1213 There were no significant improvements in Apgar scores but the babies did seem to be very active. This series is too small to justify any firm conclusions but the aerosol/tablet regimens was much more convenient and acceptable to patients and nurses than the intravenous regimen. A study of the efficacy of oral salbutamol in the long-term delay of labour and its place in the prevention of R.D.S. is con-
tinuing. Saint Mary’s
Portsmouth PO3 6AD.
FOOD: INFLUENCE OF FORM ON ABSORPTION
SIR Two items in The Lancet of Nov. 8 emphasise the need for experiments to investigate the way that the form in which food is taken, as well as food composition, influence the absorption of fat and carbohydrate in the human small bowel. Dr Heaton’s letter on p. 927 draws attention to the fact that there is increasing evidence that coronary heart-disease is the result of habitual over-nutrition caused largely by eating fibredepleted foods. The ease with which refined foods (particularly
carbohydrates) are eaten and their failure to cause satiety until eaten in excessive quantities is recognised, but what influence does the refinement of a carbohydrate have on its behaviour in the bowel? Does it move faster or slower than its unrefined equivalent? We have shown that the addition of 14.5gof guar flour (a plant storage polysaccharide, undigestible in the human small bowel) to a Lundh type liquid meal (consisting of 35g Casilan, 35 g corn oil, 70 ml of 50% lactulose solution, homogenised with 350 ml of water) prolonged mouth-to-csecum transit-time by 100-125% (see figure) as judged by the first appearance of hydrogen in the breath.’1
in 10 minutes and further blood samples for glucose analysis were taken at 15-minute intervals for 2 hours from commencement of the meal. The order of the test and control meals was randomised and each subject was tested on two consecutive mornings. There was no significant rise or fall of mean blood-glucose levels after the meal containing the guar flour, whereas after the control meal there was a maximum rise of blood-glucose at 30 minutes (279+562 mg/100 ml, mean±S.E.M.) and a maximum fall (hypoglycxmia) at 120 minutes (14-1+2-5 mg/100 ml) (Student’s t test in both cases giving a P value of less than 0.02). These findings of prolonged mouth-to-caecum transit-time and reduction of postprandial glycsemia by the addition to a test meal of an undigestible plant storage polysaccharide indicate that such substances can ’have unexpected and potentially useful effects. While we wholeheartedly support the view that too much is eaten by too many, there now seems to be sufficient evidence to suggest that the physico-chemical properties as well as the composition of food are important and worthy of further study. The hypothesis of Professor Hunt and others on p. 905 stated that, in the more obese individuals of the population, the greater the ratio energy intake/volume of food and drink the greater will be the degree of obesity. While their hypothesis is restricted to obese individuals and their main concern was with the quantity of fluid taken with the food, which one feels certain will prove to be very important, it is clear that the energy intake/volume of food ratio can be reduced by including in the food undigestible substances such as dietary fibres. Although bran has been shown to accelerate rather than slow gastric emptying other dietary fibres have not yet been investigated and may have the opposite effect. Also the rate of gastric emptying may not be the only factor which influences duration of satiety; small-bowel transit-time, which may be influenced by dietary fibre, may also be important. In a study similar to the second one described above, nine subjects ascribed a value of 2-3+0-4 (mean+s.E.M.) to the sensation of hunger experienced 5 hours after a liquid test meal containing guar flour. This assessment was made on an arbitrary scale on which zero represented no hunger and 4 represented the sensation of hunger experienced 5 hours after the control meal (guar-free) (t test: p<0.02). The presence of an unabsorbable plant polysaccharide had clearly prolonged the duration of satiety. While it is not fair to the authors of this hypothesis to read more into it than they intend, there is sufficient epidemiological evidence linking obesity and refined food4 to suggest that in any population the energy density of food, which may be related to the amount of fibre in the food, is probably important in the regulation of the degree of obesity of the individuals. However, does this aspect of food (energy density) operate solely through controlling satiety or is absorption also affected?
A. R. LEEDS M. A. GASSULL G. L. METZ D. J. A. JENKINS
Medical Research Council, U
Gastroenterology Unit, Central Middlesex Hospital,
HOURS Breath hydrogen in stead of glucose.
London NW10 7NS.
With guar flour.
PENTASOMY OF X CHROMOSOME
Is starch digestion by amylase, in vivo, accelerated or slowed by the extraction from food of undigestible carbohydrates? Is the absorption of monosaccharides accelerated or slowed by the absence of "dietary" fibre? There is already some evidence that "dietary" fibres can affect the shape of the glucose-tolerance curve,2 and preliminary studies in this Unit show that postprandial glucose levels are reduced by the addition of 15 g guar flour to a similar Lundh type liquid meal (35 g Casilan, 35g corn oil, 35 g glucose, 350 ml water). Blood samples were taken from four subjects after an overnight fast; the meal was 1. Bond, J. H., Levitt, M. D.J. Lab. clin. Med. 1975, 2 Jeffreys, D. B. Proc. Nuir. Soc. 1974, 33, 11A.
SIR,-Numerical abnormalities of the common, but to
of relatively knowledge only 6 pentasomy X have been previously reported. 5 We describe here a newborn girl with karyotype 49, confirmed by quinacrine-fluorescence banding. Both parents have normal karyotypes. The infant is the second child of healthy unrelated parents (mother aged 29, father 30). She was born by spontaneous vertex delivery after an uneventful our
3. McCance, R. A., Prior, K. M., Widdowson, E. M. Br J Nutr 1953, 7, 98. 4. Trowell, H. Plant Foods for Man, 1975, 1, 157. 5. Brody, J., Fitzgerald, M. G., Spiers, A. S. D.J. Pediat. 1967, 70, 105. 6. Kesaree, N., Woolley, P. V. ibid. 1963, 63, 1099.
lasting 38 weeks. Cytogenetic analysis was because the appearance of the infant suggested Turner’s syndrome. She was small for dates (birth-weight 2260g, head circumference 30.5 cm, length 43 cm). The following physical abnormalities were noted: neck webbing, low posterior hairline with excessive hair, antimongoloid slant to the eyes, wide nasal bridge, a single transverse left palmar crease, and overlapping of the fourth and fifth toes on both feet. A cardiac murmur was also audible. The physical and intellectual development of this infant will be followed with interest.
MEMBRANE FRAGMENTS WITH KOINOZYMIC PROPERTIES RELEASED FROM VILLOUS ADENOMA OF THE RECTUM
Cytogenetics Unit, State Health Laboratories Perth, Western Australia. 158 High Street, Fremantle, Western Australia.
SIR,-We read with interest the letter from Dr Chandler and his colleagues (Nov. 8, p. 931) describing particles associated with microvillous border of pig intestinal mucosa and advancing the hypothesis that these could be fragments released from the brush border. Chandler’s pictures are similar to fig. 5a of Hollman and Staubli,’ who studied 93 cases of human rectal polyposis. We wish to report on the release of membrane fragments from the microvilli of a hypersecreting villous adenoma of the
MARIE T. MULCAHY J. B. STEVENS
SIR,—Dr Coles and others report (Nov. 15, p. 978) that only 50% of mothers breast-feeding on discharge from hospital still doing so at two months. We have recently studied infant feeding patterns in a geographically identified area of London (South Camden), and over 95% of mothers with children under 5 years of age living in the area have been seen. The proportion of mothers who attempted to breast-feed and the proportion who were still breast-feeding at three weeks are shown in the accompanying table. 50% of our mothers had
MOTHERS WHO ATTEMPTED TO BREAST-FEED AND MOTHERS STILL BREAST-FEEDING AFTER THREE WEEKS, BY SOCIAL-CLASS DISTRIBUTION
4 in starch
6 anode, -
isozymes observed in native secretion fluid of villous of secretion fluid, appearing with the void volume in Sepharose 4B. 3, A.P. isozymes of secretion fluid with Vo/Ve value of 0, 53 in Sepharose 4B. 4, serum-A.P. isozymes of patient with villous adenoma. 5, serum-A.P. of patient with focal cholestasis, showing liver and koinozymic type ofA.P. 6, serum-A.p. of patient with cirrhosis, showing liver and intestinal type of A.P. 1,
up breast-feeding by three weeks, and we wonder if the mothers whom Coles et al. report, having given up breast-feeding by two months had not already done so five weeks earlier. Our data also demonstrate very dramatic social-class differences. Precisely those babies whom one would most like to see being breast-fed are not breast-fed at the moment. We would be the first to applaud the appointment of "lactation nurses", but this is not enough. About half the mothers who fail to establish full lactation report things beginning to go wrong in hospital: despite the presence of "lactation staff", at hours when these are not present other, less experienced, staff give contradictory and confusing advice. A further group of mothers "fail" during their first two or three days at home, often before the community services are aware that the mother and baby have been discharged. We firmly believe that the best person to remedy this situation is the health visitor.’ We are now asking our health visitors to conduct the antenatal discussions about feeding, visit the mother in the obstetric unit, and have immediate contact with the mother when she is home. We stress to the mothers that breast-feeding is not necessarily fully established during their hospital stay (particularly in those babies whose mothers have obstetric medication during delivery), and reassure them that one competent friend (their health visitor) is available with help and advice throughout the whole period of lactation; we shall report the results of this approach.
Thomas Coram Research Unit, 41 Brunswick Square, London WC1N 1AZ.
MARTIN C. O. BAX HILARY HART
Sloper, K., McKean, L., Baum, J. D. Archs Dis. Childh. 1975, 50, 165. Richards, M. P. M., Bernal, J. F. Findings of the Third International Congress on Psychosomatic Medicine in Obstetrics and Gynæcology. Basle (in the press).
Fig. 2-Koinozymic fraction collected on Millipore filter stained for A.P. pH 9.0 with &bgr;-glycerophosphate. Positive reaction evidenced by leadphosphate precipitate. at
- .Triple-layered membrane ofA.p.-positive vesicles. A.p.-non-reactive vesicle.
in a 74-year-old man. The fluid originating from this contained alkaline phosphatase (A.P.) with a particular isozyme pattern as revealed in starch gel (fig. 1) and in other media.
Of specific interest is the macromolecular component for some 65% of the total A.P. activity in this secretion. This component has the behaviour of the koinozymic fraction we described for human serum-A.P.2-4 In particular, this component appears with the void 1. Hollman, K. H., Staubli, W.J. Microsc. 1962, 1, 137. 2. de Broe, M. E., Wieme, R. J. Isozymes; p. 799. New York, 1975. 3. de Broe, M. E., Borgers, M., Wieme, R. J. Clin. chim. Acta, 1975, 4. Wieme, R. J., de Broe, M. E. Clin. Chem. 1975, 21, 1008.