Modular Formula: an approach to management of infants with specific or complex food intolerances

History of Acquired Monosaccharide Intolerance in Houston, Texas

It is appropriate that we begin the clinical part of this conference with a discussion of acquired monosaccharide intolerance. This disease is the most severe form of carbohydrate malabsorption and maldigestion that can afflict an infant. The following article describes the pathophysiology of the disease, as well as its treatment, much of which was based on studies done by the Section of Pediatric Gastroenterology and Nutrition at Baylor College of Medicine. Acquired monosaccharide intolerance has almost disappeared from the United States but remains a problem in the developing world where it is included as part of the diagnosis of environmental enteropathy. Present research on this disease seems to sometimes duplicate what is already known.

The use of modular nutrients in pediatrics

BACKGROUND

Nutrient modules are commonly used by pediatricians and dietitians. There is no readily available current literature to which those using nutrient modules can refer. Therefore, we review nutrient module composition, module use in pediatrics, and complications associated with the use of nutrient modules.

METHODS

Using an online database, Meduline, we searched the literature from 1996 through 1995.

RESULTS

Nutrient modules are single or multiple nutrients that can be combined with a diet to add nutrients or to change the composition of the diet. These nutrients exist as a food or as medically compounded elements of a diet but alone are not complete foods.

DISCUSSION

The addition of modules to a diet can alter the composition of a diet so that a single nutrient may become deficient and the diet cannot support normal growth and development. With use of nutrient modules, diets can be prepared to meet the specific needs of children with common or rare nutritional problems.

CONCLUSION

Health care providers who use nutrient modules must understand the importance of diet composition and the careful monitoring of pediatric patients.

Effects of changes in infusion rate versus glucose concentration on absorption in infant miniature pig small intestine

The effect of changes in the rate of infusion versus glucose concentration on glucose, water, and sodium absorption was studied in 20 infant miniature pigs using the single-pass small intestinal perfusion technique. During infusions of glucose loads of up to 75.0 mumol/min, glucose absorption increased similarly whether rate of infusion or glucose concentration was increased. Beyond 75.0 mumol/min, glucose absorption was not altered by changes in infusion rate, but was enhanced by increases in glucose concentration (slope of rate vs. concentration, p less than 0.0001). Net water and sodium absorption were similar in the two groups except for a decrease at the highest glucose concentration (rate vs. concentration at 187.5 mumol/min, p less than 0.05). A glucose concentration of 112.5 mM resulted in maximal glucose, water, and sodium absorption.

Selected topics in therapeutic nutrition

Although parenteral and enteral nutrition has advanced rapidly in the last 5 years, prevention of nutritional problems in children still depends on the practice of basic nutritional principles. Breast-feeding remains the best alimentation for the infant. Increased support of breast-feeding in children with cleft lip and/or palate is a simple application of basic therapeutic nutrition. Proper feeding can avert the need for parenteral or enteral nutrition. As our knowledge of nutritional therapeutics expands, the practitioner will be able to play a greater role in both preventive and therapeutic nutrition.

Intestinal surface area in infants with acquired monosaccharide intolerance

Acquired monosaccharide intolerance is characterized by the malabsorption of all carbohydrates, resulting in profuse acidic diarrhea. Five infants with this syndrome, ranging from two to six months of age, were studied by measuring their ability to absorb glucose given by intestinal perfusion. Jejunal biopsies obtained at the time of perfusion were studied by light and electron microscopy, and surface area measurements were obtained. Glucose absorption and surface area were significantly decreased (P less than 0.005) during the acute phase of the disease and improved during convalescence. A linear correlation (r = 0.8757) was observed between the ability to absorb glucose and intestinal surface area. It is concluded that the loss of absorptive surface is a major cause of the reduced carbohydrate absorption and consequent diarrhea.