letters to the editor deficiency
Dear
Sir:
could different
During the past decade the occurrence of a peculiar syndrome characterized by growth retardation, hypogonadism, hepatosplenomegaly, and anemia in boys has been reported from the Middle East (1, 2). Since zinc supplementation is said to cause dramatic improvement, deficiency of zinc in the diet has been implicated as the probable etiological factor in the pathogenesis of the syndrome (3). Over the years we have been actively engaged in studying various aspects of malnutrition in North Indian children (4-7). More recently we have observed several cases with the characteristic manifestations of the aforesaid syndrome in Simla Hills. It is noteworthy that around 25% of our subjects are females-an observation which is in sharp contrast with the experience gained in Iran and Egypt (3). The fact that salient features of the syndrome in our subjects showed fast amelioration in a few weeks’ to a few months’
time
after
nutritional
rehabilitation
with a high protein-high calorie diet but without any added zinc supplements is of particular interest. Furthermore, a group of children who received extra zinc supplement evinced no significant difference in the therapeutic response. Our experience casts some doubt on the validity of the hypothesis that zinc deficiency may well be the cause of this syndrome. Or
Bioavailability Dear
have context.
we are in fact dealing with a It would be interesting to the experience of other workers in this entity?
Suraj Assistant
Professor
Department
of
Government
Medical
Hospitals Jammu
180001,
Gupte,
M.D.
Pediatrics
College
Kashmir,
and Associated India
References 1. EMINIANS,
J., J. G. REINHOLD,
H.
AMIRHAKINI,
2.
3.
4.
5.
6.
SHARIF
AND
C. A. KFOURY, G. H. M. ZIAI. Zinc nutrition of Iran. Am. J. Clin.
of children in Fars Province Nutr. 20: 734, 1967. GURSON, C. T. The biochemical aspects of proteincalorie malnutrition. In: Newer Methods of Nutritional Biochemistry, edited by A. A. Albanese. New York and London: Academic Press, 1972, p. 65. SANSTEAD, H. H., A. S. PRASAD, A. R. SCHULERT, Z. FARID, A. MIALE, JR., S. BA5ILLY AND W. J. DARBY. Human zinc deficiency, endocrine manifestations, and response to treatment. Am. J. Clin. Nutr. 20: 422, 1967. GUPTE, S., AND S. MEHTA. Advanced protein-calorie malnutrition: clinical observations on North Indian Children. Pediat. Clin. India 5: 91, 1971. GUPTE, S., S. MEHTA AND B. N. S. WALIA. Small bowel function in protein-calorie malnutrition. Indian Pediat. 7: 481, 1970. GUPTE, S. Nutritional recovery syndrome. New EngI.
J. Med. 293: 1194. 1974. 7. GUPTE, S., Indian infants malnutrition 19, 1975.
J. C. LAL. Mortality among North and children with severe protein-calorie (a preliminary report). Med. Surg. 15:
AND
of folate
Sir:
which may invalidate the the presence in the intestinal lumen of bile, which contains unlabeled folate in concentrations (6, 7) similar to that in the authors’ perfusion fluid. In our experience (N. Colman, L.H. Bernstein, and V. Herbert, unpublished observations), such perfusion yields an aspirate which contains 33 to 66% bile and intestinal fluid. Thus, a significant troduces results,
The Nelson et al article comparing bioavailability of folate from different sources, published in the September issue of the Journal (1), differed from previous triple lumen tube perfusion studies of folate absorption (2-5) because it determined folate absorption from unlabeled material. This inTheAmericanfournal
it be that
of Clinical
Nutrition
29: MARCH
a variable
namely,
1976, pp. 235-241.
Printed
in U.S.A.
235
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Zinc