ADC

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER


[Advanced]
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this link to a friend
Right arrow Similar articles in ADC Online
Right arrow Similar articles in PubMed
Right arrow Add article to my folders
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Brewster, D R
Right arrow Articles by O'Loughlin, E V
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Brewster, D R
Right arrow Articles by O'Loughlin, E V
Arch Dis Child 1997;76:242-248 ( March )

Comparison of milk and maize based diets in kwashiorkor

D R Brewster,a M J Manary,b I S Menzies,c R L Henry,d E V O'Loughline

a College of Medicine, University of Malawi, Blantyre, Malawi, b Washington University School of Medicine, St Louis, USA, c Department of Clinical Biochemistry, King's College Medical School, London, d Faculty of Medicine and Health Sciences, University of Newcastle, Australia, e New Children's Hospital, University of Sydney, Westmead, Australia

Correspondence to: Dr David Brewster, Flinders University and Maternal and Child Health, Royal Darwin Hospital, PO Box 41326, Casuarina, NT 0811, Australia.

Accepted 16 September 1996

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 maize-soya-egg to the standard milk diet in the treatment of kwashiorkor.
DESIGN---The diets were alternated three monthly in the sequence milk-maize-milk. 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.


Key messages

  • Children with kwashiorkor had a lower mortality and better weight gain on the standard milk diet compared with a maize-soya-egg diet
  • Diets were similar in protein and energy densities, were supplemented with zinc, and the maize was germinated to increase palatability
  • Intestinal permeability improved with nutritional rehabilitation on the milk diet but worsened on the maize diet
  • The milk group experienced more initial diarrhoea in hospital, which was due to lactose intolerance rather than cows' milk allergy
  • We recommend a low lactose milk based diet in the treatment of kwashiorkor, rather than a local staple diet



Keywords: kwashiorkor; intestinal permeability; Africa.

© 1997 by Archives of Disease in Childhood


This article has been cited by other articles:


Home page
 Am. J. Clin. Nutr.Home page
E. H. I. Diop, N. I. Dossou, M. M. Ndour, A. Briend, and S. Wade
Comparison of the efficacy of a solid ready-to-use food and a liquid, milk-based diet for the rehabilitation of severely malnourished children: a randomized trial
Am. J. Clinical Nutrition, August 1, 2003; 78(2): 302 - 307.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
R H Kukuruzovic, A Haase, K Dunn, A Bright, and D R Brewster
Intestinal permeability and diarrhoeal disease in Aboriginal Australians
Arch. Dis. Child., October 1, 1999; 81(4): 304 - 308.
[Abstract] [Full Text]

Home page
 Arch. Dis. Child.Home page
D R Brewster, M J Manary, I S Menzies, E V O'Loughlin, and R L Henry
Intestinal permeability in kwashiorkor
Arch. Dis. Child., March 1, 1997; 76(3): 236 - 241.
[Abstract] [Full Text]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER
ARCH DIS CHILD FETAL NEONATAL ED ED PRACTICE
Terms and conditions relating to subscriptions purchased online  ¦  Website terms and conditions  ¦  Privacy policy
Copyright © 1997 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health