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Carbohydrate malabsorption in acutely malnourished children and infants: a systematic review.

ABSTRACT: Severe acute malnutrition (SAM) accounts for approximately 1 million child deaths per year. High mortality is linked with comorbidities, such as diarrhea and pneumonia.The aim of this systematic review was to determine the extent to which carbohydrate malabsorption occurs in children with SAM.The PubMed and Embase databases were searched. Reference lists of selected articles were checked.All observational and controlled intervention studies involving children with SAM in which direct or indirect measures of carbohydrate absorption were analyzed were eligible for inclusion. A total of 20 articles were selected for this review.Most studies reported carbohydrate malabsorption, particularly lactose malabsorption, and suggested an increase in diarrhea and reduced weight gain in children on a lactose-containing diet. As most studies reviewed were observational, there was no conclusive scientific evidence of a causal relationship between lactose malabsorption and a worse clinical outcome among malnourished children.The combined data indicate that carbohydrate malabsorption is prevalent in children with SAM. Additional well-designed intervention studies are needed to determine whether outcomes of SAM complicated by carbohydrate malabsorption could be improved by altering the carbohydrate/lactose content of therapeutic feeds and to elucidate the precise mechanisms involved.

SUBMITTER: Kvissberg MA

PROVIDER: S-EPMC4684688 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Carbohydrate malabsorption in acutely malnourished children and infants: a systematic review.

Kvissberg Matilda A MA Dalvi Prasad S PS Kerac Marko M Voskuijl Wieger W Berkley James A JA Priebe Marion G MG Bandsma Robert H J RH

Nutrition reviews 20151117 1

<h4>Context</h4>Severe acute malnutrition (SAM) accounts for approximately 1 million child deaths per year. High mortality is linked with comorbidities, such as diarrhea and pneumonia.<h4>Objective</h4>The aim of this systematic review was to determine the extent to which carbohydrate malabsorption occurs in children with SAM.<h4>Data sources</h4>The PubMed and Embase databases were searched. Reference lists of selected articles were checked.<h4>Data extraction</h4>All observational and controll ...[more]

PMID: 26578625

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Project description:Background: Rehydration strategies in children with severe acute malnutrition (SAM) and severe dehydration are extremely cautious. The World Health Organization (WHO) SAM guidelines advise strongly against intravenous fluids unless the child is shocked or severely dehydrated and unable to tolerate oral fluids. Otherwise, guidelines recommend oral or nasogastric rehydration using low sodium oral rehydration solutions. There is limited evidence to support these recommendations. Methods: We conducted a systematic review of randomised controlled trials (RCTs) and observational studies on 15 th June 2017 comparing different strategies of rehydration therapy in children with acute gastroenteritis and severe dehydration, specifically relating to intravenous rehydration, using standard search terms. Two authors assessed papers for inclusion. The primary endpoint was evidence of fluid overload. Results: Four studies were identified, all published in English, including 883 children, all of which were conducted in low resource settings. Two were randomised controlled trials and two observational cohort studies, one incorporated assessment of myocardial and haemodynamic function. There was no evidence of fluid overload or other fluid-related adverse events, including children managed on more liberal rehydration protocols. Mortality was high overall, and particularly in children with shock managed on WHO recommendations (day-28 mortality 82%). There was no difference in safety outcomes when different rates of intravenous rehydration were compared. Conclusions: The current 'strong recommendations' for conservative rehydration of children with SAM are not based on emerging evidence. We found no clinical trials providing a direct assessment of the current WHO guidelines, and those that were available suggested that these children have a high mortality and remain fluid depleted on current therapy. Recent studies have reported no evidence of fluid overload or heart failure with more liberal rehydration regimens. Clinical trials are urgently required to inform guidelines on routes and rates of intravenous rehydration therapy for dehydration in children with SAM.

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Project description:Early childhood is a critical time for establishing food preferences and dietary habits. In order for appropriate advice to be available to parents and healthcare professionals it is essential for researchers to understand the ways in which children learn about foods. This review summarizes the literature relating to the role played by known developmental learning processes in the establishment of early eating behavior, food preferences and general knowledge about food, and identifies gaps in our knowledge that remain to be explored. A systematic literature search identified 48 papers exploring how young children learn about food from the start of complementary feeding to 36 months of age. The majority of the papers focus on evaluative components of children's learning about food, such as their food preferences, liking and acceptance. A smaller number of papers focus on other aspects of what and how children learn about food, such as a food's origins or appropriate eating contexts. The review identified papers relating to four developmental learning processes: (1) Familiarization to a food through repeated exposure to its taste, texture or appearance. This was found to be an effective technique for learning about foods, especially for children at the younger end of our age range. (2) Observational learning of food choice. Imitation of others' eating behavior was also found to play an important role in the first years of life. (3) Associative learning through flavor-nutrient and flavor-flavor learning (FFL). Although the subject of much investigation, conditioning techniques were not found to play a major role in shaping the food preferences of infants in the post-weaning and toddler periods. (4) Categorization of foods. The direct effects of the ability to categorize foods have been little studied in this age group. However, the literature suggests that what infants are willing to consume depends on their ability to recognize items on their plate as familiar exemplars of that food type.

Dataset Information

Carbohydrate malabsorption in acutely malnourished children and infants: a systematic review.

Publications

Carbohydrate malabsorption in acutely malnourished children and infants: a systematic review.

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