Darling, Jonathan Charles; (1997) Amylase-digested and fermented weaning foods in the dietary management of acute diarrhoea in malnourished Tanzanian children. Doctoral thesis (M.D), UCL (University College London).

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Abstract

Developing countries need better weaning foods in order to combat malnutrition, which is an important underlying factor contributing to mortality and morbidity in children. Such foods are particularly necessary during and after episodes of diarrhoeal disease, an important cause of impaired growth. Amylase from germinating cereal grains in the form of an amylase-rich flour (ARF) enables preparation of porridges with a higher energy density than conventional weaning foods. This can be combined with lactic fermentation, which inhibits pathogen growth. These food technologies are inexpensive, can be implemented at the household level, and are therefore particularly appropriate for use in developing countries. There have been no previous randomised controlled trials comparing ARF-processed or lactic-fermented foods to conventional weaning foods in the dietary management of acute diarrhoea. In a controlled clinical trial, 75 children age 6-25 months admitted to hospital with acute diarrhoea were rehydrated and then randomly allocated to 3 maize porridge dietary groups: conventional, amylase-digested (AMD), and fermented and amylase-digested (FAD). The study diets were given ad libitum five times daily and all intakes except breast milk were weighed. Comparison of admission characteristics and acute phase proteins between groups demonstrated that randomisation had been effective. Mean daily energy intakes over 4 days in the conventional, AMD and FAD groups respectively, were 32.4 (95% Cl 28.7-36.6), 46.0 (39.6-53.4) and 37.3 (31.8-43.9) kcal/kg/day. The energy intake in the AMD group was 42% higher than the conventional group (p = 0.003). There were no significant differences between the groups for duration of diarrhoea, frequency of stooling or vomiting. The overall mortality during admission was 6%, with no significant difference between groups. Lactulose:mannitol (L/M) permeability tests were performed on admission, at 3 days, and at follow up 2 and 4 weeks after discharge. The L/M ratios were compared between dietary treatment groups and to a group of age matched, healthy controls. Results show that children with diarrhoea had raised L/M ratios (geometric mean 0.85, 95% Cl 0.68-1.05) compared to controls (0.14, 0.12-0.17) on admission. There was a significant difference in the change in L/M ratios between admission and 3 days between dietary treatment groups in favour of the FAD group (p < 0.05). Urinary lactose concentrations in spot urine samples taken prior to the permeability test were also measured. There was a significant correlation with the L/M ratio (correlation coefficient = 0.62, p < 0.001). The mean feed osmolalities measured in two samples for each study food were: conventional 22.5; AMD 62.0; and FAD 334.5 mmol/kg. Cyanide is present in unprocessed white sorghum, which was used to manufacture ARF, but is removed by normal processing. Urinary thiocyanate levels were measured in 27 consecutive study patients who had consumed at least 12 consecutive study meals. Geometric means were: conventional 14.7 (95% Cl 9.1-23.8); AMD 16.7 (7.0-40.0); FAD 17.4 (9.1-33.4) ?mol/l (normal range < 90 ?mol/l) indicating that there had been no significant exposure to cyanide. The foods were received favourably by mothers. Starch digestion using amylase from germination is a safe and effective way of improving energy intake in children with acute diarrhoea, while lactic fermentation improves intestinal permeability. Both technologies have a useful role in the dietary management of acute diarrhoea.

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