priebe is with the Centre for Medical Biomics, University Medical Centre of Groningen, University of Groningen, The Netherlands. R.H. Bandsma is with the Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
| | - Robert H J Bandsma
- M.A. Kvissberg and R.H. Bandsma are with the Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University Medical Centre Groningen, University of Groningen, The Netherlands. P.S. Dalvi and R.H. Bandsma are with the Physiology and Experimental Medicine Program, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada. P.S. Dalvi is with the Center for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada. M. Kerac is with the Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. W. Voskuijl is with the College of Medicine, University of Malawi, Blantyre, Malawi. J.A. Berkley is with the Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom. J.A. Berkley is with the KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya. M.G. Priebe is with the Centre for Medical Biomics, University Medical Centre of Groningen, University of Groningen, The Netherlands. R.H. Bandsma is with the Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada.
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