Background: There is a strong relationship between diarrhoea, malnutrition, and intestinal integrity. To investigate the effect of different dietary-treatment on intestinal permeability during acute diarrhoea, 87 Tanzanian children aged 6-25 months were recruited to this study when admitted to hospital.
Methods: Children with acute diarrhoea were rehydrated and then randomly assigned to one of three dietary treatment groups: a conventional low-energy density porridge, a high-energy density amylase digested porridge (AMD), or a high-energy density amylase digested and then fermented porridge (FAD). Lactulose/mannitol permeability tests were performed on admission, at 3 days, and at follow-up 2 and 4 weeks after discharge. The lactulose/mannitol (L/M) ratios were compared between dietary treatment groups and to a group of age-matched, healthy control subjects.
Results: Children with diarrhoea had higher L/M ratios (geometric mean 0.85, 95% CI 0.68-1.05) compared with control subjects (0.14, 0.12-0.17) on admission. There was a significant difference in the change in L/M ratio between admission and 3 days between dietary treatment groups in favour of the FAD group (p < 0.05).
Conclusions: Dietary treatment and intestinal damage at admission explain 13.5% of the variation in L/M ratio, but when age at admission and age at weaning are included as covariants, 21.9% is explained. FAD porridge seems to be more effective in the treatment of intestinal permeability than AMD or conventional porridge. Urinary lactose concentrations in spot urine samples taken prior to the permeability test were also measured. There was a significant correlation with the L/M ratio (correlation coefficient = 0.62, p < 0.001).
PIP: The effect of three dietary treatments on intestinal permeability during acute diarrhea was compared in 86 Tanzanian children 6-25 months of age admitted to Muhimbili Medical Center's Pediatric Diarrhea Treatment Unit in Dar es Salaam in 1992. 55 children (64%) had received foods other than breast milk during the first week of life. After rehydration, children were randomly assigned to receive a conventional low-energy density porridge (n = 33), a high-energy density amylase digested (AMD) porridge (n = 28), or AMD porridge followed by fermented amylase digested (FAD) porridge (n = 25). Lactulose/mannitol (L/M) permeability tests were performed at admission, after 3 days, and at 2 and 4 weeks after hospital discharge. Children with diarrhea had higher L/M ratios (geometric mean, 0.85; 95% confidence interval (CI), 0.68-1.05) at admission than the 30 age-matched healthy controls (mean, 0.14; 95% CI, 0.12-0.17). The L/M ratio of study children fell over time and approached values recorded among healthy controls by the first follow-up visit. The change in L/M ratio between admission and day 3 of hospitalization was significantly greater in the FAD group (89%) than the conventional or AMD groups (44% and 75%, respectively). Dietary treatment and intestinal damage at admission explained 13.5% of the variation in this L/M ratio, while age at admission and age at weaning explained an additional 8.4%. These findings suggest that a porridge that has been both amylase digested and fermented effectively repairs mucosal damage through trophic effects on intestinal epithelium and should be administered to children with acute diarrhea to prevent malnutrition.