Publications

BACKGROUND: The digestion and absorption of ingested protein may be reduced in children with environmental enteric dysfunction (EED), reducing systemic amino  acid availability for protein synthesis with resultant growth faltering. This has  not been directly measured in children with EED and associated growth faltering.  OBJECTIVES: To evaluate the systemic availability of algal (spirulina) and legume  (mung bean) indispensable amino acids (IAAs) in children with EED. METHODS:  Indian children (18-24 mo) from urban slums were assigned to EED (n = 24) or  no-EED (control, n = 17) groups based on the lactulose rhamnose test, where the  lactulose rhamnose ratio cutoff for diagnosing EED (≥0.068) was the mean + 2SD of  its distribution in healthy, age-, and sex-matched children of high socioeconomic  status. Fecal biomarkers of EED were also measured. Systemic IAA availability was  calculated from the plasma: meal IAA enrichment ratio for each protein. True  ileal mung bean IAA digestibility was measured by the dual isotope tracer method  using spirulina protein as reference. Co-administration of free  (13)C(6)-phenylalanine allowed for estimating true ileal phenylalanine  digestibility of both proteins, and a phenylalanine absorption index. RESULTS:  There was no significant difference (independent t-test) in the systemic IAA  availability from spirulina or mung bean protein between EED and no-EED groups.  There was no between-group difference in true ileal phenylalanine digestibility  and its absorption index, or in mung bean IAA digestibility. CONCLUSIONS: The  systemic IAA availability of algal and legume protein, or the latter's  IAA/phenylalanine digestibility, is not significantly reduced in children with  EED and does not correlate with linear growth. This study was registered in  Clinical Trials Registry of India (CTRI) with registration number:  CTRI/2017/02/007921.