Journal article
Carbohydrate maldigestion induces necrotizing enterocolitis in preterm pigs
University of Copenhagen1
Baylor College of Medicine2
Innate Immunology, Division of Veterinary Diagnostics and Research, National Veterinary Institute, Technical University of Denmark3
Division of Veterinary Diagnostics and Research, National Veterinary Institute, Technical University of Denmark4
National Veterinary Institute, Technical University of Denmark5
University of Memphis6
Aarhus University7
Texas Children's Hospital8
Microbial Ecology, Division of Veterinary Diagnostics and Research, National Veterinary Institute, Technical University of Denmark9
Thymann T, Moller HK, Stoll B, Stoy AC, Buddington RK, Bering SB, Jensen BB, Olutoye OO, Siggers RH, Molbak L, Sangild PT, Burrin DG. Carbohydrate maldigestion induces necrotizing enterocolitis in preterm pigs. Am J Physiol Gastrointest Liver Physiol 297: G1115-G1125, 2009. First published October 1, 2009; doi: 10.1152/ajpgi.00261.2009.
Necrotizing enterocolitis (NEC) remains the most severe gastrointestinal disorder in preterm infants. It is associated with the initiation of enteral nutrition and may be related to immature carbohydrate digestive capacity. We tested the hypothesis that a formula containing maltodextrin vs. a formula containing lactose as the principal source of carbohydrate would predispose preterm pigs to a higher NEC incidence.
Cesarean-derived preterm pigs were given total parenteral nutrition for 48 h followed by total enteral nutrition with a lactose-based (n = 11) or maltodextrin-based (n = 11) formula for 36 h. A higher incidence (91% vs. 27%) and severity (score of 3.3 vs. 1.8) of NEC were observed in the maltodextrin than in the lactose group.
This higher incidence of NEC in the maltodextrin group was associated with significantly lower activities of lactase, maltase, and aminopeptidase; reduced villus height; transiently reduced in vivo aldohexose uptake; and reduced ex vivo aldohexose uptake capacity in the middle region of the small intestine.
Bacterial diversity was low for both diets, but alterations in bacterial composition and luminal concentrations of short-chain fatty acids were observed in the maltodextrin group. In a second study, we quantified net portal absorption of aldohexoses (glucose and galactose) during acute jejunal infusion of a maltodextrin-or a lactose-based formula (n = 8) into preterm pigs.
We found lower net portal aldohexose absorption (4% vs. 42%) and greater intestinal recovery of undigested carbohydrate (68% vs. 27%) in pigs acutely perfused with the maltodextrin-based formula than those perfused with the lactose-based formula. The higher digestibility of the lactose than the maltodextrin in the formulas can be attributed to a 5- to 20-fold higher hydrolytic activity of tissue-specific lactase than maltases.
We conclude that carbohydrate maldigestion is sufficient to increase the incidence and severity of NEC in preterm pigs.
| Language: | English |
|---|---|
| Publisher: | American Physiological Society |
| Year: | 2009 |
| Pages: | G1115-G1125 |
| ISSN: | 15221547 and 01931857 |
| Types: | Journal article |
| DOI: | 10.1152/ajpgi.00261.2009 |
| ORCIDs: | 0000-0001-7480-6064 and 0000-0002-6125-7892 |
Aminopeptidases Animal Nutritional Physiological Phenomena Animals Animals, Newborn Cesarean Section Digestion Disease Models, Animal Enteral Nutrition Enterocolitis, Necrotizing Galactose Glucose Humans Hydrolysis Infant Formula Infant, Newborn Intestinal Absorption Intestines Lactase Lactose Parenteral Nutrition Polysaccharides Premature Birth Severity of Illness Index Swine Time Factors alpha-Glucosidases
