Nutritional status and breath hydrogen test.docx

Nutritional status and breath hydrogen test.docx

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Nutritionalstatusandbreathhydrogentest

JPediatr（RioJ）. 2002Mar-Apr;78

（2）:

113-9.

[Nutritionalstatusand breath hydrogen testwithlactoseandlactuloseinTerenaIndianchildren].

[ArticleinPortuguese]

AlvesGM1, deMoraesMB, Fagundes-NetoU.

Authorinformation

∙1DepartamentodePediatria,UniversidadeFederaldoMatoGrossodoSul,CampoGrande,MS.

Abstract

OBJECTIVE:

Toevaluatethenutritionalstatus,absorptionandtoleranceoflactoseandtheoccurrenceofsmall-bowelbacterialovergrowth.

METHODS:

Across-sectionalstudyincludingall264TerenaIndianchildrenyoungerthan10yearsfromtwotribes（LimãoVerdeandCórregoSeco）inMatoGrossodoSul.Thenutritionalstatuswasassessedbaseduponweightandheight,usingNCHSdataasreference.The breath hydrogen testafteranorallactose（18g）administrationwasusedforevaluationoflactoseabsorptionandtolerance.Theoccurrenceofbacterialovergrowthwasevaluatedusingthe breath hydrogen testaftertheadministrationoflactulose（5g）.

RESULTS:

Themedianzscoresofweight-for-age,weight-for-heightandheight-for-agewere,respectively,ininfantsunder1year（n=34）:

-0.66,+0.60and-0.85.Between1and5years（n=111）,thevalueswere:

-0.50,+0.28and-1.17.Between5and10years（n=119）,theseanthropometricvalueswere,respectively:

-0.09,+0.50and-0.60.Deficientlactoseabsorptionormalabsorptionwasverifiedonlyafterthefourthyearofagein89.3%ofthe197evaluatedchildren.Lactoseintolerancewasfoundin37.1%ofthem.Small-bowelovergrowthwasdetectedin11.5%oftheTerenaIndianchildren（n=252）.

CONCLUSIONS:

Theprevalenceofrecentmalnutritionwaslow,butthemedianheight-for-agewaslowerthantheNCHSreference.Theprevalenceofontogeneticlactasedeficiencywashigh.BacterialovergrowthmaybeconsideredasevidenceoftheoccurrenceofnonsymptomaticenvironmentalenteropathyinTerenaIndianchildren.

NutritionalstatusandbreathhydrogentestwithlactoseandlactuloseinTerenaIndianchildren

Estadonutricionaletestedohidrogênionoarexpiradocomlactoseelactuloseemcriançasindígenasterenas

GildneyMariadosSantosAlves, MauroBatistadeMorais, UlyssesFagundes-Neto

JPediatr（RioJ）2002;78

（2）:

113-9

Introduction

Thehealthstatusofagivenpopulationdependsontheexpressionofitsgeneticcharacteristicsininteractionwithseveralenvironmentalfactors.Inchildren,nutritionalstatusandgrowthareclassicallyconsideredsomeofthemostimportanthealthstatusindicators

（1）.Inspecificpopulations,theseaspectsareofparamountimportance,sincetheyallowcomparinggroupswithdifferentlifestyles.ThisappliestoBrazilianindigenouspopulationswhich,especiallyinthelastfiftyyears,haveundergonesocialchangesduetotheircontactandinterchangewiththenonindigenoussociety.WithregardtotheBrazilianindigenouspopulation,therearesomepublicationsonCaiapós

（2）,IndiansfromAltoXingu（3-5）,fromtheAmazonregion（6）andXavantes,fromMatoGrosso（7）.

Itiswidelyknownthateatinghabitsplayavitalroleinthehealthstatusofacommunity.However,theontogeneticdeficiencyoflactasemayinfluencetheformationofeatinghabitsinawidevarietyofethnicgroupsaroundtheglobe.InBrazil,thehighprevalenceofontogeneticlactasedeficiencywasdeterminedbyassessingthebloodglucosecurveinyoungadults（8）,schoolersfromalargeBrazilianurbancenter（9）,andinIndianchildrenfromAltoXingu（10）afterlactoseoverload.Arecentstudy,whichusedlactoseconcentrationclosetothatobservedinusualeatingpatterns,revealedlesserfrequencyoflactosemalabsorptioninagroupofstudentslivinginthecountrysideofthestateofSãoPaulo,byusingthebreathhydrogentest（11）.Itisextremelyimportantthattheprevalenceofontogeneticlactasedeficiencyandlactoseintolerancebetakenintoconsiderationwhennutritionalinterventionprogramsaredesigned.

Ontheotherhand,tropicalenteropathymayappearasaresultofinadequateenvironmentalandbasichealthconditions,causingfunctionalandmorphologicalsmallboweldisorders（12,13）.Inthiscase,theremightbedigestivedisordersandabnormalnutrientuptake.

Tropicalenteropathyisnormallyassociatedwiththeexcessiveproliferationofbacteriaintheproximalsmallbowel,whichmaybedetectedbyanoninvasivemethodknownasbreathhydrogentest,aftertheoralintakeoflactulose（14）.

Consideringtheimportanceofthevariablesdescribedabove,theaimofthisstudywastoassessthenutritionalstatus,absorptionandtoleranceoflactoseandsmall-bowelbacterialovergrowthinindigenouschildrenfromtheTerenastribe,fromtwovillageslocatedinAquidauana,stateofMatoGrossodoSul.

Patientsandmethods

IndiansfromtheTerenastribe

ThestudywascarriedoutintheTerenasvillagesofLimãoVerdeandCórregoSeco,locatedinAquidauana,stateofMatoGrossodoSul.Theinitialestimateofthetotalpopulationofthesevillageswas1,500inhabitantsin1995.ThecontactoftheseIndians,whospeakalanguageoftheAruakfamily,withourcivilizationwasmadeinthemid-nineteenthcentury.TheseIndiansparticipatedintheParaguayanWar.Theirlandwasmarkedoffintheearlytwentiethcentury.TherehavebeenconflictsoverlandamongtheseIndiansfromthattimeon.Inthevillages,thebuildingsusedbythecommunity（administration,healthcenter,school）aremadeofbrick,haveelectricity（suppliedbythepublicelectricnetwork）andawatermainthatdeliverswaterfromanartesianwell.Thewallsofthehousesaremadeoftreetrunksandmudandtheroofiscoveredwithburitipalmleaves.Thehousesdonothaveelectricpowerorawatersystem.TheTerenasgrowcorn,beans,rice,cassava,andfruit,andsellthesurplusatthetownmarket.

Patients

Across-sectionalstudywasconductedwithIndianchildrenfromtwovillages（LimãoVerdeandCórregoSeco）.Duringthefirststageofthestudy,in1995,theonlyinclusioncriteriaconsistedinstudyingthelargestpossiblenumberofchildrenagedlessthan10years.Allchildren（264）inthisagegroupwereincluded（125malesand139females）.Thechildren'sweightandheightwererecorded.Lateron,accordingtooperationalavailability,thefollowingtestswereperformed:

244（92.4%）stooltestsforthedetectionofintestinalparasites,251（92.4%）toleranceandlactoseabsorptiontestsbasedonbreathhydrogenand252（95.1%）respiratorytestsafterlactuloseintakefordetectionofbacterialovergrowthintheproximalsmallbowel.Lessthan10%ofthetargetpopulationsubmittedtoanthropometricassessmentdidnotdothestooltestfordetectionofintestinalparasitesandthelactoseandlactulosebreathhydrogentestsforoperationalreasons,sincenoexclusioncriteriawereestablished.Ifthechildhadepisodesofacutediarrhea,wasusingantimicrobialmedicationorhadnootherinfectiousdiseasethatmightinterferewiththerespiratorytest,theexamwasperformedatleastonemonthafterthechild'srehabilitation.ThefieldworkcontinueduntilMarch1997.Atthetimeofrespiratorytests,themedianage（25thand75thpercentilesbetweenparentheses）ofchildrenwas:

6yearsand8months（4yearsand6months;9yearsand6months）forlactose（n=251）and6yearsand8months（4yearsand4monthsand9yearsand1month）forlactulose（n=252）.

Methods

1-Anthropometricassessment

WeightandheightmeasuresforcommunitystudieswereobtainedasrecommendedbyJelliffe（1968）

（1）.Twomechanicalscales（Filizola）wereusedtomeasureweight:

oneforinfantsandtheotheroneforolderchildren.Thechildrenwereweighedwithouttheirclothing.Forheightmeasurement,childrenuptotheageoftwoyearswerekeptonthesupineposition,andthoseolderthantwoyearswereontheuprightposition.Twoanthropometerswereused.Thechildrenwhowereinthestanding,uprightpositionshouldkeeptheirspinalcolumnandlegsstraightened.Zscoresandtheweight-for-age,weight-for-height,andheight-for-ageratioswerecalculatedbyEPI-INFOversion6.2（15）,takingintoconsiderationthevaluesoftheNationalCenterforHealthStatistics（NCHS）（16）.Thevalueof-2.0standarddeviationswasusedascutoffpointformalnutrition,basedonZscores,asrecommendedbytheWorldHealthOrganization（17）.

Thenutritionalstatusofchildrenagedlessthan60monthswasevaluatedbyGomezclassificationsystem,whichisbasedontheweight-for-agepercentage（18）.ThebirthdatewasobtainedfromthebirthcertificateofeachIndianchild.

2-Hydrogenbreathtesting

Lactoseandlactulosehydrogenbreathtestsweredoneinthemorning,afteran8-12hourfastingperiod.Forbreast-fedinfants（n=29）,theminimumfastingperiodwasfourhours.

2.1-Lactoseoverload

Eachchildwasgivenasingle18-gramdoseoflactoseinaqueoussolutionat10%.Breathsampleswerecollectedfordetermininghydrogenconcentrationimmediatelybefore（basalsampleorfastingsample）andat30,60,90and120minutesafterlactoseadministration（11）.Thetestwasinterpretedaccordingtotherecommendationsfoundintheliterature（14,19）,consideringtheincreaseinbreathhydrogenconcentrationinanyofthesamplesinrelationtothebasalvalue:

adequatelactoseabsorption-increaselessthan10ppm（partspermillion）;suspectedlactasedeficiency-increasebetween10and20ppm;andlactasedeficiency-increasehigherthan20ppm（partspermillion）.Lactoseintolerancewascharacterizedonthethreesubsequentdaysaftertheintakeof18gramsoflactose,whenthechildhadoneormoreofthefollowingsymptoms:

flatulence,abdominalpainanddiarrhea.

Thesesymptomswereassessedbyoneoftheresearchersbymeansofhealthmonitorsavailablefrom