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Blood Xylose Concentrations in Protein Energy Malnutrition
Abstract
One-hour blood xylose concentrations have been advocated as screening tests for coeliac disease in childhood. It was therefore postulated that this test might be useful as a diagnostic index of the degree of malabsorption associated with protein energy malnutrition (PEM) and that it might indicate the type and severity of the nutritional abnormality. In addition, it was hypothesised that this test might be useful to document response to therapy. Seventy-six children with PEM were divided into 3 groups (marasmic (M), marasmic kwashiorkor (MK) and kwashiorkor (K» and I-hour blood xylose concentrations and serum albumin levels were estimated on admission, and in 45 and 43 patients respectively, on day 7 and on clinical recovery. Blood xylose levels were correlated with type of PEM, severity of oedema, serum albumin levels and response to treatment. An assessment was also made to elucidate whether gastro-intestinal infection influenced blood xylose concentrations. In addition, 22 patients (3 M, 9 MK and 10 K) had jejunal biopsies within 3 days of admission, with repeat biopsies in 13 (2 M, 5 MK and 6 K) before discharge from hospital. Results show, on admission, a significant difference in blood xylose and albumin levels between the marasmic and the two oedematous groups (MK and K), no significant difference existing between blood xylose levels in the 3 study groups by day 7, or on recovery. Gastro-intestinal infection did not alter this. Serum albumin levels were highest in the M group, on admission and throughout the study. Decreased xylose and albumin concentrations were associated with gross oedema. Further, no correlation was found between blood xylose and serum albumin levels in any group, nor between blood xylose concentrations and jejunal histology grade. It is suggested that low blood xylose concentrations in PEM are the result of dilution rather than malabsorption. The test does not indicate the degree of small-bowel atrophy, nor does it provide significant additional information to the clinical appraisal.
