Effect of different sugars on diarrhoea of acute kwashiorkor.

Abstract

Children with kwashiorkor almost invariably have diarrhoea which may be severe and prolonged. The exact cause is often obscure and the manage- ment unsatisfactory (Brock et al., 1955; Trowell, 1958; Pretorius and Smit, 1958). Recently Bowie, Brinkman, and Hansen (1965), and Bowie, Barbezat, and Hansen (1967) found that the majority of their kwashiorkor patients with severe diarrhoea res- ponded with a dramatic reduction in daily stool weights on a lactose-free diet, with or without added glucose. The diarrhoea was related to lactose malabsorption as a result of intestinal lactase deficiency. Other disaccharidases were much less affected, and absorption tests for sucrose and mal- tose were normal. In Uganda, Wharton (1968) found intolerance to disaccharides and glucose in kwashiorkor patients, and he was able to control the diarrhoea with a diet containing fructose as the only carbohydrate. The present investigation was undertaken to evaluate further the effect of different sugars on the diarrhoea of kwashiorkor in an area where life-threatening diarrhoea is less frequently encountered than reported from other centres (Pretorius, Wehmeyer, and Mey, 1964; Wharton, 1968). Material and Methods From August 1966 until March 1968, 120 Bantu male infants between 9 and 36 months of age suffering from kwashiorkor were studied in Pretoria at the Nutrition Clinic for Children. Though patients with severe kwashiorkor were included, those who appeared mori- bund or had obvious parenteral infections were excluded from the study. All children received the same support- ive therapy after admission, including electrolyte solutions, a multivitamin syrup, supplementary potassium, and antibiotics by mouth. On the day after admission the children were allocated at random to 1 of 6 dietary regimens for a period of 13 days.