EFFECT OF DIFFERENT SUGARS ON DIARRHOEA OF ACUTE KWASHIORKOR

The effect of different dietary sugars on diarrhoea in kwashiorkor patients was tested over 13 days in 6 groups of about 20 patients each. In 5 groups the diet consisted of a basic casein formula, with the addition of 6·3% of either glucose, sucrose, dextrin-maltose, lactose, or no sugar. The 6th group received cow's milk (4·8% lactose). The patients in the groups which received lactose had initially more severe diarrhoea and higher lactic acid excretion than the patients in the other groups. Diarrhoea improved in all groups over the experimental period, but the incidence of diarrhoea and abnormal lactic acid excretion in the group receiving the 6·3% lactose formula was still high at the end of the experimental period. On the other hand the group on cow's milk (4-8% lactose), in spite of high lactic acid excretion, did not have more diarrhoea than the other groups at the end of the experimental period. It seemed that there was a threshold for lactose tolerance and that tolerance improved during initiation of cure. There were no significant differences between the stool weights and lactic acid excretion of the other groups, either at the beginning or at the end of the experiment. Initiation of cure, whether judged clinically or by disappearance of oedema, weight change, or albumin regeneration, did not differ among the groups. Intestinal biopsies and disaccharidase assays done in 33 patients showed a depression of all enzyme activities, especially lactase. It is concluded that in the Pretoria area milk is generally tolerated sufficiently well for initiation of cure in kwashiorkor patients, so that a lactose free formula is not routinely indicated. In individual patients, however, it may be necessary to exclude lactose, in which case sucrose is the logical choice, since it is easily available, inexpensive, and well tolerated.