Lactose malabsorption by premature infants: Magnitude and clinical significance

MacLean, William C.; Fink, Beverly B.

doi:10.1016/s0022-3476(80)80186-7

Cited by 133 publications

(56 citation statements)

References 16 publications

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“…This process of bacterial fermentation of undigested carbohydrates plays an important role in normal intestinal biology such as water and salt absorption in the colon, energy salvation, and colonic mucosal maturation (4,11). Because of a relative lactase deficiency in the small intestine, a significant amount of lactose ingested by normal premature infants may be fermented into SCFAs and then absorbed (12,13). However, in some premature infants, an abnormal state of SCFA overproduction may arise during periods of significant carbohydrate malabsorption and/or bacterial overgrowth, which may exceed the buffering and absorptive capacity of the colon and lead to an increased concentration of SCFAs in the colon (13,14).…”

Section: Discussionmentioning

confidence: 99%

“…Because of a relative lactase deficiency in the small intestine, a significant amount of lactose ingested by normal premature infants may be fermented into SCFAs and then absorbed (12,13). However, in some premature infants, an abnormal state of SCFA overproduction may arise during periods of significant carbohydrate malabsorption and/or bacterial overgrowth, which may exceed the buffering and absorptive capacity of the colon and lead to an increased concentration of SCFAs in the colon (13,14). Levels of SCFAs in the distal ileum may also increase from backward reflux across the ileocecal valve or as a result of local bacterial overgrowth.…”

Section: Discussionmentioning

confidence: 99%

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Short-Chain Fatty Acids Induce Colonic Mucosal Injury in Rats with Various Postnatal Ages

et al. 2005

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Short-Chain Fatty Acids Induce Colonic Mucosal Injury in Rats with Various Postnatal Ages

et al. 2005

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“…Studies have substantiated bacterial fermentation of carbohydrates in premature (5,6) and term newborns (7) on a formula diet, in breast-fed infants (8), in infants taking a mixed diet (9), as well as in older children (10). In newborns, measured intestinal lactase activity is inadequate to account for the digestion of a normal lactose load (approximately 2 g/kg/feeding) (1 1).…”

mentioning

confidence: 99%

“…In newborns, measured intestinal lactase activity is inadequate to account for the digestion of a normal lactose load (approximately 2 g/kg/feeding) (1 1). Calculations from in vitro data and at least one clinical study have suggested that up to two-thirds of the ingested lactose may be assimilated from the colon (5,6,11). While it has been assumed that the same colon fermentation pathway used in adults accounts for lactose assimilation in newborns, this supposition is unlikely.…”

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confidence: 99%

Short-Chain Fatty Acid Profile in the Colon of Newborn Piglets Using Fecal Water Analysis

Murray

McClung

et al. 1987

Pediatr Res

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ABSTRACT. Short-chain fatty acid production and assimilation is unlikely to occur a t significant levels in the newborn because the colon at birth is sterile, and only gradually acquires an anaerobic flora. This study profiled short-chain fatty acid levels in the colon lumen over the initial 21 days of life. Fecal samples were removed surgically from the cecum, right, and left colon from 36 York piglets, 0-21 days of life. Samples were subjected to in vitro dialysis and centrifugation methods to quantitate fecal water short-chain fatty acids, electrolytes, osmolality, and pH. A three-way analysis of variance examined piglet age, colon site of fecal samples, and method of fecal water analysis, for each variable. No differences were found between techniques of fecal water collection. Newborns showed production of short-chain fatty acids a s early a s the 1st day of life in limited amounts. Levels were stable between days 5 and 14, and then abruptly accumulated in the lumen. Acetate was predominant early, with propionate and butyrate responsible for late peaks. The production and assimilation of short-chain fatty acids was nearly complete proximal to the left colon. Age and colon site showed significant interactions for each fatty acid (p < 0.001). The combined osmolar contributions of short-chain fatty acids and electrolytes accounted completely for the luminal osmolality after the 2nd wk of life. Previously there was an "osmolar gap" suggesting that lactose or its breakdown products were present in the lumen and were being removed by pathways other than through short-chain fatty acid production. (Pediatr Res 22:720-724, 1987) Abbreviations SCFA, short-chain fatty acids CEN, centrifugation DIA, in vitro dialysis POST-DIA, postdialysis centrifugation ANOVA, analysis of variance ip, intraperitonealThe passage of carbohydrates across the ileocecal valve is a normal phenomenon throughout life. A metabolic pathway for carbohydrate digestion in the colon has been well established (1). In the anaerobic environment of the colon, fecal organisms ferment carbohydrate to gasses (H2, C02, CH4) and SCFA (acetate, butyrate, and propionate). The presence of SCFA is critical to the normal physiology of the colon. SCFA absorption from the lumen of the colon is rapid and efficient, and their

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“…In infancy, incomplete lactose digestion in breast-fed babies is normal and natural (MacLean & Fink, 1980). Human milk has a 6% lactose content and up to 40% is normally maldigested.…”

Section: Beyond Discomfort To Health Consequences Of Lactose Intolerancementioning

confidence: 99%

Fermentation, fermented foods and lactose intolerance

Nw¹

2002

Eur J Clin Nutr

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Lactose (milk sugar) is a fermentable substrate. It can be fermented outside of the body to produce cheeses, yoghurts and acidified milks. It can be fermented within the large intestine in those people who have insufficient expression of lactase enzyme on the intestinal mucosa to ferment this disaccharide to its absorbable, simple hexose sugars: glucose and galactose. In this way, the issues of lactose intolerance and of fermented foods are joined. It is only at the extremes of life, in infancy and old age, in which severe and life-threatening consequences from lactose maldigestion may occur. Fermentation as part of food processing can be used for preservation, for liberation of pre-digested nutrients, or to create ethanolic beverages. Almost all cultures and ethnic groups have developed some typical forms of fermented foods. Lessons from fermentation of non-dairy items may be applicable to fermentation of milk, and vice versa.

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Lactose malabsorption by premature infants: Magnitude and clinical significance

Cited by 133 publications

References 16 publications

Short-Chain Fatty Acids Induce Colonic Mucosal Injury in Rats with Various Postnatal Ages

Short-Chain Fatty Acids Induce Colonic Mucosal Injury in Rats with Various Postnatal Ages

Short-Chain Fatty Acid Profile in the Colon of Newborn Piglets Using Fecal Water Analysis

Fermentation, fermented foods and lactose intolerance

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