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. 2002 Dec;87(6):522–525. doi: 10.1136/adc.87.6.522

Maldigestion and malabsorption of dietary lipid during severe childhood malnutrition

J Murphy 1, A Badaloo 1, B Chambers 1, T Forrester 1, S Wootton 1, A Jackson 1
PMCID: PMC1755840  PMID: 12456554

Abstract

Background: Diets rich in lipid are used to provide energy density in treating children with severe malnutrition, but the extent to which their digestion and absorption can cope with the load effectively is uncertain.

Aim: To determine the extent of impaired digestion or absorption, in three groups of eight malnourished children (aged 5–23 months) using isotopic probes of the predominant fatty acids in coconut and corn oil used to fortify the diet.

Methods: Each child received oral doses of one of three 13C labelled triglycerides (trilaurin, triolein, or trilinolein). The recovery of 13C label in stool either as triglyceride (TAG) or fatty acid (FA), was used to assess digestion and absorption. In a separate test, the recovery of label in stool following an oral dose of [13C]-glycocholate was measured to assess bile salt malabsorption.

Results: The median recovery of label in stool was 9% (range 1–29%) of administered dose. Following treatment there was a reduction in stool 13C excretion for the labelled TAG (<1%). In half the subjects, label was recovered as TAG in stool (median 0.6%, range 0–44%). Most label in stool was recovered as FA (median 30%, range 0–100%). Following [13C]-glycocholate, label was recovered in excess in about one third of studies.

Conclusion: Abnormalities in the gastrointestinal handling of lipid were observed in over 50% of children with severe malnutrition, reflecting problems in absorption, although impaired solubilisation or hydrolysis could also be contributory factors. The underlying lesion improves as treatment progresses, leading to concomitant improvement in function.

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Figure 1 .

Figure 1

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Recovery of 13C label in the form of TAG and FA isolated from stool, as a percentage of an oral dose of 13C labelled trilaurin, triolein, and trilinolein in children at phase 1. Each bar represents the results for a single child for each 13C labelled TAG.

Figure 2 .

Figure 2

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Recovery of 13C label in stool as a percentage of an oral dose of 13C labelled glycocholate in children during rehabilitation for severe malnutrition at each of the three phases. Each point represents the results for a single child.

Selected References

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