Irritable bowel syndrome in Indonesian adolescents

Abstract Objective: Irritable bowel syndrome is a frequent functional gastrointestinal disorder. The aims of this study were to investigate its epidemiology, focusing on the role of intestinal mucosal integrity and to evaluate the impact on the quality of life. Methods: A community-based survey applying a comparative cross sectional approach was conducted in six high schools in Palembang. Subjects were recruited using multistage random sampling divided in two groups. Rome III criteria were used to establish a diagnosis of IBS in combination with a questionnaire to determine risk factors. Determination of fecal alpha-1-antitrypsin and calprotectin levels was performed to determine impaired intestinal mucosal integrity. A questionnaire was used to evaluate how quality of life was affected by irritable bowel syndrome. Results: The survey was performed in 454 14−18 years old adolescents, of whom 30.2% fulfilled the Rome III criteria for IBS, with the following subtypes: 36.5% diarrhea, 18.9% constipation, 21.9% mixed, and 22.6% unclassified. Major risk factors were female gender, bullying, age 14-16 years, history of constipation and diarrhea, eating nuts, and drinking coffee, tea, and soft drinks. There was a significant association with intestinal inflammation (p = 0.013). A significantly impaired quality of life was found (p = 0.001). Conclusions: The prevalence of irritable bowel syndrome in adolescents was high, with bullying, female gender, age 14-16 years, constipation and diarrhea, and dietary consumption of soft drinks, coffee, and tea as risk factors. A significant association with intestinal inflammation was found.

Iron Supplementation with or without Optimized Complementary Feeding Recommendations: Effect on Micronutrient Status and Growth of 1-2 Year Old Myanmar Children.

Objectives: Children under 2-years of age are at high risk of micronutrient deficiencies and growth faltering due partly to poor complementary feeding. This study aimed to compare the effect of optimized complementary feeding recommendations (CFRs) to iron supplementation on micronutrient status and growth of Myanmar children. Methods: A randomized, partially-blinded, placebo-controlled trial (NCT01758159) was conducted for 24 weeks among 1-2 year old children from Ayeyarwady, Myanmar. Optimized CFRs were developed by Linear Programming using locally available foods. Randomization by village for CFRs or non-CFRs and by child (n=432) for iron supplements or placebo, created: 1.CFR+Fe; 2.CFR-alone; 3.Fe-alone; or 4.Placebo-control groups. Mother from CFRs received regular training on optimized CFRs and children from Fe received 15mg Ferric-NaEDTA daily. Serum ferritin(SF), transferrin-receptor(sTfR), zinc(Zn), retinol-binding-protein(RBP); C-reactive protein, α-1 acid glycoprotein and anthropometry were assessed at baseline and endline. Results: At baseline, 88.4% of children had anemia (Hb<110g/L); after adjusting for infection, 36.1% had iron-deficiency-anemia(IDA) (Hb<110g/L, SF<12μg/L), 37.2% iron-deficiency(ID) (SF<12μg/L), 33.6% zinc-deficiency (Zn<9.9μmol/L), 54.9% low vitamin-A status (RBP<1.05μmol/L); and 27.7% were stunted. At endline, anemia was reduced by all 3 interventions. Fe-alone reduced ID and IDA [OR=0.02, 95%CI(0.02,0.44), P=0.002] and [OR=0.06, 95%CI(0.01,0.41) P=0.004] respectively but increased stunting [OR=2.96, 95%CI(1.05, 8.33), P=0.04]. There was no between-groups difference for zinc and vitamin-A deficiencies at endline. Conclusions: Optimized CFRs with or without iron supplementation can reduce anemia. Iron supplementation reduce ID and IDA but also increase stunting. It is interesting to study about competitive absorption of supplemental iron or dietary iron with dietary zinc with potential to zinc deficiency and stunting.

Effects of realimentation on small intestinal morphology and disaccharidase activity in malnutrition Sprague-Dawley rats.

Low birth-weight infant and intrauterine growth retardation are still a health problem, especially in Indonesia due to high prevalence and need to be reduced. Malnutrition in infants are most common occur in low birth-weight infants. Malnutrition in rats resulted in hypotrophic and normoplastic mucosa of the small intestine. The finding was not only showed that small intestine was able to maintain its cell number in condition with restriction nutrient, however also suggested the posibility of epithelial regeneration if given adequate nutrient intake. Did realimentation recover the hypotrophic normoplastic mucosa to normotrophic normoplastic? The study aim to answer that question. Experimental animal study with post test-control group design was performed using 40 male litter of Sprague-Dawley rats, was fed standard chow. The study was divided into phases prenatally-induced malnutrition and continued with phase realimentation. The result of this study is the body weight, mucosal thickness, villus height, cryptus depth, ratio of villus/ crypt, number of villi, protein content, and disaccharidases of rats realimentation group was higher than non-realimentation group, but lower than control group. Prenatally-induced malnutrition did not reduced the population of small intestinal enterocytes. Realimentation in rats in prenatally-induced malnutrition was able to improve the hypotrophy of small intestinal mucosa and to increase the disaccharidases activities but did not reach the normal values. Realimentation in rats in prenatally-induced malnutrition was able to improve the maturity of small intestine mucosa but did not reach the normal values. The information will be helpfull to decide the policy of maternal malnutrition.

Elastase-1 concentration in feces of term and preterm infants aged 0 – 4 months.

Fecal elastase-1 concentration reflects exocrine pancreatic function. There have been some reports from Europe, but so far there has not been a report of fecal elastase-1 concentration in Indonesia, especially concerning infants. The aim of this study is to know the concentration of elastase-1 in feces of infants aged 1-120 days as a preliminary report of the study of the ontogeny of pancreatic elastase-1 in term and preterm infants. Fecal elastase-1 were measured from feces of 28 healthy preterm and 34 healthy term infants up to 120 days (4 month) of age. Elastase-1 concentration in infants less than 14 days of age fluctuated below 200 μg/gram feces. At the first day of life 80% preterm and 60% term infants had elastase-1 concentration less than 200 μg/gram feces, and by the age of 7 days 50% preterm and 33% term infants had elastase-1 concentration less than 200 μg/gram feces. After 14 days of age its concentration was more than 200 μg/gram feces, regardless of gestational age. This preliminary study corroborates supported the previous studies that the level of fecal elastase-1 reached normal level after 14 days. Future longitudinal study is needed to know elastase-1 concentration in infants less than 14 days.

Quantitative analysis of lactose and lactulose in urine by high performance liquid chromatography for determination of intestinal lactase activity.

Determination of intestinal lactase activity is directly done by measuring its activity in intestinal epithelium. This is an invasive method and ethically can not be done in healthy infants. Indirectly, determination of lactase activity, stated as excretion and ingestion ratio of lactose and lactulose, needs 30 hours hospitalized infants. The aim of this study was to look for a method for determination of lactase activity which is not invasive and not necessary hospitalized. Using this method lactose and lactulose were given as a single oral load after 2 hours fasting. Urine were collected for 5 hours starting from consuming sugar solution and then lactose and lactulose concentration in the urine were measured by High Performance Liquid Chromatography. The results showed single oral load of lactose and lactulose can be used for determination of lactase activity in infant and the infants were observed only for 7 hours.