Hypoallergenic and anti-inflammatory feeds in children with complicated severe acute malnutrition: an open randomised controlled 3-arm intervention trial in Malawi.
Hypoallergenic and anti-inflammatory feeds in children with complicated severe acute malnutrition: an open randomised controlled 3-arm intervention trial in Malawi.
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患有复杂性严重急性营养不良的儿童的低过敏性和抗炎饲料：马拉维的一项开放随机对照三臂干预试验。
DOI：
10.1038/s41598-019-38690-9
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发表时间：
2019
影响因子：
4.6
通讯作者：
Bartels RH
中科院分区：
文献类型：
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作者：
Bartels RH
尽管进行了标准管理，复杂性严重急性营养不良（SAM）儿童的肠道病理仍然存在。鉴于非 IgE 介导的胃肠道食物过敏和克罗恩病的肠道病理学相似，我们测试了有效治疗这些疾病的治疗性饲料是否可能有益于患有复杂 SAM 的儿童。在初步临床稳定后，2016年1月1日至12月31日期间，在马拉维布兰太尔伊丽莎白女王中心医院收治的95名6-23个月大的儿童被随机分配到标准饲料、元素饲料或聚合物饲料中，为期14天。作为肠道炎症标志物的粪便钙卫蛋白的变化以及各组的主要结果相似：元素与标准 4.1μg/mg 粪便/天（95% CI，−29.9，38.15；P= 0.81）和聚合与标准 10（−23.96，43.91；P= 0.56）。大多数儿童的肠道和全身炎症以及粘膜完整性的生物标志物在基线时高度异常，并且所有三组中都持续存在异常值。复杂 SAM 的肠病在长达 14 天的时间里对标准饲料或替代治疗饲料均没有反应。更好地了解复杂 SAM 肠道病理的发病机制是为改进治疗干预措施的开发提供信息的当务之急。
Intestinal pathology in children with complicated severe acute malnutrition (SAM) persists despite standard management. Given the similarity with intestinal pathology in non-IgE mediated gastrointestinal food allergy and Crohn’s disease, we tested whether therapeutic feeds effective in treating these conditions may benefit children with complicated SAM. After initial clinical stabilisation, 95 children aged 6–23 months admitted at Queen Elizabeth Central Hospital, Blantyre, Malawi between January 1stand December 31st, 2016 were allocated randomly to either standard feeds, an elemental feed or a polymeric feed for 14 days. Change in faecal calprotectin as a marker of intestinal inflammation and the primary outcome was similar in each arm: elemental vs. standard 4.1 μg/mg stool/day (95% CI, −29.9, 38.15;P= 0.81) and polymeric vs. standard 10 (−23.96, 43.91;P= 0.56). Biomarkers of intestinal and systemic inflammation and mucosal integrity were highly abnormal in most children at baseline and abnormal values persisted in all three arms. The enteropathy in complicated SAM did not respond to either standard feeds or alternative therapeutic feeds administered for up to 14 days. A better understanding of the pathogenesis of the gut pathology in complicated SAM is an urgent priority to inform the development of improved therapeutic interventions.