FLUID INTAKE AND INDUSTRIAL PROCESSING IN APPLE JUICE INDUCED CHRONICNONSPECIFIC DIARRHEA

Dietary factors have been shown to contribute to the occurrence or per sistence of chronic non-specific diarrhoea (CNSD). Among these are low dietary fat, high fluid consumption, and the consumption of apple jui ce. Prompted by the clinical impression that freshly pressed and unpro cessed ('cloudy') apple juice was less Likely to induce diarrhoea than normal, enzymatically processed ('clear') apple juice, both juices we re compared in terms of carbohydrate malabsorption, gastric emptying, and effects on defecation patterns. Clear and cloudy apple juice diffe r in their fibre and non-absorbable monosaccharide and oligosaccharide contents. Ten healthy children aged 3 . 6 to 5 . 9 years ingested 10 ml/kg of clear and cloudy apple juice; in five of them it was enriched with 40 mg of [1-C-13]-glycine. Clear apple juice resulted in increas ed (greater than or equal to 20 ppm) breath hydrogen excretion in 8/10 , compared with 5/10 after cloudy apple juice; peak breath hydrogen wa s higher in the clear apple juice group (35 (4) and 18 (3) ppm, respec tively). Gastric emptying as determined by means of labelled breath ca rbon dioxide ((CO2)-C-13) excretion was similar with both juices. In a four week crossover clinical trial 12 children, formerly diagnosed as having CNSD, were given extra clear fluids (excluding fruit juices; g reater than or equal to 50% over basal consumption), clear apple juice , or cloudy apple juice, for five day periods. Extra fluids and cloudy apple juice did not influence stool frequency and consistency compare d with the basal period. In contrast, clear apple juice significantly promoted diarrhoea. It is suggested that, in addition to fructose, the increased availability of non-absorbable monosaccharides and oligosac charides as a result of the enzymatic processing of apple pulp is an i mportant aetiological factor in apple juice induced CNSD.