TY - JOUR
T1 - Lactulose
T2 - Mannitol diagnostic test by HPLC and LC-MSMS platforms: Considerations for field studies of intestinal barrier function and environmental enteropathy
AU - Lee, Gwenyth O.
AU - Kosek, Peter
AU - Lima, Aldo A.M.
AU - Singh, Ravinder
AU - Yori, Pablo P.
AU - Olortegui, Maribel P.
AU - Lamsam, Jesse L.
AU - Oliveira, Domingos B.
AU - Guerrant, Richard L.
AU - Kosek, Margaret
N1 - Publisher Copyright:
© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
PY - 2014/10/8
Y1 - 2014/10/8
N2 - Objectives: The lactulose: mannitol (L: M) diagnostic test is frequently used in field studies of environmental enteropathy (EE); however, heterogeneity in test administration and disaccharide measurement has limited the comparison of results between studies and populations. We aim to assess the agreement between L: M measurement between high-performance liquid chromatography with pulsed amperometric detection (HPLC-PAD) and liquid chromatography-tandem mass spectrometry (LC-MSMS) platforms.Methods: The L: M test was administered in a cohort of Peruvian infants considered at risk for EE. A total of 100 samples were tested for lactulose and mannitol at 3 independent laboratories: 1 running an HPLC-PAD platform and 2 running LC-MSMS platforms. Agreement between the platforms was estimated.Results: The Spearman correlation between the 2 LC-MSMS platforms was high (r≥ 0.89) for mannitol, lactulose, and the L: M ratio. The correlation between the HPLC-PAD platform and LC-MSMS platform was r=0.95 for mannitol, r=0.70 for lactulose, and r=0.43 for the L: M ratio. In addition, the HPLC-PAD platform overestimated the lowest disaccharide concentrations to the greatest degree.Conclusions: Given the large analyte concentration range, the improved accuracy of LC-MSMS has important consequences for the assessment of lactulose and mannitol following oral administration in populations at risk for EE. We recommend that researchers wishing to implement a dual-sugar test as part of a study of EE use an LC-MSMS platform to optimize the accuracy of results and increase comparability between studies.
AB - Objectives: The lactulose: mannitol (L: M) diagnostic test is frequently used in field studies of environmental enteropathy (EE); however, heterogeneity in test administration and disaccharide measurement has limited the comparison of results between studies and populations. We aim to assess the agreement between L: M measurement between high-performance liquid chromatography with pulsed amperometric detection (HPLC-PAD) and liquid chromatography-tandem mass spectrometry (LC-MSMS) platforms.Methods: The L: M test was administered in a cohort of Peruvian infants considered at risk for EE. A total of 100 samples were tested for lactulose and mannitol at 3 independent laboratories: 1 running an HPLC-PAD platform and 2 running LC-MSMS platforms. Agreement between the platforms was estimated.Results: The Spearman correlation between the 2 LC-MSMS platforms was high (r≥ 0.89) for mannitol, lactulose, and the L: M ratio. The correlation between the HPLC-PAD platform and LC-MSMS platform was r=0.95 for mannitol, r=0.70 for lactulose, and r=0.43 for the L: M ratio. In addition, the HPLC-PAD platform overestimated the lowest disaccharide concentrations to the greatest degree.Conclusions: Given the large analyte concentration range, the improved accuracy of LC-MSMS has important consequences for the assessment of lactulose and mannitol following oral administration in populations at risk for EE. We recommend that researchers wishing to implement a dual-sugar test as part of a study of EE use an LC-MSMS platform to optimize the accuracy of results and increase comparability between studies.
KW - Environmental enteropathy
KW - Intestinal absorption
KW - Intestinal permeability
KW - Lactulose
KW - Mannitol assay
KW - Tropical enteropathy
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U2 - 10.1097/MPG.0000000000000459
DO - 10.1097/MPG.0000000000000459
M3 - Article
C2 - 24941958
AN - SCOPUS:84917691570
SN - 0277-2116
VL - 59
SP - 544
EP - 550
JO - Journal of pediatric gastroenterology and nutrition
JF - Journal of pediatric gastroenterology and nutrition
IS - 4
ER -