Prevalence of lactose intolerance and fat malabsorption in children aged 36 until 59 months and thei

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Prevalence of lactose intolerance and fat
malabsorption in children aged 36 until 59 months
and their relationship with nutritional status
In Kelurahan Pejatan Barat, Kecamatan Pasar
Minggu, Jakarta Selatan, DKI Jaya,
IndonesiaBibi Passchier Edwin
CuperusSeptember 2004 February 2005
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Place and time of the research

• Kelurahan Pejatan Barat, Kecamatan Pasar Minggu,
  Jakarta Selatan, DKI Jaya, Indonesia
• Department of paediatric gastro-hepatology of the
  Dr. Cipto Mangunkusumo Hospital, Jakarta,
  Indonesia
• From September 2004 until February 2005

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Demographics Pasar Minggu, Pejaten Barat (1)

• Area size 30 km2
• Inhabitants 33.438 (17.748 ?, 15.690 ?)
• Middle high and high income 40
• gt Rp. 2.000.000 per month
• Middle low income 36
• Rp. 500.000 till 2.000.000 per month
• Low income 24
• lt Rp. 500.000

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Demographics Pasar Minggu, Pejaten Barat (2)

• TNI (Tentara Nasional Indonesia) or Polri (Polisi
  Republic Indonesie) 1220 (34)
• Civil Servant 1007 (29)
• Religion
• Muslim 98
• Others 2

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Study design

• Observational cross-sectional study

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Objectives

• What is the prevalence of lactose intolerance and
  fat malabsorption in children of 36-59 months in
  Kelurahan Pejatan Barat, Kecamatan Pasar Minggu,
  Jakarta Selatan, DKI Jaya, Indonesia?
• Is there a relationship between
• Nutritional status and lactose intolerance?
• Nutritional status and fat malabsorption?
• Breastfeeding and lactose intolerance?
• Breastfeeding and fat malabsorption?

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Subject

• Children, aged 36 until 59 months in Kelurahan
  Pejatan Barat, Kecamatan Pasar Minggu, Jakarta
  Selatan, DKI Jaya, Indonesia.
• Inclusion criteria Exclusion criteria
• a. Children aged 36 until 59 months a.
  Chronic or systemic diseases
• b. Oral permission of the parents b. Acute,
  chronic or bloody
• c. Children with normal nutrition
  diarrhea
• and mild to moderate c. Children with severe
  undernutrition undernutrition or obesity
• d. Patients who are using
  antibiotics

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Recruit the subjects
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Methods (1)

• We asked permission to the Kepala Kelurahan and
  Kepala Puskesmas of Kelurahan Pejatan Barat,
  Kecamatan Pasar Minggu, Jakarta Selatan, DKI
  Jaya, Indonesia.
• We informed all caders of the RWs and RTs about
  the research. We asked for their cooperation.
• Because of no cooperation of 3 RWs, only 5 were
  included in this study.
• In each of these RWs, we examined all children
  aged 36 until 59 months.
• Physical examination we determined nutritional
  status by measuring weight and height.

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Methods (2)

• 6. Informed the parents about the details of the
  research and asked to sign the informed consent
  for permission.
• 7. Interviewed the parents by using a
  questionnaire.
• 8. Applying inclusion and exclusion criteria on
  the children.
• 9. According to inclusion and exclusion criteria
  we included 113 children.
• 10. Performing BHT and collecting faeces
• 11. Faeces analysis steatocrite.
• 12. Statistic analysis using a SPSS 12.0.1
  program.

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Sample size

• N Za2 PQ ? 0,05 (reliance of 95)
• D2 Za 1,96
• P prevalence of fat malabsorption
  respectively lactose intolerance, based
  on former literature
• Q 1 P
• D power 1 0,90 0,10
• Fat malabsorption P0,90 ? N35
• Lactose intolerance P0,20 ? N64
• Undernutrition P 0,22 ? N66 Total examined
  N120

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Operational definition (1)

• Fat absorption and the severity of fat
  malabsorption were determined by measuring
  steatocrite in the faeces. The scale that is
  being used, is as followed
• normal fat absorption 0-4
• mild fat malabsorption 5-10
• moderate fat malabsorption 11-25
• severe fat malabsorption gt 25
• Lactose intolerance was diagnosed by using the
  following scale by a positive result on the BHT
  (gt10 ppm) and by the appearance of clinical
  symptoms.
• no malabsorption lt10 ppm
• no malabsorption, unless
• there are symptoms 10 - 20 ppm
• lactose malabsorption gt20 ppm

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Operational definition (2)

• Nutritional status was assessed by calculating
  bodyweight/age ratio, bodyweight/height ratio and
  height/age ratio according to WHO and NCHS.
• Obesity (Obesitas) gt120
• Overweight (Lebih) 110-120
• Good nutritional status (Cukup) 90-100
• Mild-moderate nutritional (Kurang) 70-lt90
• Severe malnutrition (Gizi buruk) lt70

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Results (1)
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Results (2)
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Results (3)
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Results (4)
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Graphs (1)
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Graphs (2)
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Discussion (1)

• Lactose Intolerance
• Playground versus community
• Lactose malabsorption versus bacterial overgrowth
• Most likely a genetical cause

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Discussion (2)

• Fat Malabsorption
• Fat consumption
• Intake of fat
• Expensive
• Other sources of fat
• Malabsorption versus maldigestion
• Parasital infections

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Discussion (3)

• Correlation nutritional status and lactose
  intolerance
• Severe malnutrition
• Correlation nutritional status and fat
  malabsorption
• Severe malnutrition

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Discussion (4)

• Correlation breastfeeding and lactose intolerance
• Non comparable groups
• Correlation breastfeeding and fat malabsorption
• Non comparable groups

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Conclusion

• Prevalences
• Lactose Intolerance 48
• Fat Malabsorption 94
• Lactose intolerance, primary genetic cause
• No relationships were found in
• Nutritional status vs lactose intolerance
• Nutritional status vs fat malabsorption
• Breastfeeding vs lactose intolerance

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Suggestions (1)

• For an accurate prevalence of lactose
  intolerance, assess BHT with glucose on children
  with an increase of hydrogen in the exhaled
  breath in the first 30 minutes.
• For an accurate prevalence of fat malabsorption,
  look at the amount of fat in the childrens diet.

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Suggestions (2)

• Measure steatocrite using the Van de Kamer method
  
• Assessing Xylose test to look for enteropathy
• Look for parasitic infections
• Make comparable groups for looking to
  breastfeeding