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Comparison of milk and maize based diets in kwashiorkor


The dual sugar test of intestinal permeability is a reliable non-invasive way of assessing the response of the small intestinal mucosa to nutritional rehabilitation.

AIM To compare a local mix of maize-soya-egg to the standard milk diet in the treatment of kwashiorkor.

DESIGN The diets were alternated three monthly in the sequence milk-maize-milk. There were a total of 533 kwashiorkor admissions of at least five days during the study who received either milk or maize. Intestinal permeability was assessed at weekly intervals by the lactulose-rhamnose test in 100 kwashiorkor cases, including 55 on milk and 45 on the maize diet.

RESULTS Permeability ratios (95% confidence interval) on the milk diet improved by a mean of 6.4 (1.7 to 11.1) compared with −6.8 (−16.8 to 5.0) in the maize group. The improved permeability on milk occurred despite more diarrhoea, which constituted 34.8% of hospital days (29.8 to 39.8) compared with 24.3% (17.8 to 30.8) in the maize group. Case fatality rates for all 533 kwashiorkor admissions were 13.6% v 20.9%, respectively, giving a relative risk of death in the maize group of 1.54 (1.04 to 2.28). The maize group also had more clinical sepsis (60% v 31%) and less weight gain (2.9 v 4.4 g/kg/day) than the milk group.

IMPLICATIONS Milk is superior to a local maize based diet in the treatment of kwashiorkor in terms of mortality, weight gain, clinical sepsis, and improvement in intestinal permeability.

  • Children with kwashiorkor had a lower mortality and better weight gain on the standard milk diet compared with a maize-soya-egg diet

  • Diets were similar in protein and energy densities, were supplemented with zinc, and the maize was germinated to increase palatability

  • Intestinal permeability improved with nutritional rehabilitation on the milk diet but worsened on the maize diet

  • The milk group experienced more initial diarrhoea in hospital, which was due to lactose intolerance rather than cows’ milk allergy

  • We recommend a low lactose milk based diet in the treatment of kwashiorkor, rather than a local staple diet

  • kwashiorkor
  • intestinal permeability
  • Africa.

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