In vivo estimation of lactose hydrolysis in premature infants using a dual stable tracer technique

Kien, C. Lawrence; Ault, Kathleen; McClead, Richard E.

doi:10.1152/ajpendo.1992.263.5.e1002

Cited by 11 publications

(8 citation statements)

References 16 publications

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“…As noted above, a fraction of ingested lactose (and possibly other dietary carbohydrates) is fermented in the colon of preterm infants, where much of the constituent energy can be absorbed as short-chain fatty acids and lactate (Kien et al, 1987;Kien et al, 1989;Kien et al, 1990b;Kien, 1990;Kien et al, 1992a;Kien, 1996). This process of colonic salvage or retrieval of carbohydrate energy compensates, at least in part, for the inefficiency of dietary energy utilization resulting from inefficient small intestinal digestion of lactose by preterm infants (Kien et al, 1992b;Kien et al, 1996).…”

Section: Fate Of Lactose or Other Dietary Carbohydrates Reaching The Colon: Possible Clinical Significancementioning

confidence: 98%

Nutrient Requirements For Preterm Infant Formulas

Klein

2002

The Journal of Nutrition

327

231

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Achieving appropriate growth and nutrient accretion of preterm and low birth weight (LBW) infants is often difficult during hospitalization because of metabolic and gastrointestinal immaturity and other complicating medical conditions. Advances in the care of preterm-LBW infants, including improved nutrition, have reduced mortality rates for these infants from 9.6 to 6.2% from 1983 to 1997. The Food and Drug Administration (FDA) has responsibility for ensuring the safety and nutritional quality of infant formulas based on current scientific knowledge. Consequently, under FDA contract, an ad hoc Expert Panel was convened by the Life Sciences Research Office of the American Society for Nutritional Sciences to make recommendations for the nutrient content of formulas for preterm-LBW infants based on current scientific knowledge and expert opinion. Recommendations were developed from different criteria than that used for recommendations for term infant formula. To ensure nutrient adequacy, the Panel considered intrauterine accretion rate, organ development, factorial estimates of requirements, nutrient interactions and supplemental feeding studies. Consideration was also given to long-term developmental outcome. Some recommendations were based on current use in domestic preterm formula. Included were recommendations for nutrients not required in formula for term infants such as lactose and arginine. Recommendations, examples, and sample calculations were based on a 1000 g preterm infant consuming 120 kcal/kg and 150 mL/d of an 810 kcal/L formula. A summary of recommendations for energy and 45 nutrient components of enteral formulas for preterm-LBW infants are presented. Recommendations for five nutrient:nutrient ratios are also presented. In addition, critical areas for future research on the nutritional requirements specific for preterm-LBW infants are identified.

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Section: Fate Of Lactose or Other Dietary Carbohydrates Reaching The Colon: Possible Clinical Significancementioning

confidence: 98%

Nutrient Requirements For Preterm Infant Formulas

Klein

2002

The Journal of Nutrition

327

231

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“…As mentioned previously, another study measured mean lactose 'digestion and absorption' to be ~0.7 mg/min/cm, here was calculated to a corresponding d2 = 0.009/min. Other studies have used enzyme activity to measure gut function with varying morbidities and degrees of maturity [47,48,49,50]. One study estimated intestinal lactose hydrolysation to glucose and galactose to be approximately 80% [47].…”

Section: Cgm Derived Resultsmentioning

confidence: 99%

“…Other studies have used enzyme activity to measure gut function with varying morbidities and degrees of maturity [47,48,49,50]. One study estimated intestinal lactose hydrolysation to glucose and galactose to be approximately 80% [47]. Overall, almost none of these studies provide data useful for directly quantifying the rate constant for glucose absorption in the intestine.…”

Section: Cgm Derived Resultsmentioning

confidence: 99%

Modelling intestinal glucose absorption in premature infants using continuous glucose monitoring data

Knopp

Signal

Harris

et al. 2019

Computer Methods and Programs in Biomedicine

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Background: Model-based glycaemic control protocols have shown promise in neonatal intensive care units (NICUs) for reducing both hyperglycaemia and insulin-therapy driven hypoglycaemia. However, current models for the appearance of glucose from enteral feeding are based on values from adult intensive care cohorts. This study aims to determine enteral glucose appearance model parameters more reflective of premature infant physiology.Methods: Peaks in CGM data associated with enteral milk feeds in preterm and term infants are used to fit a two compartment gut model. The first compartment describes glucose in the stomach, and the half life of gastric emptying is estimated as 20 minutes from literature. The second compartment describes glucose in the small intestine, and absorption of glucose into the blood is fit to CGM data. Two infant cohorts from two NICUs are used, and results are compared to appearances derived from data in highly controlled studies in literature. Results:The average half life across all infants for glucose absorption from the gut to the blood was 50 minutes. This result was slightly slower than, but of similar magnitude to, results derived from literature. No trends were found with gestational or postnatal age. Breast milk fed infants were found to have a higher absorption constant than formula fed infants, a result which may reflect known differences in gastric emptying for different feed types.Conclusions: This paper presents a methodology for estimation of glucose appearance due to enteral feeding, and model parameters suitable for a NICU model-based glycaemic control context.

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“…Stable isotope techniques have also been used in studies indicating the capability of premature infants to digest and absorb lactose (Kien, Ault, & McClead, 1992). In addition, infants with severe glucose or lactose malabsorption can be diagnosed with labeled glucose using a breath test (Lifschitz et al, 1988).…”

Section: High-precision Mass Spectrometric Analysismentioning

confidence: 99%

High‐precision mass spectrometric analysis using stable isotopes in studies of children

Schierbeek

Akker

Fay

et al. 2011

Mass Spectrometry Reviews

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The use of stable isotopes combined with mass spectrometry (MS) provides insight into metabolic processes within the body. Herein, an overview on the relevance of stable isotope methodology in pediatric research is presented. Applications for the use of stable isotopes with MS cover carbohydrate, fat, and amino acid metabolism as well as body composition, energy expenditure, and the synthesis of specific peptides and proteins, such as glutathione and albumin. The main focus of these studies is on the interactions between nutrients and the endogenous metabolism within the body and how these factors affect the health of a growing infant. Considering that the early imprinting of metabolic processes hugely impacts metabolism (and thus functional outcome) later in life, research in this area is important and is advancing rapidly. The major fluxes on a metabolic level are the synthesis and breakdown rates. They can be quantified using kinetic tracer analysis and mathematical modeling. Organic MS and isotope ratio mass spectrometry (IRMS) are the two most mature techniques for the isotopic analysis of compounds. Introduction of the samples is usually done by coupling gas chromatography (GC) to either IRMS or MS because it is the most robust technique for specific isotopic analysis of volatile compounds. In addition, liquid chromatography (LC) is now being used more often as a tool for sample introduction of both volatile and non-volatile compounds into IRMS or MS for (13)C isotopic analyses at natural abundances and for (13)C-labeled enriched compounds. The availability of samples is often limited in pediatric patients. Therefore, sample size restriction is important when developing new methods. Also, the availability of stable isotope-labeled substrates is necessary for measurements of the kinetics and concentrations in metabolic studies, which can be a limiting factor. During the last decade, the availability of these substrates has increased. Furthermore, improvements in the accuracy, precision, and sensitivity of existing techniques (such as GC/IRMS) and the development of new techniques (such as LC/IRMS) have opened up new avenues for tackling these limitations.

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In vivo estimation of lactose hydrolysis in premature infants using a dual stable tracer technique

Cited by 11 publications

References 16 publications

Nutrient Requirements For Preterm Infant Formulas

Nutrient Requirements For Preterm Infant Formulas

Modelling intestinal glucose absorption in premature infants using continuous glucose monitoring data

High‐precision mass spectrometric analysis using stable isotopes in studies of children

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