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Title: Carbohydrate maldigestion induces necrotizing enterocolitis in preterm pigs

item Burrin, Douglas - Doug
item THYMANN, THOMAS - University Of Copenhagen
item STOLL, BARBARA - Children'S Nutrition Research Center (CNRC)
item STOY, A. - University Of Copenhagen
item MOLLER, H. - University Of Copenhagen
item BUDDINGTON, RANDAL - University Of Memphis
item BERING, STINE - University Of Copenhagen
item JENSEN, BENT - University Of Aarhus
item OLUTOYE, OLUYINKA - Baylor College Of Medicine
item SIGGERS, R. - University Of Copenhagen
item MOLBACK, LARS - Technical University Of Denmark
item SANGILD, PER - University Of Copenhagen

Submitted to: Acta Paediatrica
Publication Type: Abstract Only
Publication Acceptance Date: 9/21/2009
Publication Date: 10/9/2009
Citation: Burrin, D.G., Thymann, T., Stoll, B., Stoy, A.C., Moller, H., Buddington, R.K., Bering, S., Jensen, B.B., Olutoye, O., Siggers, R., Molback, L., Sangild, P.T. 2009. Carbohydrate maldigestion induces necrotizing enterocolitis in preterm pigs [abstract]. Acta Paediatrica. 98(Suppl. 460):97.

Interpretive Summary:

Technical Abstract: Necrotizing enterocolitis (NEC) is a major gastrointestinal disorder in preterm infants. Key risk factors for NEC are enteral feeding and microbial colonization. Maldigestion of carbohydrate secondary to immature digestive function has been suspected to cause bacterial overgrowth and NEC. We investigated whether the NEC incidence in preterm pigs fed formulas with lactose or maltodextrin as the main carbohydrate differed due to carbohydrate maldigestion. Cesarean-delivered preterm pigs were given total parenteral nutrition (TPN) for 48 h, then enterally fed either a lactose (n = 11) or a maltodextrin (n = 11) formula for 7-36 h before euthanization and tissue collection. In a second study, 16 preterm TPN-fed pigs were used to quantify net portal absorption of hexoses during an acute jejunalin fusion of either a maltodextrin- or lactose-based formula (n = 8). Results showed that NEC incidence (91 vs. 27%) and severity score (3.3 vs. 1.8) was higher (P < 0.05) in the maltodextrin than the lactose group, coinciding with lower indices of hexose absorption and activities of lactase and maltase. NEC was associated with altered assemblages of luminal bacteria and short chain fatty acids concentrations. In the second study, hexose absorption accounted for 42 and 4% (P < 0.01) of the infused lactose and maltodextrin respectively, resulting in 27 vs. 68% of the infused lactose vs. maltodextrin being undigested in the small intestinal lumen. The different digestion rates were explained by a 5- to 20-fold higher specific activity for lactase compared with sucrase-isomaltase and maltrase-glucoamylase. In conclusion, dietary carbohydrate maldigestion was sufficient to increase the incidence NEC in premature piglets.