Shivakumar Nirupama, Morrison Douglas J, Hegde Shalini G, Kurpad Anura V, Kelly Paul
Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences (A Unit of CBCI Society for Medical Education), Bangalore, India.
Center for Doctoral Studies, Manipal Academy of Higher Education, Manipal, India.
Eur J Clin Nutr. 2025 Mar;79(3):181-194. doi: 10.1038/s41430-024-01510-z. Epub 2024 Oct 8.
Assessing the digestive and absorptive capacity of the gastro-intestinal tract (GIT) using minimally- or non-invasive methods, particularly in children, has been difficult owing to the complex physiology and variability in functional measurements. However, measuring GIT function is increasingly important with the emerging relevance of childhood environmental enteropathy (EE) as a mediating factor in linear growth faltering, severe acute malnutrition, poor oral vaccine uptake and impaired cognition. In EE, sub-optimal nutrient digestion and absorption (malabsorption) forms the critical link to the conditions mentioned above. The present narrative review discusses probable mechanisms that can cause malabsorption of macronutrients, along with mechanistic and experimental evidence, in children (if not, in adults) with EE. The strengths and limitations of the human experimental studies are examined in relation to a battery of existing and potential tests that are used to measure malabsorption. From the available studies conducted in children, lactose and fat malabsorption are more likely to occur in EE. Breath tests (non-invasive) measuring carbohydrate (C-starch/sucrose/lactose), fat (C-mixed triglyceride) and dipeptide (benzoyl-L-tyrosyl-L-1-C-alanine) malabsorption with modifications to the existing protocols seem suitable for use in children with EE. Future research should focus on understanding the degree of macronutrient malabsorption using these tests, in different settings, and link them to functional outcomes (such as growth, muscle strength, cognition).
由于胃肠道生理功能复杂且功能测量存在变异性，使用微创或非侵入性方法评估胃肠道（GIT）的消化和吸收能力一直很困难，尤其是在儿童中。然而，随着儿童环境肠病（EE）作为线性生长发育迟缓、严重急性营养不良、口服疫苗接种率低和认知障碍的中介因素的重要性日益凸显，测量GIT功能变得越来越重要。在EE中，营养物质消化和吸收不佳（吸收不良）是上述病症的关键环节。本叙述性综述讨论了在患有EE的儿童（若不是成人）中可能导致常量营养素吸收不良的机制，以及相关的机制和实验证据。结合一系列用于测量吸收不良的现有和潜在测试，审视了人体实验研究的优势和局限性。从针对儿童开展的现有研究来看，乳糖和脂肪吸收不良在EE中更易发生。对现有方案进行改进后，通过呼气试验（非侵入性）测量碳水化合物（C-淀粉/蔗糖/乳糖）、脂肪（C-混合甘油三酯）和二肽（苯甲酰-L-酪氨酰-L-1-C-丙氨酸）吸收不良，似乎适用于患有EE的儿童。未来的研究应聚焦于在不同环境下使用这些测试来了解常量营养素吸收不良的程度，并将其与功能结果（如生长、肌肉力量、认知）联系起来。
