Multiple micronutrient supplementation transiently ameliorates environmental enteropathy in Malawian children aged 12-35 months in a randomized controlled clinical trial.

Abstract

BACKGROUND:

Environmental enteropathy (EE) is subclinical, diffuse villous atrophy characterized by T cell infiltration of the small intestinal mucosa associated with nutrient malabsorption and stunting. EE is assessed by the lactulose:mannitol (L:M) test, whereby nonmetabolized sugars are ingested and quantified in the urine. Multiple micronutrient (MN) deficiency morphologically mimics EE, and ω-3 (n-3) polyunsaturated fatty acids reduce mucosal inflammation in Crohn disease.

OBJECTIVE:

We tested the hypothesis that supplementary MNs, with or without fish oil (FO), would improve L:M in rural Malawian children aged 1-3 y compared with a control (C) group receiving a placebo.

METHODS:

The MNs and FO provided the Recommended Dietary Intake for 26 vitamins, minerals, eicosapentaenoic acid, and docosahexaenoic acid. This was a 3-arm, randomized, double-blind, placebo-controlled clinical trial, with the primary outcomes being the change in L:M (ΔL:M) after 12 and 24 wk of supplementation. Comparisons were made for ΔL:M after 12 and 24 wk within each group by using a Wilcoxon matched pairs signed rank test, because the data are not normally distributed.

RESULTS:

A total of 230 children had specimens adequate for analysis; all had an abnormal baseline L:M, defined as >0.10. After 12 wk, children who received MNs + FO had a ΔL:M [mean (95% CI)] of -0.10 (-0.04, -0.15; P = 0.001), and children receiving only MNs had ΔL:M of -0.12 (-0.03, -0.21; P = 0.002). After 24 wk, children who received MNs + FO had a ΔL:M of -0.09 (-0.03, -0.15; P = 0.001); children receiving only MNs had a ΔL:M of -0.11 (-0.02, -0.20; P = 0.001), and the C group had ΔL:M of -0.07 (0.02, -0.16); P = 0.002). Linear growth was similar in all groups, ∼4.3 cm over 24 wk.

CONCLUSION:

Although the effect was modest, these data suggest MNs can transiently ameliorate EE in rural African children. The trial was registered at clinicaltrials.gov as NCT01593033.

• Authors: Hannah E Smith, Kelsey N Ryan, Kevin B Stephenson, Claire Westcott, Chrissie Thakwalakwa, Ken Maleta, Jacqueline Y Cheng, J Thomas Brenna, Robert J Shulman, Indi Trehan, Mark J Manary
• Journal: The Journal of nutrition (J Nutr) Vol. 144 Issue 12 Pg. 2059-65 (Dec 2014) ISSN: 1541-6100 [Electronic] United States
• PMID: 25411039 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 American Society for Nutrition.

Chemical References

• Fatty Acids, Unsaturated
• Fish Oils
• Micronutrients
• Vitamin A
• Docosahexaenoic Acids
• Mannitol
• Lactulose
• Eicosapentaenoic Acid

Topics

• Child, Preschool
• Cluster Analysis
• Dietary Supplements
• Docosahexaenoic Acids (administration & dosage)
• Dose-Response Relationship, Drug
• Double-Blind Method
• Eicosapentaenoic Acid (administration & dosage)
• Energy Intake
• Fatty Acids, Unsaturated (blood)
• Female
• Fish Oils (administration & dosage)
• Follow-Up Studies
• Humans
• Infant
• Intestinal Diseases (drug therapy)
• Intestinal Mucosa (drug effects, metabolism)
• Lactulose (urine)
• Malawi
• Male
• Mannitol (urine)
• Micronutrients (administration & dosage, deficiency)
• Nutrition Assessment
• Patient Compliance
• Recommended Dietary Allowances
• Vitamin A (administration & dosage)