Moderate and severe protein energy malnutrition in childhood: effects on jejunal mucosal morphology and disaccharidase activities.
The enzymatic activities of maltase, sucrase, and lactase were determined in jejunal biopsies obtained from 24 children with gastrointestinal symptoms and different degrees of protein energy malnutrition (PEM) to see if these differences were related to the extent of malnutrition or concomitant small intestinal mucosal injury. Even in patients with moderate PEM, lactase activities were significantly lower than control values. The decrease in lactase activity seemed to depend on the severity of malnutrition. In contrast, maltase and sucrase activities were decreased only in second and third degrees of PEM, while no significant changes were observed in first degree and marasmic kwashiorkor. Histologically, all children with PEM had grade I to II mucosal injury which did not correlate with the degree of malnutrition. These results indicate that PEM affects each of the disaccharidases of the jejunal mucosa differently, with lactase being most sensitive to PEM and reflecting most closely the degree of PEM. In contrast, morphological changes showed no correlation with the degree of PEM.