The interrelationship between diarrhea, malnutrition, and small bowel integrity was investigated prospectively in 68 Gambian infants aged 0-18 mo. Profiles of growth and morbidity were recorded for 8 mo. Each month intestinal permeability was measured by the differential uptake of orally administered lactulose (L) and mannitol (M). In well infants the mean L:M ratio was 0.42 (range 0.11-1.42). This ratio was increased slightly for underweight (60-80% wt for age) infants (mean 0.52) but considerably for those with marasmus (less than 60% wt for age) (mean 1.3, p less than 0.001), for those with acute or chronic diarrhea (mean 1.0 and 2.85, respectively; p less than 0.001), or with measles (mean 1.4, p less than 0.001). Sequential studies of ward patients with malnutrition and diarrhea showed a rapid fall in L:M ratios with resolution of diarrhea. These studies suggest that damage to the small intestine may play an important part in the development of infant malnutrition in The Gambia.

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1. Factors affecting the intestinal uptake and urinary excretion of mannitol, lactulose and 51Cr-labelled ethylenediaminetetra-acetate (51Cr-EDTA), have been investigated in normal subjects and three patients with ileostomy. 2. The distribution volume of markers within the body, the rate of disappearance from plasma and renal clearance were assessed after an intravenous injection of a mixture of mannitol (2 g), [14C]mannitol (10 microCi), lactulose (0.1 g) and 51Cr-EDTA (5 microCi). 3. The urinary recovery of all the intravenously administered markers was close to 100%. Distribution volumes and patterns of excretion were virtually identical. Oxidation of intravenously administered mannitol accounted for only about 1% of the dose. 4. The passage of an orally administered mixture of markers was traced through the intestine and into urine. Transit time through the gastrointestinal tract was measured by the breath hydrogen method and by radionuclide scanning. 5. The passage of markers from mouth to the large bowel was essentially complete by 3.5 h. In some subjects the marker appeared in the large bowel as early as 30-40 min but in others it took three times as long. 6. After an oral dose the urinary excretion of mannitol fell progressively from 2 to 6 h, whereas the excretion of lactulose and 51Cr-EDTA increased slightly. As a consequence the lactulose/mannitol and 51Cr-EDTA/mannitol ratios in urine collected between 0 and 2 h were more than twofold higher than in urine collected between 4 and 6 h (P less than 0.001). After 6 h, the urinary excretion

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SUMMARYIn two experiments a total of twelve male rats were reared from weaning for up to 63 weeks on an essential fatty acid (EFA)-deficient diet alone (2 x two animals) or supplemented with the methyl esters of linoleic acid (18: 2w6) (2 x two animals) or linolenic acid (18: 3w3) (2 x two animals). Testicular development was normal in rats given 18:2w6, but in rats fed the EFAdeficient diet alone, and in those supplemented with 18:3w3 the testes were reduced in size. Histologically, a degeneration of the seminiferous tubules was noted, with progressive loss of the germinal cells, and with an absence of spermatozoa in the lumina of the seminiferous tubules and epididymides. Leydig cells appeared unaffected, and were prominent. The six rats in Experiment 1 were capable of mating with females reared on commercial diets, but only the two 18: 20)6 supplemented animals were fertile. There was a marked reduction in the percentage of arachidonic acid (20:4wj6) and docosapentaenoic acid (22: 516) in the total fatty acids of the atrophic testes. There was no compensatory increase in long-chain derivatives of 18: 3w3 in the 18: 3w3 fed rats and it is concluded that linolenic acid cannot replace linoleic acid in the development of the rat testis.