Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-27T05:54:52.942Z Has data issue: false hasContentIssue false
  • English
  • Français

Age-related association of small intestinal mucosal enteropathy with nutritional status in rural Gambian children

Published online by Cambridge University Press:  09 March 2007

David I. Campbell ,
Peter. G. Lunn  and
Marinos Elia
David I. Campbell*
Affiliation:
Medical Research Council, Keneba, The Gambia Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle-Upon-Tyne NE1 4LP, UK
Peter. G. Lunn
Affiliation:
Medical Research Council, Keneba, The Gambia Department of Biological Anthropology, University of Cambridge, Cambridge CB2 3DZ, UK
Marinos Elia
Affiliation:
Medical Research Council, Keneba, The Gambia
*
*Corresponding author:Dr David I. Campbell, fax +44 191 202 302, email d.i.campbell@ncl.ac.uk
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Small bowel enteropathy (assessed by the lactulose (L): mannitol (M) permeability test) is a major factor in infant growth faltering and malnutrition in The Gambia. However, little is known about its persistence and nutritional effect beyond 2 years of age. This was addressed by two cross-sectional studies of intestinal permeability and nutritional status in 162 residents, aged 2–60 years, living in three villages in rural Gambia. L:M ratio was found to be highest in the youngest children and although there was a significant improvement with age (P<0·0001), values were always greater than the range found in UK counterparts. M recovery (mean value 5·68 (SE 0·12)%) was at all times between one-third and one-half of expected UK values and showed no improvement with age. Gut barrier function, assessed by L uptake, improved with age (P<0·001) and fell within the UK normal range beyond age 10 years. Both the L:M permeability ratio and L recovery were significantly associated with height-for-age z-scores (r−0·31 and −0·22 respectively, P<0·001), a relationship that persisted throughout childhood and into adulthood. Change in height-for-age z-score beween the two visits was also related to the L:M ratio (r−0·24, P=0·018). The close within-subject correlation of permeability variabilities between the two visits suggests a long-term persistence of enteropathy within individuals. It appears that the small bowel enteropathy previously described in Gambian infants persists through to adulthood. Although the lesion improves with age, the relationship between attained height and L:M permeability raises the possibility that enteropathy may continue to limit growth throughout childhood and puberty.

Keywords

GrowthIntestinal permeabilityEnteropathyTropicalThe Gambia
Type
Research Article
Information
British Journal of Nutrition , Volume 88 , Issue 5 , November 2002 , pp. 499 - 505
Copyright
Copyright © The Nutrition Society 2002

References

Baker, SJ & Mathan, VI (1972) Tropical enteropathy and tropical sprue. American Journal of Clinical Nutrition 25, 1047–1055.CrossRefGoogle ScholarPubMed
Behrens, RH, Lunn, PG, Northrop, CA, Hanlon, PW & Neale, G (1987) Factors affecting the integrity of the intestinal mucosa of Gambian children. American Journal of Clinical Nutrition 45, 1433–1441.CrossRefGoogle ScholarPubMed
Cook, GC (1980) Tropical Gastroenterology, pp. 271–324. Oxford: Oxford University Press.Google Scholar
Ford, RPK, Menzies, IS, Phillips, AD, Walker-Smith, JA & Turner, MW (1985) Intestinal sugar permeability: Relationship to diarrhoeal disease and small bowel morphometry. Journal of Paediatric Gastroenterology and Nutrition 4, 568–574.CrossRefGoogle Scholar
Freeman, JV, Cole, TJ, Chinn, S, Jones, PRM, White, EM & Preece, MA (1995) Cross sectional stature and weight reference curves for the UK, 1990. Archives of Disease in Childhood 73, 17–24.Google Scholar
Lindenbaum, J, Alam, AK & Kent, TH (1966) Subclinical small-intestinal disease in East Pakistan. British Medical Journal 2, 1616–1619.CrossRefGoogle ScholarPubMed
Lindenbaum, J (1973) Tropical enteropathy. Gastroenterology 64, 637–652.Google Scholar
Lunn, PG (2000) The impact of infection and nutrition on gut function and growth in childhood. Proceedings of the Nutrition Society 59, 147–154.CrossRefGoogle ScholarPubMed
Lunn, PG & Northrop-Clewes, CA (1992) Intestinal permeability: Update on the enzymatic assay of mannitol. Clinica Chimica Acta 205, 151–152.Google Scholar
Lunn, PG, Northrop-Clewes, CA & Downes, RM (1991a) Intestinal permeability, mucosal injury and growth faltering in Gambian infants. Lancet 338, 907–910.CrossRefGoogle ScholarPubMed
Lunn, PG, Northrop-Clewes, CA & Downes, RM (1991b) Recent developments in the nutritional management of diarrhoea, 2. Chronic diarrhoea and malnutrition in The Gambia: studies on intestinal permeability. Transactions of the Royal Society of Tropical Medicine and Hygiene 85, 8–11.Google Scholar
Menzies, IS, Laker, MF & Pounder, R (1979) Abnormal intestinal permeability to sugars in villous atrophy. Lancet ii, 1107–1109.Google Scholar
Menzies, IS, Zuckerman, MJ, Nukajam, WS, Somasundaram, SG, Murphy, B, Jenkins, AP, Crane, RS & Gregory, GG (1999) Geography of intestinal permeability and absorption. Gut 44, 483–489.CrossRefGoogle ScholarPubMed
Northrop, CA, Lunn, PG & Behrens, RH (1990) Automated enzymatic assays for the determination of intestinal permeability probes in urine. 1, Lactulose and lactose. Clinica Chimica Acta 187, 79–88.CrossRefGoogle ScholarPubMed
Prentice, AM & Cole, TJ (1994) Seasonal changes in growth and energy status in the Third World.Proceedings of the Nutrition Society 53, 509–519.Google Scholar
Sullivan, PG, Marsh, MN, Miriakin, R, Hill, SM, Milla, P & Neale, G (1991) Chronic diarrhoea and malnutrition – Histology of the small intestinal lesion. Journal of Paediatric Gastroenterology and Nutrition 12, 195–203.Google ScholarPubMed
Travis, S & Menzies, IS (1992) Intestinal permeability: functional assessment and significance. Clinical Science 82, 471–488.Google Scholar