Nutritional rehabilitation of malnourished children detected by Screening Tool for Assessment of Malnutrition in Pediatric: Urban versus rural settings.

BACKGROUND: Malnutrition presents a major global health burden. In Egypt, it remains an important issue in children under 5 years especially in rural communities. AIM OF THE STUDY: The aim of the study was to screen 2-5 years old children enrolled from Egyptian hospitals in rural and urban areas for the risk of malnutrition using Screening Tool for Assessment of Malnutrition in Pediatric (STAMP) and to evaluate the effectiveness of nutritional intervention programs. SUBJECTS AND METHODS: This cross-sectional study was conducted on 90 patients recruited from two hospitals in urban and rural Cairo, Dietary history and anthropometric measurements were assessed. Patients at intermediate and severe risk of malnutrition according to STAMP were given tailored nutritional programs. RESULTS: In the rural hospital, 4.4% of the screened children were underweight, 22.2% were marginally underweight, and 73.3% had normal weight. Regarding the urban hospital, 15.6% were marginally underweight, 84.4% had normal weight and no underweight patients. Among the rural group 35.6% were at high risk according to STAMP score results compared to 20% in the urban group. Nevertheless, the only significant differences were the more stunting and higher BMI in rural hospital patients. After nutritional intervention, high-risk category patients decreased in both groups coupled by significant improvement in the anthropometric parameters and nutrition data with no significant differences between them. CONCLUSION: Nutritional education and prompt implementation of nutritional rehabilitation program for malnourished children detected by screening tools result in improvement in their nutritional status disregards their location whether urban or rural.

Modified Atkins diet for drug-resistant epilepsy and the risk of urolithiasis.

BACKGROUND: Ketogenic diet (KD) is widely used for drug-resistant epilepsy (DRE). The study was designed to evaluate one of the risk factors for development of renal calculi with KD. METHODS: Twenty patients with DRE on Modified Atkins diet (MAD) were subjected to full history and laboratory investigations, including microscopic urine analysis, urinary calcium after overnight fasting, and calcium/creatinine ratio, as well as pelviabdominal ultrasound. Frequency and severity of seizures assessed by Chalfont severity score were recorded. All assessment measures were repeated after 3 and 6 months of KD therapy. RESULTS: There were significant reductions in both frequency and severity of seizures, yet 2 patients (10%) developed renal stones after 6 months on KD. Gross hematuria was reported in 1 of those 2 patients (50%), but microscopic hematuria was detected in both patients. The urine calcium and the urine calcium/creatinine ratio were elevated in both patients having renal calculi after 6 months. CONCLUSIONS: KD increases the risk of renal stones with hypercalciuria among the causes. We recommend initiation of prophylactic measures once KD is commenced by maximizing fluid intake and urine alkalinization with regular urinary studies including calcium/creatinine ratio and renal ultrasound for patients with symptoms. IMPACT: KD has been increasingly used in epilepsy management and beyond. The potential side effects of such diet should be highlighted while valuing the merits. KD increases the risk of renal stones because of hypercalciuria among other causes. We recommend initiation of prophylactic measures once KD is commenced by maximizing fluid intake and urine alkalinization with estimation of urinary calcium/creatinine ratio and renal ultrasound in patients with relevant symptoms.

Experience with MAD on children with epilepsy in Egypt after classic KD failure.

BACKGROUND AND AIM: Modified Atkins diet (MAD) is a less restrictive type of ketogenic diet (KD) as compared to the classic one. The aim of this study was to evaluate the impact of 9 months MAD treatment on the growth and seizure control in patients with intractable epilepsy as well as the quality of life (QoL) of their mothers. SUBJECTS AND METHODS: The study included 15 patients with intractable epilepsy who could not tolerate their classic KD management plan. From the 15 recruited cases, only seven patients completed this nine months prospective study. After neurological reassessment, the patients were prescribed MAD tailored from the local Egyptian ingredients. Arabic translation of the WHO Quality of life Instruments (WHOQOL-BREF) scale was calculated for the mothers initially and 9 months later. Daily seizure frequency with severity assessment by Chalfont scale was recorded as well as monthly weight and length throughout the study period. RESULTS: Mothers 'QoL in all WHOQOL-BREF domains significantly improved (P < .001) after nine months follow-up coupled by significant decrease in Chalfont scores from 51.00 ± 15.45 to 20.57 ± 21.45 and daily seizure frequency from 13.29 ± 6.99 to 2.71 ± 3.68. Regarding anthropometric data, there was significant increase in patients' weight and length as well as in the z-score for weight and length. CONCLUSION: After nine months of MAD, growth and seizure parameters significantly improved in the intractable epilepsy patients as well as their mothers& QoL. We thus recommend MAD as a more flexible alternative in intractable epilepsy patients who can not tolerate classic KD.

Breastfeeding practice in Kuwait: determinants of success and reasons for failure.

To explore the possible determinants of duration of breastfeeding in Kuwait, 234 mothers completed a questionnaire concerning the feeding of their youngest infant. The questionnaire addressed the factors that contributed to their willingness to continue breastfeeding and enquired about the factors leading to their decision to end it. Only 26.5% of the mothers had continued breastfeeding for 6 months or more. Separate family housing, higher maternal age, late initiation of breastfeeding, being employed without the feasibility to breastfeed at work, breastfeeding information given after rather than before birth, and maternal and infant sickness were all significant contributors influencing early cessation. Father's support was a significant factor that encouraged the practice. In conclusion, preventive strategies are recommended for boosting breastfeeding, with special emphasis on the factors linked to early cessation, aiming at full implementation of the WHO global public health recommendations for successful breastfeeding in Kuwait.

Pattern of beverage intake and milk and dairy products sufficiency among high-school students in Kuwait.

High consumption of soft drinks has been associated with lower intakes of milk and calcium-rich foods and higher body mass index (BMI). This study aimed to explore the pattern of beverage intake among Kuwaiti high-school students. A questionnaire on knowledge, attitudes and practices concerning beverages and milk and dairy products intake was completed by 190 Kuwaiti students aged 16-18 years and BMI was calculated for 181 of them. Intake of sweetened carbonated beverages and to a lesser extent packaged fruit juices affected the sufficiency of milk and dairy products intake among the sample of high-school students in Kuwait. Although BMI was not related to milk and dairy insufficiency, more of the overweight and obese students displayed incorrect practices. Nutritional education of high-school students on the importance of milk and dairy products as well as the hazards of excess sweetened carbonated beverages and packaged juice is recommended to prevent the obesity epidemic prevailing in Kuwait.

Breastfeeding practice in Kuwait: determinants of success and reasons for failure

هدفت هذه الدراسة إلى التعرف على المحددات المحتملة لمدة الإرضاع الطبيعي من الثدي في الكويت لدى 234 من الأمهات اللاتي استكملن استبيانات حول إطعام أصغر أطفالهن سنا. وقد تناولت الاستبيانات العوامل التي تسهم في الترحيب باستمرار الرضاعة الطبيعية من الثدي، كما تضمنت تساؤلات حول العوامل التي أدت لاتخاذهن قرارا بإنهائها. واتضح للباحثين أن 26.5 % فقط من الأمهات قد واصلن الرضاعة الطبيعية من الثدي لمدة وصلت أو تجاوزت ستة أشهر، وأن العوامل التي يعتد بها إحصائيا من حيث المساهمة في التأثر على الإيقاف الباكر للرضاعة هي:السكن في مسكن منفصل عن بقية الأسرة، وارتفاع سن الأم، والبدء المتأخر بالرضاع من الثدي، وكون الأم موظفة مع عدم وجود تسهيلات للرضاعة الطبيعية من الثدي أثناء العمل، وتلقي معلومات حول الإرضاع الطبيعي من الثدي بعد الولادة وليس قبلها، ومرض الأم أو الرضيع. كما أن دعم الآباء كان عاما يعتد به في تشجيع ممارسة الرضاعة الطبيعية من الثدي. واستنتج الباحثون ضرورة التوصية باسراتيجيات وقائية لتعزيز الرضاعة الطبيعية من الثدي، مع تأكيد خاص على العوامل التي ترتبط بالإيقاف المبكر للرضاعة، تنفيذا للتوصيات التي أصدرتها منظمة الصحة العالمية في سياق الصحة العامة العالمية لإنجاح الإرضاع الطبيعي من الثدي في الكويت

ABSTRACT To explore the possible determinants of duration of breastfeeding in Kuwait, 234 mothers completeda questionnaire concerning the feeding of their youngest infant. The questionnaire addressed the factors thatcontributed to their willingness to continue breastfeeding and enquired about the factors leading to theirdecision to end it. Only 26.5% of the mothers had continued breastfeeding for 6 months or more. Separatefamily housing, higher maternal age, late initiation of breastfeeding, being employed without the feasibilityto breastfeed at work, breastfeeding information given after rather than before birth, and maternal and infantsickness were all significant contributors influencing early cessation. Father’s support was a significant factor thatencouraged the practice. In conclusion, preventive strategies are recommended for boosting breastfeeding, withspecial emphasis on the factors linked to early cessation, aiming at full implementation of the WHO global publichealth recommendations for successful breastfeeding in Kuwait.

RÉSUMÉ Afin d'étudier les déterminants possibles de la durée de l'allaitement maternel au Koweït, 234 mèresont rempli un questionnaire sur l'alimentation de leur plus jeune enfant. Le questionnaire portait sur les facteurscontribuant à leur volonté de poursuivre l'allaitement et sur les facteurs qui les ont conduit à leur décisiond'y mettre fin. Seules 26,5 % des mères ont allaité au sein pendant au moins 6 mois. Les facteurs contribuantsignificativement à un arrêt précoce de l'allaitement au sein étaient les suivants : une résidence familiale séparée,un âge maternel élevé, une initiative tardive de l'allaitement, un emploi sans possibilité d'allaiter sur le lieu detravail, une communication sur l'allaitement faite après la naissance plutôt qu'avant, et une affection chez lamère et/ou chez l'enfant. Le soutien du père était un facteur important qui favorisait la pratique de l'allaitement.En conclusion, des stratégies préventives sont recommandées afin de promouvoir l'allaitement au sein tout enprenant particulièrement en compte les facteurs liés à un arrêt précoce de l'allaitement, et de viser une mise enoeuvre intégrale des recommandations mondiales de l'OMS en santé publique pour la réussite de l'allaitementmaternel au Koweït.

Pattern of beverage intake and milk and dairy products sufficiency among high-school students in Kuwait

High consumption of soft drinks has been associated with lower intakes of milk and calcium-rich foods and higher body mass index [BMI]. This study aimed to explore the pattern of beverage intake among Kuwaiti high-school students. A questionnaire on knowledge, attitudes and practices concerning beverages and milk and dairy products intake was completed by 190 Kuwaiti students aged 16-18 years and BMI was calculated for 181 of them. Intake of sweetened carbonated beverages and to a lesser extent packaged fruit juices affected the sufficiency of milk and dairy products intake among the sample of high-school students in Kuwait. Although BMI was not related to milk and dairy insufficiency, more of the overweight and obese students displayed incorrect practices. Nutritional education of high-school students on the importance of milk and dairy products as well as the hazards of excess sweetened carbonated beverages and packaged juice is recommended to prevent the obesity epidemic prevaiting in Kuwait

Une consommation élevée de boissons sucrées a été associée à une réduction des apports en lait et aliments riches en calcium ainsi qu’à une élévation de l'indice de masse corporelle. L'étude visait à explorer les caractéristiques de la prise de boissons sucrées chez des élèves du secondaire au Koweït. Un questionnaire sur les connaissances, les attitudes et les pratiques concernant la prise de boissons sucrées, de lait et de produits laitiers a été rempli par 190 élèves du Koweït âgés de 16 à 18 ans, et l'indice de masse corporelle a été calculé pour 181 d'entre eux. La prise de boissons gazeuses sucrées et dans une moindre mesure de jus de fruit préemballés affectait la suffisance des apports en lait et en produits laitiers au sein de l'échantillon d'élèves du secondaire au Koweït.Si l'indice de masse corporelle n'était pas lié à des apports en lait et produits laitiers insuffisants, les élèves en surpoids et obèses étaient plus nombreux à avoir de mauvaises pratiques. Une éducation nutritionnelle des élèves du secondaire sur l'importance du lait et des produits laitiers ainsi que sur les dangers de l'abus de boissons gazeuses sucrées et de jus de fruit préemballés est recommandée afin de prévenir l'épidémie d'obésité prévalente au Koweït

Modified Atkins diet vs classic ketogenic formula in intractable epilepsy.

OBJECTIVES: The study was designed to evaluate the efficacy, safety, and tolerability of the ketogenic diet (KD) whether classic 4:1 formula or the modified Atkins diet (MAD) in intractable childhood epilepsy. PATIENTS AND METHODS: Anthropometric measurements and serum lipid profile were measured upon enrollment and after 3 and 6 months in 40 patients with symptomatic intractable epilepsy. Fifteen were given MAD diet, ten were kept on classic 4:1 ketogenic liquid formula, and the rest were allowed to eat as desired. RESULTS: The liquid ketogenic formula group showed significantly higher body mass index compared with those who did not receive KD after 6 months. The lipid profile of KD patients was within normal limits for age and sex during the study period. The rate of change of frequency and severity of seizures showed best improvement in ketogenic liquid formula patients followed by the MAD group than the patients on anti-epileptic medications alone. CONCLUSION: The KD whether classic 4:1 or MAD is a tolerable, safe, and effective adjuvant therapy for intractable symptomatic childhood epilepsy with limited adverse effects on the growth parameters and accepted changes in the lipid profile. The liquid ketogenic formula patients showed better growth pattern and significantly more seizure control.

CD95 expression in white blood cells of malnourished infants during hospitalization and catch-up growth.

Malnutrition continues to be a major health burden in developing countries. Flow cytometric estimation of the apoptotic marker CD95 in peripheral neutrophils, lymphocytes and monocytes was done for 18 infants with non-oedematous protein energy malnutrition (PEM) and 12 oedematous ones, on hospital admission and after supervised nutritional rehabilitation, and compared with 12 matched controls. CD95 counts in the 3 types of white blood cells were significantly higher in PEM infants and showed improvement after nutritional rehabilitation yet not reaching the control values. Enhanced apoptosis in the leukocytes of peripheral blood of PEM patients may be a marker of increased infection and immune disturbances. This derangement reverses upon proper nutritional rehabilitation.

CD95 expression in white blood cells of malnourished infants during hospitalization and catch-up growth

Malnutrition continues to be a major health burden in developing countries. Flow cytometric estimation of the apoptotic marker CD95 in peripheral neutrophils, lymphocytes and monocytes was done for 18 infants with non-oedematous protein energy malnutrition [PEM] and 12 oedematous ones, on hospital admission and after supervised nutritional rehabilitation, and compared with 12 matched controls. CD95 counts in the 3 types of white blood cells were significantly higher in PEM infants and showed improvement after nutritional rehabilitation yet not reaching the control values. Enhanced apoptosis in the leukocytes of peripheral blood of PEM patients may be a marker of increased infection and immune disturbances. This derangement reverses upon proper nutritional rehabilitation

Rotavirus fecal antigen retrieval in infantile intussusception.

This study was designed to assess the plausibility of an association between natural rotavirus infection and intussusception. It was conducted on 21 infants suffering from acute gastroenteritis (GE) complicated by intussusception who were compared to another 40 age- and sex-matched infants suffering from acute GE characterized by watery nonmucoid diarrhea without surgical complications. All enrolled patients were subjected to detailed history documentation, thorough clinical examination and laboratory investigations, complete stool analysis, and detection of rotavirus antigen in stools using the ELISA technique. Plain abdominal X-ray and ultrasound were also performed. The results of this study revealed 24 positive cases for rotavirus antigen in the stools of the acute uncomplicated GE patients (60.0%), while there were only ten positive cases in the intussusception group (47.6%). No significant difference in severity was detected between the two groups studied, especially in terms of signs of dehydration and need for IV fluids (p > 0.05). Most of the rotavirus positive cases among the intussusception group presented either in February or December (p < 0.05) with no significant seasonal pattern among the acute GE group (p > 0.05). In conclusion, rotavirus antigen retrieval from stools of GE patients complicated with intussusception was not statistically different from those detected among acute uncomplicated GE. Additionally, there was no association between seasonality or severity of rotavirus positive cases in acute GE patients and those with intussusception. It is thus prudent to say that wild rotavirus infection in GE patients does not carry an extra risk for the occurrence of intussusception.

Sleep-wake cycle disturbances in protein-energy malnutrition: effect of nutritional rehabilitation.

A standard sleep questionnaire was given to the parents of 26 infants with protein-energy malnutrition who underwent polysomnographic evaluation. These investigations were repeated approximately 2 months after enrolment in a nutritional rehabilitation programme based on World Health Organization guidelines. Anthropometric values and serum serotonin levels were also measured. After nutritional rehabilitation there was a significantly higher percentage of non-rapid eye movement (REM) sleep; 2nd REM time, and latency times for sleep and REM sleep increased. Percentages of REM sleep and serum serotonin levels decreased significantly. Protein-energy malnutrition seems to affect the sleep-wake cycle; disturbed serotonin levels may be among the factors responsible.

T-lymphocyte subsets and thymic size in malnourished infants in Egypt: a hospital-based study.

Thymus size was assessed ultrasonographically and correlated to the percentage of CD4 and CD8 T-lymphocytes in peripheral blood in 32 infants with protein-energy malnutrition (PEM) and compared with 14 healthy control infants. The study revealed thymus atrophy in patients with PEM, especially the oedematous type, accompanied by changes in the peripheral lymphocyte subsets. These changes were reversible after nutritional rehabilitation. However, they may affect the immune status of PEM patients and may require a longer duration of nutrition rehabilitation than required for recovery of anthropometric measures. We recommend proper assessment of the immune functions of PEM patients during nutritional rehabilitation until full recovery.

T-lymphocyte subsets and thymic size in malnourished infants in Egypt: a hospital-based study

Thymus size was assessed ultrasonographically and correlated to the percentage of CD4 and CD8 T-lymphocytes in peripheral blood in 32 infants with protein-energy malnutrition [PEM] and compared with 14 healthy control infants. The study revealed thymus atrophy in patients with PEM, especially the oedematous type, accompanied by changes in the peripheral lymphocyte subsets. These changes were reversible after nutritional rehabilitation. However, they may affect the immune status of PEM patients and may require a longer duration of nutrition rehabilitation than required for recovery of anthropometric measures. We recommend proper assessment of the immune functions of PEM patients during nutritional rehabilitation until full recovery

Sleep-wake cycle disturbances in protein-energy malnutrition: effect of nutritional rehabilitation

A standard sleep questionnaire was given to the parents of 26 infants with protein-energy malnutrition who underwent polysomnographic evaluation. These investigations were repeated approximately 2 months after enrolment in a nutritional rehabilitation programme based on World Health Organization guidelines. Anthropometric values and serum serotonin levels were also measured. After nutritional rehabilitation there was a significantly higher percentage of non-rapid eye movement [REM] sleep; 2nd REM time, and latency times for sleep and REM sleep increased. Percentages of REM sleep and serum serotonin levels decreased significantly. Protein-energy malnutrition seems to affect the sleep-wake cycle; disturbed serotonin levels may be among the factors responsible

Structural and functional affection of the heart in protein energy malnutrition patients on admission and after nutritional recovery.

BACKGROUND AND OBJECTIVES: The pathogenesis of different malnutrition diseases was suggested to affect the heart. This study was designed to detect cardiac affection in protein energy malnutrition (PEM) patients, whether clinically or by electrocardiogram (ECG) and echocardiogram, and to assess the value of the cardiac marker troponin I in patients at risk of myocardial injury with special emphasis on the effect of nutritional rehabilitation. PATIENTS AND METHODS: The present study was carried out on 30 PEM infants (16 nonedematous - 14 edematous) and 10 apparently healthy age and sex-matched infants acting as the control group. All studied infants were subjected to full history taking laying stress on dietetic history, thorough clinical and anthropometric measurements. Echocardiography and ECG were also performed. Laboratory investigations were performed including complete blood count, CRP, total proteins, albumin, liver and kidney functions as well as estimation of troponin-I in blood by immulite. Following initial evaluation, all malnourished infants were subjected to nutritional rehabilitation program for approximately 8 weeks, after which the patients were re-evaluated using the same preinterventional parameters. RESULTS: The results of the present study demonstrated that electrical properties of myocardium assessed by ECG showed significant decrease of R wave and QTc interval in patients compared to controls with significant improvement after nutritional rehabilitation. Echocardigraphic changes showed that cardiac mass index was significantly lower in both groups of malnourished cases compared to the controls with significant increase after nutritional rehabilitation. The study showed that the parameters of left ventricular (LV) systolic function which are the ejection fraction, fractional shortening and velocity of circumferential fiber shortening were not significantly reduced in patients compared to the controls. The diastolic function also showed no significant difference in the E wave/A wave (e/a) ratio between patients and controls. However, the systolic time interval showed significantly higher LV pre-ejection index in patients in comparison to controls. Edematous and nonedematous cases did not show any significant differences in ECG and echocardigraphic data before or after nutritional rehabilitation. The hearts of two severely affected patients uniquely demonstrated marked decrease of LV end diastolic diameter (LEVDd) together with the detection of troponin-I in their sera. CONCLUSION: We can conclude that malnutrition, regardless of its type, has a definite effect on cardiac volume, muscle mass, as well as the electrical properties of the myocardium. The systolic functions of the heart are affected more than the diastolic functions and this affection becomes manifest only in severe cases and may constitute a bad prognostic parameter thus necessitating more intense management and strict follow-up of such cases.

Pancreatic size in protein energy malnutrition: a predictor of nutritional recovery.

BACKGROUND: Pancreatic exocrine dysfunction has been frequently recorded in protein energy malnutrition (PEM) because the pancreas requires optimal nutrition for enzyme synthesis. This pancreatic enzyme insufficiency may play a role in the continuation of PEM. OBJECTIVE: This study was designed to assess the pancreatic head size and exocrine pancreatic functions, namely serum amylase and lipase, in PEM and its subtypes and correlate any defect present with the various clinical and laboratory data of the PEM patients with special emphasis on the effect of nutritional rehabilitation. PATIENTS AND METHODS: A total of 33 cases of PEM; 15 marasmus, 10 kwashiorkor (KWO) and eight marasmic kwashiorkor (MKWO) were recruited from Ain Shams University children's hospital, together with 12 matched controls. The mean age of patients was 11.87 +/- 7.8 months and that of the controls was 14.83 +/- 7.7 months. Detailed history taking and thorough clinical examination with special emphasis on anthropometric measurements were taken for each studied infant as well as laboratory investigations which included; complete blood count, liver and kidney functions and serum amylase and lipase. Ultrasonographic assessment of pancreatic head size was performed for the cases and controls. Nutritional rehabilitation program was carried out for 3-6 months followed by reassessment of the cases. RESULTS: The pancreatic head size values were significantly lower in all subtypes of PEM (1.52 +/- 0.6, 2.73 +/- 0.12 and 3.00 +/- 0.54 cm(3) in the marasmus, KWO and MKWO respectively) compared to the controls (5.13 +/- 2.33 cm(3)). The serum amylase and lipase were also significantly lower in all subgroups of PEM when compared to the controls with significant improvement following nutritional rehabilitation coupled by a significant increase in pancreatic head size too. No significant differences were recorded when we compared the subgroups together except for a significant higher rate of change in serum amylase in edematous patients compared to nonedematous ones. The length of nutritional rehabilitation period, age of the patient, weight and serum albumin were the most determinant factors for pancreatic head size as evident from the multiple regression analysis study. CONCLUSION: The potentially correctable exocrine pancreatic insufficiency in cases of PEM should be carefully thought of when planning the nutritional rehabilitation program for such patients as it could be responsible for the serious continued morbidity issues that they face. We thus recommend that estimation of pancreatic head size and exocrine function should be included in the evaluation of PEM patients and they could also be used as a prognostic parameter. SPONSORSHIP: The patients enrolled were among those admitted and managed freely in the children's Hospital Faculty of Medicine Ain Shams University, including the use of the ultrasound apparatus, while the kits have been purchased by authors who contributed in financing the study.

Ultrasonographic gastric emptying in protein energy malnutrition: effect of type of meal and nutritional recovery.

OBJECTIVE AND DESIGN: The earlier reports of disturbed gastric motility in protein energy malnutrition (PEM) point out to its possible contribution in the difficulties faced during nutritional rehabilitation. This study was thus designed to assess the ultrasonographic gastric emptying time (GET) using 20 ml/kg body weight of both liquid and semisolid meals, in 27 patients suffering from PEM as well as in 15 healthy matching infants to delineate any defect present, its degree in different types of PEM and the effect of nutritional rehabilitation. PATIENTS: The patients were recruited from the in-patient department of Children's Hospital, Ain Shams University, Cairo, Egypt. They were divided into three groups: 10 marasmic infants, 10 marasmic kwashiorkor (marasmic KWO) and seven kwashiorkor (KWO) cases. Ultrasonographic GET assessment was carried out within 72 h of admission and 30+/-7 days after nutritional rehabilitation. RESULTS: The gastric half-emptying time T(1/2) of both liquid and semisolid meals was markedly prolonged in patients with marasmus and marasmic KWO. It was more delayed for the semisolid than the liquid meals. This delay was reversible after nutritional rehabilitation of the patients, indicating that it was secondary to the malnourished status. On the other hand, T(1/2) of both liquid and semisolid meals showed no statistically significant delay in the KWO group and nutritional rehabilitation added no further to the results. CONCLUSION: PEM, especially marasmus and marasmic KWO, causes a delay in GET, which is reversible on nutritional recovery. This must be considered during nutritional rehabilitation of such patients to decrease the duration of their hospitalization and thus decrease the morbidity in PEM.

Nutritional stunting in Egypt: which nutrient is responsible?

We looked at the relationship between linear growth retardation and deficiencies of certain nutrients in Egyptian children. A group of 107 stunted children aged between 10 and 18 years were subjected to history-taking, physical examination and laboratory investigations. Selected cases were referred to radiology for assessment of bone age. Thirty-nine children were enrolled as controls. Serum haemoglobin, alpha-tocopherol, retinol and magnesium levels were significantly decreased in stunted children compared with the controls. Serum zinc levels were also lower in the stunted group but not significantly so. We conclude that several nutrient deficiencies occur simultaneously in stunted children and all of them may be responsible for stunting.