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

1. Plasma tyrosine and urinary p-hydroxyphenyl lactic acid (PHPLA) and p-hydroxyphenyl acetic acid (PHPAA) were studied in thirty patients with marasmus and twenty normal controls in the same age group.2. In the control group conventional tyrosyluria was not observed but 30% of the group excreted high levels of PHPAA. In the group with marasmus, plasma tyrosine and urinary PHPLA and PHPAA values were significantly higher than the control values. However only 13.3% of the patients were considered to have conventional tyrosyluria and 52.3% were found to excrete high levels of PHPAA.3. Administration of ascorbic acid resulted in a reduction of PHPLA excretion while it had no effect on PHPAA excretion.4. It was inferred that (a) tyrosyluria in marasmus is due to the reduced activity of the hepatic enzyme 4-hydroxyphenyl pyruvate: oxygen oxidoreductase (hydroxylating, decarboxylating) (PHPPA-oxidase; EC 1. 13. 11. 27) due to the deficiency of ascorbic acid and (b) high excretion of PHPAA is related to age and nutrition of the child and is unaffected by the administration of ascorbic acid.5. It was further inferred that urinary excretion of PHPLA is a reliable index of tyrosyluria.

800 singly born normal newborn infants were studied for their anthropometry. All the physical measurements tended to be lower than those for their Western counterparts. Out of 651 infants born after 37 weeks of gestation, 25.34 per cent weighed 2500 G. or less; 18.12 per cent had a crown heel length less than 47 cm.; 91.24 per cent had a crown rump length less than 32 cm., 14.44 per cent had a head circumference less than 33 cm. and 12.3 per cent had a chest circumference less than 30 cm.

Glucose utilization coefficient was determined in 50 marasmic patients and 25 age matched healthy controls after administering glucose intravenously in three dosage schedules. The coefficient was directly related to the amount of glucose administered and the values were comparable in the marasmic and control subjects in their respectve schedules indicating normal glucose utilization in marasmus. Fasting blood glucose levels were significantly low in the patients compared to the controls. However, in only two patients fasting blood glucose value fell in the hypoglycemic range (less than 50 mg/dl).

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.

A child with bilateral absence of the thumbs, unilateral radial aplasia, bilateral talipes equinovarus, incomplete descent of testes, internal hydrocephalus and ventricular septal defect (ventriculo-radial dysplasia) is reported and a brief resume of the relevant literature on the subject is presented.