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. 1984 Sep;25(9):942–947. doi: 10.1136/gut.25.9.942

Nutritional support of malnourished lactose intolerant African patients.

S J O'Keefe, J K Adam, E Cakata, S Epstein
PMCID: PMC1432498  PMID: 6469079

Abstract

The effectiveness of two commonly available liquid diets was assessed in 40 severely malnourished black African patients. All patients were shown to have normal xylose absorption. The diets were given according to the manufacturer's recommendations. One diet was lactose containing (LC diet) (150 g/d) and high protein (112 g/d), the other normal protein and lactose free (LF diet) (protein 67 g/d), total energy content being similar. Patients were randomly divided into two equal groups and allocated (blind) to one of the diets. Tolerance and nitrogen balance were assessed over two three day periods on half and then full strength formulations. Severe intolerant symptoms were observed in 50% of patients on half strength and 94% of patients on full strength lactose containing diet with evidence of malabsorption of fluid, nitrogen, and fat. Despite high stool nitrogen losses (3.75 +/- 1.04 g/d), however, positive nitrogen balance was achieved in most patients receiving the full strength LC formulation. On the other hand, the full strength LF diet was generally well tolerated and was associated with significantly lower faecal losses and positive nitrogen balance. The results indicate that high density lactose containing liquid formulae are poorly tolerated by severely malnourished black African patients, while lactose free formulae containing approximately 10 g nitrogen/d are well tolerated and result in positive nitrogen balance.

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Selected References

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  1. AMINI F. Giardiasis and steatorrhoea. J Trop Med Hyg. 1963 Jul;66:190–192. [PubMed] [Google Scholar]
  2. BOWIE M. D., BRINKMAN G. L., HANSEN J. D. DIARRHOEA IN PROTEIN-CALORIE MALNUTRITION. Lancet. 1963 Sep 14;2(7307):550–551. doi: 10.1016/s0140-6736(63)92645-x. [DOI] [PubMed] [Google Scholar]
  3. Bank S., Barbezat G. O., Marks I. N. Post-gastrectomy steatorrhoea due to intestinal lactase deficiency. S Afr Med J. 1966 Jul 9;40(25):597–599. [PubMed] [Google Scholar]
  4. Bayless T. M., Rothfeld B., Massa C., Wise L., Paige D., Bedine M. S. Lactose and milk intolerance: clinical implications. N Engl J Med. 1975 May 29;292(22):1156–1159. doi: 10.1056/NEJM197505292922205. [DOI] [PubMed] [Google Scholar]
  5. Burman D. The jejunal mucosa in kwashiorkor. Arch Dis Child. 1965 Oct;40(213):526–531. doi: 10.1136/adc.40.213.526. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Campos J. V., Neto U. F., Patricio F. R., Wehba J., Carvalho A. A., Shiner M. Jejunal mucosa in marasmic children. Clinical, pathological, and fine structural evaluation of the effect of protein-energy malnutrition and environmental contamination. Am J Clin Nutr. 1979 Aug;32(8):1575–1591. doi: 10.1093/ajcn/32.8.1575. [DOI] [PubMed] [Google Scholar]
  7. Cook G. C., Kajubi S. K. Tribal incidence of lactase deficiency in Uganda. Lancet. 1966 Apr 2;1(7440):725–729. doi: 10.1016/s0140-6736(66)90888-9. [DOI] [PubMed] [Google Scholar]
  8. Debongnie J. C., Newcomer A. D., McGill D. B., Phillips S. F. Absorption of nutrients in lactase deficiency. Dig Dis Sci. 1979 Mar;24(3):225–231. doi: 10.1007/BF01308435. [DOI] [PubMed] [Google Scholar]
  9. Falaiye J. M. Present status of subclinical intestinal malabsorption in the tropics. Br Med J. 1971 Nov 20;4(5785):454–458. doi: 10.1136/bmj.4.5785.454. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Garza C., Scrimshaw N. S., Young V. R. Human protein requirements: interrelationships between energy intake and nitrogen balance in young men consuming the 1973 FAO/WHO safe level of egg protein, with added non-essential amino acids. J Nutr. 1978 Jan;108(1):90–96. doi: 10.1093/jn/108.1.90. [DOI] [PubMed] [Google Scholar]
  11. Jersky J., Kinsley R. H. Lactose deficiency in the South African Bantu. S Afr Med J. 1967 Dec 16;41(46):1194–1196. [PubMed] [Google Scholar]
  12. Jones D. V., Latham M. C., Kosikowski F. V., Woodward G. Symptom response to lactose-reduced milk in lactose-intolerant adults. Am J Clin Nutr. 1976 Jun;29(6):633–638. doi: 10.1093/ajcn/29.6.633. [DOI] [PubMed] [Google Scholar]
  13. Keohane P. P., Attrill H., Jones B. J., Brown I., Frost P., Silk D. B. The roles of lactose and Clostridium difficile in the pathogenesis of enteral feeding associated diarrhoea. Clin Nutr. 1983 Mar;1(4):259–264. doi: 10.1016/0261-5614(83)90003-1. [DOI] [PubMed] [Google Scholar]
  14. Klipstein F. A., Samloff I. M., Schenk E. A. Tropical sprue in Haiti. Ann Intern Med. 1966 Mar;64(3):575–594. doi: 10.7326/0003-4819-64-3-575. [DOI] [PubMed] [Google Scholar]
  15. LEBLOND C. P., MESSIER B. Renewal of chief cells and goblet cells in the small intestine as shown by radioautography after injection of thymidine-H3 into mice. Anat Rec. 1958 Nov;132(3):247–259. doi: 10.1002/ar.1091320303. [DOI] [PubMed] [Google Scholar]
  16. LINDENBAUM J. MALABSORPTION DURING AND AFTER RECOVERY FROM ACUTE INTESTINAL INFECTION. Br Med J. 1965 Aug 7;2(5457):326–329. doi: 10.1136/bmj.2.5457.326. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Milner P. F., Irvine R. A., Barton C. J., Bras G., Richards R. Intestinal malabsorption in Strongyloides stercoralis infestation. Gut. 1965 Dec;6(6):574–581. doi: 10.1136/gut.6.6.574. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Moshal M. G., Hift W., Kallichurum S., Pillay K. Malabsorption and its causes in Natal. S Afr Med J. 1973 Jun 30;47(25):1093–1103. [PubMed] [Google Scholar]
  19. O'Keefe S. J., Adam J. K. Primary lactose intolerance in Zulu adults. S Afr Med J. 1983 May 14;63(20):778–780. [PubMed] [Google Scholar]
  20. O'Keefe S. J., Thusi D., Epstein S. The fat and the thin--a survey of nutritional status and disease patterns among urbanized Black South Africans. S Afr Med J. 1983 Apr 30;63(18):679–683. [PubMed] [Google Scholar]
  21. Solomons N. W., García-Ibañez R., Viteri F. E. Hydrogen breath test of lactose absorption in adults: the application of physiological doses and whole cow's milk sources. Am J Clin Nutr. 1980 Mar;33(3):545–554. doi: 10.1093/ajcn/33.3.545. [DOI] [PubMed] [Google Scholar]
  22. Stanfield J. P., Hutt M. S., Tunnicliffe R. Intestinal biopsy in kwashiorkor. Lancet. 1965 Sep 11;2(7411):519–523. doi: 10.1016/s0140-6736(65)91474-1. [DOI] [PubMed] [Google Scholar]
  23. Tandon B. N., Das B. C., Saraya A. K., Deo M. G. Functional and structural studies of small bowel in ankylostomiasis. Br Med J. 1966 Mar 19;1(5489):714–716. doi: 10.1136/bmj.1.5489.714. [DOI] [PMC free article] [PubMed] [Google Scholar]

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