ARS | Publication request: Perturbed zinc homeostasis in rural 3-5-y-old Malawian children is associated with abnormalities in intestinal permeability attributed to tropical enteropathy

Submitted to: Pediatric Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: January 11, 2010
Publication Date: June 6, 2010
Citation: Manary, M.J., Abrams, S.A., Griffin, I.J., Quimper, M.M., Shulman, R.J., Hamzo, M.G., Chen, Z., Maleta, K., Manary, M.J. 2010. Perturbed zinc homeostasis in rural 3-5-y-old Malawian children is associated with abnormalities in intestinal permeability attributed to tropical enteropathy. Pediatric Research. 67(6):671-675.

Interpretive Summary: A disease called tropical enteropathy is a major public health problem worldwide. Tropical enteropathy is characterized by problems with how sugar is absorbed by the body. Patients with this condition may also have problems with absorbing enough of the mineral zinc from their diet. In this study, conducted in the nation of Malawi, we studied whether these two problems were related to each other. We studied 25 children aged 3–5 years at risk for tropical enteropathy and zinc deficiency. We found that abnormal zinc absorbing and leaking out from the gut is associated with early signs of tropical enteropathy in these children. This suggests that many children in Malawi who have this problem might benefit from being given extra zinc.

Technical Abstract: Tropical enteropathy and zinc deficiency are major public health problems worldwide. Tropical enteropathy is characterized by reduced mannitol absorption with normal or increased lactulose absorption when a dual sugar absorption test is administered, the results of which are reported as the lactulose: mannitol ratio (L: M). Zinc homeostasis is quantified with a dual stable isotope test. This study tested the hypothesis that endogenous fecal zinc (EFZ) was correlated with the L: M. A dual sugar absorption test and dual stable isotope test were performed on 25 asymptomatic Malawian children aged 3-5 years at risk for tropical enteropathy and zinc deficiency. EFZ and net zinc retention were estimated and correlated with the L: M. Twenty-two children (88%) had an abnormal L: M (L: M>0.10), and the L: M was 0.24+/-0.10 (mean+/-SD). EFZ was 1.68+/-1.06 mg/d, a quantity greater than is seen in healthy populations from the developed world. EFZ was positively correlated with the L: M (r=0.62, p<0.001). Net zinc retention (0.67+/-1.6 mg/d) was negatively correlated with the L: M (r=-0.47, p=0.02). This suggests that perturbed zinc homeostasis is associated with subclinical enteropathy in these children.