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

Abstract

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.

Sponsorship: This study was supported by a university fund from the Faculty of Medicine, Ain Shams University, Cairo, Egypt.

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References

  • Achour L, Meance S & Briend A (2001): Comparison of gastric emptying of a solid and a liquid nutritional rehabilitation food. Eur. J. Clin. Nutr. 55, 769–772.

    Article  CAS  Google Scholar 

  • Adesola AO (1968): The influence of severe protein deficiency (Kwashiorkor) on gastric acid secretion in Nigerian children. Br. J. Surg. 55, 866.

    CAS  PubMed  Google Scholar 

  • Berthelemy P, Bouisson M, Vellas B, Moreau J, Vaysse N, Albarede JL & Ribet A (1992): Post prandial cholecystokinin secretion in elderly with protein-energy under nutrition. J. Am. Geriatr. Soc. 40, 365–369.

    Article  CAS  Google Scholar 

  • Bilir S (1972): Acquired disaccharide intolerance in children with malnutrition. Am. J. Clin. Nutr. 25, 664–671.

    Article  CAS  Google Scholar 

  • Bolondi L, Bortolotti M, Santi V, Calletti T, Gaiani S & Labo G (1985): Measurement of gastric emptying time by real-time ultrasonography. Gasteroenterology 89, 752–759.

    Article  CAS  Google Scholar 

  • Camilleri M, Zinsmeister AR, Greydanus MP, Brown ML & Proano M (1991): Towards a less costly but accurate test of gastric empting and small bowel transient. Dig. Dis. Sci. 36(5), 609–615.

    Article  CAS  Google Scholar 

  • Case KO, Cuddy PG & Dooling McGurk EP (2000): Nutrition support in the critically ill patient. Crit. Care Nurs. 22, 75–89.

    Article  CAS  Google Scholar 

  • Clarke RJ & Alexander-Williams J (1973): The effect of preserving antral innervation and of a pyloroplasty on gastric emptying after vagotomy in man. Gut 14, 300–307.

    Article  CAS  Google Scholar 

  • Dahlqvist A & Lindquist B (1971): Lactose intolerance and protein malnutrition. Acta Pediatr Scand 60, 488–494.

    Article  CAS  Google Scholar 

  • Darwiche G, Bjorgell O, Thorsson O & Almer LO (2003): Correlation between simultaneous scintigraphic and ultrasonographic measurement of gastric emptying in patients with type I diabetes mellitus. J. Ultrasound Med. 22, 459–466.

    Article  Google Scholar 

  • De Onis M, Monterio C, Akré J & Clugston G (1993): The worldwide magnitude of protein-energy malnutrition: an overview from the WHO Global Database on child growth. Bull. World Health Organ. 71, 703–712.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Elias E, Gibson GJ, Greenwood LP, Hunt JN & Tripp JH (1968): The slowing of gastric emptying by monosaccharides and disaccharides in test meals. J. Physiol. 194, 317–326.

    Article  CAS  Google Scholar 

  • Franco VHM, Collares EF & Troncon LE (1985): Gastric emptying in childrens. III Study on marasmic protein-caloric malnutrition. Arq. Gasteroenterol. S. Paulo 22, 88–92.

    CAS  Google Scholar 

  • Franco VHM, Collares EF & Troncon LE (1986): Gastric emptying in children. IV Studies on kwashiorkor and on marasmic kwashiorkor. Arq. Gastroenterol. S. Paulo 23, 42–46.

    CAS  Google Scholar 

  • Gracey M, Cullity GJ & Suharjono Sunoto (1977): The stomach in malnutrition. Arch. Dis. Child. 52, 325–327.

    Article  CAS  Google Scholar 

  • Gryboski JD, Burger J, McCallum R & Lange R (1992): Gastric emptying in childhood inflammatory bowel disease: nutritional and pathological correlates. Am. J. Gastroentrol. 87, 1148–1153.

    CAS  Google Scholar 

  • Guyton AC (1996): Secretory functions of the alimentary tract, In Textbook of Medical Physiology, 9th Edition, eds AC Guyton & JE Hall, pp 821–824. Philadelphia/London/Toronto: WB Saunders.

    Google Scholar 

  • Heird WC (2004): Food insecurity, hunger and undernutrition, In Nelson, Textbook of Pediatrics, eds RE Behrman, RM Kliegman & HB Jenson, Chapter 42, pp 167–173. WB Saunders Company.

    Google Scholar 

  • Irvine E.J, Tougas G, Lappalainen R & Bathurst NC (1993): Reliability and interobserver variability of ultrasonographic measurement of gastric emptying rate. Dig. Dis. Sci. 38, 803–810.

    Article  CAS  Google Scholar 

  • Lieverse RJ, Jansen JB & Masclee AM. Lamers CB (1994): Satiety effects of cholecystokinin in humans. Gastroentrology 106, 1451–1454.

    Article  CAS  Google Scholar 

  • Marzio L, Giacobbe A, Conoscitore P, Facciorusso D, Frusciante V & Modoni S (1989): Evaluation of the use of ultrasonography in the study of liquid gastric emptying. Am. J. Gastroenterol. 84, 496–500.

    CAS  PubMed  Google Scholar 

  • Minami H & McCallum RW (1984): The physiology and pathophysiology of gastric emptying in humans. Gastroenterology 86, 1592–1610.

    CAS  PubMed  Google Scholar 

  • Nicholson JF & Pesce MA (2004): Reference ranges for laboratory tests and procedures, In Nelson, Textbook of pediatrics, 17 Edition, eds RE Behrman, RM Kliegman & HB Jenson, Chapter 710, pp 2396–2427. Philadelphia, PA: W.B. Saunders Company.

    Google Scholar 

  • Osman GA, EL-Khayat HA, El-Sayed HL, El-Hodhod MA & El-Garf WT (1999): Gastrin in protein energy malnutrition. Sci. Med. J. (ESCME). 11, 1–9.

    CAS  Google Scholar 

  • Park JE & Park K (1979): Textbook of Preventive Social Medicine, 7th Edition, p 81 Napier: Hesers Banner Sides, Phnat.

  • Prove J & Ehrlein HJ (1983): Effect of 5-hydroxytryptophan and insulin on gastric motility and emptying in dogs. Q.J. Exp. Physiol. 68, 209–219.

    Article  CAS  Google Scholar 

  • Silang R, Regalado M, Cheng TH & Wesson DE (2001): Prokinetic agents increase plasma albumin in hypoalbuminimic chronic dialysis patients with delayed gastric emptying. Am. J. Kidney Dis. 37, 287–293.

    Article  CAS  Google Scholar 

  • Stanfield JP, Hutt MS & Tunnicliffe R (1965): Intestinal biopsy in kwashiorkor. Lancet ii, 519–523.

    Article  Google Scholar 

  • Viteri FE & Schneider RE (1974): Gastrointestional alterations in protein calorie malnutrition. Med. Clin. North Am. 58, 1487.

    Article  CAS  Google Scholar 

  • Waterlow JC & Alleyne GAO (1971): PEM in children: Advances in knowledge in the last 10 years. Adv. Protein Chem. 25, 117–335.

    Article  CAS  Google Scholar 

  • Weaver LT, Rosenthal SR, Gladstone W & Winter HS (1992): Carnitine deficiency: a possible cause of gastrointestinal dysmotility. Acta Paediatr. 81, 79–81.

    Article  CAS  Google Scholar 

  • Wellcome T (1970): Wellcome trust working study: Committee on nutrition. Lancet 2, 302.

    Google Scholar 

  • WHO. (1999): Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers. World health organization, Geneva.

  • Yagci M, Yamac K, Acar K, Cingi E, Kitapci M & Haznedar R (2002): Gastric emptying in patients with vitamin B12 deficiency. Eur. J. Nucl. Med. Mol. Imaging 29, 1125–1127.

    Article  CAS  Google Scholar 

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Correspondence to M F Nassar.

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Shaaban, S., Nassar, M., Sawaby, A. et al. Ultrasonographic gastric emptying in protein energy malnutrition: effect of type of meal and nutritional recovery. Eur J Clin Nutr 58, 972–978 (2004). https://doi.org/10.1038/sj.ejcn.1601931

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