Features of the component composition of the body in children with diseases of the digestive system and small intestinal bacterial overgrowth

Introduction: small intestinal bacterial overgrowth (SIBO) in the small intestine is one of the risk factors for the development of secondary malabsorption syndrome and growth retardation in children. Aim: to identify features of anthropometric indicators and body composition in children with gastroenterological pathology and diagnosed SIBO. Patients and methods: 117 children were examined, median age 13,0 [11,0: 15,0], 65 (55,6%) boys and 52 (44.4%) girls with digestive diseases (functional dyspepsia, GERD, chronic gastroduodenitis), of which 60 children with hydrogen-induced H2-SIBR (group No. 1) and 57 children without H2-SIBR (group No. 2). A standard clinical, laboratory and instrumental examination was performed. The determination of H2-SIBR was carried out using a non-invasive method - the Lactofan hydrogen breath test. For an integral assessment of the hydrogen level for 90 minutes. The AUC index (Area Under Curve, “area under curve” H2, ppm) was calculated in exhaled air. The measurement of body component composition (absolute, FM, kg, and percentage of fat,%FM, lean mass content,%LMC, active cell mass, AKM, kg) was performed using bioimpedance measurement («Diamant»). Results: There were no statistically significant differences in the main (length, body weight, BMI) and additional anthropometric indicators (waist and hip circumference, their ratio) between group 1 and 2 (p>0.05). In patients of group 1, in comparison with group 2, both the frequency of low%LMC (23/38.4% and 5/8.8%, p = 0.048) and the frequency of low content of ACM (25/41.7% and 8/14.0%, p = 0.015) in the body were statistically significantly higher. AUC H2 (0-90 min.) was significantly higher in children with low than normal levels of ACM in the body of children of group 1 (51.00 [22.00-62.0] and 16.00 [7.50-38.0], p = 0.047). Conclusion: In practical work in patients with diseases of the digestive system and identified SIBO, it is extremely important to timely identify deviations in the nutritional status using not only anthropometric methods, but also a more accurate method - bioimpedance, followed by timely dietary, non-drug and drug correction of both the underlying disease and SIBO.

small intestinal bacterial overgrowth, SIBO, children, determination of hydrogen in exhaled air, Lactophan, body component composition, malabsorption

1. Ivashkin V.T., Maev I.V., Abdulganieva D.I. et al. Federal clinical guidelines. Bacterial overgrowth syndrome. Developers: Interregional Public Organization “Scientific Community for Promoting Clinical Study of the Human Microbiome”, Russian Gastroenterological Association, Russian Society for the Prevention of Non-Infectious Diseases. 2023: 4-13 (in Russ.)@@ Ивашкин В.Т., Маев И.В., Абдулганиева Д.И. и соавт. Федеральные клинические рекомендации. Синдром избыточного бактериального роста. Разработчики: Межрегиональная Общественная Организация «Научное сообщество по содействию клиническому изучению микробиома человека», Российская гастроэнтерологическая ассоциация, Российское общество профилактики неинфекционных заболеваний. 2023: 4-13.

2. Hammer H.F., Fox M.R., Keller J. et al. European guideline on indications, performance, and clinical impact of hydrogen and methane breath tests in adult and pediatric patients: European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Neurogastroenterology and Mot. United European Gastroenterology Journal. 2022;10(1):15-40. doi: 10.1002/ueg2.12133.

3. Esposito S., Biscarini A., Federici B. et al. Role of Small Intestinal Bacterial Overgrowth (SIBO) and Inflammation in Obese Children. Frontiers in Pediatrics. 2020;(8):1-15. doi: 10.3389/fped.2020.00369.

4. Avelar Rodriguez D., Ryan P.M., Toro Monjaraz E.M. et al. Small Intestinal Bacterial Overgrowth in Children: A State-Of-The-Art Review. Frontiers in Pediatrics. 2019;(7):363. doi: 10.3389/fped.2019.00363.

5. Rezaie A., Buresi M., Lembo A. et al. Hydrogen and methane-based breath testing in gastrointestinal disorders: the North American Consensus. Am J Gastroenterol. 2017;(112): 775-84. doi: 10.1038/ajg.2017.46.

6. Quigley E.M.M., Murray J.A., Pimentel M. et al. AGA clinical practice update on small intestinal bacterial overgrowth: expert review. Gastroenterology. 2020;(159): 1526-32. doi: 10.1053/j.gastro.2020.06.090.

7. Collins B.S., Lin H.C. Chronic abdominal pain in children is associated with high prevalence of abnormal microbial fermentation. Dig Dis Sci. 2010; 55: 124-30. doi: 10.1007/s10620-009-1026-7.

8. Mello C.S., Tahan S., Melli L.C.F. et al. Methane production and small intestinal bacterial overgrowth in children living in a slum. World Journal of Gastroenterology: WJG. 2012; 18(41): 5932. doi: 10.3748/wjg.v18.i41.5932.

9. Cho Y.K., Lee J., Paik, C.N. Prevalence, risk factors, and treatment of small intestinal bacterial overgrowth in children. Clinical and Experimental Pediatrics. 2023; 66(9): 377-383. doi: 10.3345/cep.2022.00969

10. Donowitz J.R., Pu Z., Lin Y. et al. Small Intestine Bacterial Overgrowth in Bangladeshi Infants Is Associated with Growth Stunting in a Longitudinal Cohort. American Journal of Gastroenterology. 2022; 117 (1): 167-175. doi: 10.14309/ajg.0000000000001535.

11. Jiang N.M., Tofail F., Moonah S.N. et al. Febrile illness and pro-inflammatory cytokines are associated with lower neurodevelopmental scores in bangladeshi infants living in poverty. BMC Pediatrics. 2014; 14 (1): 50. doi: 10.1186/1471-2431-14-50.

12. Wielgosz-Grochowska J.P., Domanski N., Drywień M.E. Influence of Body Composition and Specific Anthropometric Parameters on SIBO Type. Nutrients. 2023; 15(18): 4035. doi: 10.3390/nu15184035.

13. Edleeva A.G., Khomich M.M., Leonova I.A. et al. Bioimpedansometry as a method for assessing the component composition of the body in children over 5 years old. Children’s medicine of the North-West. 2011;2 (3): 30-35. (in Russ.)@@ Эдлеева А.Г., Хомич М.М., Леонова И.А. и др. Биоимпедансометрия как метод оценки компонентного состава тела у детей старше 5 лет. Детская медицина Северо-Запада. 2011;2 (3): 30-35.

14. Kedrinskaya A.G. Obraztsova G.I. Leonova I.A. Body composition in children with overweight and obesity.Russian pediatric journal. 2018; 21(2): 73-77. (in Russ.) doi 10.18821/1560-9561-2018-21-2-73-77.@@ Кедринская А.Г. Образцова Г.И. Леонова И.А. Компонентный состав тела у детей с избыточной массой тела и ожирением. Российский педиатрический журнал. 2018; 21(2): 73-77. doi: 10.18821/1560-9561-2018-21-2-73-77.

15. Peled Y., Gilat T., Liberman E. et al. The development of methane production in childhood and adolescence. J Pediatr Gastroenterol Nutr. 1985; Aug; 4(4):575-9. doi: 10.1097/00005176-198508000-00013.

16. Shabalov A.M., Kornienko E.A., Arsentiev V.G. et al. Hydrogenogenic and methanogenic variants of the course of bacterial overgrowth syndrome in the small intestine in children with diseases of the digestive system and allergic pathology. Pediatrician. 2024:15 (3): 35-47. (in Russ.) doi: 10.17816/PED15335-47.@@ Шабалов А.М., Корниенко Е.А., Арсентьев В.Г. и др. Водородогенный и метаногенный варианты течения синдрома избыточного бактериального роста в тонкой кишке у детей с заболеваниями органов пищеварения и аллергической патологией. Педиатр; 2024;15(3):35-47. doi: https://doi.org/10.17816/PED15335-47.

17. Сai J., Jingwei B., Changtao J. et al. Bile acid metabolism and signaling, the microbiota, and metabolic disease. Pharmacology and therapeutics. 2022; Sep. 237: 108238. doi: 10.1016/j.pharmthera.2022.108238.

18. Belei O., Olariu L., Dobrescu A. et al. The relationship between non-alcoholic fatty liver disease and small intestinal bacterial overgrowth among overweight and obese children and adolescents. Journal of Pediatric Endocrinology and Metabolism. 2017; 30 (11): 1161-1168. doi: 10.1515/jpem-2017-0252.