Relationship between nutritional status and histologic findings in small bowel mucosa of children presenting with diarrhoea of more than 14 days' duration

In order to study the eventual effects of malnutrition on small intestinal mucosa, we evaluated 85 children with diarrhoea of more than 14 days' durat ion, aged from 4 to 114 months (median 17 months). A proximal small intesti nal biopsy was obtained and villus height, crypt depth, mucosal thickness, and total mucosal thickness mere measured. Gomez, Waterlow, and Z score cri teria were applied, Statistical analyses were performed with the Spearman c orrelation test and the non-parametrical tests of Wilcoxon, Mann-Whitney, a nd Kruskal-Wallis. A value of p < 0.05 was considered significant. Average villus height was 269.2 mu m (+/-87.5 mu m); crypt depth 113.0 mu m (+/- 33 .8 mu m); mucosal thickness 210.5 mu m (+/- 73.2 mu m); total mucosal thick ness 485.9 mu m (+/- 111.8 mu m); and villus height/crypt depth ratio 2.5:1 (+/- 0.8:1). Five children had kwashiorkor and 13 had marasmus, Villus hei ght for kwashiorkor children ranged from 151 mu m to 353.3 mu m (average 28 6.7 mu m), crypt depth from 90.3 mu m to 154 mu m (average 111.11 mu m). Ac cording to Gomez criteria, as malnutrition increased, mucosal thickness and the villus/crypt ratio decreased, Waterlow criteria had no relation to muc osal sizes, When distributed in sequential decrease according to their nutr itional state, the Z score for weight for age and weight for height indices showed a positive correlation with villus height, total mucosal thickness, and villus/crypt ratio.