title: Use of the lactulose to mannitol ratio to evaluate childhood environmental enteric dysfunction: a systematic review.
abstract: Childhood gut dysfunction (enteropathy) is common in resource-poor environments. Stunting is its presumed major consequence. Identification of biomarkers of gut dysfunction could identify the presence of, and, ideally, assess interventions for, enteropathy. Classically, enteropathy has been identified histopathologically. However, less invasive assays may be more sensitive for detecting earlier perturbations reflecting specific functional derangements. The most commonly used test has been the urinary lactulose to mannitol ratio (L:M), which primarily assesses gut leakiness, and which also measures absorption. We systematically reviewed the L:M literature published from 2000 to 2010 pertinent to children in developing country settings, and identified 25 relevant publications representing heterogeneous studies. We conclude that the L:M test has many attributes, including reflecting 2 physiologic processes (absorption and permeability) and likely correlation with growth failure consequent to child gut dysfunction. However, improved test technical performance, data reporting, and correlation with host phenotypes are needed to maximize the utility of this test.
authors.affiliation: Departments of Pediatrics and Global Health, University of Washington, Seattle.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Denno
authors.affiliation: Bill & Melinda Gates Foundation, Seattle, Washington.
authors.forename: Kelley
authors.initials: K
authors.lastname: VanBuskirk
authors.affiliation: Bill & Melinda Gates Foundation, Seattle, Washington.
authors.forename: Zakia C
authors.initials: ZC
authors.lastname: Nelson
authors.affiliation: Bill & Melinda Gates Foundation, Seattle, Washington.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Musser
authors.affiliation: Bill & Melinda Gates Foundation, Seattle, Washington.
authors.forename: Deborah C
authors.initials: DC
authors.lastname: Hay Burgess
authors.affiliation: Departments of Pediatrics and Molecular Microbiology, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Phillip I
authors.initials: PI
authors.lastname: Tarr
mesh_terms: D015415:Biomarkers / Q000652:urine*; D002675:Child, Preschool; D003906:Developing Countries; D003938:Diagnostic Techniques, Digestive System; D004777:Environment; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000503:physiopathology; D007792:Lactulose / Q000008:administration & dosage / Q000378:metabolism / Q000652:urine; D008353:Mannitol / Q000008:administration & dosage / Q000378:metabolism / Q000652:urine; D009748:Nutrition Disorders; D011203:Poverty
chemical_list: D015415:Biomarkers; D008353:Mannitol; D007792:Lactulose
keywords: biological markers; environment; intestinal diseases/diagnosis