Perturbed zinc homeostasis in rural 3-5-y-old malawian children is associated with abnormalities in intestinal permeability attributed to tropical enteropathy

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 < 0.001). Net zinc retention (0.67 ± 1.6 mg/d) was negatively correlated with the L:M (r =-0.47, p = 0.02). This suggests that perturbed zinc homeostasis is associated with subclinical enteropathy in these children.