1. Sixty marasmic children and fifteen normal age-matched controls were investigated for the absorption of 2. A significant amount of malabsorption, with respect to both the dietary ingredients, was observed in the 3. The levels of conjugated bile acids in the duodenal juice samples of marasmic children were significantly lower 4. Significant correlations were observed between bile acid levels and fat absorption and also between microflora 5. The pathophysiology of malabsorption in marasmus is discussed in the light of these findings. fats and proteins. Their duodenal juice samples were also analysed for bile salts and microflora. majority of the marasmic children.as compared with those of normal controls, while the reverse was true for free bile acids and bacterial counts. and free bile acids.

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1. Sixty marasmic children were investigated for the absorption of xylose, proteins and fats. Their duodenal juice samples were also analysed for bile salts and microflora.2. The marasmic children were then studied in three groups of twenty by allocating them to three different dietary schedules: a high-protein diet (30% of the total energy from protein), a high-fat diet (40% of the total energy from fat) and a high-carbohydrate diet (70% of the total energy from carbohydrate) for 2 weeks and the previous measurements repeated.3. Whereas the high-fat diet resulted in improved fat absorption, along with an increase in total and conjugated bile acids, and the high-carbohydrate diet led to improved xylose absorption, the diet rich in protein resulted in an improvement in the absorption of all three dietary ingredients. It appears that a high-protein diet improves the overall absorption process by improving the intestinal environment as a whole, while high-carbohydrate and high-fat diets bring about adaptive changes related to the respective absorptive processes.Malabsorption is a welkrecognized phenomenon in protein-energy malnutrition (PEM) (Viteri et al. 1964) and a number of pathophysiological alterations have been described in PEM . It is, however, difficult to say whether these pathophysiological alterations and malabsorption are the cause or the effect of malnutrition.Therapeutic treatment with diets rich in proteins and energy is the most common method of management of PEM. A high-protein diet is known to improve the absorption status (Viteri et al. 1973;Stanfield, 1976) as well as pancreatic functions in PEM. A few reports on the adaptive effect of a high-fat diet on bile acids and fat absorption (Gomez et al. 1954; and of a high-carbohydrate diet on pancreatic amylase (Reboud et al. 1960;Zoppi et al. 1972Zoppi et al. , 1973 are also available. However, a comprehensive study investigating separately the effects of a protein-rich, a fat-rich and a carbohydrate-rich diet on a large number of factors involved in the digestive and absorptive processes has not been undertaken. We have attempted to study this aspect in marasmic children.

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