Methodology for carrying out the Benedict method. Determination of carbohydrates in the feces of adults and children. Deviations from the norm

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Digestive problems are common in young children. To find out their origin and select treatment tactics, doctors prescribe various diagnostic tests. Feces for carbohydrates in an infant are examined if the child is suspected of having lactase deficiency.

The study allows us to accurately determine the causes of disruption of the digestive tract in infants, namely, to evaluate the process of breakdown and absorption of carbohydrates.

As a rule, this analysis is carried out in the first year of a child’s life, since in most cases the signs disappear over time, and the baby’s digestion returns to normal.

Why get tested?

A stool test for carbohydrates is carried out in case of lactose malabsorption or infant intolerance to foods that contain milk sugar. The analysis determines the norm of carbohydrate content in the feces of a newborn, which is extremely important for children in the first year of life, since during this period their main diet is.

If, as a result of the diagnosis, elevated carbohydrates are detected in the baby’s stool, most likely, this means that the child’s body is not able to digest lactose or milk sugar. This is a sign of a threat to his health and development.

Not only does this disease cause severe discomfort in the baby (abdominal pain and increased gas production), lactase deficiency also deprives him of the ability to fully absorb nutrients from milk. And this becomes the cause of insufficient, delayed physical development, etc. That is why it is necessary to conduct an analysis, and if carbohydrates in the feces of an infant are elevated, look for the causes of this condition.

Indications

The main indication for analyzing stool for carbohydrates in infants, as mentioned above, is the suspicion of lactase deficiency.

The following signs may indicate this:

• Retarded physical development. The symptom indicates that the carbohydrate content in the feces of a newborn is increased against the background of enzymopathy - insufficient absorption of nutrients by the body. In this case, it is recommended that the child grow systematically and if he does not meet the age criteria, contact a specialist.
• Frequent and copious stools (up to 8 times a day), sometimes with a sour odor and mucus.
• , colic, bloating.
• on the skin.
• Difficult to treat iron deficiency anemia.

All these symptoms cannot be ignored. But diagnosing lactase deficiency only on the basis of clinical signs of the disease is incorrect. The diagnosis can be confirmed by analyzing stool for carbohydrates in infants and having it interpreted by a specialist.

Preparing for a stool test for carbohydrates

In order for the study to be reliable, that is, the norms of carbohydrates in the feces of a newborn correspond to their real value, it is necessary to correctly collect biological material for analysis.

It is important to take feces not from the child, but from a clean oilcloth or other non-absorbent surface, immediately after the baby has emptied his intestines. For research, a teaspoon of feces is enough, and its liquid part should be collected.

Before the test, the baby should receive the same food as usual. There is no need to introduce something new into his diet or disturb the nursing mother. Otherwise, the result of the analysis may be far from the truth.

The child's bowel movements should be spontaneous. Feces for analysis are collected in a special sterile plastic container, which is hermetically sealed. You can buy it at any pharmacy.

The container with the collected material for research must be delivered to the laboratory within 4 hours. The results of the analysis usually become known after 2 days.

Decoding

The norm of carbohydrates in a baby's feces is from 0 to 0.25%. Indicators of 0.3-0.5% are considered a minor deviation of the study. In this case, you do not need to do anything.

The average deviation from the norm for the content of carbohydrates in the stool of an infant is 0.6-1%. In this situation, monitoring and testing for stool acidity may be recommended.

A cause for alarm is the increased content of carbohydrates in the feces of a newborn - more than 1-1.65%. This condition requires treatment.

Deviations from the norm

Examination of children under three months of age makes it practically impossible to determine the recommended amount of carbohydrates in the feces of an infant. At such a tender age, a microbial biofilm is just forming in the digestive tract, and enzymatic processes are developing in the intestines. This is why there is no need to worry if there are elevated carbohydrates in a newborn’s stool. Under no circumstances should you stop breastfeeding. Most likely, the analysis will have to be repeated in the future.

Various deviations from the norm in the level of carbohydrates in the feces of an infant usually indicate conditions such as the immaturity of the enzymatic systems of the digestive tract. In this case, the pediatrician may prescribe additional studies and carry out treatment and preventive measures aimed at correcting microbiological disorders in the baby’s intestines.

It would be wrong to self-medicate, especially if the result of the test for carbohydrates in the baby’s stool is more than 2.0%.

The need to determine the amount of carbohydrates in the baby's feces is required by 1 out of 15 newborns. This study does not always give a positive result.

Timely determination of the norm of carbohydrates in the baby’s feces is an important diagnostic measure, which becomes the right step towards recovery if any pathologies are detected. Therefore, there is no need to worry that your child is scheduled for this test.

Useful video about lactase deficiency

Determination of carbohydrates in feces - laboratory testing of fecal matter. After deciphering the test results, the quantitative content of sugars, disaccharides, maltose, poly- and monosaccharides in the biological sample is established. If maltose, lactose and galactose are detected in the feces, further studies are carried out to determine the cause of the pathological process. The Benedict method allows you to identify the ability of the gastrointestinal tract of an adult and a child to digest and absorb carbohydrates. Laboratory testing is most often used to diagnose lactase deficiency in newborns and children in the first year of life.

To determine carbohydrates in feces, the Bernard method is used, based on the reduction of copper ions

How is laboratory research carried out?

Laboratory analysis is based on the ability of simple carbohydrates to act as a component or catalyst in various chemical reactions. They reduce copper cations that are part of organic and inorganic compounds. During the chemical reaction, the color of the ingredient changes, which allows us to judge the presence of mono- and polysaccharides in biological samples.

After removing the stool from a sterile container, the required amount of distilled water is measured into it. After centrifugation, a chemical reagent is added to the biological sample. By the changed color one can judge the quantitative content of carbohydrates in feces:

• green - carbohydrate concentration exceeds 0.05%;
• yellow - the sample contains at least 0.5% sugars;
• red - carbohydrate level exceeds 2%.

If the mixture of feces and reagent has retained its original light blue color, then the cause of dyspeptic disorders is not associated with improper breakdown and absorption of carbohydrates.

Warning: “Before conducting a diagnostic study, you should not make adjustments to your diet or adhere to any diet. To obtain reliable test results, it is necessary to deliver the biological sample to the laboratory immediately after bowel movement.”

Indications for analysis

Determination of carbohydrates in feces can be an independent diagnostic analysis or carried out in conjunction with other studies, which include:

• coprogram;
• genetic markers of lactose intolerance;
• studies to identify intestinal dysbiosis.

Biochemical research is not carried out on children in the first three months of life. At this age, digestive processes are just beginning to form, and the result of the analysis will be uninformative.

Determination of carbohydrates in feces is indicated for patients with dyspeptic disorders

Gastrointestinal tract dysfunction

The study is prescribed for pathologies of the small intestine and pancreas. If you suspect the absence of one of the digestive enzymes in the body, the procedure helps to determine its type.

The procedure is indicated for adults and children with frequent dyspeptic disorders. Determination of carbohydrates in feces allows us to determine the cause of painful sensations in the abdomen, impaired peristalsis, and excessive gas formation. The study is prescribed to patients who complain of bloating, nausea and vomiting after each meal. Indications for laboratory testing also include:

• chronic diarrhea of ​​unknown origin;
• the occurrence of symptoms of flatulence, especially after eating foods containing significant amounts of sugars and starch;
• sudden weight loss;
• suspected carbohydrate malabsorption.

Carbohydrates in feces can appear not only for pathological reasons. This condition is often diagnosed in people who eat an unbalanced and monotonous diet.

Warning: “Before carrying out the analysis, the laboratory assistant evaluates the external characteristics of the feces, notes signs of rotting and fermentation. These pathological processes occur in the patient’s gastrointestinal tract when it is impossible to fully break down starch. Fecal fermentation occurs in people with a partial or complete inability to absorb simple and complex carbohydrates.”

Lactase deficiency

Determination of carbohydrates in feces is necessary for the timely detection of lactase deficiency in young children. Lactose is a disaccharide that is present in large quantities in breast milk. During metabolism, it is broken down into galactose and glucose, and then completely absorbed in the gastrointestinal tract. The digestive enzyme lactase processes lactose (milk sugar). When it is deficient in the child’s body, symptoms of dyspepsia occur:

• bloating;
• poor weight gain;
• painful colic.

Lactase deficiency is most common in premature babies. When a pathology is diagnosed, the child is prescribed replacement therapy and the diet is adjusted.

Determination of carbohydrates in feces is carried out if lactase deficiency is suspected in infants

Normal values

Carbohydrates should not be contained in the stool of children and adults in normal health. Even in the body of those with a sweet tooth, the breakdown of these organic compounds occurs, and then the absorption of the products of their metabolism. Carbohydrates begin to be processed immediately in the oral cavity by enzymes contained in human saliva. As food passes through the gastrointestinal tract, it is completely absorbed.

Exceeding the values ​​is allowed only in small children. The amount of carbohydrates in a baby's feces varies between 0.001-0.25%. If the baby does not suffer from a lack of appetite and is gaining weight well, then pediatricians do not consider indicators of 0.5-0.6% to be a deviation. But exceeding this value becomes the reason for further examination of the child for the presence of lactase deficiency.

Regular delivery of stool samples for testing is recommended for every child of any age. Adults should also periodically check their digestive system in this way. The coprogram determines existing disturbances in the gastrointestinal tract, identifies the progression of pathologies and inflammatory processes. One of the important indicators of the quality of food absorption is the carbohydrate content in feces.

Symptoms of impaired carbohydrate absorption

Lactose intolerance (inability to digest milk sugar) is a serious disorder in the body of an adult, and even more so of a child who has been fed exclusively on milk since birth. In the early stages of detecting a problem, it is easier to cope with associated negative factors. There are a number of signs of such a deficiency, knowing which parents will be able to suspect the presence of a problem even before testing:

• abdominal pain;
• bloating, gases;
• stool is represented by constant liquid discharge of a foamy consistency;
• sour smell of stool;
• insufficient weight gain;
• baby's anxiety during breastfeeding.

As for the unusual odor, it appears against the background of increased acidity of the baby's feces. The normal pH is 5.5, but when lactase deficiency occurs, this figure can drop to 4. If the indicated symptoms are present, it is advisable to show the newborn to a pediatrician. The specialist will prescribe tests to determine the level of carbohydrates in the stool, determine the cause of their content, and help cope with the identified digestive problems.

Self-medication of an infant is unacceptable! Only based on the results of research can the causes of gastrointestinal disorders be discovered and the degree of enzymatic disorders determined.

Determination of carbohydrates in feces of adults and children

Analysis of stool for carbohydrates in infants in the first months of life is carried out according to a given medical scheme; it allows one to monitor the formation and development of the digestive system.

Carbohydrates are detected and tested in the feces of children and adults by performing the Benedict test in the laboratory. Specialists interpret the results obtained and determine the amount of maltose, disaccharides, sugars, mono- and polysaccharides in the biomaterial. If galactose or maltose is present in the stool, it is important to establish the cause of the pathology. The Benedict Method determines the ability of the digestive organs in adults and children to properly digest and assimilate consumed food.

The procedure itself consists of mixing the sample with distilled water and placing the mixture in a centrifuge, after which the reagent is added. During the chemical reaction, the color of the reagent changes, indicating the presence of poly- and monosaccharides in the biomaterial. The changed color indicates the quantitative carbohydrate content:

• Yellow – the sample contains sugars in an amount of at least 0.5%;
• Green – carbohydrate concentration above 0.5%;
• Red – increased carbohydrate content is 2% or more.

When the substance prepared for analysis retains its previous light blue color as normal, then dyspeptic disorders of the digestive system are not associated with impaired absorption and preliminary breakdown of carbohydrates.

Indications for analysis

An analysis for the determination of carbohydrates is prescribed to patients at any age if dyspeptic disorders occur. A fecal examination is carried out if symptoms indicating lactase deficiency are detected. In particular, it is necessary to submit feces of a newborn for study in case of indigestion, which is accompanied by frequent regurgitation, flatulence, abdominal pain, constipation or, conversely, diarrhea. It is worth examining a child’s feces if weight gain is insufficient for a particular age period. If the functions of internal organs are impaired, the diet is reviewed and adjusted, and treatment is provided if necessary.

The described study is also prescribed for adult patients who have the following symptoms:

• regular vomiting, frequent nausea;
• causeless weight loss;
• persistent diarrhea of ​​unknown origin;
• chronic disorder of the digestive system;
• flatulence in the presence of foods high in starch and glucose in the diet.

Preparation for analysis and collection of material

Correct sampling of biological material will help determine the amount of carbohydrates in feces. To do this, you should follow some rules:

• The baby's diet should not change before collecting stool. It is not recommended to introduce new complementary foods or eliminate familiar and frequently consumed foods from the diet. Similar requirements apply to nursing mothers. Otherwise, the analysis indicators will be distorted.
• It is unacceptable to use enemas or laxatives to force the baby to empty his bowels. Everything should happen naturally.
• The reliability of the research will be incorrect due to the use of any medications. For this purpose, it is necessary to stop drug therapy, if possible, at least 3 days in advance.
• It is not recommended to collect feces from a fabric surface due to the fact that it quickly absorbs the moisture needed in full for analysis. Before collecting biomaterial, it is better to place the infant on a sterile waterproof diaper and sit him on a potty (at an older age), previously washed and sterilely processed.
• There are special pharmaceutical containers for collecting stool for subsequent delivery to the laboratory. They are completely sterile, tightly screwed on with a lid, and equipped with a special spatula.
• In order to obtain the most accurate research results, feces are handed over to a medical institution within 4 hours from the moment of defecation and are not stored at home. Usually the results are released after two days.

Feces are collected in the morning after natural bowel movements. Its quantity should be at least one serving spoon. If there is liquid discharge, the maximum volume must be submitted to a medical facility for examination.

As for the adult category of people donating feces for the described analysis, you cannot adhere to diets immediately before the procedure, this will distort the value of the indicators.

Stool carbohydrate test results

The main objective of the described research method is aimed at determining the percentage of carbohydrates in feces. The analysis may also show:

• with optical microscopy, the presence of fatty acids in feces;
• acid balance level;
• the number of C-reactive protein, leukocytes, which determine the presence of an inflammatory process.

The doctor compares the child’s test results with his general health. If there is an excess or underestimation of the carbohydrate norm, but the baby feels satisfactory, treatment may not be prescribed.

Such cases in pediatrics require careful monitoring of the baby’s development and correction of his diet, while a repeat stool test is prescribed and an acidity test is performed.

Gastrointestinal tract dysfunction

Feces are submitted for laboratory testing in cases where there are signs of disruption of the digestive system, in particular the pancreas and intestines.

If a deficiency of any digestive enzyme is suspected, the procedure described will accurately identify its type. Using a laboratory table of reference values, the doctor can easily determine the cause of the formation of gases, bloating, pain in the abdominal area, and worsening peristalsis. The most common cause of malabsorption of saccharides, in addition to lactase deficiency, is Crohn's disease and celiac disease.

The appearance of carbohydrates in feces during bowel movements can be caused not only by diseases, but also by pathological processes in the gastrointestinal tract. The analysis will be positive against the background of a monotonous and unbalanced diet. For example, when an adult abuses dairy products. The child should be fed fresh fruits, vegetables, lean meats, fish, cereals (depending on age). It is necessary to limit the consumption of fatty, fried, spicy, salty foods.

Having received the biomaterial for analysis, the laboratory technician evaluates its external characteristics and determines the presence of processes such as fermentation and decay. They are the result of improper breakdown of starch in the gastrointestinal tract. Fermentation of stool indicates an inadequate ability of the body to absorb carbohydrates.

Detection of carbohydrates in feces is an important analysis that helps to timely determine lactase deficiency in children and adults. Lactose is a disaccharide found in milk. When it is broken down, glucose and galactose are obtained, which are completely absorbed by the digestive organs. Lactose is processed under the action of a special enzyme, lactase, the lack of which in the body leads to the unpleasant conditions indicated above: lack of weight, colic, bloating, gas, etc.

Congenital lactase deficiency is detected in early infancy. However, the problem can also be acquired, appearing for the first time in adulthood. Practice shows that disorders of the digestive system are observed more often in premature infants. Often the diagnosis of lactose intolerance in a baby is transient and is associated with imperfections in the digestive system. The child will outgrow this over time; it is only important to correctly formulate his diet, temporarily replacing regular formulas with low-lactose ones and limiting the consumption of breast milk.

The main component of breast milk is lactose, which is necessary for infants, as it provides about 40% of the child’s energy and nutritional needs. This substance is involved in the absorption of iron and calcium, stimulates the growth and development of normal intestinal microflora.

In the body, lactose is broken down into galactose and glucose, which occurs under the action of the enzyme lactase.

Lactose (more precisely, lactase) deficiency is spoken of when this enzyme is absent in the body or is not produced in sufficient quantities. This causes difficulty in digesting milk and dairy products or the inability to digest them (lactose intolerance).

Kinds

By origin, lactase deficiency can be

• primary
• or secondary.

Primary lactase deficiency, in turn, is divided into congenital and transient. Congenital is caused by a certain gene set, while transient (temporary) lactase deficiency occurs in premature infants and full-term babies with an immature intestinal enzymatic system. After the first year of life, the intestines begin to function normally, and these types of problems disappear.

Secondary lactase deficiency is said to occur in the case of damage to intestinal cells involved in the production of enzymes resulting from intestinal infections, helminthic infestations, and food allergies.

Depending on the degree of lactase formation, they are divided into

• partial (hypolactasia)
• and complete (alactasia) its insufficiency.

Causes

Causes of lactose intolerance include:

• prematurity;
• heredity;
• failures at the genetic level;
• the child’s age is more than 5 years (in three to five year old children, lactase activity decreases, and this continues until adulthood);
• diseases of the intestinal mucosa (rotovirus infection, helminths, giardiasis, enteritis of other origins).

Symptoms of lactose intolerance

The disease has a rather characteristic picture.

One of the signs is flatulence (increased gas production), in which seething in the stomach is clearly audible and its bloating is noticeable. This is explained by the fact that in the intestines, lactose is broken down by bacteria into gases: CO2, CH4, H2. The child feels discomfort in the abdomen, cramps and colic, which do not disappear after using proven remedies (such as stroking the abdomen). The baby may twist his legs, pull them to his stomach, cry and be capricious.

Another characteristic symptom is loose stools (diarrhea). Normally, an infant has a number of bowel movements up to 6-8 times a day. As a rule, each feeding is accompanied by a bowel movement. Diarrhea is explained by a large amount of undigested lactose in the intestine, and since lactose is an osmotically active substance, it “pulls” fluid into the intestinal cavity. The stool is liquid, with a sour odor, foaming or bubbling, and with secondary lactase deficiency, the stool may contain mucus, food particles, and be greenish in color.

Often, instead of diarrhea, constipation is noted. Constipation is said to occur when a child does not have bowel movements for one day or more.

With severe lactose intolerance, children do not gain weight and even lose it, which indicates dehydration. Undigested lactose and the acidic environment of intestinal contents lead to the growth of pathogenic microflora and the development of intestinal dysbiosis.

All of these signs are associated with milk intake and appear immediately after the start of feeding or some time after it.

Diagnostics

Diagnosing lactase deficiency is not difficult. Characteristic symptoms allow you to immediately make the correct diagnosis.

Additional studies include:

• Diet diagnostics – milk and dairy products are excluded from the child’s diet, after which all symptoms disappear. When milk is introduced into the diet, signs of malaise return again.
• determination of fecal pH - the environment of the intestinal contents becomes acidic, that is, below 7.0.
• determination of carbohydrates in feces (Benedict test) - in children under one year of age the norm is 0.25%, and in older children and adults there are no carbohydrates. If their content in feces increases to 0.5% or higher, the test is considered positive.
• determining the hydrogen content in exhaled air - this method is used for older children. When the hydrogen content is more than 20 ppm, and blood sugar is less than 20 mg/dl, they speak of lactase deficiency.

Differential diagnosis is necessary so as not to confuse the disease with intestinal infections, gastroenteritis and an allergic reaction to the milk protein - casein.

Treatment of lactase deficiency

The treatment is carried out by a pediatrician.

First of all, it is necessary to establish the cause that caused lactose intolerance and try to eliminate it.

In case of secondary lactase deficiency, infectious and non-infectious enterocolitis, helminthiasis, giardiasis and others are treated. The duration of treatment for secondary lactase deficiency corresponds to the period of treatment for the underlying disease: 14 days or more.

Mom's diet while breastfeeding

In case of primary lactose intolerance, mothers are advised to limit or completely avoid whole milk, but keep fermented milk products, butter and cheeses in the diet, since they are the source of calcium needed by the baby. Also, a nursing woman should reduce her intake of sweet foods. However, it is important that the diet itself is balanced.

In no case should you give up breastfeeding, since mother’s milk, in addition to nutrients and vitamins, contains antibodies that create the child’s immunity and lactase. Most of the enzyme is present in hind milk, so the baby should suckle at the breast for at least 20 minutes. Night feedings should also not be stopped, because it is at night that hind milk is produced in greater quantities.

For moderately severe lactose intolerance, it is recommended to add Lactase Enzyme, Lactase Baby or Lactazar to breast milk. To do this, before starting feeding, you should express about 50 ml of milk and dissolve one of the listed drugs in it. After a minute, give the mixture to the baby from a spoon and continue breastfeeding. Enzymes must be added to each feeding without skipping; the dose volume depends on the level of carbohydrates in the feces.

Lactase withdrawal should occur gradually, as breastfeeding decreases due to the introduction of complementary foods.

Diet of children on artificial nutrition

For formula-fed children, lactose-free, low-lactose or soy formulas should be selected.

Complementary foods for children with lactase deficiency begin to be introduced earlier; vegetable purees and cereals are prepared on lactose-free or low-lactose bases. Fruit juices, on the other hand, are added to the menu later. Children should be given yoghurts, fermented milk mixtures with live biobacteria, and cheeses.

Table. Chemical composition and energy value of low-lactose and lactose-free milk formulas (in 100 ml of finished mixture)

In older children and adults, lactase deficiency is moderate to mild. They are advised to avoid whole milk, condensed milk and ice cream for life. Fermented milk products and cheeses are not limited.

Forecast

The prognosis for children suffering from lactase deficiency is favorable.

In the secondary form, after treatment of the underlying disease, it disappears without a trace. Primary transient lactose intolerance weakens by 6-7 months and gradually disappears.

With congenital deficiency of this enzyme, people are recommended only minor dietary restrictions. Despite its absence in the body, lactase is still produced in small quantities by intestinal bacteria, which allows even people with this diagnosis to consume a little whole milk.

*This article was written in accordance with the “National Program for Optimizing Feeding of Children in the First Year of Life”, approved by the Union of Pediatricians of Russia in 2011.