TY - JOUR
T1 - A cross-sectional study of associations between the 13C-sucrose breath test, the lactulose rhamnose assay, and growth in children at high risk of environmental enteropathy
AU - Shivakumar, Nirupama
AU - Huq, Sayeeda
AU - Paredes-Olortegui, Maribel
AU - Konyole, Silvenus Ochieng
AU - Devi, Sarita
AU - Yazbeck, Roger
AU - Owino, Victor O.
AU - Brouwer, Andrew F.
AU - Kosek, Margaret N.
AU - Kelly, Paul
AU - Morrison, Douglas J.
AU - Lee, Gwenyth O.
PY - 2024/12
Y1 - 2024/12
N2 - Background: Environmental enteropathy’ (EE) is common among children who are highly exposed to enteric pathogens in low-resource settings. We optimized and validated a stable isotope-based breath test of intestinal sucrase activity (13C-SBT) as a noninvasive test of carbohydrate digestion and metabolism. Objectives: The primary objective of this study was to assess the relationship between the 13C-SBT and the lactulose/rhamnose ratio (LR) and growth in children. Secondary objectives were to assess the relationship between the 13C-SBT and additional biomarkers of EE. We also characterized the relationship between the 13C-SBT and child sex and dietary diversity, as well as household socio-economic status and food security. Methods: In this cross-sectional study, 12-to-15-mo-old children were recruited in Bangladesh, India, Kenya, and Peru. Children were assessed with a 4-h 13C-SBT and a 90-min LR test. Plasma was collected to determine the citrulline and kynurenine/tryptophan ratio. Length and weight were measured, and other variables were assessed through questionnaires. For a subset of children, anthropometry was re-measured after 3 mo. Linear regression was used to examine associations corresponding to each objective. Results: Three sites generated 13C-SBT breath curves that enabled pooled analysis. Differences in 13C-SBT breath curves, LR ratios, and other EE biomarkers were observed between sites. No associations were observed for 13C-SBT summary measures and LR or child growth [e.g., the association between LR and cumulative percent dose recovered at 90 min: –0.39; 95% confidence interval (CI): –1.79, 0.70]. Length-for-age and weight-for-age were positively associated with the time to 50% of dose recovered (0.05; 95% CI: 0.01, 0.09, and 0.05; 95% CI: 0.02, 0.07, respectively), and dietary diversity was associated with time at which 50% of the dose recovered by 240 min is recovered and cumulative percent dose recovered at 90 min (–0.10; 95% CI: –0.18, –0.02 and 2.67; 95% CI: 0.47, 4.88, respectively). Conclusions: In children at risk of EE, there were no associations between the 13C-SBT, LR, or other EE biomarkers encompassing different pathophysiological domains of EE. This trial was registered at clinicaltrials.gov as NCT04109352.
AB - Background: Environmental enteropathy’ (EE) is common among children who are highly exposed to enteric pathogens in low-resource settings. We optimized and validated a stable isotope-based breath test of intestinal sucrase activity (13C-SBT) as a noninvasive test of carbohydrate digestion and metabolism. Objectives: The primary objective of this study was to assess the relationship between the 13C-SBT and the lactulose/rhamnose ratio (LR) and growth in children. Secondary objectives were to assess the relationship between the 13C-SBT and additional biomarkers of EE. We also characterized the relationship between the 13C-SBT and child sex and dietary diversity, as well as household socio-economic status and food security. Methods: In this cross-sectional study, 12-to-15-mo-old children were recruited in Bangladesh, India, Kenya, and Peru. Children were assessed with a 4-h 13C-SBT and a 90-min LR test. Plasma was collected to determine the citrulline and kynurenine/tryptophan ratio. Length and weight were measured, and other variables were assessed through questionnaires. For a subset of children, anthropometry was re-measured after 3 mo. Linear regression was used to examine associations corresponding to each objective. Results: Three sites generated 13C-SBT breath curves that enabled pooled analysis. Differences in 13C-SBT breath curves, LR ratios, and other EE biomarkers were observed between sites. No associations were observed for 13C-SBT summary measures and LR or child growth [e.g., the association between LR and cumulative percent dose recovered at 90 min: –0.39; 95% confidence interval (CI): –1.79, 0.70]. Length-for-age and weight-for-age were positively associated with the time to 50% of dose recovered (0.05; 95% CI: 0.01, 0.09, and 0.05; 95% CI: 0.02, 0.07, respectively), and dietary diversity was associated with time at which 50% of the dose recovered by 240 min is recovered and cumulative percent dose recovered at 90 min (–0.10; 95% CI: –0.18, –0.02 and 2.67; 95% CI: 0.47, 4.88, respectively). Conclusions: In children at risk of EE, there were no associations between the 13C-SBT, LR, or other EE biomarkers encompassing different pathophysiological domains of EE. This trial was registered at clinicaltrials.gov as NCT04109352.
KW - environmental enteropathy
KW - gut function
KW - intestinal permeability
KW - sucrose breath test
UR - http://www.scopus.com/inward/record.url?scp=85208064661&partnerID=8YFLogxK
U2 - 10.1016/j.ajcnut.2024.10.001
DO - 10.1016/j.ajcnut.2024.10.001
M3 - Article
C2 - 39384142
AN - SCOPUS:85208064661
SN - 0002-9165
VL - 120
SP - 1354
EP - 1363
JO - American Journal of Clinical Nutrition
JF - American Journal of Clinical Nutrition
IS - 6
ER -
