Wednesday, January 28, 2004

Is your infant fussy? It could be digestion

Juice choice strong factor in avoiding problem

Carbohydrate malabsorption may not be on the tip of every parent’s tongue, but it is a commonplace yet often undiagnosed condition that can significantly affect the health of your baby, according to authors of a preliminary study published in the journal Nutrition.

Carbohydrate malabsorption is the inability to fully digest the naturally-occurring sugars in foods and beverages. It is often silent and may not be associated with easily recognized signs or symptoms, but it can make babies restless, fussy, and less likely to sleep well. In more severe cases, carbohydrate malabsorption can lead to diarrhea, colicky behavior, or potentially slowed growth performance.

In the study, infants five to six months old who were less able to digest the sugars in one 4-ounce juice serving expended more energy for the next three hours than infants who tolerated the juice they were fed. The combination of less energy absorbed and more energy expended when infants are fed a juice that contains hard-to-digest carbohydrates could contribute to concerns about any child who has subpar growth performance.

“The inability to tolerate certain carbohydrates can be serious in babies and toddlers,” explained Dr. Fima Lifshitz, director of pediatrics and senior nutrition scientist, Sansum Medical Research Institute, Santa Barbara, Calif., and senior author of the study.

“In our study of 32 babies, we observed that the babies who malabsorbed carbohydrates spent more energy, had a higher calculated metabolic rate, and had a trend towards reduced growth performance as measured by their weight/length ratio. In previous studies we showed that even for children without obvious symptoms, the restlessness and discomfort associated with the condition can adversely affect parent-to-child interaction and the enjoyment of a happy baby.”

“The good news is that carbohydrate malabsorption may be controlled by making the right dietary decisions,” added Lifshitz. “We have seen in several previous clinical studies a clear connection between perceptible carbohydrate malabsorption and the type of juice the child is fed.”

Juices like apple and pear juice contain several sugars that make them less digestible. They contain sorbitol and have an imbalance of fructose and glucose, which contributes to the problem of carbohydrate malabsorption, according to the researchers. White grape juice, on the other hand, contains no sorbitol and has an even balance of fructose and glucose.

Sorbitol is an indigestible sugar alcohol found in many fruit juices. Fructose, when not balanced by a similar amount of glucose, is also difficult for young children to digest. Researchers attribute the symptoms of carbohydrate malabsorption to the bacterial digestion of these undigested carbohydrates in the lower intestine and colon. This creates gas, which may then lead to restlessness and colicky-like symptoms.

“Were I advising a parent of a young child on introducing a juice as a weaning food,” said Lifshitz, “I would recommend the one containing the appropriate blend of sugars -- white grape juice. The literature clearly shows that babies are less likely to experience digestive problems with this juice than with those with a more problematic carbohydrate profile.”

Dr. Lifshitz emphasizes that juice should be consumed in moderation, and encourages parents to consult their pediatricians to find out the best age to introduce juice to their babies. The American Academy of Pediatrics recommends against introducing juice prior to 6 months of age.