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Invasive fungal infections are increasingly common and carry high morbidity and mortality, yet fungal diagnostics lag behind bacterial diagnostics in rapidly identifying the causal pathogen. We previously devised a fluorescent hybridization-based assay to identify bacteria within hours directly from blood culture bottles without subculture, called phylogeny-informed rRNA-based strain identification (Phirst-ID). Here, we adapt this approach to unambiguously identify 11 common pathogenic Candida species, including C. auris, with 100% accuracy from laboratory culture (33 of 33 strains in a reference panel, plus 33 of 33 additional isolates tested in a validation panel). In a pilot study on 62 consecutive positive clinical blood cultures from two hospitals that showed yeast on Gram stain, Candida Phirst-ID matched the clinical laboratory result for 58 of 59 specimens represented in the 11-species reference panel, without misclassifying the 3 off-panel species. It also detected mixed Candida species in 2 of these 62 specimens, including the one discordant classification, that were not identified by standard clinical microbiology workflows; in each case the presence of both species was validated by both clinical and experimental data. Finally, in three specimens that grew both bacteria and yeast, we paired our prior bacterial probeset with this new Candida probeset to detect both pathogen types using Phirst-ID. This simple, robust assay can provide accurate Candida identification within hours directly from blood culture bottles, and the conceptual approach holds promise for pan-microbial identification in a single workflow. Lay Summary Candida bloodstream infections cause considerable morbidity and mortality, yet slow diagnostics delay recognition, worsening patient outcomes. We develop and validate a novel molecular approach to accurately identify Candida species directly from blood culture one day faster than standard workflows.

Objectives. We describe the national dissemination of an evidence-based community cardiovascular disease prevention program for midlife and older women using the RE-AIM (reach effectiveness adoption implementation maintenance) framework and share key lessons learned during translation. Methods. In a 2010 to 2014 collaboration between the StrongWomen program and the National Extension Association of Family and Consumer Sciences, we assessed reach, adoption, implementation, and maintenance using survey methods, and we assessed effectiveness using a pretest–posttest within-participants design, with weight change as the primary outcome. Results. Overall reach into the population was 15 per 10 000. Of 85 trained leaders, 41 (48%) adopted the program. During the 12-week intervention, weight decreased by 0.5 kilograms, fruit and vegetable intake increased by 2.1 servings per day, and physical activity increased by 1238 metabolic equivalent (MET)-minutes per week (all P Conclusions. The StrongWomen–Healthy Hearts program can be implemented with high fidelity in a variety of settings while remaining effective. These data provide direction for program modification to improve impact as dissemination continues.

Background. Strength training (ST) is an important health behavior for aging women; it helps maintain strength and function and reduces risk for chronic diseases. This study assessed change in physical fitness following participation in a ST program implemented and evaluated by community leaders. Method. The StrongWomen Program is a nationally disseminated, research-based, community ST program active in 40 states. The Senior Fitness Test is used to assess upper and lower body strength, upper and lower body flexibility, aerobic fitness, and agility; data are collected prior to and following program participation. Results. For these analyses, five states provided deidentified data for 367 female participants, mean age 63 (±11) years. Attendance in approximately 10 weeks of twice-weekly classes was 69.4%. Paired t tests were used to analyze pre–post change. Significant improvements were observed ( p < .01) in all Senior Fitness Test measures. Data are stratified by age-group and compared with published, age-based norms. Conclusions. This study demonstrates that it is feasible for community leaders to conduct pre–post physical fitness evaluations with participants and that participants experienced improvements across several important domains of physical fitness.

Introduction.The epidemic of obesity is a multifaceted public health issue. Positive policy and environmental changes are needed to support healthier eating and increased physical activity.Methods.StrongWomen Change Clubs (SWCCs) were developed through an academic-community research partnership between researchers at Cornell University and Tufts University and community partners (cooperative extension educators) in rural towns in seven U.S. states. Extension educators served as the local leader and each recruited 10–15 residents to undertake a project to improve some aspect of the nutrition or physical activity environment. Most residents had limited (or no) experience in civic engagement. At 6 and 12 months after implementation, the research team conducted key informant interviews with SWCC leaders to capture their perceptions of program process, benchmark achievement, and self-efficacy.Results.At 12 months, each SWCC had accomplished one benchmark; the majority had completed three or more benchmarks. They described common processes for achieving benchmarks such as building relationships and leveraging stakeholder partnerships. Barriers to benchmark achievement included busy schedules and resistance to and slow pace of change.Conclusion.Findings suggest that community change initiatives that involve stakeholders, build upon existing activities and organizational resources, and establish feasible timelines and goals can successfully catalyze environmental change.

We evaluated cardiac response to weight loss induced by a very-low-energy (VLE) diet similar to commer- cially available protein-sparing diets. Such diets have been im- plicated in sudden death, and whether organ and tissue responses to them are untoward is not known. Rapid weight loss was in- duced in rats with weights ranging from obese to normal, and cardiac mass and myocardial histomorphometry were assessed. Over 3 wk body weight dropped from 544 ± 12 to 417 ± 21 g (P < 0.001). Heart weight was less in the VLE group than in obese controls (1246 ± 115 vs 1625 ± 179 mg, P < 0.001), as were the weights of the left ventricle (805 ± 81 vs 1061 ± 134 mg, P < 0.001) and right ventricle (198 ± 27 vs 265 ± 40 mg, P < 0.002). Reduction in heart weight was commensurate with loss of body weight (r = 0.89). Myocyte cross-sectional area was reduced in the VLE group (452.6 ± 108.6 to 331.8 ± 41.5 j.�m2, P < 0.05), with no structural abnormalities. We conclude that weight loss in the weight range studied is accompanied by pro- portional reduction in cardiac mass and myocyte size. Myocar- dial regression is not accompanied by myocyte dropout or edema, and likely represents a simple adaptation to reduced body size. Am J Clin Nutr 1994;59:566-71.

The intake of a very-low-energy diet (VLED) complete in all essential nutrients decreases liver mass and total liver protein in dietary obese rats. To determine how these findings may affect hepatic drug metabolizing activity, the aminopyrine breath test was performed in nine male dietary obese Sprague-Dawley rats weighing 440-460 g. Animals were maintained on a VLED, and at 0, 14, and 21 d were injected with 9.25 k Bq (0.25 microCi) [dimethylamine-14C]aminopyrine and placed in airtight restraining cages; exhaled 14CO2 was collected for 120 min. VLED animals had an increased half-life of exhaled 14CO2 (P < 0.01) and a decreased rate constant of aminopyrine elimination (P < 0.01) consistent with decreased N-demethylation of aminopyrine. Decreased liver glutathione suggests reduced ability to detoxify drugs through this conjugation pathway. These studies suggest that animals on VLEDs have reduced capacity for demethylation of aminopyrine as measured by oxidative elimination of 14CO2, and may exhibit decreased metabolism of other drugs.

A food frequency survey of 254 low-income, elderly (aged 60 to 96), free-living Mexican Americans and non-Hispanic whites was conducted as part of a larger study of the adjustment and health of older persons residing in a San Antonio barrio. Weekly intakes of selected foods were determined using the food frequency questionnaire from the Hispanic Health and Nutrition Examination Survey. We used t-tests to determine significance of difference in frequency of food consumption by ethnicity. The variance in consumption of selected foods was estimated with multiple regression analysis for the independent variables marital status, age, sex, education level, income, birthplace, and ethnicity. Ethnicity was the major variable influencing food intake. There were significant differences (p≤.05) between ethnic groups: Mexican Americans consumed eggs, poultry, legumes, organ meats, avocados/olives, flour tortillas, and sugar more frequently than non-Hispanic whites; they also used saturated fats in cooking more frequently than non-Hispanic whites; and they consumed skim milk, ice cream/ice milk, beef, all fruits or juices, all vegetables, breads, and oil/margarine less frequently than non-Hispanic whites. The results suggest that ethnicity plays a major role in predicting dietary patterns.

Magnesium and calcium play multiple dynamic roles in pulmonary structure and function. When magnesium is deficient, the action of calcium is enhanced. In contrast, an excess of magnesium blocks calcium. These interactions are important to the respiratory patient because the intracellular influx of calcium causes bronchial smooth-muscle contraction. The possibility exists that magnesium deficiency contributes to pulmonary complications. During the past few years, there has been an increase in calcium consumption in the US population but little change in magnesium intake, which has caused an imbalance in the calcium: magnesium ratio. Although serum levels are used to assess magnesium deficiency, cells can be deficient despite normal serum values. These findings indicate that pulmonary patients should be monitored routinely for magnesium deficiency.

Hepatic effects of very-low-energy diets (VLEDs) and refeeding were studied in dietary obese rats. Rats weighing 490-530 g (ages 72-119 d) were randomly assigned to control (C) and VLED groups. Control animals consumed a complete diet ad libitum whereas VLED animals consumed 20% of the energy intake of C animals for 7, 14, or 21 d, and some VLED animals were refed the C diet for 7 d. Hepatic weights, lipid, DNA, and total protein decreased in VLED animals. Observed hepatocytic lipid was high in C and progressively decreased in VLED rats. Hepatocytes from VLED rats lost cytoplasmic organelles, contained myelin figures, and became smaller. Decreased protein-DNA ratios and lipids in these same animals is consistent with atrophy. Other biochemical findings included reductions in blood urea nitrogen, albumin, triglycerides, total protein, and glucose, all of which are synthesized or metabolized by the liver. These observations suggest that attenuation of hepatic function is likely.

Low molecular weight oligosaccharides of glucose may be utilized as a calorie source when given intravenously. Preliminary safety studies included the parenteral infusion of four healthy subjects with a solution of glucose oligosaccharides at a rate of 0.5 mg/kg/min for 1, 2, or 3 hours. Approximately 100% of the oligosaccharides was retained with only trace amounts of the glucose oligosaccharides recovered in the urine. In further studies, 12 healthy males, ages 22-31, were infused with a 10% solution of glucose oligosaccharides containing 25 μCi [U-14C]glucose oligosaccharides/liter at a rate of 2.5 or 5.0 mg/kg/min for 12 hours with or without insulin (0.12 unit/g oligosaccharides) given subcutaneously in 3 equi-divided doses. Four additional subjects received cold oligosaccharides at a rate of 1.75 mg/kg/min without insulin. Eighty percent of the glucose oligosaccharides consisted of 2 to 8 glucose chain lengths. Blood glucose and oligosaccharide glucose concentrations and 14CO2 were measured hourly. ...

As dietitians accept the challenges of the 1980s, they must realize the positive and dynamic role that is theirs to play in the movement for increased emphasis on nutrition education for physicians and other health care professionals.

Evidence in the medical literature substantiating the effect of test diets on the outcome of specific diagnostic tests is scanty and, in some cases, controversial. It has been clearly demonstrated that some test diets definitely affect the outcomes of some diagnostic tests. Therefore, these diets should be effectively and consistently used. Medical professionals should be familiar with specific test diets. There should be systematic management regarding the content of instructions to the patient, who gives the instructions, and how follow-up is made on compliance with the test diet. Clinical dietitians should be versatile regarding all test diets that may influence diagnostic test outcome. All test diets in dietary manuals for which there is no medical basis for effectiveness should be eliminated.

Little is known about the specific effects of defined formula diets (DFD) on mucosal growth of the small intestine, pancreas, or liver. In the present study male Sprague Dawley rats weighing 220 to 250 g were fed isocaloric amounts of DFD (61 kcal/day) by continuous intragastric infusion. The diets fed were Vivonex, Vivonex-HN, Flexical, and Ensure. Oral chow- fed rats with intragastric water infusions served as reference. All groups gained weight: chow 50.50 g, Vivonex 27.17 g (P < 0.005), Vivonex-HN 25.40 g (P < 0.005), Flexical 30.5 g (P < 0.01), Ensure 39.29 g (NS). After 2 weeks rats were killed, the small bowel excised, rinsed, and divided into eight equal segments. Mucosal weight, DNA, and protein concentration per centimeter segment were measured. The pancreas was also removed, homogenized, and amylase activity assayed (units/g). Livers were excised, weighed, lipid content measured, and liver histology was examined by light microscopy. Mucosal weight, DNA, and protein concentrations per segment were decreased significantly in most bowel segments of DFD fed rats. Amyhase activity per gram pancreas was significantly reduced in rats fed Vivonex, Flexical, and Ensure. Serum amylase activity was also lowered in animals on DFD. There was significant accumulation of lipid in the liver of Vivonex and Flexical animals (P < 0.01). Liver histology confirmed the striking increase in fat in the Vivonex and Fhexical groups. These effects may result from differences in DFD absorption, mucosal metabolism, stimulation of enteric hormone release, and/or bile and pancreatic secre- tions. Am. J. Clin. Nutr. 33: 2106-2118, 1980.

The gastrointestinal response in rats nourished by continuous intragastric infusion of a variety of defined formula diets was compared with animals consuming the same diets orally. Two groups of rats were fed isocaloric amounts of DFD (73 kcal/day); group I : sham-operated, orally-fed: group 2: operated, intragastrically-fed. Diets included: Vivonex (V), Flexical (F), Vital, Vivonex high nitrogen, and a control casein rat liquid formula diet (C). After 2 wk rats were killed and the liver, pancreas, and small bowel removed. The bowel was divided into eight equal segments. Mucosal weight, DNA, and protein concentration per cm segment were measured. Pancreatic amylase activity (units/g), and liver weight and lipid content were measured. Weight gain was comparable in all oral-fed groups, but was decreased in all gastric-fed animals compared to the oral-fed group. Nitrogen retention was not influenced by route of feeding but was significantly lower for Vivonex and Flexical animals (p < 0.01) in both oral-fed and gastric-fed groups. There was significant accumulation of lipid in the liver of both oral-fed and gastric-fed animals sustained on Vivonex and Vivonex high nitrogen (p

One hundred and thirty-one young Mexican-American women were interviewed and assessed nutritionally at their first obstetrical visit in a city-county hospital. About half had an intake of less than the recommended allowance for one or more nutrients or were frankly anemic, as judged by hemoglobin levels. The majority demonstrated little accurate information concerning foods as sources of nutrients. Considerable confusion was shown in their answers to questions concerning newborn birth weight, diet, and maternal weight gain. The fundamentals of prenatal education regarding nutrition for these patients must begin with foods and their relative values, emphasize the dependence of the fetus on maternal diet, and clarify the relationship of weight gain to obstetrical health. Ideally, such an educational effort should begin in early childhood.

A NNTIB prototype has been developed and implemented at the University of Alabama in Birmingham School of Medicine. The further development of the Bank as a shared national resource was considered at a workshop carried out in conjunction with the 1983 ASCN meeting. Through this forum it was confirmed that the concept of a NNTIB is both valid and viable, receiving the support of a variety of nutrition educators and the endorsement of the ASCN Committee on Nutrition Education. The general recommendations of the workshop participants were that a modification of the test-item bank prototype be used as the model for the development of a national bank. A key recommendation was the development of a committee to oversee the acceptance and review of test items included in the NNTIB. Recognizing that the major constraints in the development of a national bank are likely to be logistical, mechanical, and fiscal, it is our belief that each of the limitations could be overcome if the Bank were adopted by a parent society with a long-term commitment to its continued support and development. After such support has been identified and pilot trials have been carried out, the implications of the NNTIB for advances in the field of nutrition go well beyond improved quality of testing materials and extend into the critical area of the establishment of standards of nutrition education and certification of competency. The development of the NNTIB offers a challenge to nutrition educators, national nutrition organizations, and interested governmental agencies for their involvement and support.

Summary There is increasing awareness that every practicing physician should have a sound knowledge of the role that nutrition plays in all areas of medicine. This report summarizes efforts at the University of Texas Health Science Center to incorporate nutrition into the medical curriculum. Keys to success include: a united effort of administration, faculty and students; financial support; and a dynamic and relevant approach in curriculum planning.

The nutritional status of 57 patients with hemophilia was studied at the South Texas Comprehensive Hemophilia Center, San Antonio. Dietary and anthropometric analyses were assessed as part of the nutrition evaluation. Calcium and vitamin A were two nutrients whose consumption was most often reported to be below one-half of the RDA. No statistically significant difference in caloric or nutrient intake was found between below-poverty income level groups. Participation in supplemental food programs produced some improvement in dietary intake. Some patients with hemophilia were overweight and some were underweight for their heights. When the weights of patients with hemophilia were compared to standards for age-adjusted ideal, desirable body weight, more than one-half of the subjects 25 years old or older exceeded the weight range for large frame men. Weight control should be emphasized for the patients who lead a sedentary life because of the physical limitations imposed by the complications of hemophilia.

Effects of low-calorie semistarvation diets on gastrointestinal and cardiac organ systems were studied. Male Sprague Dawley rats were divided into two groups, Group I, control (C) and Group II, semistarvation (SS), and maintained on a diet designed after low-calorie modified-fasting regimens in popular use. C animals consumed this diet ad libitum; SS animals received 23% of the total calories of C but the same ratio of calories from protein, carbohydrate, and fat and the same quantity and quality of all essential nutrients. Final weights of total body, heart, liver, and small intestine were lower in SS than in C animals. Protein depletion in SS compared with C animals was evident for heart, pancreas, and intestinal mucosa. Unless aggressively supplemented, low-calorie SS diets may deplete protein stores of the gastrointestinal organs of digestion and absorption and contribute to decrease in body nitrogen stores, specifically cardiac muscle.

Avoidance of saturated fat and cholesterol by 1,210 Mexican Americans and 866 non-Hispanic whites was assessed as part of a population-based survey of diabetes and cardiovascular risk factors. Participants ranged in age from 25 to 64 years and resided in three socioeconomically distinct neighborhoods of San Antonio, TX: low income, middle income, and upper income. A scale was constructed to assess the degree to which individuals avoided six dietary sources of saturated fat and cholesterol. Women of both ethnic groups were found to avoid saturated fat and cholesterol to a greater degree than men, scoring higher on five of the six components of the scale. Saturated fat/cholesterol avoidance increased significantly with increased socioeconomic status in both ethnic groups. Although there were no ethnic differences in overall saturated fat/cholesterol avoidance, more non-Hispanic whites recognized milk, eggs, and visible fat on meat as food sources to avoid. The scale described in this paper provides useful information about the specific food components recognized as dietary sources of saturated fat and cholesterol and helps identify those population groups that would benefit from nutrition education programs. Because of its simplicity and ease of administration, the scale may be a useful tool in epidemiological research. J Am Diet Assoc 88:172, 1988.

The effect on the intestinal mucosa of continuously infusing single amino acids, glycine, valine and histidine into the stomach and ileum was compared with saline and an amino acid mixture (AA) in rats fed to parenteral nutrition. After gastric infusion, glycine did not differ from saline, valine increased mucosa in the proximal segments and histidine alone increased mucosa in the proximal bowel equal to AA. After ileal infusion, all amino acids increased mucosa in the ileum. Valine and histidine, but not glycine, increased mucosa in the remote proximal small bowel. Therefore, regional differences occur in mucosal growth response to single amino acids.

A nationwide survey of core competencies of nutrition knowledge and skills that primary care physicians should know and/or be able to do has been completed. Nutrition competencies were synthesized from a review of clinical nutrition practices as reported in the medical literature and by medical school faculty group discussions. A nutrition competency questionnaire was sent to 445 practicing physicians and to 752 department chairpersons in every US medical school in the disciplines of family practice, medicine, obstetrics and gynecology, pediatrics, psychiatry, and surgery. The overall response rate for practitioners and faculty combined was 46.03%. Of the 55 nutrition competencies, 28 items received very strong support (greater than 90% of respondents marked agree or completely agree). Twenty-two competencies received strong support (80 to 89% of respondents marked agree or completely agree), and five items received mixed support (40 to 79% of respondents marked agree or completely agree). Statistical comparisons of the item responses between practitioners and faculty were significantly different (p less than 0.05) on 19 (35%) of the items. It is anticipated that the 50 nutrition competencies that have received strong or very strong agreement among the 551 physicians representing primary care disciplines across the US will serve as guidelines for continued development of medical school curriculum and continuing medical education in clinical nutrition.

Low residue, chemically defined diets containing all essential nutrients in a readily assimilated form, require minimal digestion and are almost entirely absorbed in the upper gastrointestinal tract. Within the past decade, these diets have been reported to provide nutritional support in a variety of clinical situations. The chemically defined diets presently available commercially differ in several respects. In order to provide optimal nutritional care utilizing chemically defined diets, the physician should compare the diet formulas and make the most appropriate choice for each individual patient. A comparative nutritional analysis of the currently available chemically defined diets is given.

Nutrition plays a significant modulating role in the aging process and is an important component in the health care of the elderly. While considerable study of the nutritional needs of the elderly has been accomplished in recent years, we are as yet very limited in our knowledge and understanding of the nutrient requirements of the elderly, the methodology for assessing nutritional status, and the impact of disease on the nutritional status of the elderly. Clearly, the dynamic interrelationships of nutrition, aging, and the aged emerge as pressing and important aspects of modern medicine. To probe into the intricacies of these relationships is a monumental challenge. This challenge will certainly accelerate in the future.

The gastrointestinal response to oral alimentation of low residue commercial defined formula diets or a rat liquid formula was studied. Male Sprague-Dawley rats (220-250 g) were fed isocaloric amounts (73 kcal/day) of Vivonex (V), Vivonex HN (VHN), Flexical (F), Vital (Vit), or a control Casein diet 116EC (C). Nitrogen (N) retention was calculated from N intake minus N excretion/day. After 2 weeks, rats were killed and the liver, pancreas, and small bowel removed and weighed. Pancreatic amylase activity (U g) and liver lipid were measured. The bowel was divided into eight equal segments, and mucosal weight, DNA, and protein concentration per centimeter were measured. Despite isocaloric feeding, body weight gain was lower in V and VHN groups, and higher in F and Vit groups compared to the C. Amylase specific activity was increased in V, VHN, and F groups, while the liver lipid was increased in the V and VHN groups when compared to C animals. The most proximal intestinal segment weight, mucosal weight, protein and DNA of V, VHN, and Vit groups were less than C animals, while distal segments were similar. F animals showed greater intestinal mass than C rats. These studies indicate statistically significant differences in gastrointestinal response as a result of nutrient variation of defined formula diets.

A recent development in the treatment of obesity is the widespread use of very-low-calorie diets. This study assessed the response to refeeding (RF) after semistarvation (SS) in a rat model. Male Sprague-Dawley rats (440 g) were semistarved for 21 d, receiving a nutritionally complete defined formula diet at 23% of calories of control (C) rats fed ad libitum, and subsequently refed over 21 d (SS----RF). Organ weight, contents of protein and DNA, and the protein-DNA ratio were determined for the liver, pancreas, small intestine, and heart. Compared with C animals, SS----RF animals showed variable repletion of tissue protein but not of tissue DNA. The higher protein-DNA ratio shown in these organ systems suggests a cellular hypertrophic adaptive response to refeeding. A persistent reduced number of cells in ratio to protein concentration is evident despite refeeding over 21 d. Very-low-calorie diets as well as refeeding influence nitrogen economy of selected organ systems.

The diet plan marketed by the United Sciences of America, Incorporated (USAI) claims to offer "optimal nutrition" for the health of Americans. This claim raises the question, what is an "optimal" diet? Analyses of the four diet products--a fiber energy bar, an omega-3 fatty-acid concentrate, a calorie-control formula, and a master formula of mixed ingredients--raise questions regarding safety and efficacy of this plan. Still further questions focus on endorsement of the USAI diet plan and the relation of endorsement to receiving "grants" from the producer.

The metabolism of intravenously administered maltose was compared with glucose in 5 fasting, adult, noninsulin-dependent, mildly diabetic subjects and contrasted with normal controls. After an iv injection of 25 g maltose containing 5 μCi maltose-U-14C or 25 g glucose containing either 5 μCi glucose-1-14C or glucose-U-14C, expired breath and urine were collected over a 6-hr period. Blood samples obtained at 0, 15, 30, 60, 90, and 120 min were assayed for insulin, total reducing substances and glucose. Equal amounts of maltose and glucose were oxidized to 14CO2. The rate of oxidation for maltose was much slower with a peak 14CO2 excretion 100 min later than for glucose. Diabetic subjects showed a delayed peak 14CO2 excretion after both sugars compared with normal subjects.Serum glucose concentration after maltose infusion remained less than 95 mg/10 ml over the entire 2-hr period, in contrast to the elevation of serum glucose following glucose administration. The increase in total serum reducing s...

Inability to absorb lactose due to low intestinal lactase is common in many population groups. This study is the first to compare lactose tolerance in 282 Mexican-American (MA) children and 51 Anglo-American (AA) children 2 to 14 years of age with the dietary intake of selected nutrients found in milk. A lactose tolerance test and a 24-hr dietary recall were obtained for each child. Gastrointestinal symptoms were carefully recorded for a 24-hr period following the lactose load. Overall prevalence of lactose malabsorption was 37% in MA children and 8% in AA children, and it increased with age. Number of symptoms occurring in lactose malabsorbers of both ethnic groups also increased with age. Mean protein intake exceeded Recommended Dietary Allowances at all ages for both ethnic groups. Mean consumption of vitamin A, calcium, and energy was below the Recommended Dietary Allowance for MA children. There were no differences in calories, nutrient, or milk intakes between lactose absorbers and malabsorbers, but AA children drank more milk than MA children. Fifteen percent of lactose-absorbing MA, 23% of malabsorbing MA, but no AA children reported having symptoms after drinking milk. There was a significantly greater incidence of lactose intolerance in MA as compared to AA children. This suggests that Mexican-Americans share in the high incidence of primary lactose intolerance characteristic of the majority of the orld's peoples.

To the Editor. —In the March issue of theArchives,Dr Tilson et al are the authors of an article entitled "Compensatory Hypertrophy of the Ileum After Gastroduodenojejunal Exclusion" ( Arch Surg 110:309, 1975). This is a study of the compensatory hypertrophy of the gut by examination of the ileum after bypass of pancreatobiliary secretions to the colon. Hypertrophy of the ileum occurred after esophagoileostomy and gastroduodenojejunal exclusion. A hypothesis seeking to reconcile the conflicting notions of intraluminal and hormonal stimuli was discussed by the authors. In the discussion of the methods, there is a description of the experimental preparation. Animals were studied two weeks postoperatively. Absolutely no mention was made as to the nutritional support of the experimental animals. What kind of food was allowed? How much food was taken? Gut adaptation to luminal and hormonal factors depend, at least to some extent, on nutrient input. It was suprising to