Effect of different sugars on diarrhoea of acute kwashiorkor.

Prinsloo, J. G.; Wittmann, Walter; Pretorius, P. J.; Kruger, H.; Fellingham, S. A.

doi:10.1136/adc.44.237.593

Cited by 35 publications

(19 citation statements)

References 15 publications

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“…Surprisingly, the change to high energy milk with increase in lactose intake to 8.7 g/kg/day was not associated with an increase in diarrhoea, suggesting that lactase activity improves quicker with nutritional rehabilitation than abnormal permeability. This is consistent with the concept of a threshold for lactose intolerance, which improves during the initiation of cure 36. Although special low lactose or elemental formulas are too expensive for use in this setting, our results suggest that recovery of gut integrity during the initial treatment phase of kwashiorkor would benefit from a lower lactose milk formula, such as K-mix-II 37…”

Section: Discussionsupporting

confidence: 88%

Comparison of milk and maize based diets in kwashiorkor

Brewster

Manary

Menzies

et al. 1997

Archives of Disease in Childhood

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The dual sugar test of intestinal permeability is a reliable non-invasive way of assessing the response of the small intestinal mucosa to nutritional rehabilitation. Aim-To compare a local mix of maizesoya-egg to the standard milk diet in the treatment of kwashiorkor. Design-The diets were alternated three monthly in the sequence milk-maizemilk. There were a total of 533 kwashiorkor admissions of at least five days during the study who received either milk or maize. Intestinal permeability was assessed at weekly intervals by the lactulose-rhamnose test in 100 kwashiorkor cases, including 55 on milk and 45 on the maize diet. Results-Permeability ratios (95% confidence interval) on the milk diet improved by a mean of 6.4 (1.7 to 11.1) compared with −6.8 (−16.8 to 5.0) in the maize group. The improved permeability on milk occurred despite more diarrhoea, which constituted 34.8% of hospital days (29.8 to 39.8) compared with 24.3% (17.8 to 30.8) in the maize group. Case fatality rates for all 533 kwashiorkor admissions were 13.6% v 20.9%, respectively, giving a relative risk of death in the maize group of 1.54 (1.04 to 2.28). The maize group also had more clinical sepsis (60% v 31%) and less weight gain (2.9 v 4.4 g/kg/day) than the milk group. Implications-Milk is superior to a local maize based diet in the treatment of kwashiorkor in terms of mortality, weight gain, clinical sepsis, and improvement in intestinal permeability. (Arch Dis Child 1997;76:242-248)

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Section: Discussionsupporting

confidence: 88%

Comparison of milk and maize based diets in kwashiorkor

Brewster

Manary

Menzies

et al. 1997

Archives of Disease in Childhood

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“…In our experience troublesome diarrhoea is not often encountered in pellagra children while they are on a moderate lactose intake (milk as part of their diet). Furthermore, as previously shown (Prinsloo et al, 1969) most kwashiorkor patients tolerate milk feeds well and diarrhoea usually subsides within 2 weeks of admission to hospital. These findings have a practical bearing on preventive and therapeutic measures in malnutrition (at least where severe and prolonged diarrhoea is not a general accompanying feature).…”

Section: Resultssupporting

confidence: 59%

“…The practical significance of lactose intolerance in children suffering from proteincalorie malnutrition was indicated first by Dean (1957) and later by Hansen (1963, 1965). In our area kwashiorkor patients also had low intestinal lactase levels, though generally diarrhoea was not as severe as reported Received 10 March 1971. from other centres (Prinsloo et al, 1969). The medical history of pellagra children revealed diarrhoea to be a complaint in about 16% of the patients (Prinsloo et al, 1968).…”

mentioning

confidence: 98%

Lactose absorption and mucosal disaccharidases in convalescent pellagra and kwashiorkor children

Prinsloo¹,

Wittmann²,

Kruger³

et al. 1971

Archives of Disease in Childhood

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“…Lactase also recovers more slowly in the blind loop during treatment with antibiotics (3). This enzyme seems to be most vulnerable in acute infections (1,37), gluten-sensitive enteropathy (38), and malnutrition (39). The relative vulnerability of the disaccharidases in the experimental blind loop syndrome therefore appears to mimic that seen in human disease, and for that reason the experimental blind loop may provide an excellent model for future investigation of the pathogenesis of many types of secondary disaccharidase deficiency in man.…”

mentioning

confidence: 99%

Pathogenesis of Mucosal Injury in the Blind Loop Syndrome

Jonas¹,

Flanagan²,

Forstner³

1977

J. Clin. Invest.

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A B S T R A C T The effect of intestinal bacterial overgrowth on brush border hydrolases and brush border glycoproteins was studied in nonoperated control rats, control rats with surgically introduced jejunal selfemptying blind loops, and rats with surgically introduced jejunal self-filling blind loops. Data were analyzed from blind loop segments, segments above and below the blind loops, and three corresponding segments in the nonoperated controls. Rats with selffilling blind loops had significantly greater fat excretion than controls and exhibited significantly lower conjugated:free bile salt ratios in all three segments. Maltase, sucrase, and lactase activities were significantly reduced in homogenates and isolated brush borders from the self-filling blind loop, but alkaline phosphatase was not affected. The relative degradation rate of homogenate and brush border glycoproteins was assessed by a double-isotope technique involving the injection of D-[6-3H]glucosamine 3 h and D-[U-14C]glucosamine 19 h before sacrifice, and recorded as a 3H: 14C ratio. The relative degradation rate in both homogenate and brush border fractions was significantly greater in most segments from rats with selffilling blind loops. In the upper and blind loop segments from rats with self-filling blind loops, the 3H:14C ratios were higher in the brush border membrane than in the corresponding homogenates, indicating that the increased rates of degradation primarily involve membrane glycoproteins. Incorporation of D-[6-3H]glucosamine by brush border glycoproteins was not reduced in rats with self-filling blind loops, suggesting that glycoprotein synthesis was not affected. Polyacrylamide gel electrophoresis of brush border glycoproteins from the contaminated segments indicated that the large molecular weight glycoproteins,

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Effect of different sugars on diarrhoea of acute kwashiorkor.

Cited by 35 publications

References 15 publications

Comparison of milk and maize based diets in kwashiorkor

Comparison of milk and maize based diets in kwashiorkor

Lactose absorption and mucosal disaccharidases in convalescent pellagra and kwashiorkor children

Pathogenesis of Mucosal Injury in the Blind Loop Syndrome

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