Children with malabsorption of nutrients – Causes and solutions

03/01/2024

Children with poor digestion, constant illness, non-standard weight are the worries of many families with children of nutrient malabsorption syndrome. Without prompt intervention the child may suffer from severe malnutrition, affecting his/her resistance and stature in the future.

What is malabsorption in children?

Malabsorption is a decrease in the ability to absorb nutrients when consuming food through the digestive tract, and is one of the leading causes of malnutrition in children. There are several causes for Malabsorption, including both congenital and non-congenital factors, causing disorders in the absorption process such as: Defects in hydrolysis in the intestinal lumen; defects in the absorptive capacity of the mucosa; Defects in the vascular and lymphatic systems affect nutrient transport.

This condition is common in young children due to their immature digestive system, and immune system and requires the use of antibiotics, which leads to an imbalance in the intestinal microflora.

Malabsorption is one of the leading causes of malnutrition in children

Children’s malabsorption is able to be detected by digestive disorders such as:

Diarrhea: Diarrhea is one of the most common symptoms of malabsorption. Stool characteristics and quantity can be a useful symptom to help identify malabsorption in children.

– Liquid stool during the first week of life in newborns and after regular formula feeding is suggestive of congenital glucose-galactose malabsorption or congenital lactase deficiency. Skin irritation and erythema in the perianal area are characteristic of the acidic stools seen in carbohydrate malabsorption.

– Large, greasy and foul-smelling stools indicate poor fat absorption such as pancreatic insufficiency.

– Nocturnal diarrhea indicates enteritis caused by toxigenic Escherichia coli bacteria and in congenital mucosal defects.

– Bloody stools are a sign of an inflammatory process such as inflammatory bowel disease or eosinophilic enteritis.

– Floating stools may be due to high fat content in the stool, but can also be due to high gas content such as carbohydrate malabsorption. Liquid stools containing undigested food particles are a common sign of chronic nonspecific diarrhea in toddlers and are not a sign of malabsorption.

Abdominal bloating and flatulence: due to bacterial fermentation of malabsorbed carbohydrates in the colon and due to intestinal bacterial overgrowth.

Abdominal pain: due to intestinal distension or inflammation.

Swollen feet, puffy eyes and dropsy: due to protein loss or malabsorption.

Furthermore, malabsorption is also manifested in other non-gastrointestinal disorders such as: Failure to develop or slow growth secondary to malabsorption of nutrients; Loss of appetite and loss of appetite due to inflammation of the intestinal mucosa; Weakness, fatigue, and general malaise secondary to poor nutrition or anemia; Late puberty and amenorrhea due to protein-energy malnutrition; Blood clotting problems due to vitamin K deficiency; Paleness and anemia (due to iron, folate or vitamin B12 deficiency); and many other symptoms caused by deficiencies in specific nutrients.

It can be seen that malabsorption has countless consequences for the health and development of children. If not intervened in time, malabsorption can put the child’s health in danger and indirectly affect the child’s stature and resistance in the future. Here are some suggestions on overcoming poor digestion in young children.

Tips for poor digestion in young children

Solutions for digestive disorders:

Digestive disorders such as diarrhea, bloating, and indigestion need to be treated properly because only when the child’s digestive system is stable can nutrients be absorbed normally. To treat properly, caregivers need to determine the root cause of these digestive disorders such as: bacterial infections, intestinal microbiological imbalance, intolerance to lactose in milk, allergies. Cow’s milk protein allergy, gluten allergy… If the cause is not determined, the child needs to be examined by doctors and nutritionists to have an appropriate treatment plan.

For children with poor fat absorption:

Since the 1950s, a group of fats with an average length of 6 – 12 carbons, also known as Medium chain triglycerides (MCTs), have been introduced into clinical nutrition for dietary treatment of malabsorption syndrome thanks to its ability to aid in rapid absorption and dissolution by the human body.

In the first months of a child’s life, the digestive system is not fully developed, the exocrine pancreas is underdeveloped, so the amount of fat-digesting enzyme lipase secreted by the pancreas is very small[3], affects the absorption of long chain triglycerides (LCT) as this type of fat requires pancreatic lipase for hydrolysis and digestion. Meanwhile, MCT medium-chain fats have many advantages in terms of digestion speed and easier absorption compared to LCT long-chain fats because the digestion and absorption process of MCTs does not require many enzymes from bile and pancreas, the process of absorption into the blood does not have to go through a complicated process of transformation into micelles, chylomicrons to enter the lymphatic system, and does not need carnitine to be transported into the mitochondria as raw material for the energy conversion process.

Many clinical studies have shown differences between the absorption of MCT fat-containing and non-fat-containing products, for example a study in Switzerland showed increased fat absorption. In infants, lipid digestion is poor when using formula milk containing MCT, which is many times higher than normal formula milk (83,1% so với 42,7%)[5]. Or like a study in Australia, when studying the amount of lipid residue in the stool due to not being absorbed, it showed that children using MCT formula milk had 4g, while children using milk without MCT had the amount of fat in the stool up to 22g.

For children with poor protein absorption:

Protein metabolism is a complex process that requires functional integration of different parts of the gastrointestinal tract for proper digestion, absorption, and transport. The first digestive process begins in the stomach in the form of proteolysis and with an appropriate pH environment. Other parts of the intestine are also involved in the presence of cholecystokinin, proteases and other pancreatic enzymes. Therefore, any functional impairment of any segment of the intestine can significantly affect protein digestion and absorption.

In clinical nutrition, Whey protein from cow’s milk is used as a fast-absorbing and easily digestible protein source. Whey protein contains many essential amino acids that are quickly digested, helping to provide amino acids after meals, stimulating the assimilation and accumulation of muscle proteins more effectively than casein protein and hydrolyzed casein, which are also found in milk. Its absorption rate is estimated to be about 10g/hour. At this rate, it only takes 2 hours to completely absorb a 20g dose of whey[8]. Therefore, whey is added to many formula milk products as an easily absorbed protein source to help support essential muscle recovery..

Whey protein is often added to formula milk products to help restore the baby’s necessary muscle mass

For children with malabsorption of micronutrients:

Malabsorption syndrome not only affects the absorption of some macronutrients such as carbohydrates, lipids, proteins but also affects trace elements such as vitamins and minerals. Supplementing soluble fiber FOS (fructo-oligosaccharide) is one way to help increase the absorption and bioavailability of some vitamins and minerals. FOS actually increases water content in the colon, increasing the solubility of some water-soluble vitamins and some minerals[9].

In addition, FOS is a good food source for Bifido bacteria, which help produce short-chain fatty acids, lactate, and butyrate, thereby reducing the pH in the intestinal lumen, thereby increasing absorption. epithelial absorption through proliferation of epithelial cells in the colon, creating an acidic environment more favorable for mineral solubility and improved intestinal health. 

For children with poor digestion and malabsorption due to intestinal microflora imbalance 

In the first years of life, a child’s intestinal microflora is still in the stage of completion, so it is very common for children to suffer from digestive problems. In addition to breastfeeding babies (a useful source of nutrients for the development of intestinal microflora with abundant prebiotic fiber HMO as food for probiotics), Caregivers can consider supplementing probiotics and prebiotic fiber to support their child’s immature digestive system.

In a study titled “Probiotics for preventing and treating excessive crying in infants: a systematic review and meta-analysis” was published in JAMA – a monthly peer-reviewed medical journal by the Association Published by the American Medical Association, scientists have shown that supplementing probiotics for infants in the first three months of life can help prevent colic, constipation and acid reflux, thereby reducing unexplained crying, improves absorption and digestion problems caused by intestinal inflammation and microflora imbalance.

Probiotics help improve absorption and digestion problems caused by intestinal inflammation and microflora imbalance.

Baby caregivers can consider some sources of probiotic and probiotic foods that are safe for each stage. For newborns, breast milk is the best food source to help perfect their immune and digestive systems. In addition, currently some formula milk products are supplemented with probiotics Lactobacillus acidophilus or Bifidobacterium and some prebiotics such as HMO, GOS, FOS… For children whose age over 6 months oldand  have started solid foods, the caregiver can consider giving children yogurt and drinking yogurt, or quality and safe fermented foods.

Thus, malabsorption in children often comes from gastrointestinal problems. In addition to treating the digestive disorders mentioned above, caregivers can also supplement the child’s diet with easily absorbed nutrients that support digestion, thereby optimizing the amount of nutrients from daily consumed food.

References:

1. Ensari A. The Malabsorption Syndrome and Its Causes and Consequences. Pathobiology of Human Disease. 2014:1266–87. doi: 10.1016/B978-0-12-386456-7.03804-1. Epub 2014 Aug 21. PMCID: PMC7149679.

2. El Baba, M. (2012). Approach to a Child with Malabsorption. In: Elzouki, A.Y., Harfi, H.A., Nazer, H.M., Stapleton, F.B., Oh, W., Whitley, R.J. (eds) Textbook of Clinical Pediatrics. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-02202-9_184

3. Seaton TB, Welle SL, Warenko MK, Campbell RG. Thermic effect of medium-chain and long-chain triglycerides in man. Am J Clin Nutr. 1986;44:630-4.

4. Lebenthal E, Choi TS, Lee PC. The development of pancreatic function in premature infants after milk-based and soy-based formulas. Pediatr Res. 1981 Sep;15(9):1240-4. doi: 10.1203/00006450-198109000-00003. PMID: 7197347.

5. Shah, Neha D. “The Use of Medium-Chain Triglycerides in Gastrointestinal Disorders.” (2017).

6. Kuhni M. [Nutrition of children with steatorrhea using fats of medium-chain fatty acids]. Schweiz Med Wochenschr. 1968; 98: 755-759

7. Burke V., Anderson C.M. Experience with medium chain triglycerides in malabsorptive states in childhood. Aust paediat J. 1967; 3: 135-143

8. Oberoi A, Giezenaar C, Jensen C, Lange K, Hausken T, Jones KL, Horowitz M, Chapman I, Soenen S. Acute effects of whey protein on energy intake, appetite and gastric emptying in younger and older, obese men. Nutr Diabetes. 2020 Oct 2;10(1):37. doi: 10.1038/s41387-020-00139-8. PMID: 33004790; PMCID: PMC7531014.

9. Bilsborough S, Mann N. A review of issues of dietary protein intake in humans. Int J Sport Nutr Exerc Metab. 2006;16(2):129–152. doi: 10.1123/ijsnem.16.2.129.

10. Sabater-Molina M, Larque E, Torrella F, Zamora S. Dietary fructooligo- saccharides and potential benefits on health. J Physiol Biochem 2009;65(3): 315e28

11. G.T. Costa, Q.D.J.S. Vasconcelos, G.C. Abreu, A.O. Albuquerque, J.L. Vilar, G.F. Aragão, Systematic review of the ingestion of fructooligosaccharides on the absorption of minerals and trace elements versus control groups, Clinical Nutrition ESPEN, Volume 41, 2021, Pages 68-76, ISSN 2405-4577, https://doi.org/10.1016/j.clnesp.2020.11.007.

 

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