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Am J Physiol Gastrointest Liver Physiol (October 1, 2009). doi:10.1152/ajpgi.00261.2009
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Research Article

CARBOHYDRATE MALDIGESTION INDUCES NECROTIZING ENTEROCOLITIS IN PRETERM PIGS

Thomas Thymann,1 Hanne K. Moller,2 Barbara Stoll,3 Ann Cathrine Støy,2 Randal K Buddington,4 Stine B Bering,5 Bent Borg Jensen,5 Oluyinka O. Olutoye,6 Richard H Siggers,1 Lars Molbak,2 Per T Sangild,1 and Douglas G. Burrin7,*

1University of Copenhagen 2Technical University of Denmark 3USDA Children's Nutrition Research Center 4University of Memphis 5 6Baylor College of Medicine 7Children's Nutritional Research Center

Submitted 1 July 2009 ; revision received 28 September 2009 ; accepted in final form 28 September 2009

ABSTRACT

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. 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 (TPN) for 48 hrs followed by 36 hrs of total enteral nutrition with a lactose- (n=11) or maltodextrin-based (n=11) formula. A higher incidence (91 vs. 27%) and severity (scores of 3.3 vs. 1.8) of NEC was observed in the maltodextrin vs. the lactose group. Compared to the lactose group, this higher NEC occurrence 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 mid intestine. The bacterial diversity was low for both diets, but alterations in bacterial composition and luminal concentrations of short chain fatty acids were observed with the maltodextrin diet. In a second study, we quantified net portal absorption of aldohexoses (glucose and galactose) during an acute jejunal infusion of either a maltodextrin-or lactose-based formula (n=8) in preterm pigs. We found lower net portal aldohexose absorption (42 vs. 4%) and increased intestinal recovery of undigested carbohydrate (68 vs. 27%) in pigs acutely perfused with a maltodextrin- compared to a lactose-based formula, respectively. The higher digestion of the lactose relative to the maltodextrin in the formulas can be attributed to a 5-20 fold higher hydrolytic activity of tissue-specific lactase compared to maltases. We conclude that carbohydrate maldigestion is sufficient to increase the incidence and severity of NEC in preterm pigs.

enteral nutrition; maltodextrin; premature; lactose


* Children's Nutritional Research Center dburrin{at}bcm.edu






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