American Journal of Clinical Nutrition, Vol 21, 1042-1052, Copyright © 1968 by The American Society for Clinical Nutrition, Inc.

Malabsorption and Malnutrition in Rural Haiti

¹ From the Hôpital Albert Schweitzer, Deschapelles, Haiti, Columbia University College of Physicians and Surgeons, New York City, and the University of Rochester School of Medicine and Dentistry, Rochester, New York

Studies of jejunal morphology and function and hematologic and biochemical determinations relevant to the state of nutrition have been performed in 61 residents of rural Haiti who, on the basis of clinical symptoms and the presence or absence of megaloblastic erythropoiesis, have been divided into three groups: tropical sprue, protein deficient, and asymptomatic. Jejunal morphology was found to be abnormal in all 61 subjects studied; xylose absorption was subnormal in all subjects except five asymptomatic persons; and the absorption of vitamin B₁₂ was subnormal in every subject tested with the exception of three asymptomatic persons. In general, abnormalities of intestinal morphology and function were most severe in patients with overt tropical sprue, less severe in subjects with protein deficiency, and mildest in asymptomatic subjects. The incidence of anemia and dieficiencies of vitamin B₁₂, albumin, calcium, and cholesterol was highest in subjects with tropical sprue and protein deficiency.

Twenty-three patients, equally divided between those with tropical sprue, protein deficiency and those asymptomatic, were treated with folic acid, tetracycline, or both, without dietary supplementation. Clinical improvement with weight gain was prominent both in patients with tropical sprue and those with protein deficiency. Improvement in jejunal morphology and absorptive capacity and in nutritional deficiencies occurred in all of the patients with tropical sprue and in some of the other subjects.

These observations indicate that abnormalities of jejunal morphology are ubiqquitous in this population, that malabsorption is common, and that these intestinal changes are associated with a spectrum of clinical manifestations and laboratory abnormalities. They suggest that malabsorption may be of relevance in the etiology of some nutritional deficiencies even in the absence of overt manifestations of intestinal disease. Although the etiologic factors responsible for the intestinal abnormalities may well be multiple, the beneficial effect of treatment with folic acid or tetracycline that was evident in some subjects who were either protein deficient or asymptomatic suggests that their intestinal disease was a subclinical form of tropical sprue.