Lactulose and Other Non-Absorbable Sugars in Infant Milk Feeds

Beach, Richard; Menzies, Ian S.

doi:10.1016/s0140-6736(83)91548-9

Cited by 17 publications

(13 citation statements)

References 4 publications

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“…McCance & Madders report 50% recovery of intravenously administered rhamnose but do not specify whether this refers to the L-or D-form [14]. During absorption tests employing lactose and lactulose extraneous dietary sources must be eliminated [5]; insufficient rhamnose is present in the diet to produce an error when this sugar is used [ 1 I]. During absorption tests employing lactose and lactulose extraneous dietary sources must be eliminated [5]; insufficient rhamnose is present in the diet to produce an error when this sugar is used [ 1 I].…”

Section: Discussionmentioning

confidence: 99%

“…Except for lactose during pregnancy and lactation [ I l l these sugars have no endogenous source in the human and the quantity excreted in the urine corresponds closely to intestinal absorption. During absorption tests employing lactose and lactulose extraneous dietary sources must be eliminated [5]; insufficient rhamnose is present in the diet to produce an error when this sugar is used [ 1 I]. Nevertheless analysis of 'baseline' urine collected immediately before each test is an advisable precaution.…”

Section: Discussionmentioning

confidence: 99%

“…Nothing was allowed by mouth for 2 i h after commencing the test, and dietary sources of lactose and lactulose [5] were completely excluded for I8 h before, and throughout the test period. Adults received double this dose in 300 ml after an overnight fast.…”

Section: Methodsmentioning

confidence: 99%

“…Adults received double this dose in 300 ml after an overnight fast. Nothing was allowed by mouth for 2 i h after commencing the test, and dietary sources of lactose and lactulose [5] were completely excluded for I8 h before, and throughout the test period.…”

Section: Methodsmentioning

confidence: 99%

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Intestinal permeability and lactose hydrolysis in human rotaviral gastroenteritis assessed simultaneously by non‐invasive differential sugar permeation

Noone

Menzies

Banatvala

et al. 1986

Eur J Clin Investigation

109

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Changes in intestinal permeability and lactose hydrolysis have been investigated in three adults and fifteen infants with acute rotaviral gastroenteritis by differential sugar absorption. The method involves chromatographic measurement of urinary lactose, lactulose and L-rhamnose excretion following combined ingestion in an iso-osmolar test solution. All patients had abnormal intestinal permeability indicated by raised urine lactulose/L-rhamnose excretion, ratio of percentages recovered in 5 h, of 0.462 (0.100-1.227) mean and range, compared with 0.027 (0.008-0.052) for healthy controls (P less than 0.001). Ten patients also had urinary lactose/lactulose excretion ratios raised above the normal range (0.014-0.41, mean 0.258) during their acute illness, indicating impaired intestinal lactose hydrolysis. Both indices had become normal 4 weeks after the acute illness, serial investigation of five patients showing that improvement was complete much earlier. Except for the short duration these changes are similar to those associated with villous atrophy in coeliac disease. The test procedure was verified with respect to intestinal lactose hydrolysis by demonstrating a linear relationship between lactose/lactulose excretion and log jejunal mucosal lactase activity by in vitro assay (R2 = 0.95) in a further group of subjects. Differential lactose/lactulose/L-rhamnose absorption provides a non-invasive and sensitive index of small intestinal integrity of value for the interpretation of prolonged or otherwise complicated enteritis and the distinction of primary secondary intestinal lactase deficiency.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Intestinal permeability and lactose hydrolysis in human rotaviral gastroenteritis assessed simultaneously by non‐invasive differential sugar permeation

Noone

Menzies

Banatvala

et al. 1986

Eur J Clin Investigation

109

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“…Although hyperosmolar feeds have been incriminated in the pathogenesis of necrotising enterocolitis,' we think it highly unlikely that the markers were responsible for our findings, as the concentrations used were well within those present in many infant milk formulas. 4 We suggest that although it is not known whether the passage of bloody stools in our babies represented incipient enterocolitis, the enhanced intestinal permeability described might well allow the absorption of other molecules, such as microbial antigens and toxins, contributing to the devastating damage that characterises necrotising enterocolitis.…”

Section: Patients Methods and Resultsmentioning

confidence: 85%

Enhanced intestinal permeability in preterm babies with bloody stools.

Weaver¹,

Laker²,

Nelson³

1984

Archives of Disease in Childhood

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SUMMARY During a study of the intestinal permeability of newborn babies, three exhibited a sudden increase in lactulose absorption in association with the passage of bloody stools. An enhanced intestinal permeability may be an expression of the disruption of mucosal integrity in necrotising enterocolitis.It has been suggested that increased intestinal permeability caused by mucosal injury may be the final common pathway in necrotising enterocolitis.1 Patients, methods, and resultsThe passive intestinal permeability of 38 preterm babies to lactulose and mannitol was studied longitudinally for 21 days after birth.2 These hydrophilic markers cross the gut wall passively, are not metabolised, and are fully recoverable in the urine. Both are handled in the same way by the body in all respects except routes of absorption.3 Lactulose, the larger molecule, is probably absorbed by a paracellular pathway via intercellular spaces between mucosal cells, at extrusion zones at villous tips and other sites of enterocyte loss. Mannitol, the smaller molecule, is thought to pass through aqueous pores in the enterocyte cell membrane. Less than 1% of ingested lactulose, and 5% of mannitol is absorbed by the healthy neonate.Babies received regular milk feeds containing 200 mg lactulose and 40 mg mannitol/100 ml (5-8 and 2-2 mmol/l respectively) made up feed, amounts within those already present in many 'ready to feed' formulas.4 When a steady state of input and output had been reached, daily urine samples were collected for marker and creatinine analyses. The ratio of the amounts of the two markers in the urine to the fixed amounts in the feeds is an expression of the permeability of the gut to the markers.The stippled area in the Figure represents the range of urinary lactulose:mannitol excretion ratios exhibited by normal babies. A decline in excretion ratios during the first week after starting oral feeds occurred. A parallel decline in lactulose:creatinine ratios indicated that this was due to a decrease in lactulose rather than an increase in mannitol absorption.Three babies (represented by continuous lines in the Figure) showed a sudden increase in lactulose absorption in association with the passage of bloody stools. A baby of 34 weeks' gestation passed stools flecked with fresh blood on the fourth and fifth days after starting feeds, but otherwise remained clinically, biochemically, and haematologically well. No pathogens or enterotoxins were identified from her faeces or elsewhere. Proctoscopy showed an inflamed rectal mucosa.5 An 8 fold rise in the urinary latulose:mannitol excretion ratio was observed, representing an increase in lactulose absorption when expressed as a lactulose:creatinine ratio. The second baby, also of 34 weeks' gestation, passed four consecutive bloody stools four days after starting feeds, followed by a 3-5 fold rise in lactulose absorption, which returned to normal, however, within 24 hours. No cause for his symptoms was found. The third baby, of 31 weeks' gestation, showed an enhanced intestinal pe...

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Milk Feeding and Changes in Intestinal Permeability and Morphology in the Newborn

Weaver,

Laker,

Nelson

et al. 1987

J. pediatr. gastroenterol. nutr.

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SummaryThe contrasting effects of natural versus cow's milk formula (CMF) on upper gastrointestinal development in the newborn were studied. The passive intestinal permeability of neonatal human infants and guinea pigs was measured using the nonmetabolisable markers lactulose and mannitol. Mucosal morphology was examined in guinea pigs by light microscopy. Nineteen full‐term human infants and 63 guinea pigs were studied during the 1st week of extrauterine life. The naturally fed infants showed a decline in intestinal permeability to lactulose following the onset of feeding. This was not shared by those fed CMF. The CMF‐fed guinea pigs showed a persistently higher intestinal permeability than the naturally fed animals throughout the 1st week of life. No differences were observed in the villous heights or crypt depths between feeding groups, but both showed an increase in intraepithelial lymphocyte number during the 1st week. Cow's milk formula may cause a persistently higher intestinal permeability, or natural feeding may promote a decline in permeability in the enterally fed newborn.

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Lactulose and Other Non-Absorbable Sugars in Infant Milk Feeds

Cited by 17 publications

References 4 publications

Intestinal permeability and lactose hydrolysis in human rotaviral gastroenteritis assessed simultaneously by non‐invasive differential sugar permeation

Intestinal permeability and lactose hydrolysis in human rotaviral gastroenteritis assessed simultaneously by non‐invasive differential sugar permeation

Enhanced intestinal permeability in preterm babies with bloody stools.

Milk Feeding and Changes in Intestinal Permeability and Morphology in the Newborn

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