| Abstract
| - The dual sugar test of intestinal permeability is a reliable non-invasive way of assessing the response of the small intestinal mucosa to nutritional rehabilitation. AIM. To compare a local mix of maize-soya-egg to the standard milk diet in the treatment of kwashiorkor. DESIGN. The diets were alternated three monthly in the sequence milk-maize-milk. There were a total of 533 kwashiorkor admissions of at least five days during the study who received either milk or maize. Intestinal permeability was assessed at weekly intervals by the lactulose-rhamnose test in 100 kwashiorkor cases, including 55 on milk and 45 on the maize diet. RESULTS. Permeability ratios (95% confidence interval) on the milk diet improved by a mean of 6.4 (1.7 to 11.1) compared with −6.8 (−16.8 to 5.0) in the maize group. The improved permeability on milk occurred despite more diarrhoea, which constituted 34.8% of hospital days (29.8 to 39.8) compared with 24.3% (17.8 to 30.8) in the maize group. Case fatality rates for all 533 kwashiorkor admissions were 13.6% v 20.9%, respectively, giving a relative risk of death in the maize group of 1.54 (1.04 to 2.28). The maize group also had more clinical sepsis (60% v 31%) and less weight gain (2.9 v 4.4 g/kg/day) than the milk group. IMPLICATIONS. Milk is superior to a local maize based diet in the treatment of kwashiorkor in terms of mortality, weight gain, clinical sepsis, and improvement in intestinal permeability. Key messages. Children with kwashiorkor had a lower mortality and better weight gain on the standard milk diet compared with a maize-soya-egg diet Diets were similar in protein and energy densities, were supplemented with zinc, and the maize was germinated to increase palatability Intestinal permeability improved with nutritional rehabilitation on the milk diet but worsened on the maize diet The milk group experienced more initial diarrhoea in hospital, which was due to lactose intolerance rather than cows’ milk allergy We recommend a low lactose milk based diet in the treatment of kwashiorkor, rather than a local staple diet
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