Milk-induced malabsorption in malnourished African patients

Article Abstract:

Malnutrition is very common in rural Africa, and previous studies have shown that many Africans have primary hypolactasia. People with this condition produce abnormally low amounts of an enzyme called lactase. Lactase is the enzyme that is responsible for digesting the lactose (sugar) present in milk. People who do not have enough of this enzyme cannot digest milk, and thus they can have severe diarrhea if they drink any milk or too much milk, depending on the amount of lactase they produce. (Another term for hypolactasia is lactose intolerance.) Therefore, this raises the question, is milk appropriate for treating malnourished African patients? In an attempt to answer this question, a study was done with 50 malnourished rural African patients who had hypolactasia. The subjects were treated with either whole milk, acidified milk (which contains half as much lactose as whole milk), or a diet without any lactose (lactose-free diet). The diets were administered to the patients through a nasogastric tube (a tube inserted into the nose that goes to the stomach). During the first two days of treatment, mild diarrhea occurred in 37 percent of the patients treated with acidified milk, in 54 percent of those on the lactose-free diet, and in 63 percent of those on the whole milk diet. Another 22 percent of the patients receiving the whole milk diet had to discontinue the diet because of severe diarrhea, while no patients on the lactose-free diet developed severe diarrhea. It is concluded that whole milk is not well tolerated in malnourished African patients with hypolactasia; acidified milk may be useful for these patients, however. (Consumer Summary produced by Reliance Medical Information, Inc.)

Food and nutrition, Africa, Africans, Lactose intolerance

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Insulin and the efficacy of total parenteral nutrition

Article Abstract:

Total parenteral nutrition (TPN) is a method of feeding that supplies all necessary nutrients intravenously; it is used with patients who cannot eat or tolerate a feeding tube. In many cases patients are given TPN because they have become malnourished from the long-term effects of disease. A study was performed to determine whether the addition of insulin to the TPN solution would help malnourished patients gain weight faster and more efficiently. Insulin has an important role in the synthesis of tissues, such as muscle. Sixty patients received TPN with insulin and 75 received TPN without insulin; no subject was diabetic or had glucose intolerance. Body composition was analyzed after two weeks to measure increases in body cell mass (BCM). BCM is the proportion of body tissues made up of functioning, work-performing cells; it is the component that is rapidly depleted during starvation. Both groups, with and without insulin, showed a significant gain in BCM after two weeks of TPN. BCM improvement was greater with higher blood insulin levels, higher caloric intake, and with most severe cases of malnutrition. Older patients showed a slower gain in BCM than younger patients. In conclusion, the addition of insulin to TPN supported a more rapid resolution of malnutrition when compared with standard TPN solutions without insulin. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Physiological aspects, Insulin, Parenteral therapy

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Comparison of substrate utilization by indirect calorimetry during cyclic and continuous total parenteral nutrition

Article Abstract:

Total parenteral nutrition (TPN) is the provision of all calories and nutrients in an intravenous solution; TPN is used for persons who cannot eat or tolerate feeding by a tube into the digestive tract. While many hospital patients receive TPN temporarily during recovery from illness or surgery, some persons must continue on TPN at home for an indefinite period. Home TPN can be infused continuously around the clock or on a cyclic basis, only during the night. Few studies have compared the risks and benefits of cyclic versus continuous TPN. Five adult men receiving home TPN were studied while on cyclic and continuous schedules; their total daily calorie intake was constant on both regimens. The subjects' metabolisms were evaluated to determine when their bodies were storing and when they were burning or utilizing the three fuel sources, protein, fat and carbohydrate. On cyclic TPN, more fat was burned and less was stored, and less carbohydrate was burned in comparison with continuous TPN. As expected, cyclic TPN was found to mimic the natural pattern of eating meals because the body alternates between storing and burning energy sources. This rotation between nourishing and non-nourishing periods may reduce certain risks of TPN associated with continuous infusion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Artificial feeding, Feeding methods

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