Lactose intolerance among severely malnourished children with diarrhoea admitted to the nutrition unit, Mulago hospital, Uganda.
Lactose intolerance among severely malnourished children with diarrhoea admitted to the nutrition unit, Mulago hospital, Uganda.
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DOI：
10.1186/1471-2431-10-31
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发表时间：
2010-05-06
期刊：
影响因子：
2.4
通讯作者：
Bachou, Hanifa
中科院分区：
文献类型：
--
作者：
Nyeko, Richard;Kalyesubula, Israel;Bachou, Hanifa
背景：乳糖不耐症是营养不良婴儿腹泻的常见并发症，也是治疗失败的原因之一。在严重的蛋白质能量营养不良中，营养损伤和感染性损伤的结合降低了肠黏膜产生乳糖酶的能力，乳糖酶是消化乳糖所必需的。严重营养不良的标准管理包括用以乳糖为基础的高能量配方奶进行营养康复。然而，其中一些儿童可能患有乳糖不耐症，这可能导致不良治疗结果的高发率。因此，本研究旨在确定该人群中乳糖不耐症的患病率及其相关因素。方法：2006年10月至2007年2月，对穆拉戈医院姆瓦纳穆吉姆营养科（MNU） 196名3-60月龄严重营养不良腹泻患儿进行描述性横断面研究。结果：研究期间共纳入196例严重营养不良腹泻患儿，其中50例（25.5%）存在乳糖不耐症（大便减少物质>或= 1 +[0.5%]，大便pH < 5.5），糜烂性营养不良27/75患儿（36.0%）发生率高于糜烂性营养不良-糜烂性营养不良6/25患儿（24.0%）和糜烂性营养不良17/96患儿（17.7%）。水肿性营养不良（p = 0.032）、肛周皮肤糜烂（p = 0.044）、高平均排便频率（p = < 0.001）和前3个月内腹泻次数（p = 0.007）是乳糖不耐症的独立预测因素。双变量分析显示，与乳糖不耐症显著相关的其他因素包括：年龄小于3-12个月；缺乏最新的免疫接种；持续腹泻;呕吐;脱水，腹胀。纯母乳喂养少于4个月和治疗性牛奶开始时腹泻恶化是其他因素。结论：在本研究中，乳糖不耐受的患病率为25.5%，相对较高。应通过粪便pH值和还原性物质进行常规筛查，特别是在患有腹泻的严重营养不良儿童中，表现为水肿性营养不良，肛周皮肤糜烂，平均大便频率较高，并且在过去3个月内有过100或2次腹泻发作。对于发现有乳糖不耐症迹象的儿童，以及对标准治疗配方奶粉反应不佳的儿童，应考虑使用无乳糖饮食，如酸奶。
BACKGROUND: Lactose intolerance is a common complication of diarrhoea in infants with malnutrition and a cause of treatment failure. A combination of nutritional injury and infectious insults in severe protein energy malnutrition reduces the capacity of the intestinal mucosa to produce lactase enzyme necessary for the digestion of lactose. The standard management of severe malnutrition involves nutritional rehabilitation with lactose-based high energy formula milk. However, some of these children may be lactose intolerant, possibly contributing to the high rate of unfavorable treatment outcomes. This study was therefore designed to establish the prevalence of lactose intolerance and associated factors in this population.METHODS: A descriptive cross sectional study involving 196 severely malnourished children with diarrhoea aged 3-60 months was done in Mwanamugimu Nutrition Unit (MNU), Mulago hospital between October 2006 and February 2007.RESULTS: During the study period, 196 severely malnourished children with diarrhoea were recruited, 50 (25.5%) of whom had evidence of lactose intolerance (stool reducing substance >or= 1 + [0.5%] and stool pH < 5.5) and it occurred more commonly in children with kwashiorkor 27/75 (36.0%) than marasmic-kwashiorkor 6/25 (24.0%) and marasmus 17/96 (17.7%). Oedematous malnutrition (p = 0.032), perianal skin erosion (p = 0.044), high mean stool frequency (p = < 0.001) and having >or=2 diarrhoea episodes in the previous 3 months (p = 0.007) were the independent predictors of lactose intolerance. Other factors that were significantly associated with lactose intolerance on bi-variate analysis included: young age of 3-12 months; lack of up to-date immunization; persistent diarrhoea; vomiting; dehydration, and abdominal distension. Exclusive breastfeeding for less than 4 months and worsening of diarrhoea on initiation of therapeutic milk were the other factors.CONCLUSIONS: The prevalence of lactose intolerance in this study setting of 25.5% is relatively high. Routine screening by stool pH and reducing substances should be performed especially in the severely malnourished children with diarrhoea presenting with oedematous malnutrition, perianal skin erosion, higher mean stool frequency and having had >or=2 diarrhoea episodes in the previous 3 months. Use of lactose-free diets such as yoghurt should be considered for children found to have evidence of lactose intolerance and whose response on standard therapeutic milk formula is poor.