Comparison of milk and maize based diets in kwashiorkor

Brewster, David; Manary, Mark J.; Menzies, Ian S.; Rl, Henry; O’Loughlin, Edward

doi:10.1136/adc.76.3.242

Cited by 35 publications

(26 citation statements)

References 32 publications

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“…Recent research conducted within the context of usual practice in Malawian NRUs has demonstrated the superiority of milk over maize-based diets for treating kwashiorkor and suggested the importance of micronutrients in reducing mortality. 2,21,22 The introduction of appropriate treatment protocols in refugee situations has reduced mortality in severely malnourished children, in some situations to less than 5%. 23 However, there are many confounding variables that need to be considered when comparing treatment response in a humanitarian emergency to the circumstances of presentation and management in a long-established NRU.…”

Section: Discussionmentioning

confidence: 99%

The impact of the human immunodeficiency virus type 1 on the management of severe malnutrition in Malawi

Kessler

Daley

Malenga

et al. 2000

Annals of Tropical Paediatrics

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A study was undertaken in a central nutritional rehabilitation unit in southern Malawi to assess the impact of HIV infection on clinical presentation and case fatality rate. HIV seroprevalence in 250 severely malnourished children over 1 year of age was 34.4% and overall mortality was 28%. HIV infection was associated significantly more frequently with marasmus (62.2%) than with kwashiorkor (21.7%) (p < 0.0001). Breastfed children presenting with severe malnutrition were significantly more likely to be HIV-seropositive (p < 0.001). Clinical and radiological features were generally not helpful in distinguishing HIV-seropositive from HIV-seronegative children. The case fatality rate was significantly higher for HIV-seropositive children (RR 1.6 [95% CI 1.14-2.24]). The increasing difficulties of managing the growing impact of HIV infection on severely malnourished children in Malawi are discussed in the context of reduced support for nutritional rehabilitation units.

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Section: Discussionmentioning

confidence: 99%

The impact of the human immunodeficiency virus type 1 on the management of severe malnutrition in Malawi

Kessler

Daley

Malenga

et al. 2000

Annals of Tropical Paediatrics

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“…However, a recent Guatemalan study34 has reported high failure rates in non-acutely ill children of 31.6% (73 of 231). In permeability studies in Malawi,15 35 one author (DRB) encountered similar difficulties with urine collection in kwashiorkor cases and resorted to overnight urine collection, when urine bags were less likely to come off. From the additional experience in the Darwin setting, we conclude that L–R testing on urine is not a feasible outcome measure for a clinical trial in young children with diarrhoea.…”

Section: Discussionmentioning

confidence: 99%

Intestinal permeability and diarrhoeal disease in Aboriginal Australians

Kukuruzovic¹,

Haase²,

Dunn³

et al. 1999

Archives of Disease in Childhood

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Background-Northern Territory Aboriginal children hospitalised with acute gastroenteritis have high rates of acidosis, hypokalaemia, and dehydration. Aims-To determine whether Aboriginal children with and without diarrhoea have greater impairment in intestinal function than non-Aboriginal children, as assessed by increased permeability ratios. Methods-A descriptive study of 124 children (96 Aboriginal and 28 nonAboriginal) hospitalised with and without diarrhoea. Intestinal permeability was assessed by the lactulose to rhamnose (L-R) ratio from a five hour urine collection. Results-In Aboriginal children, mean L-R ratios (95% confidence intervals) were 18.3 (17.1 to 19.6) with diarrhoea and 9.0 (7.3 to 11.0) without diarrhoea, and in non-Aboriginal children they were 5.9 (2.8 to 12.3) and 4.2 (3.3 to 5.2), respectively. In patients with diarrhoea, L-R ratios were significantly raised when accompanied by acidosis (mean, 22.8; 95% CI, 17.0 to 30.5), hypokalaemia (mean, 20.7; 95% CI, 15.4 to 27.9), and > 5% dehydration (mean, 24.3; 95% CI, 19.0 to 29.6) compared with none of these complications (mean, 7.0; 95% CI, 3.5 to 13.8). Conclusion-The high incidence of acidosis, hypokalaemia, and dehydration in Aboriginal children admitted with diarrhoeal disease is related to underlying small intestinal mucosal damage. (Arch Dis Child 1999;81:304-308) Keywords: intestinal absorption; diarrhoea; Aboriginal children It is well recognised that hospitalised Aboriginal children in the Top End of Australia have more severe manifestations of diarrhoeal disease than non-Aboriginal children.1 2 These include high rates of hypokalaemia, acidosis, and lactose intolerance, particularly in those with underlying malnutrition. We believe that these complications are related to the severity of the underlying small bowel damage, which can be measured non-invasively in urine by the lactulose to rhamnose (L-R) test of intestinal permeability-a validated non-invasive test of small bowel mucosal barrier and absorptive functions.3-9 Rhamnose recovery is a measure of mucosal absorptive capacity, whereas lactulose permeability reflects barrier function. Mucosal damage or loss of villous surface area alters the rate of permeation of the sugars across the mucosal surface, with decreased rhamnose and increased lactulose recovery resulting in high L-R ratios.10 After oral administration of the sugar solution, mean urine recovery in normal subjects after five hours is about 0.25% of the lactulose and 10% of the rhamnose, giving a mean ratio of 0.025. 11For ease of expression, we have multiplied L-R ratios by 100 so that 0.025 becomes 2.5. The normal mean L-R ratio (95% confidence intervals) from studies in developed countries using this technique is 2.7 (0.8 to 5.2), 7 but there is considerable geographical variation in normal adult subjects in the developing world, with mean values varying from 4.9 to 15.6 in a recent review by Menzies et al. 12

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“…Out of the 149 children with kwashiorkor in whom permeability testing was done, 76 were treated with a milk based diet, 64 with an exclusively maize based (milk free) diet, and nine with both diets over a changeover period. Details of the diets are given in the companion paper 16 . Clinical sepsis was defined as fever, respiratory distress, a change in mental status, shock or any abrupt deterioration in condition.…”

Section: Methodsmentioning

confidence: 99%

Intestinal permeability in kwashiorkor

Brewster

Manary

Menzies

et al. 1997

Archives of Disease in Childhood

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Intestinal permeability can be assessed non-invasively using the lactuloserhamnose (L-R) test, which is a reliable measure of small intestinal integrity. Aims-To determine risk factors for abnormal intestinal permeability in kwashiorkor, and to measure changes in L-R ratios with inpatient rehabilitation. Design-A case-control study of 149 kwashiorkor cases and 45 hospital controls. The L-R test was adapted to study kwashiorkor in Malawi, with testing at weekly intervals during nutritional rehabilitation. Urine sugars were measured by thin layer chromatography in London. Conclusion-Abnormal intestinal permeability in kwashiorkor correlates with disease severity, and improves only slowly with nutritional rehabilitation. (Arch Dis Child 1997;76:236-241) Results-The initial geometric mean L-R ratios (×100) (with

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Comparison of milk and maize based diets in kwashiorkor

Cited by 35 publications

References 32 publications

The impact of the human immunodeficiency virus type 1 on the management of severe malnutrition in Malawi

The impact of the human immunodeficiency virus type 1 on the management of severe malnutrition in Malawi

Intestinal permeability and diarrhoeal disease in Aboriginal Australians

Intestinal permeability in kwashiorkor

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