Fetal intestinal lactase develops relatively late in gestation and studies of breath hydrogen excretion have suggested that greater than 66% of dietary lactose may reach the colon in some premature infants. Based on these studies one might presume that clinical intolerance and inefficient energy absorption might be associated with the ingestion of the relatively large amounts of lactose present in human milk or in formulas containing lactose as the sole carbohydrate. Thus, special premature formulas have been developed which contain decreased lactose with the carbohydrate replaced in part by glucose polymer. However, our recent studies of premature infants suggested that less than 10% of lactose and/or glucose polymer energy was actually excreted in premature infants who were 28-32 wk. gestation at birth and 12-30 days of age when studied. If our studies as well as the breath hydrogen studies are valid and representative of what occurs in most premature infants, then one might speculate that colonic bacterial flora serve a ruminant-type function by fermenting lactose and producing short-chain fatty acids which can be absorbed in the colon.
The specific aims of this proposal are: to determine fecal excretion of carbohydrate-derived energy and breath hydrogen excretion in premature infants fed lactose or lactose-plus-glucose polymer and to determine the fecal excretion of carbohydrates and short-chain fatty acids. These studies may provide information relevant to the development of appropriate formulas for such infants and also improve our understanding of the nutritional functions of the colon and the colonic bacterial flora in premature infants.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
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Nutrition Study Section (NTN)
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West Virginia University
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Kien, C L; Murray, R D; Qualman, S J et al. (1999) Lactulose feeding in piglets: a model for persistent diarrhea and colitis induced by severe sugar malabsorption. Dig Dis Sci 44:1476-84
Kien, C L; McClead, R E; Cordero Jr, L (1998) Effects of lactose intake on lactose digestion and colonic fermentation in preterm infants. J Pediatr 133:401-5
Kien, C L; Ailabouni, A H; Murray, R D et al. (1997) Technical note: pig model for studying nutrient assimilation by the intestine and colon. J Anim Sci 75:2161-4
Kien, C L; Murray, R D; Ailabouni, A H et al. (1997) Measurement of the rate of entry of intact colon-derived lactose into the circulation: a model for assessing gut uptake of molecules not endogenously synthesized. J Pediatr Gastroenterol Nutr 25:68-73
Kien, C L; McClead, R E (1996) Estimation of CO2 production in enterally fed preterm infants using an isotope dilution stable tracer technique. JPEN J Parenter Enteral Nutr 20:389-93
Kien, C L; McClead, R E; Cordero Jr, L (1996) In vivo lactose digestion in preterm infants. Am J Clin Nutr 64:700-5
Kien, C L (1996) Digestion, absorption, and fermentation of carbohydrates in the newborn. Clin Perinatol 23:211-28
Kien, C L; Murray, R D; Ailabouni, A et al. (1996) Stable isotope model for assessing production of short chain fatty acids from colon-derived sugar: application in pigs. J Nutr 126:3069-76
Kien, C L; McClead, R E; Kepner, J et al. (1993) Comparison of methods for estimating fecal carbohydrate excretion in premature infants. J Pediatr Gastroenterol Nutr 17:276-82
Kien, C L; Ault, K; McClead, R E (1992) In vivo estimation of lactose hydrolysis in premature infants using a dual stable tracer technique. Am J Physiol 263:E1002-9

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