Improving the detection of environmental enteric dysfunction: a lactulose, rhamnose assay of intestinal permeability in children aged under 5 years exposed to poor sanitation and hygiene.
dc.contributor.author | Faubion, WA | en_US |
dc.contributor.author | Camilleri, M | en_US |
dc.contributor.author | Murray, JA | en_US |
dc.contributor.author | Kelly, P | en_US |
dc.contributor.author | Amadi, B | en_US |
dc.contributor.author | Kosek, MN | en_US |
dc.contributor.author | Enders, F | en_US |
dc.contributor.author | Larson, J | en_US |
dc.contributor.author | Grover, M | en_US |
dc.contributor.author | Boe, G | en_US |
dc.contributor.author | Dyer, R | en_US |
dc.contributor.author | Singh, R | en_US |
dc.date.accessioned | 2018-03-08T13:41:33Z | |
dc.date.available | 2016-06-08 | en_US |
dc.date.issued | 2016 | en_US |
dc.date.submitted | 2018-02-20T11:51:10.730Z | |
dc.identifier.issn | 2059-7908 | en_US |
dc.identifier.other | 10.1136/bmjgh-2016-000066 | |
dc.identifier.uri | http://qmro.qmul.ac.uk/xmlui/handle/123456789/34464 | |
dc.description.abstract | BACKGROUND: Environmental enteric dysfunction (EED) is an asymptomatic intestinal disorder affecting populations living in conditions of poor sanitation and hygiene. The study tested intestinal barrier function in infants with EED. METHODS: We prospectively studied an advanced high-performance liquid chromatography mass spectrometry assay of urine collected after oral intake of the monosaccharide, L-rhamnose and the disaccharide, lactulose, in 112 children from three continents. FINDINGS: Compared to the US cohort (n=27), the cohorts of children from Peru (n=19) and Zambia (n=85) were older with evidence of growth impairment. The median (range) of age (months) was 8.0 (2.0 to 13.0), 27.0 (15.0 to 29.0) and 21.0 (12.0 to 36.0), respectively. The median (range) of height for age Z score was -0.1 (-1.8 to 2.4), -1.8 (-3.3 to -0.2) and -2.3 (-8.5 to 1.2), respectively. Among children with valid sugar data (n=22 USA, n=19 Peru, n=73 Zambia), there were no significant differences in the median rhamnose urine concentrations between the three groups. The median (range) lactulose concentration (µg/mL) was 6.78 (0.29 to 31.90), 47.60 (4.23 to 379.00) and 75.40 (0.67 to 873.00) in the US, Peruvian and Zambian cohorts, respectively (p<0.001). The lactulose/rhamnose ratio (LRR) was higher in cohorts from Peru (0.75, 0.15, 5.02) and Zambia (2.26, 0.08, 14.48) compared to the US (0.14, 0.06, 1.00) cohort (p<0.001). In a multivariate effect modification model, higher weight-for-age z scores were associated with lower post-dose lactulose when rhamnose excretion was constant (p=0.003). CONCLUSIONS: This non-invasive two saccharide permeability protocol measures changes in intestinal permeability in children with EED and permits the identification of individuals for interventional trials. | en_US |
dc.description.sponsorship | This project was supported by the Bill & Melinda Gates Foundation. This publication was supported in part by Grant Number UL1TR000135 from the National Center for Advancing Translational Sciences (NCATS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH | en_US |
dc.format.extent | e000066 - ? | en_US |
dc.language | eng | en_US |
dc.language.iso | en | en_US |
dc.relation.ispartof | BMJ Glob Health | en_US |
dc.rights | CC BY-NC | |
dc.title | Improving the detection of environmental enteric dysfunction: a lactulose, rhamnose assay of intestinal permeability in children aged under 5 years exposed to poor sanitation and hygiene. | en_US |
dc.type | Article | |
dc.rights.holder | 2016. The authors | |
dc.identifier.doi | 10.1136/bmjgh-2016-000066 | en_US |
pubs.author-url | https://www.ncbi.nlm.nih.gov/pubmed/28588929 | en_US |
pubs.issue | 1 | en_US |
pubs.notes | No embargo | en_US |
pubs.publication-status | Published online | en_US |
pubs.volume | 1 | en_US |
dcterms.dateAccepted | 2016-06-08 | en_US |
qmul.funder | Environmental enteropathy in Zambia: biomarkers defined by pathogenesis::Bill & Melinda Gates Foundation (BMGF ) | en_US |
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