Malnutrition and malabsorption: studies in the Punjab

Abstract

A dietary deficiency was inadequate to explain the severe folate or iron deficiency frequently found among Punjabi villagers. In 18 such patients 13 had subclinical steatorrhea D-xylose malabsorption and abnormalities of jejunal mucosal biopsies. Nutritional anemia would otehrwise have been the diagnosis. Classical tropical sprue was diagnosed in 27 patients. Subclinical malabsorption was thought to be the cause for the marginal nutritional deficiency and for overt deficiency states in pregnant women and preschool children. Severe folate deficiency was found in 60 of 100 women in the last trimester of pregnancy and in 73% of 140 women within 12 hours of a full-term delivery. In another village among 1173 nonpregnant adults only 4 gave a history of attacks of diarrhea. Of 185 who gave 24-hour stool specimens 67 had steatorrhea excreting an average of 13 gm of fat daily. The incidence of steatorrhea was greater in the upper and middle socioeconomic groups than in the lower class. A very high incidence of steatorrhea and of D-xylose malabsorption was found in 100 women after delivery. Jejunal biopsy done on every 5th subject with steatorrhea and on 5 subjects without steatorrhea showed only minor inflammatory changes. In a current study fat and nitrogen balances are being investigated. A high incidence of steatorrhea has been found in 31 nonpregnant females and 29 males aged 16-65 years. Of these 60 subjects 32 excreted over 6 gm of fat daily. few had any symptoms. In 10 from whom jejunal biopsies were obtained findings were normal. Anemia was uncommon. Only 2 were severely anemic. Both had hookworm infestation. Neither had steatorrhea. Parasitic infestation was found in half of the subjects studied. No relationship was found between the incidence of steatorrhea and fat intake level of hemoglobin folate level or parasitic infestation.(PR FFF: Ludhiana)