Publications

Assessing the digestive and absorptive capacity of the gastro-intestinal tract (GIT) using minimally- or non-invasive methods, particularly in children, has  been difficult owing to the complex physiology and variability in functional  measurements. However, measuring GIT function is increasingly important with the  emerging relevance of childhood environmental enteropathy (EE) as a mediating  factor in linear growth faltering, severe acute malnutrition, poor oral vaccine  uptake and impaired cognition. In EE, sub-optimal nutrient digestion and  absorption (malabsorption) forms the critical link to the conditions mentioned  above. The present narrative review discusses probable mechanisms that can cause  malabsorption of macronutrients, along with mechanistic and experimental  evidence, in children (if not, in adults) with EE. The strengths and limitations  of the human experimental studies are examined in relation to a battery of  existing and potential tests that are used to measure malabsorption. From the  available studies conducted in children, lactose and fat malabsorption are more  likely to occur in EE. Breath tests (non-invasive) measuring carbohydrate  ((13)C-starch/sucrose/lactose), fat ((13)C-mixed triglyceride) and dipeptide  (benzoyl-L-tyrosyl-L-1-(13)C-alanine) malabsorption with modifications to the  existing protocols seem suitable for use in children with EE. Future research  should focus on understanding the degree of macronutrient malabsorption using  these tests, in different settings, and link them to functional outcomes (such as  growth, muscle strength, cognition).