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Tropical enteropathy and zinc deficiency are major public health problems worldwide. Tropical enteropathy is characterized by reduced mannitol absorption with normal or increased lactulose absorption when a dual sugar absorption test is administered, the results of which are reported as the lactulose:mannitol ratio (L:M). Zinc homeostasis is quantified with a dual stable isotope test. This study tested the hypothesis that endogenous fecal zinc (EFZ) was correlated with the L:M. A dual sugar absorption test and dual stable isotope test were performed on 25 asymptomatic Malawian children aged 3-5 y at risk for tropical enteropathy and zinc deficiency. EFZ and net zinc retention were estimated and correlated with the L:M. Twenty-two children (88%) had an abnormal L:M (L:M>0.10), and the L:M was 0.24+/-0.10 (mean+/-SD). EFZ was 1.68+/-1.06 mg/d, a quantity greater than is seen in healthy populations from the developed world. EFZ was positively correlated with the L:M (r=0.62, p

Substantial losses of nutrients may occur during tube (gavage) feeding of fortified human milk. Our objective was to compare the losses of key macronutrients and minerals based on method of fortification and gavage feeding method. We used clinically available gavage feeding systems and measured pre- and post-feeding (end-point) nutrient content of calcium (Ca), phosphorus (Phos), protein, and fat. Comparisons were made between continuous, gravity bolus, and 30-minute infusion pump feeding systems, as well as human milk fortified with donor human milk-based and bovine milk-based human milk fortifier using an in vitro model. Feeding method was significantly associated with fat and Ca losses, with increased losses in continuous feeds. Fat losses in continuous feeds were substantial, with 40 ± 3 % of initial fat lost during the feeding process. After correction for feeding method, human milk fortified with donor milk-based fortifier was associated with significantly less loss of Ca (8 ± 4% vs. 28 ± 4%, p< 0.001), Phos (3 ± 4% vs. 24 ± 4%, p < 0.001), and fat (17 ± 2% vs. 25 ± 2%, p = 0.001) than human milk fortified with a bovine milk-based fortifier (Mean ± SEM).

Few data have evaluated Zn balance in young children after the first year of life. The objective of the present study was to study the relationships among Zn intake, absorption, endogenous faecal excretion, and retention in a group of healthy children. Thirty children, aged 15–48 months, were studied on a diet representative of their usual daily mineral intake. Zn absorption was assessed using a dual-tracer stable-isotope technique. Endogenous Zn faecal excretion and Cu absorption were determined in a subset of children. We found that Zn intake from the in-patient weighed dietary record (5·0 (sd 2·1) mg/d) was significantly greater than the current estimated average requirement (EAR; 2·5 mg/d; P r2 P>0·4, for all). Absolute Zn absorption was significantly related to Zn intake (r2 0·696; P r2 0·506; P sd 10·8) %) despite the high Zn intake. The EAR for Zn based on this dataset would appear to be between 4·2 and 4·7 mg/d to allow for a net average retention of 120 μg/d consistent with growth needs. We concluded that at relatively high Zn intakes there was little evidence of down regulation of absorption or up regulation of urinary or endogenous faecal Zn excretion across the intake range studied. Zn retention was positively correlated with intake. A Zn intake between 4·2 and 4·7 mg/d should meet the requirement for normal growth for this age group.

Few calcium balance data are available from young children on which to base dietary recommendations.The objective of the study was to evaluate the relation between calcium intake and balance in healthy children aged 1-4 y consuming typical American diets.Subjects were assigned to a diet with nutrient intakes similar to those of their usual diet. Calcium absorption was assessed by using a dual-tracer stable-isotope technique. Endogenous fecal excretion was measured in a subset of children, and net calcium balance was calculated.Mean calcium intake was 551 mg/d (range: 124-983 mg/d), and mean (+/-SEM) calcium retention was 161 +/- 17 mg/d. Both linear and nonlinear modeling of balance data showed that a calcium intake of approximately 470 mg/d led to calcium retention of 140 mg/d, which is the amount that meets expected bone growth needs in children of this age. No evidence was found that calcium intakes of 800 to 900 mg/d reached the threshold intake beyond which no additional increase in calcium retention would occur.Bone growth needs in 1-4-y-old children following American diets are met by a daily calcium intake of approximately 470 mg/d, which suggests that the current Adequate Intake of 500 mg/d is close to the actual Estimated Average Requirement. The benefits and risks of higher calcium intakes consistent with threshold values should be evaluated in a controlled trial before those intakes could be used as a basis for dietary recommendations.

In adults, adaptation to changes in magnesium intake is largely due to changes in fractional magnesium absorption and urinary magnesium excretion. We sought to examine whether these homeostatic mechanism also occurred in young children.Children, 12-48 m old were studied (n=30). They were adapted to a home diet representative of their usual magnesium intake for 7 d then admitted for a stable isotope study. Children received 5 mg Mg-25 intravenously, and 10 mg Mg-26 orally (5 mg with breakfast and 5 mg with lunch). Magnesium absorption was calculated from the relative fractional excretion of the oral and intravenous isotopes in the urine samples. Endogenous fecal magnesium absorption was calculated in a subgroup from the fecal and urinary excretion of the intravenous tracer.Magnesium intake (mean +/- SD; 106 +/- 25 mg/d) was significantly greater than the Estimated Average Requirement (EAR) described by the Institute of Medicine in the US (65 mg/d, p0.0001). Across the range of intake studied, fractional magnesium absorption was significantly (P = 0.0383) but weakly (r(2) = 0.144) related to magnesium intake. Absolute magnesium absorption (the product of fractional absorption and intake) significantly increased as intake increased (r(2) = 0.566, P0.0001). Urinary magnesium excretion was unrelated to magnesium intake (r(2) = 0.036, P = 0.31). Endogenous fecal magnesium excretion tended to increase as magnesium intake increased (r(2) = 0.312, P = 0.12). Magnesium retention (absolute absorption minus urinary and fecal losses) was positive in 26 of the 30 subjects studied, and was linearly related to magnesium intake (r(2) = 0.157, P = 0.0304). A magnesium intake of 52-78 mg/d would appear to be required to meet the needs for absorbed magnesium for half the children at this age range, suggesting that the current EAR is broadly appropriate.In young children, consuming magnesium intakes typical of the US population, fractional magnesium absorption is a major site of magnesium homeostasis, but magnesium retention increased linearly across the intake range studied. Our results support at EAR for magnesium of 55-80 mg/d and an RDA of 70-100 mg/d.

Few studies have evaluated iron absorption in small children after the first year of life. Our objectives were to examine the relations among iron intake, iron absorption, and iron status in a group of healthy children. We studied 28 children, ages 12 to 48 mo, after a 7-d home adaptation to a diet representative of their usual daily mineral intake. A multi-tracer stable isotope study was performed to assess iron absorption both from a meal ((58)Fe) and from a reference iron dose ((57)Fe) given with ascorbic acid without a meal. Iron intake was 6.9 +/- 2.4 mg, approximately the 35th percentile of typical U.S. intakes. Absorption of (58)Fe was related to serum ferritin (r(2) = 0.319, P = 0.0018) and more so to reference dose iron absorption (r(2) = 0.653, P0.0001). Iron absorption was negatively correlated with zinc intake (r(2) = 0.090, P = 0.0049) but was not correlated with iron intake (P = 0.20). However, zinc intake was not correlated with measures of iron status, including reference dose iron absorption and serum ferritin (r(2)0.1, P0.25). Total absorbed iron was similar to needs estimated by the Institute of Medicine. We conclude that iron absorption in young children is more closely related to iron status than to iron intake. Reference dose iron absorption may be superior to serum ferritin as a surrogate measure for iron status in this age group. Although zinc intake may affect iron absorption from a meal, it does not appear to have a detectable effect on overall iron status in otherwise well-nourished children.