INTESTINAL PERMEABILITY IN KWASHIORKOR

Intestinal permeability can be assessed non-invasively using the lactu lose-rhamnose (L-R) test, which is a reliable measure of small intesti nal integrity. Aims-To determine risk factors for abnormal intestinal permeability in kwashiorkor, and to measure changes in L-R ratios with inpatient rehabilitation. Design-A case-control study of 149 kwashior kor cases and 45 hospital controls. The L-R test was adapted to study kwashiorkor in Malawi, with testing at weekly intervals during nutriti onal rehabilitation. Urine sugars were measured by thin layer chromato graphy in London. Results-The initial geometric mean L-R ratios (x100) (with 95% confidence interval) in kwashiorkor were 17.3 (15.0 to 19.8 ) compared with 7.0 (5.6 to 8.7) for controls. Normal ratios are <5, s o the high ratios in controls indicate tropical enteropathy syndrome. Abnormal permeability in kwashiorkor was associated with death, oligur ia, sepsis, diarrhoea, wasting and young age. Diarrhoea and death were associated with both decreased L-rhamnose absorption (diminished abso rptive surface area) and increased lactulose permeation (impaired barr ier function) whereas nutritional wasting affected only L-rhamnose abs orption. Despite clinical recovery, mean L-R ratios improved little on treatment, with mean weekly ratios of 16.3 (14.0 to 19.0), 13.3 (11.1 to 15.9) and 14.4 (11.0 to 18.8). Conclusion-Abnormal intestinal perm eability in kwashiorkor correlates with disease severity, and improves only slowly with nutritional rehabilitation.