Dextrose in Malnutrition

It has been observed that children with malnutrition and an accompanying diarrhea usually have a markedly impaired ability to digest fats and complex carbohydrates, even though these children may not exhibit all the symptoms characteristic of celiac disease. In view of these findings it seemed possible that the ability to utilize fats and starches might be impaired in malnutrition of less severe degree.

To test this hypothesis, 5 children from 8-13 years old and from 10-20% underweight were used as subjects. These children were underweight presumably because of lack of proper food. Four of the 5 had hypertrophied tonsils; no other abnormality was observed. Three types of diet were used: a normal diet, similar to the customary hospital diet; a fat diet containing increased amounts of butter and cream, and with a F.A:G ratio of 1.5:1, supposedly below the ketogenic level. The third or dextrose diet was the diet used in the treatment of celiac disease in this clinic; rich in protein, minerals and vitamins, very low in fat, and containing the carbohydrate almost wholly in the form of dextrose. The quantities of dextrose ingested daily varied from 220 gm. for the smallest child, to 445 gm. for the largest boy. Each child was given at least 2 diets, one child received each of the 3 in turn. The pertinent data as to gains in weight are shown in Table I.

Consistent and satisfactory gains were rarely observed on any diet if the caloric intake was below 45 calories per pound body weight; regular gains were the rule whenever the daily intake was greater than 50 calories per pound. With any caloric intake, however, the largest and most consistent gains were made when the children were given the dextrose diet. To achieve a similar gain from the fat diet, from 250 to 500 additional calories per day were needed. Undoubtedly, during the first few days of the dextrose diet, a considerable portion of the weight gain could be ascribed to water retention; the gain thus made was not subsequently lost, however, and the very high nitrogen retentions observed indicate that this first water storage was soon replaced by nitrogenous tissue.