Intestinal fructose malabsorption is associated with increased lactulose fermentation in the intestinal lumen

Ozaki, Roberto Koity Fujihara; Speridião, Patrícia da Graça Leite; Soares, Ana Cristina Fontenele; Morais, Mauro Batista de

doi:10.1016/j.jped.2017.08.006

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Original articles • J. Pediatr. (Rio J.) 94 (6) • Nov-Dec 2018 • https://doi.org/10.1016/j.jped.2017.08.006 copy

Intestinal fructose malabsorption is associated with increased lactulose fermentation in the intestinal lumen^☆ ☆ Please cite this article as: Ozaki RK, Speridião PG, Soares AC, Morais MB. Intestinal fructose malabsorption is associated with increased lactulose fermentation in the intestinal lumen. J Pediatr (Rio J). 2018;94:609-15. , ^☆☆ ☆☆ Study carried out at Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Disciplina de Gastroenterologia Pediátrica, São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To study fructose malabsorption in children and adolescents with abdominal pain associated with functional gastrointestinal disorders. As an additional objective, the association between intestinal fructose malabsorption and food intake, including the estimated fructose consumption, weight, height, and lactulose fermentability were also studied.

Methods:

The study included 31 patients with abdominal pain (11 with functional dyspepsia, 10 with irritable bowel syndrome, and 10 with functional abdominal pain). The hydrogen breath test was used to investigate fructose malabsorption and lactulose fermentation in the intestinal lumen. Food consumption was assessed by food registry. Weight and height were measured.

Results:

Fructose malabsorption was characterized in 21 (67.7%) patients (nine with irritable bowel syndrome, seven with functional abdominal pain, and five with functional dyspepsia). Intolerance after fructose administration was observed in six (28.6%) of the 21 patients with fructose malabsorption. Fructose malabsorption was associated with higher (p < 0.05) hydrogen production after lactulose ingestion, higher (p < 0.05) energy and carbohydrate consumption, and higher (p < 0.05) body mass index z-score value for age. Median estimates of daily fructose intake by patients with and without fructose malabsorption were, respectively, 16.1 and 10.5 g/day (p = 0.087).

Conclusion:

Fructose malabsorption is associated with increased lactulose fermentability in the intestinal lumen. Body mass index was higher in patients with fructose malabsorption.

KEYWORDS
Abdominal pain; Fructose; Dyspepsia; Eating; Body mass index

	Intestinal fructose malabsorption		p
	Yes (n = 21)	No (n = 10)
Age	8.7 ± 3.2	10.2 ± 3.1	0.234^a a Student's t-test.
Male gender	10 (47.6%)	4 (40.0%)	1.000^b b Fisher's exact test.
Female gender	11 (52.4%)	6 (60.0%)
Fructose intolerance	6 (28.6%)	2 (20.0%)	1.000^b b Fisher's exact test.
Type of functional gastrointestinal disorder
Functional dyspepsia (n = 11)	5 (45.5%)	6 (54.5%)
Irritable bowel syndrome (n = 10)	9 (90.0%)	1 (10.0%)	0.091^c c Chi-squared test.
Functional abdominal pain (n = 10)	7 (70.0%)	3 (30.0%)

Breath test period	Intestinal fructose malabsorption		p ^c c Mann-Whitney test.
	Yes (n = 20)^a a Two patients did not undergo the breath test with lactulose, one of them with fructose malabsorption. Both were hydrogen producers after the administration of fructose (increase in hydrogen concentration in the exhaled air >10 ppm compared to the baseline).	No (n = 9)^a a Two patients did not undergo the breath test with lactulose, one of them with fructose malabsorption. Both were hydrogen producers after the administration of fructose (increase in hydrogen concentration in the exhaled air >10 ppm compared to the baseline).
Fasting up to 60 min (ppm/min)^b b Median (25th and 75th percentiles).	503 (315; 866)	202 (139; 272)	<0.001
60-180 min (ppm/min)^b b Median (25th and 75th percentiles).	3450 (2640; 4005)	1290.0 (1102; 1935)	<0.001
Total (fasting up to 180 min) (ppm/min)^b b Median (25th and 75th percentiles).	4159 (2940; 5066)	1560 (1267; 2033)	<0.001

	Intestinal fructose malabsorption		p
	Yes (n = 21)	No (n = 10)
Food registry
Fructose (g/day)	16.1 (9.0; 27.6)	10.5 (1.8; 16.8)	0.087^a a Median (25th and 75th percentiles); Mann-Whitney test.
Fructose (g/kg/weight/day)	0.58 (0.25; 0.78)	0.28 (0.05; 0.69)	0.091^a a Median (25th and 75th percentiles); Mann-Whitney test.
Energy (kcal/day)	1723 (1441; 2159)	1397 (1314; 1644)	0.049^a a Median (25th and 75th percentiles); Mann-Whitney test.
Carbohydrates (g/day)	258.0 ± 65.3	200.0 ± 41.7	0.016^b b Mean ± standard deviation; Student's t-test.
Carbohydrates (g/kg/weight/day)	8.7 ± 2.9	7.1 ± 2.4	0.128^b b Mean ± standard deviation; Student's t-test.
Proteins (g/day)	63.8 ± 17.7	54.2 ± 14.0	0.147^b b Mean ± standard deviation; Student's t-test.
Proteins (g/kg/weight/day)	2.2 ± 0.8	1.9 ± 0.5	0.292^b b Mean ± standard deviation; Student's t-test.
Lipids (g/day)	56.8 ± 21.1	50.0 ± 8.4	0.334^b b Mean ± standard deviation; Student's t-test.
Food fiber (g/day)	15.3 ± 6.4	12.4 ± 2.9	0.193^b b Mean ± standard deviation; Student's t-test.
z-score
Height for age	+0.07 ± 0.9	-0.21 ± 1.1	0.469^b b Mean ± standard deviation; Student's t-test.
BMI for age	+0.74 ± 1.3	-0.42 ± 1.5	0.036^b b Mean ± standard deviation; Student's t-test.

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[1] * Corresponding author. E-mail:maurobmorais@gmail.com (M.B. Morais).