Carbohydrate absorption from fruit juices in infants.

OBJECTIVE: To compare the absorption of carbohydrate in particular from a lower (10 mL/kg(-1)) quantity than that previously tested, of white grape juice and pear juice after a single feeding and after ingestion twice daily for 2 weeks, and determine their respective effects on stool water content, in healthy infants. STUDY PARTICIPANTS: Twelve healthy, well-nourished infants, 5 to 9 months of age, who were recruited from the general population. DESIGN/METHODS: Infants underwent a breath hydrogen test after a serving of pear juice. Three to 5 days later, the test was repeated after a serving of white grape juice. Infants were randomly assigned to receive a 10 mL/kg(-1) serving of grape juice or pear juice twice daily for 2 weeks. The breath tests were repeated after the ingestion of the juices in the same sequence. With the second breath test with pear juice, a charcoal marker and 20 mg (13)C fructose, a stable, nonradioactive isotope, were mixed with the juice. Water content of the stools was compared before and after the 2-week feeding of the juice, and fecal samples were analyzed for (13)C enrichment by mass spectrometry. RESULTS: After the ingestion of the fruit juices, only 1 infant had an abnormal peak hydrogen (H(2); >/=10 ppm), which followed the pear juice. That same infant was the only one who had H(2) levels >/=10 ppm after grape juice. There was no significant difference in the peak breath H(2) levels after grape juice and pear juice either at the beginning of the study or 2 weeks after taking the juice assigned (2.8 ppm +/- 2.9 vs 6.2 ppm +/- 9, respectively). The difference in breath H(2) response before and after the 2 weeks of fruit juice intake was not significant. Mean (+/-standard deviation) fecal (13)C enrichment at baseline was 3.0 Delta%o (+/-2.4), which was not significantly different from after 2 weeks of juice intake (2.4 Delta%o [+/-1.5]), regardless of the juice assigned: 2.7 Delta%o (+/-1.6) for grape juice and 2.2 Delta%o (+/-1.5) for pear juice. Mean (+/-standard deviation) percentage of fecal water at baseline was 24.1% (+/-5.1), which was not significantly different from after 2 weeks of juice (22.5% [+/-6]), regardless of the juice received: 21.8% (+/-5.8) for grape juice and 23.2% (+/-6.7) for pear juice. CONCLUSION: When either grape or pear juice is administered in a dosage of 10 mL/kg/day, the carbohydrate is well absorbed, produces no adverse gastrointestinal symptoms, and has no effect on stool water in healthy infants.

Fish oil supplementation does not impair the gut immune response to Trichinella spiralis infection in rats.

BACKGROUND: Fish oil has been recommended as a source of omega-3 fatty acids for preterm infants and for therapy of some inflammatory diseases. METHODS: Because fish oil supplementation could downregulate the host's immune response, we studied the gut inflammatory response to an enteric infection in 72 rats assigned to three dietary groups with differing fatty acid profile: 1) fish oil, rich in eicosapentaenoic and docosahexaenoic acid; 2) olive oil, containing 71% monounsaturated fat; and 3) rat chow, containing 57% saturated fat. One half (n = 36) of the rats were infected with Trichinella spiralis larvae; the other half served as controls. The inflammatory response to initial infection (study 1), and type I hypersensitivity response to a subsequent parasite-derived antigenic challenge (study 2) were assessed. Jejunal inflammatory cell infiltrate, mean villus height, disaccharidase levels, changes in short-circuit current in response to glucose absorption, and chloride secretagogues (study 1) were measured 9 days after infection. Short-circuit current changes induced by chloride secretion were measured when the proximal jejunum was challenged with T. spiralis-derived antigen 40 days after infection (study 2). RESULTS: In study 1, jejunal tissue from infected animals had more eosinophilic infiltrate, lower disaccharidase levels, and less glucose absorptive and chloride secretory capacity than tissue from noninfected animals. In study 2, the jejunum of infected animals showed an antigen-induced chloride secretory response, whereas no response was obtained from jejunal tissue from noninfected animals. Type of diet did not affect the response in either study. CONCLUSION: Under the conditions of this experiment, fish oil supplementation did not interfere with the local intestinal inflammatory response after T. spiralis infection.

Nutritional management of regurgitation in infants.

Infantile regurgitation is a frequently occurring problem. Throughout the world, anxious parents are imploring physicians to eliminate their infant's regurgitation. General practitioners, pediatricians and pediatric gastroenterologists strive to alleviate infantile regurgitation and its related parental stress. In this paper we define the scope of the problem and analyze the optimal, cost-efficient management approach to simple regurgitation in infants. The intent of this paper is to disseminate this information to practicing physicians and other health care professionals in an attempt to minimize the impact of this annoying problem of infancy and to eliminate confusion and expensive diagnostic tests and use of sub-optimal treatment modalities. Parental reassurance and dietary management by feeding thickened formula are important components in managing regurgitation in infants while maintaining optimal nutritional intake for adequate growth and development.

Addition of rice cereal to formula does not impair mineral bioavailability.

BACKGROUND: The effect of adding rice cereal to formula on calcium and iron bioavailability was studied. METHODS: Fourteen healthy infants were studied at 2-week intervals to assess the absorption of calcium and iron from formula or formula mixed with rice cereal. Infants were randomly assigned to initiate the study either on a lactose-containing formula (F) or the same formula mixed with 6.5 g/dl of rice cereal (F + R). Calcium and iron absorption were determined using a multiple tracer approach in which calcium and iron isotopes were given orally mixed with either F or F + R and a different tracer of calcium given intravenously. Nine infants underwent calcium and iron studies and five underwent calcium studies only. A tracer amount of 46Ca was administered intravenously. Calcium absorption was determined as the ratio of the recovered oral versus intravenous tracer in the urine during the 24 hr after tracer administration. Iron incorporation into red blood cells (RBCs) was determined from the enrichment of the iron isotopes in the RBCs at 14 days after dosing. RESULTS: Mean (+/- SD) percent absorption of calcium from F was 58% (+/- 13) and from F + R 57% (+/- 18). Absorption of iron from F was 5.8% (+/- 7) and from F + R 6.3% (+/- 4) (p = 0.06). Analyses of variance for repeated measures indicated no significant correlation between amount of calories, calcium, or iron ingested, and calcium or iron absorbed. CONCLUSIONS: Adding rice cereal to formula does not impair bioavailability of calcium or iron from infant formulas. Because of the increased total calcium and iron in the mixture of formula and cereal, the overall amount of minerals absorbed from F + R may be greater than from formula alone.

Treatment of acute diarrhea in children.

In the past decade a number of studies have systematically addressed the questions that existed regarding optimal ways to rehydrate and then refeed infants and children with diarrhea. Two very thorough papers are the highlights of the past year's publications in the topic of acute gastroenteritis in children. One summarizes the recommendations of the American Academy of Pediatrics and the other questions, with a background of past research and experience, the need to estimate fluid deficit in order to determine the fluid needs of each individual patient. Oral rehydration seems to be here to stay. Abundant literature supports its advantages over intravenous therapy in otherwise healthy children. Early refeeding also seems to be widely accepted, without a need for bowel rest, formula dilution, or systematic elimination of lactose. Age-appropriate staple foods are also indicated along the refeeding process.

Role of colonic scavengers of unabsorbed carbohydrates in infants and children.

The role of the colonic bacterial flora as scavenger of carbohydrate (CHO) in general and that of fruit juice in particular is reviewed. In the large bowel, CHO is fermented to short chain fatty acids (SCFA) and gas. SCFA are not produced in the immediate neonatal period when the fecal flora is still at the first stage of its development. Studies have demonstrated that mature animals have a compensatory response to diarrhea by increasing six times the capacity to absorb fluids in the large bowel compared to the younger animals; furthermore, CHO that arrives in the colon is completely fermented to SCFA while in the younger pigs CHO passes through the colon unchanged. As in the young pigs, a similar situation can occur in young children when a relatively large amount of CHO arrives in the large bowel.

Effect of resistant and digestible starch on intestinal absorption of calcium, iron, and zinc in infant pigs.

The first nonmilk foods that are given to infants contain high levels of starch, a fraction of which is resistant to enzyme hydrolysis. Incomplete digestion of starch may interfere with the absorption of certain minerals. A fraction of dietary starch which is resistant to in vitro enzymatic hydrolysis has been termed resistant starch. The aim of this study was to compare the intestinal apparent absorption of calcium, phosphorus, iron, and zinc in the presence of either resistant or digestible starch. Twelve 7-10-d-old piglets were fitted with a T-tube inserted into the intestine approximately 3 m distal to the duodenum. Animals received in random order 200 mL of a test meal of cooked, cooled, high amylose corn starch (16.4% resistant starch), or cooked rice starch (digestible starch) administered by an orogastric tube. Both meals contained the same amount of calcium, phosphorus, iron, and zinc. The test meal also contained tracer amounts of 59Fe and 65Zn, as well as polyethylene glycol 3350, as a nonabsorbable marker. Intestinal apparent absorption of starch was greater the meal with digestible starch (71.0 +/- 17.0%) than after the meal with resistant starch (49.2 +/- 10.3) (p < 0.001). After feeding the meals with resistant and digestible starch, mineral apparent absorption was, respectively: calcium, 40.2 +/- 11.8% versus 28.1 +/- 16.4% (p < 0.05); phosphorus, 73.2 +/- 14.0% versus 67.8 +/- 18% (NS); iron, 24.1 +/- 12.2% versus 12.6 +/- 10.6% (p < 0.01), and zinc, 35.0 +/- 13.0% versus 30.6 +/- 8.22% (NS). In conclusion, a meal containing 16.4% resistant starch resulted in a greater apparent absorption of calcium and iron compared with a completely digestible starch meal. If this finding holds true for the whole bowel, administration of resistant starches could have a positive effect on intestinal calcium and iron absorption.

Anti-neutrophil cytoplasmic antibodies in Japanese children with ulcerative colitis.

OBJECTIVE: To investigate the diagnostic value of anti-neutrophil cytoplasmic antibodies (ANCA) in the diagnosis of ulcerative colitis (UC) in Japanese children. METHODOLOGY: Serum samples from 23 children with UC (17 Japanese, 6 non-Japanese), 27 children with Crohn's disease (CD) (10 Japanese, 17 non-Japanese), 10 children with other diarrhoeal diseases, and 33 normal, healthy adult volunteers were assayed for ANCA using an indirect immunofluorescence technique. RESULTS: ANCA were detected in 6/17 (35%) UC patients and 0/10 (0%) CD patients in Japanese children, and in 3/6 (50%) UC patients and 3/17 (18%) CD patients in non-Japanese children. The difference in prevalence between Japanese and non-Japanese children with UC was not statistically significant (P > 0.05). ANCA were not found in other diarrhoeal patients and volunteers. CONCLUSIONS: Although ANCA have been reported to be useful in the diagnosis of UC in adults, they may be of limited use in Japanese children. This might reflect the heterogeneity of UC.

Intestinal function and injury in acquired immunodeficiency syndrome-related cryptosporidiosis.

BACKGROUND/AIMS: The pathogenesis of the diarrhea in acquired immunodeficiency syndrome (AIDS)-related cryptosporidiosis is not known. The hypothesis of this study was that the intestinal dysfunction and injury are related to the number of organisms infecting the intestinal mucosa. The aim of this study was to study the influence of intensity of infection on intestinal function and injury in AIDS-related cryptosporidiosis. METHODS: In 16 patients with AIDS with intestinal Cryptosporidium infection, the intensity of infection was quantified by counting the total number of fecal oocysts excreted in 24 hours and by determining the percent of duodenal epithelium covered by organisms. Intestinal function was assessed by vitamin B12 absorption and serum D-xylose test. Intestinal injury was assessed by morphology of duodenal mucosa, differential urinary excretion of lactulose and mannitol, and fecal alpha 1-antitrypsin clearance. Measurements were repeated after treatment with paromomycin. RESULTS: Vitamin B12 and D-xylose absorption negatively correlated with intensity of infection. Villus atrophy occurred only in patients with oocyst excretion of > 10(8) oocyst/24 hours. Lactulose/mannitol urinary excretion ratio showed a positive correlation with intensity of infection. Intestinal function and injury improved in patients whose oocyst counts were reduced by treatment with paromomycin. CONCLUSIONS: Cryptosporidium infection in patients with AIDS causes malabsorption and intestinal injury in proportion to the number of organisms infecting the intestine.

In vivo study of colonic fermentation of carbohydrate in infants.

Dietary carbohydrate in the colon is fermented and converted into short-chain fatty acids. We studied the fate of carbohydrate that arrives in the colon under circumstances similar to those that occur during an episode of diarrhea and determined whether a quantitative correlation exists among certain indicators of colonic fermentation of carbohydrate arriving in the large bowel. A stable-isotope method was used to estimate carbon scavenging by the colon. Fourteen infants with severe malnutrition and history of watery stools and/or increased numbers of stools in the preceding 20 days were studied. Infants underwent nasocecal intubation and a 60-min infusion of 0.5 g/kg glucose containing 5 mg/kg of 13C-glucose. Stools were assessed for carbohydrate-fermenting bacteria, acetate, glucose, and 13C abundance; blood was assessed for acetate; and breath was assessed for hydrogen. Some of the infants eliminated the infusate per anus within 30 min of the infusion (group I; n = 5), while others did so 120 min or more after the infusion (Group II; n = 9). The volume of fecal output after the intracecal infusion differed significantly between group I and group II (57 +/- 13 vs. 24 +/- 4 ml; p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Colonic acetate in the circulating acetate pool of the infant pig.

To identify potential sites of acetate utilization and synthesis, we studied the contribution of colonic acetate to the circulating acetate pool in six neonatal pigs by the simultaneous i.v. infusion of [3H]acetate and colonic infusion of [14C]acetate. In the fasting state, the mean (+/- SEM) acetate concentration was 17 +/- 1 mumol/L in peripheral venous blood, 28 +/- 4 mumol/L in the femoral artery, and 46 +/- 4 mumol/L in portal blood. This concentration gradient implies that acetate was utilized either by peripheral tissues alone or by both liver and peripheral tissues. At the end of the 2-h intracecal acetate infusion, mean acetate concentration increased in the femoral artery to 186 +/- 20 mumol/L and in the portal vein to 333 +/- 31 mumol/L. In the fasted state, mean acetate concentration in the portal vein was on average 63% higher than the acetate concentration of the femoral artery, whereas specific radioactivity of the [3H]acetate in the portal vein was only 5% of that in the femoral artery. It is possible, therefore, that a high proportion of the arterial input of acetate is utilized by the portal-drained viscera. Our study identified the gastrointestinal tract as an important site of acetate utilization in the fasted state. Further, it showed that colonic acetate was efficiently absorbed and utilized in the gastrointestinal tract of infant pigs.

Age and diet affect the composition of porcine colonic mucins.

Colonic mucins may serve as a defense mechanism by binding bacterial, viral, or dietary lectins, thereby preventing them from attaching to the intestinal epithelium. Presumably, the composition of the mucins would be responsible for this phenomenon, and the composition of mucins from mature mammals would be the most effective in binding lectins. To determine whether differences in diet and/or age affect the composition of colonic mucins, we scraped fresh colonic mucosae from pigs at 0 (n = 3), 7 (n = 3), 21 (n = 3), and 180 (n = 3) d of age and purified the mucins from these mucosal scrapings. Mucins were purified by ribonuclease and deoxyribonuclease digestion, high-performance size-exclusion chromatography, and cesium chloride density-gradient ultracentrifugation. The 180-d-old pig was considered mature. No changes were observed in any of the variables analyzed in the 7-d-old animals. No changes were observed in quantities of galactosamine and galactose. The amounts of fucose and glucosamine increased by 165 and 37%, respectively, (p < 0.05) from d 0 to d 21 in the sow-fed animals, at which time fucose and glucosamine content were 48 and 22% greater, respectively, than in the 21-d-old, artificially fed group (p < 0.05). A further significant increase in fucose content was observed in the mucins from mature animals. The sulfate content in the 21-d-old, sow-fed animals was significantly lower than in both the newborn and the 21-d-old artificially fed animals. The sulfate content in all three of these groups, however, was significantly higher than that observed in the mucins of mature animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Cysteine usage increases the need for acetate in neonates who receive total parenteral nutrition.

The addition of cysteine (as cysteine HCl) to a total parenteral nutrition (TPN) solution enhances calcium and phosphate solubility because cysteine lowers the pH of the solution. To determine whether adding cysteine to TPN solutions affected the acid-base homeostasis of infants and increased their need for acetate to obviate acidosis, we studied two groups of neonates--those receiving TPN before (group C) and after (group NC) the addition of cysteine. Measurements were made before and during the first 2 wk of TPN administration. We measured the pH of our standard TPN solution with and without the addition of cysteine. Serum carbon dioxide was significantly lower in group C despite a significantly greater intake of acetate in group NC. In the in vitro study the addition of cysteine to the TPN solution lowered the pH from 5.5 to 5.1. Newborns who received TPN solutions to which cysteine was added had lower serum carbon dioxide values and a greater need to receive acetate than did newborns who received TPN solutions without cysteine.

Absorption of carbon 13-labeled rice in milk by infants during acute gastroenteritis.

To determine whether rice cereal could be used to complement a cow milk-based diet in the nutritional management of infants with acute diarrhea, we assessed its digestion and absorption in eight affected male infants, 69 to 131 days of age. They received cow milk formula with 5.4% lactose (diluted 1:1 with water and precooked rice cereal) 5 to 22 hours after admission and rehydration. The first feeding consisted of milk diluted with carbon 13-enriched rice cereal. A 48-hour fecal collection and balance study was performed. Rice cereal was reasonably well absorbed (84.0% to 95.8%) by seven of the eight infants. The study was repeated in seven of the infants after they had recovered. Our results indicated that rice cereal is well absorbed by young infants with acute diarrhea and that it is an adequate nutrient supplement for this patient population.

Histologic findings are not correlated with disaccharidase activities in infants with protracted diarrhea.

Histologic assessment as well as information about the disaccharidase activity of the small intestinal mucosa can be useful in the management of patients with small intestinal mucosal damage. In an effort to determine whether the degree of small intestinal mucosal damage would be reflected in a corresponding reduction in disaccharidase activity, we compared small intestinal mucosal histology with the results of disaccharidase activity measured in per oral suction small intestinal biopsies obtained from 21 infants with protracted diarrhea. The degree of small intestinal mucosal damage was graded using a subjective score (i.e., 0 to 4+ damage) by a pathologist (P) and by a computer-assisted digitizing system (to assess villus surface area, VSA, and villus/crypt ratio, V/C) in a blinded fashion. The mean (+/- SD) age of the infants was 2.5 +/- 1.5 months, and the duration of diarrhea was 25.2 +/- 11.5 days. There was good correlation between the results obtained from the digitizing system and from the pathologist: VSA versus P, r = 0.695; V/C versus P, r = 0.791; p = 0.0004. All infants demonstrated some degree of small intestinal mucosal damage. The mean (+/- SD) values for P, VSA, and V/C were 2.2 +/- 1.3, 2.9 +/- 0.9, and 0.9 +/- 0.5, respectively. The mean values for lactase, sucrase, and maltase were 17.1 +/- 17.0, 71.1 +/- 54.0, and 224.3 +/- 233 mumol/min/g protein, respectively. No correlation was observed between the histologic scoring results and lactase, sucrase, or maltase measurements. Expressing the disaccharidase activities per unit wet weight of tissue did not improve the correlations. Log transformation of the data also failed to improve the correlations.(ABSTRACT TRUNCATED AT 250 WORDS)

High-performance size-exclusion chromatography of porcine colonic mucins. Comparison of Bio-Gel TSK 40XL and Sepharose 4B columns.

A high-performance size-exclusion chromatography (HPSEC) method was developed for the separation of porcine colonic mucins using a Bio-Gel TSK 40XL HPSEC column (300 mm x 75 mm). In addition, porcine gastric and bovine submaxillary mucin preparations were used to describe more fully the separation characteristics of the HPSEC column. For comparison, the same preparations were also separated using a Sepharose 4B column (100 cm x 2.6 cm). The colonic and gastric mucins eluted in the void volume (V0) of both columns. Bovine submaxillary mucin was in the elution volume (Ve) of both columns. Analytical HPSEC of fractions (V0 and Ve) of the various preparations obtained by Sepharose 4B chromatography exhibited retention times identical to those for fractions obtained by HPSEC. After separation by both methods, purified mucins were obtained by CsCl2 density gradient ultracentrifugation; analytical HPSEC profiles, protein contents, and monosaccharide compositions of both gastric and colonic mucins from either column were similar. The HPSEC method, however, is ideally suited to separate microgram to milligram quantities of colonic mucin preparations quickly: 2 to 4 h, compared with 24 to 30 h for the Sepharose 4B method.

Effect of formula carbohydrate concentration on tolerance and macronutrient absorption in infants with severe, chronic diarrhea.

To determine how the carbohydrate (CHO) content of "semielemental" formulas affects tolerance and macronutrient absorption, we enrolled 12 infants with severe diarrhea in two successive metabolic balance studies. The infants received, in random order, one of two isocaloric formulas that differed mainly in their CHO and fat concentrations. No significant differences were found between the two feeding periods for peak breath hydrogen levels and fecal osmolality. The low-CHO formula was tolerated better than the high-CHO formula, as indicated by a significantly lower stool output (mean +/- SD 387 +/- 230 vs 764 +/- 443 gm, respectively; p less than 0.05), and higher fecal pH (5.9 +/- 0.7 vs 4.9 +/- 0.5; p less than 0.05). Macronutrient absorption was greater during the ingestion of the low-CHO formula, as indicated by a significantly higher coefficient of fat absorption (p less than 0.005) and lower total fecal energy (mean +/- SD for high- vs low-CHO formula, 372 +/- 205 vs 207 +/- 102 kcal; p less than 0.05), which resulted from a lower CHO excretion (p less than 0.05). A correlation coefficient between the energy derived from CHO in feces and the total stool output was significant for both the high-CHO formula (r = 0.83; p less than 0.001) and the low-CHO formula (r = 0.7; p = 0.01). The CHO concentration of the special infant formula that we tested had an overriding effect on stool output and on fat and energy absorption.