title: Undernutrition, Vitamin A and Iron Deficiency Are Associated with Impaired Intestinal Mucosal Permeability in Young Bangladeshi Children Assessed by Lactulose/Mannitol Test.
abstract: BACKGROUND
  Lactulose/mannitol (L:M) test has been used as a non-invasive marker of intestinal mucosal -integrity and -permeability (enteropathy). We investigated the association of enteropathy with anthropometrics, micronutrient- status, and morbidity in children.
  
  
  METHODS
  The urine and blood samples were collected from 925 children aged 6-24 months residing in Mirpur slum of Dhaka, Bangladesh during November 2009 to April 2013. L:M test and micronutrient status were assessed in the laboratory of International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b) following standard procedure.
  
  
  RESULTS
  Mean±SD age of the children was 13.2±5.2 months and 47.8% were female. Urinary- lactulose recovery was 0.264±0.236, mannitol recovery was 3.423±3.952, and L:M was 0.109±0.158. An overall negative correlation (Spearman's-rho) of L:M was found with age (rs = -0.087; p = 0.004), weight-for-age (rs = -0.077; p = 0.010), weight-for-length (rs = -0.060; p = 0.034), mid-upper-arm-circumference (rs = -0.098; p = 0.001) and plasma-retinol (rs = -0.105; p = 0.002); and a positive correlation with plasma α-1-acid glycoprotein (rs = 0.066; p = 0.027). However, most of the correlations were not very strong. Approximately 44% of children had enteropathy as reflected by L:M of ≥0.09. Logistic regression analysis revealed that younger age (infancy) (adjusted odds ratio (AOR) = 1.35; p = 0.027), diarrhea (AOR = 4.00; p = 0.039) or fever (AOR = 2.18; p = 0.003) within previous three days of L:M test were the risk factors of enteropathy (L:M of ≥0.09).
  
  
  CONCLUSIONS
  Enteropathy (high L:M) is associated with younger age, undernutrition, low vitamin A and iron status, and infection particularly diarrhea and fever.
authors.affiliation: Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.|James P. Grant School of Public Health, Brac University, Mohakhali, Dhaka, Bangladesh.
authors.forename: Md Iqbal
authors.initials: MI
authors.lastname: Hossain
authors.affiliation: Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
authors.forename: Rashidul
authors.initials: R
authors.lastname: Haque
authors.affiliation: Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Mondal
authors.affiliation: Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Mahfuz
authors.affiliation: Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
authors.forename: Am Shamsir
authors.initials: AS
authors.lastname: Ahmed
authors.affiliation: Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
authors.forename: M Munirul
authors.initials: MM
authors.lastname: Islam
authors.affiliation: Division of Infectious Disease and International Health, University of Virginia, Charlottesville, Virginia, United States of America.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Guerrant
authors.affiliation: Division of Infectious Disease and International Health, University of Virginia, Charlottesville, Virginia, United States of America.
authors.forename: William A
authors.initials: WA
authors.lastname: Petri
authors.affiliation: Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.|James P. Grant School of Public Health, Brac University, Mohakhali, Dhaka, Bangladesh.
authors.forename: Tahmeed
authors.initials: T
authors.lastname: Ahmed
mesh_terms: D001459:Bangladesh; D002463:Cell Membrane Permeability; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000097:blood / Q000503:physiopathology* / Q000652:urine; D005260:Female; D005334:Fever / Q000097:blood / Q000503:physiopathology / Q000652:urine; D006801:Humans; D007223:Infant; D007408:Intestinal Absorption; D007413:Intestinal Mucosa / Q000378:metabolism / Q000503:physiopathology*; D007501:Iron / Q000378:metabolism; D019189:Iron Metabolism Disorders / Q000097:blood / Q000503:physiopathology / Q000652:urine; D007792:Lactulose / Q000097:blood / Q000652:urine; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000503:physiopathology* / Q000652:urine; D008353:Mannitol / Q000097:blood / Q000652:urine; D014801:Vitamin A / Q000378:metabolism
chemical_list: D014801:Vitamin A; D008353:Mannitol; D007792:Lactulose; D007501:Iron