Kvissberg Matilda A, Dalvi Prasad S, Kerac Marko, Voskuijl Wieger, Berkley James A, Priebe Marion G, Bandsma Robert H J
M.A. Kvissberg and R.H. Bandsma are with the Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University Medical Centre Groningen, University of Groningen, The Netherlands. P.S. Dalvi and R.H. Bandsma are with the Physiology and Experimental Medicine Program, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada. P.S. Dalvi is with the Center for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada. M. Kerac is with the Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. W. Voskuijl is with the College of Medicine, University of Malawi, Blantyre, Malawi. J.A. Berkley is with the Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom. J.A. Berkley is with the KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya. M.G. Priebe is with the Centre for Medical Biomics, University Medical Centre of Groningen, University of Groningen, The Netherlands. R.H. Bandsma is with the Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada.
Nutr Rev. 2016 Jan;74(1):48-58. doi: 10.1093/nutrit/nuv058. Epub 2015 Nov 17.
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.
重度急性营养不良（SAM）每年导致约100万儿童死亡。高死亡率与腹泻和肺炎等合并症有关。
本系统评价的目的是确定SAM患儿碳水化合物吸收不良的发生程度。
检索了PubMed和Embase数据库。检查了所选文章的参考文献列表。
所有涉及SAM患儿且分析了碳水化合物吸收直接或间接指标的观察性和对照干预研究均符合纳入标准。本评价共选择了20篇文章。
大多数研究报告了碳水化合物吸收不良，尤其是乳糖吸收不良，并表明食用含乳糖饮食的儿童腹泻增加且体重增加减少。由于所综述的大多数研究为观察性研究，因此没有确凿的科学证据证明乳糖吸收不良与营养不良儿童临床结局较差之间存在因果关系。
综合数据表明，碳水化合物吸收不良在SAM患儿中普遍存在。需要开展更多设计良好的干预研究，以确定改变治疗性喂养食品的碳水化合物/乳糖含量是否能改善合并碳水化合物吸收不良的SAM患儿的结局，并阐明其中的确切机制。
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