Daily excretion of fat and the 5-h excretion of D-xylose in urine were measured in 15 children with nutritional oedema syndrome with hypoproteinaemia (kwashiorkor) and 16 children with severe wasting (marasmus); they were from 9 months to 10 years old.

Fat excretion exceeding 5 g per day was found in 7 of the 13 children with kwashiorkor and 5 of the 12 with marasmus. Xylose excretion was similarly impaired in 7 and 9, respectively, of the children with kwashiorkor and marasmus. Only 3 of 12 biopsy samples from children with kwashiorkor showed changes in jejunal mucosa and these were minor in character; jejunal biopsy samples from marasmic children showed a marked reduction in the villus height, alteration in the villus: crypt ratio, atypical villus epithelial cells and inflammatory cell infiltration of the lamina propria. The pathogenesis of the changes is discussed.-GFG