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Objective: In this study we aimed to determine, in pediatric patients, whether norovirus infection could be associated with exacerbations of inflammatory bowel disease (IBD) and ascertain whether the clinical expression of norovirus gastroenteritis was similar in patients with IBD compared with non-IBD controls. Materials and Methods: We performed a case-control retrospective chart review, over a 10-month interval, of patients with IBD with an exacerbation of their disease. The presence of norovirus in stool and/or rectal swab samples, as determined by an enzyme-linked immunoassay, was assessed. In addition, sex, age, type of IBD, presence or absence of diarrhea, hematochezia, and the need for hospitalization were determined. A similar number of control patients who did not have IBD were used as controls. Results: Nine patients with IBD (8 ulcerative colitis/I Crohn disease) had exacerbations with diarrhea. Eight had norovirus antigen in at least 1 sample. All 9 patients with IBD presented with bloody diarrhea and 6 of the 8 norovirus-positive patients with IBD required hospitalization. All of the control patients experienced diarrhea; however, no hematochezia was noted and no hospitalization was required. Several patients with IBD and controls remained positive for norovirus months after the initial positive stool and/or rectal swab sample. The virus appeared to be more common during winter months. Conclusions: We conclude that norovirus may be associated with exacerbations of IBD. When norovirus accompanies IBD it is more likely to be associated with hematochezia than when the infection occurs in the absence of IBD.

m c ( t o o T he impetus for this issue comes from a Topic Symposium entitled, “Infant Feeding: Initiation, Problems, Approaches” held at the Peditric Academic Societies meeting in Toronto May 6, 007. The symposium focused on four aspects of eeding infants and young children. Each aspect was iscussed by an authority in the field. One presentation concerned the developmental spects of swallowing and feeding infants and oung children. Another addressed the development f gut motility in the premature infant and its elationship to enteral feeding. The third topic oncerned the behavioral treatment of feeding disrders in toddlers and finally, feeding issues related o neurologically impaired children were reviewed. Feeding premature and full-term infants through he first few years of life has become an area of nterest and study over the past two decades. The ealization that some infants and children are not fed asily or may develop feeding problems resistant to raditional approaches has led to the institution of eeding teams at larger pediatric centers. Hopefully, nformation presented at the Topic Symposium and ontained within this issue will be shared with thers as we follow emerging research concerning he optimal feeding of normal infants and children, nd those with feeding disorders.

Childhood overweight and obesity are major health problems with immediate and long-term consequences of staggering magnitude. Despite this, there are few preventive and therapeutic strategies of proven effectiveness available to public health and clinical practitioners. Accruing such evidence is currently and appropriately a health policy priority, but there is an urgent need to intervene even before comprehensive solutions are fully established. The aim of this Clinical Report on Overweight Children and Adolescents is to present information on current understanding of pathogenesis and treatment of overweight and obesity. We report on the epidemiology, molecular biology and medical conditions associated with overweight; on dietary, exercise, behavioral, pharmacological and surgical treatments; and on the primary prevention of overweight in children and adolescents.

The purpose of this study was to compare heart rate peak in obese (n=43) and normal weight (n=45) female youth. Heart rate (HR) peak was significantly lower (p2 (L min-) peak similar between groups (1.77±20.53, 1.97±0.60). Bivariate correlations for heart rate peak with body weight, percent fat, and body mass index yielded the following: -0.53, -0.54, and -0.57. These findings agree with the adult data indicating low HR peak in obese individuals. Further research is needed to explore physiologic factors that may lead to reduced HR peak in obese female youth.

Objective Two tumor necrosis factor α (TNFα) antagonists were recently licensed in the US. Infliximab was licensed in 1998 for the treatment of Crohn's disease (CD), and since 1999, it has been licensed in combination with methotrexate for treatment of rheumatoid arthritis (RA). Etanercept was licensed in 1998 for treatment of RA and, more recently, for juvenile RA and psoriatic arthritis. Because of potential immunosuppression related to use of anti-TNFα agents, we sought to identify postlicensure cases of opportunistic infection, including histoplasmosis, in patients treated with these products. Methods The US Food and Drug Administration's (FDA) passive surveillance database for monitoring postlicensure adverse events was reviewed to identify all reports received through July 2001 of histoplasmosis in patients treated with either infliximab or etanercept. Results Ten cases of Histoplasma capsulatum (HC) infection were reported: 9 associated with infliximab and 1 associated with etanercept. In patients treated with infliximab, manifestations of histoplasmosis occurred within 1 week to 6 months after the first dose and typically included fever, malaise, cough, dyspnea, and interstitial pneumonitis. Of the 10 patients with histoplasmosis, 9 required treatment in an intensive care unit, and 1 died. All patients had received concomitant immunosuppressive medications in addition to infliximab or etanercept, and all resided in HC-endemic regions. Conclusion Postlicensure surveillance suggests that acute life-threatening histoplasmosis may complicate immunotherapy with TNFα antagonists, particularly infliximab. Histoplasmosis should be considered early in the evaluation of patients who reside in HC-endemic areas in whom infectious complications develop during treatment with infliximab or etanercept.

The integrated, 4-level approach of Committed to Kids is successful because of several factors: The sessions are designed to entertain the adolescents and promote initial success; The program features parent-training methods in short, interactive, educational sessions; In severely obese adolescents, the diet intervention results in noticeable weight loss that motivates the patient to continue; also, the improved exercise tolerance resulting from the weight loss promotes increased physical activity; and The program team provides consistent feedback-patients and their families receive results and updates every 3 months. Most importantly, the program is conducted in groups of families. The adolescent group dynamics and peer modeling are primary components of the successful management of obesity in youth.

Background. Childhood obesity has been associated with elevated serum levels of total cholesterol, triglycerides, and low-density lipoproteins (LDLs). We observed the lipid profiles of obese female subjects versus obese male subjects before and after significant weight loss. Methods. We studied 29 girls and 21 boys enrolled in a multidisciplinary weight reduction program. Results. Measures were taken at enrollment and at 10 weeks. Significant improvements were observed for changes in percentage of ideal body weight and total cholesterol and triglyceride levels. In addition, LDL decreased significantly in girls but not in boys. Conclusions. A combination of diet, behavior modification, and exercise, is an effective instrument for lowering total cholesterol and triglyceride levels in obese children. In addition, girls tend to be more susceptible to a decrease in LDL level, which might result in an increased cardiovascular protective effect.

Data were collected on all patients in the Charleston, WV area tested for norovirus gastroenteritis during 2007. Of the 2687 rectal swab/stool samples, 60% were from individuals20 years of age. Stool samples were more likely to be positive compared with rectal swab samples and if obtained from January to July and from patients5 years of age.

Abnormal gastroesophageal reflux after percutaneous endoscopic gastrostomy is a serious problem in neurologically impaired children. Protective fundoplication has been advocated. Whether esophageal pH monitoring before percutaneous endoscopic gastrostomy will predict later problems with gastroesophageal reflux is unclear.Eighty-five mostly neurologically impaired pediatric patients who underwent percutaneous endoscopic gastrostomy were studied retrospectively regarding complications, success of nutritional rehabilitation, and the incidence of pathologic gastroesophageal reflux. Follow-up period was 1 to 4 years. Twenty-four-hour esophageal pH monitoring was performed in 46 patients before percutaneous endoscopic gastrostomy.There were no deaths. Two major complications occurred that required surgical intervention, and 14 minor complications occurred related to the procedure. Z-scores for weight increased significantly after percutaneous endoscopic gastrostomy. pH probe results were normal in 22 patients (group 1). Five required medical treatment for gastroesophageal reflux after percutaneous endoscopic gastrostomy, but only 1 (5%) later required Nissen fundoplication. pH probe results were abnormal in 24 patients (group 2). Nineteen required medical therapy for gastroesophageal reflux, and 7 (29%) later needed fundoplication (p0.05, incidence of fundoplication group 1 vs. group 2). Improvement in Z-scores was similar in patients requiring and not requiring fundoplication.Percutaneous endoscopic gastrostomy is a safe and effective technique for long-term nutritional support in children. Abnormal gastroesophageal reflux is common. Normal findings in an esophageal pH study before percutaneous endoscopic gastrostomy may be predictive of a favorable outcome with respect to gastroesophageal reflux. This is in contrast to patients with abnormal results in pH studies before percutaneous endoscopic gastrostomy of whom a relatively large percentage may later require fundoplication. Improved nutritional status after percutaneous endoscopic gastrostomy does not appear to have an impact on the severity of gastroesophageal reflux.

Objective.To describe factors associated with a rectal swab or stool sample positive for norovirus, rotavirus, or adenovirus.Design.Retrospective study.Setting.Charleston Area Medical Center, a regional academic medical center in Charleston, West Virginia.Methods.Rectal swab or stool samples were obtained from patients suspected of having viral gastroenteritis. These samples were sent to the Charleston Area Medical Center virology laboratory for testing in 2007. Viral antigen in rectal swab and stool samples is detected by use of commercially available immunoassay kits for each virus. Data were extracted from the virology laboratory database for the following 1-year time period: January 1, 2007, through December 31, 2007. When necessary, additional information was obtained from electronic administrative data on patients.Results.There were 2,867 rectal swab and stool samples available for viral testing. Of these samples, 1,261 (44%) were positive for a virus. Of these positive samples, 972 (77%) were positive for norovirus, 182 (14%) were positive for rotavirus, and 110 (9%) were positive for adenovirus. The patients in the youngest age group had the highest number of test results positive for all 3 viruses. When the test results for the youngest age group (0-9 years) were compared with those for all the other age groups combined (10-99 years), the proportion of positive cases was highest for the youngest age group (PConclusions.We conclude (1) that these 3 viruses are common causes of gastroenteritis in Charleston, West Virginia; (2) that infants and young children are more likely to test positive for these viruses than are older individuals; (3) that norovirus was the most common cause of gastroenteritis; and (4) that there are seasonal trends for all 3 viruses.

In 1985, the American Academy of Pediatrics (AAP) published a policy statement on the treatment of infants with acute diarrhea complicated by mild to moderate d ehydration. To determine how closely physicians in the United States follow the AAP's treatment guidelines, a questionnaire was sent to 457 pediatricians and 360 family practitioners. The questionnaire presented a hypothetical infant with acute diarrhea complicated by mild to moderate dehydration and included questions regarding the number of such patients seen yearly, length of time used to rehydrate the infant, and how formula or solids are introduced following rehydration. Complete responses were received from 53% of pediatricians and 40% of family practitioners. The number of patients with acute diarrhea seen per year did not affect physician's treatment. Pediatricians and family practitioners responded similarly to most questions. Contrary to the AAP's guidelines to rehydrate in 4 to 6 hours, 62% of responding physicians extend the rehydration period to 12 to 24 hours. Also contrary to the AAP's recommendations, 62% of pediatricians and family practitioners use a lactose-free formula. The majority of responding physicians do follow the AAP's treatment guidelines to initiate feedings with diluted formula. Significantly more pediatricians than family practitioner advance to a full-strength formula within 1 day (P = .011). Fewer than 50% of physicians polled started solids within 24 hours as suggested by the AAP. Overall, the findings suggest that very few pediatricians and family practitioners follow all aspects of the AAP's treatment guidelines for infants with acute diarrhea complicated by mild to moderate dehydration.

Pediatricians should be aware of the recommended daily allowances (RDAs) for vitamins. They also should have knowledge of the symptoms and signs of vitamin deficiencies and excesses so as to be able to institute treatment before severe and permanent functional impairment of vital organs occurs. In this article, the RDAs for vitamins will be discussed, followed by an update of fatsoluble and water-soluble vitamins. Recommended Daily Allowances (Table 1) In principle, the RDAs are based on various kinds of evidence: 1) nutrient intakes of fully breast-fed infants and of apparently healthy people from their food supply; 2) studies of subjects maintained on diets containing low or deficient levels of a nutrient, followed by correction of the deficit with measured amounts of the nutrient; 3) nutrient balance studies that measure nutrient status in relation to intake; 4) biochemical measurements of tissue saturation or adequacy of molecular function in relation to nutrient intake; 5) epidemiologic observations of nutrient status in populations in relation to intake; and 6) in some cases, extrapolation of data from animal experiments. In practice, there are limited data on which to base the RDAs.1 It should be recognized that all RDAs are somewhat arbitrary and generally on the high side.

Small amounts of lactose have been shown to be absorbed intact across the intestine and excreted unchanged in the urine of newborns and adults. We designed a study to quantitate the intestinal uptake and urinary excretion of this disaccharide in these age groups. Similar amounts of lactose were given orally to 17 term newborns (age: 24.8 +/- 3.0 h) as a standard infant formula, and to 15 adult lactose absorbers (age: 28.1 +/- 2.6 years) and 11 adult lactose malabsorbers (age: 24.7 +/- 2.9 years) as a 20% water solution. Following lactose ingestion, breath was collected every 30 or 60 min for 3 h and analyzed for hydrogen concentration. Urine was also collected, and lactose and creatinine concentrations were determined. Peak hydrogen concentration was less than 20 ppm above baseline in newborns and adult lactose absorbers and 85 +/- 14 ppm in adult lactose malabsorbers. Urinary lactose excretion, expressed as a function of body weight (mg/ml/kg b.w.), was substantially greater in newborns (4.2 +/- 0.82) than in adult lactose absorbers (0.29 +/- 0.07; p less than 0.001) and adult lactose malabsorbers (0.55 +/- 0.04; p less than 0.01). Similarly, urinary lactose excretion expressed as a ratio of urinary lactose to urinary creatinine (mg/mg) was increased (p less than 0.001) in newborns (2.05 +/- 0.26) when compared to adult lactose absorbers (0.11 +/- 0.02) and adult lactose malabsorbers (0.20 +/- 0.02). Our data demonstrate that the intestinal uptake and urinary excretion of intact lactose is significantly increased in newborns compared to adult subjects.

Obesity is a chronic condition, and long-term treatment will most likely be needed. Approved prescription medications for weight loss appear to have similar efficacy in controlled studies. No predictors of responsiveness in an individual patient or class of patients have been established. The choice of a medication is based on the underlying medical indication or contraindication of a particular drug, concurrent medication, age of the patient, need for monitoring, anticipation of the length of therapy, and the preference of a patient. Behavioral and dieting interventions, and increased physical activity are considered the primary means to promote and maintain weight loss. Weight-loss medications should be considered only as an adjunct for patients who are at substantial risk because of their obesity and in whom non-pharmacologic treatments have not resulted in sufficient weight loss to improve health or to prevent weight regain.

The integrated, 4-level approach of Committed to Kids is successful because of several factors: The sessions are designed to entertain the adolescents and promote initial success; The program features parent-training methods in short, interactive, educational sessions; In severely obese adolescents, the diet intervention results in noticeable weight loss that motivates the patient to continue; also, the improved exercise tolerance resulting from the weight loss promotes increased physical activity; and The program team provides consistent feedback-patients and their families receive results and updates every 3 months. Most importantly, the program is conducted in groups of families. The adolescent group dynamics and peer modeling are primary components of the successful management of obesity in youth.

A 5-year-old boy with short-bowel syndrome who receives home parenteral nutrition developed a calcified thrombus that involved the inferior vena cava (IVC) and the right atrium. Symptoms included 3 to 4 months of intermittent fever and 2 months of vague chest pain. Blood could not be aspirated from the IVC catheter and an IVC contrast study demonstrated the calcified thrombus. The intracardiac portion of the mass was removed surgically, but the IVC mass could not be completely excised. The boy developed a pericardial effusion 6 weeks after surgery. He was treated for this and 6 months after the initial surgery the patient was asymptomatic.

The prevalence of childhood obesity is rapidly increasing. Successful prevention and treatment of childhood obesity depends on increasing the physical activity patterns of obese youth. However, motivating the obese child to participate in physical activity is difficult.We designed a four-phase physical activity intervention, consisting of a structured progressive exercise program of moderate intensity, along with motivational methods to increase physical activity and improve body movement awareness.Seventy-three overweight children participated in the weight management program. They had a significant weight loss and reduction in body fat, which was maintained at 1-year follow-up. Subjects also maintained lean body mass and showed improved physical activity patterns.Progressive exercise, used in conjunction with nutrition and behavior modification, provides successful motivational strategies. These strategies encourage increased physical activity patterns, the adoption of regular structured exercise training, and the loss of excess body fat.

BACKGROUND Safe and effective exercise programs are needed to prevent and treat chronic diseases in childhood. In particular, preadolescent obese children should participate in activities that are specific to their special needs. METHODS We included a moderate intensity, progressive resistance training program in a multidisciplinary weight management program for obese preadolescent children. The program included diet, behavior modification, and aerobic and flexibility exercises. RESULTS The subjects reported no accidents or injuries and 100% compliance with the minimum required exercise prescription. Weight, percent ideal body weight, body mass index, and percent fat were reduced significantly at 10 weeks and did not increase significantly at 1 year follow-up. Height and lean body mass increased significantly at 1 year. CONCLUSION A resistance training program may be safely included in a multidisciplinary weight management program for obese preadolescent children.

Background Obesity is a rapidly increasing health problem among US youth. Hyperinsulinemia is associated with obesity and has been found to be a contributory factor for the development of cardiovascular disease in the obese. It has been suggested that hyperinsulinemia of obesity is a result of increased insulin secretion caused by insulin resistance. However, it has been shown in adults that decreased hepatic insulin clearance (HIC) is the primary cause of hyperinsulinemia in this population. Methods We studied 15 obese children and adolescents (11 F, 4 M; 8.6 to 18.1 years) before and 10 weeks after their enrollment in a multidisciplinary weight reduction program, which included a protein-sparing modified fast, a moderate intensity progressive exercise program, and a behavior-modification intervention. Results All patients lost weight (P 0.05). Measurements of immunoreactive insulin (IRI) and C-peptide reactivity (CPR) were performed before the program and at 10 weeks. IRI levels dropped significantly, whereas CPR levels did not change. CPR/IRI molar ratios, considered an indirect estimation of HIC, rose significantly after weight loss. Conclusions Our data suggest that hyperinsulinemia seen in obese children and adolescents is caused by decreased HIC. The cause for this decrease remains unknown, but it is reversible upon weight loss.

We administered lovastatin to two sisters, aged 4 and 17 years, who had cholesterol ester storage disease, an autosomal recessive disorder manifested by hypercholesterolemia and hypertriglyceridemia. The drug, a competitive inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase, was taken orally for 6 months. Serum lipid concentrations were determined monthly. Computed tomography of the liver was performed before and during therapy to evaluate liver fat content. The younger sister had liver biopsies before and after 6 months of lovastatin therapy to assess hepatic cholesterol stores. Both patients had marked decreases in serum levels of cholesterol, triglycerides, and low-density lipoprotein-cholesterol; high-density lipoprotein-cholesterol levels increased. Computed tomography during treatment demonstrated a significant increase in linear attenuation, suggesting a decreased liver fat content. Liver tissue obtained 6 months after lovastatin therapy was initiated had 13% less esterified cholesterol than the liver sample obtained before treatment. We conclude that lovastatin may be effective in treating children with cholesterol ester storage disease.

The medical records of 20 infants under 1 year of age who received parenteral nutrition (PN) for a minimum of 1 week were reviewed. Patients were divided into two groups based on the method of PN administration. One group received PN by the traditional two-plus-one method where lipid emulsion is given separately from the dextrose-amino acid mixture. The second group received PN by the three-in-one method where lipid emulsion is admixed with the dextrose and amino acids. There were no statistically significant differences between the two groups in the amount of calories, lipid, dextrose, protein, calcium, and phosphorus received per kg of body weight. Average daily weight gain was not statistically different, and no obvious trends were noted in serum biochemical parameters between the two groups. Average total PN days for the groups (13 +/- 7 days for the two-plus-one group vs 39 +/- 35 days for the three-in-one group) were significantly different (p less than 0.05). A cost comparison of the two methods of PN administration indicated that the two-plus-one method costs our hospital $11.78 more per day than the three-in-one solution. We conclude that the three-in-one method of PN administration is safe, efficacious, and cost effective for infants under 1 year of age.

compared to its normal counterpart HIPEC. Among the most abundantly increased (greater than 6 fold) transcripts were the TIMP3, MIP3~, and IL10 inducible chemokine (SCYA16), retinoic acid receptor beta, RAB33 (RAS oncogene). Among the most underexpressed (at least 6 fold less than control) genes were interferon induced protein 56 (IFIT1), presenilin-2 (PSEN2), VCAM1, MYBL2, SOD3, RAN (RAS oncogene), and FOSL1. Additionally, the telomerase activity assay demonstrated the presence of active telomerase in HITECs but not in HIPECs. CONCLUSION: Our model of paired HIPEC and HITEC lines will serve as a valuable tool for the identification of the origin of pathological processes in intestinal tumors.

Research indicates that prevention of adult obesity may be accomplished through the treatment of prediatric obesity. However, it is unclear whether treatment should begin during the early or later childhood years. We examined the one-year program retention and weight maintenance of 139 obese children(M=63, F=76; Age=12.11±2.6 yrs.; Range=7.1-17.6 yrs.) enrolled in a multidisciplinary pediatric weight management program. The one-year program consisted of a protein-sparing modified fast diet, followed by a balanced hypocaloric diet, nutrition education, behavior modification, and a moderate-intensity (45-55% VO2max), progressive exercise program. Measures of height, weight, percent of ideal body weight (%IBW), and body mass index (BMI) were obtained at baseline, ten weeks and one year. For statistical analysis, subjects were blocked by age as follows: 7-8 yrs., 9-10 yrs., 11-12 yrs., and 13+ yrs. A repeated measures one way analysis of variance indicated the the results in the table (%IBW, mean±S.D;*Baseline to 10 weeks and baseline to 1 year. 10 weeks to 1 year = N.S.).

Male and female serum lipid profiles in pediatric patients enrolled in a multidisciplinary weight reduction program. † 579

Serum lipid profiles in pediatric patients enrolled in a multidisciplinary weight reduction program: differences between White and African-American children. † 578

Protein Sparing Modified Fast Versus Dexfenfluramine Hydrochloride(Redux®) as a Treatment for Childhood Obesity in Male Adolescents 580

We have consistently noted cutaneous reactions in subjects ingesting large quantities of yeast. Since depression of plasma zinc has been noted in a number of cutaneous disorders we prospectively measured serum zinc and zinc-binding proteins in six adult male subjects on yeast protein as their sole source of protein for eight days. Serum zinc, albumin, alpha2-macroglobulin, copper, iron and serum amyloid A (SAA) protein were measured before and at the end of the eight day interval. Five of the six individuals developed the characteristic erythematous, papular rash of the palmar surface of the hands. Mean serum zinc in the six subjects decreased from 117.0 to 99.0 μg/dl (p

When studying mucosal barrier function of developing animals, we noted that intestinal microvillus membranes (MVM) of newborn animals differ in their fluidity and binding characteristics to lectins compared with adult MVM. To further investigate these differences and determine whether maturation of the microvillus surface could be accelerated in utero, pregnant rats were given intraperitoneal cortisone beginning on the 17th day of gestation. Control and cortisone-treated animals were allowed to deliver normally, and the small intestines from newborns were used to isolate MVM. Microvillus membrane surface characteristics were evaluated by employing an 125I-labeled fucose-specific lectin, Ulex europeus (UEA). Changes in MVM proteins were monitored by disaccharidase activities and sodium dodecyl sulfate-polyacrylamide electrophoresis. MVM fluidity was accessed using a 5-doxyl stearic acid label and electron-spin-resonance spectroscopy. Results from these studies indicate that the birth weights of newborn rats exposed to cortisone in utero were significantly reduced; sucrase activity was prematurely induced and specific activities of lactase and maltase were enhanced in the intestines of the cortisone-treated newborns as contrasted with control animals. Furthermore, binding of 125I-UEA to MVM was greatly increased in treated animals. MVM fluidity decreased (P less than 0.001) compared with control animals and resembled the structural characteristics of more mature MVM. These results suggest that cortisone exposure in utero accelerate maturation of the microvillus surface of enterocytes.

Summary The osmotic effect of unabsorbed glucose on intestinal secretion of water and electrolytes was investigated by jejunal perfusion in eight infants ranging from 2 to 17 months of age. All infants had or were recovering from acquired monosaccharide intolerance. Isocaloric solutions of glucose and glucose polymer containing 1% polyethylene glycol as a nonabsorbable marker were tested. The osmolalities of the glucose polymer solutions were '/s to % that of the glucose. No major differences were noted in carbohydrate absorption whereas mean water flux changed from secretion of 0.37 ml/min to absorption of 0.023 ml/min when glucose was replaced by glucose polymer. Sodium and potassium flux followed the same pattern. The results of this study indicate that the increased intestinal secretion in acquired monosaccharide intolerance may be a function of osmolar load in the presence of a reduced absorptive capacity. Swculation Formulas presently used to treat infants with absorptive disorders of the small bowel frequently include those which are elemental and have high osmolalities. This study implies that there is a need to further develop dietary products which are well absorbed but have a lower osmotic load. Acquired monosaccharide intolerance is a reversible clinical syndrome commonly seen in the first 6 months of infancy. This syndrome is initiated by acute diarrhea or surgical manipulation of the intestine and results in chronic acidic diarrhea, generalized malabsorption, and failure to thrive. It was first reported by Burke and Danks (1) in 1966 and further described by Lifshitz et al. (5) in 1970. The small intestinal mucosa in affected infants is characterized by atrophy or blunting of the villi causing a reduced mucosal absorptive surface which we previously reported (4) to be responsible for the malabsorption which is characterized by total carbohydrate intolerance. The oral ingestion of sugar results in a profound fermentative diarrhea with an acidic pH. In an attempt to enhance absorption, these infants are frequently treated with chemically defined formulas which contain glucose as the carbohydrate and amino acids as the protein source. These formulas have a very high osmolarity and are difficult to feed to infants with this syndrome without producing diarrhea. Even though it appears that the malabsorption of nutrients is the major stimulus for diarrhea in these infants, the osmolality of the feeding mixture may enhance the secretion of water into the intestinal lumen, worsening the symptom. The following study was designed to evaluate this phenomenon.