Imperial College London
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Dr Kevin Walsh

Faculty of Medicine, Department of Medicine

Honorary Research Fellow
 
 
 
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Contact

 

k.walsh13 Website

 
 
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Location

 

Commonwealth BuildingHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Walsh:2018:10.12688/wellcomeopenres.14706.1,
author = {Walsh, K and Calder, N and Olupot-Olupot, P and Ssenyondo, T and Okiror, W and Okalebo, CB and Muhindo, R and Mpoya, A and Holmes, E and Marchesi, J and Delamare, de la Villenaise de Chenevarin G and Frost, G and Maitland, K},
doi = {10.12688/wellcomeopenres.14706.1},
journal = {Wellcome Open Research},
title = {Modifying Intestinal Integrity and MicroBiome in Severe Malnutrition with Legume-Based Feeds (MIMBLE 2.0): protocol for a phase II refined feed and intervention trial},
url = {http://dx.doi.org/10.12688/wellcomeopenres.14706.1},
volume = {3},
year = {2018}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background: Changes in intestinal mucosal integrity and gut microbial balance occur in severe acute malnutrition (SAM), resulting in treatment failure and adverse clinical outcomes (gram-negative sepsis, diarrhoea and high case-fatality). Transient lactose intolerance, due to loss of intestinal brush border lactase, also complicates SAM, thus milk based feeds may not be optimal for nutritional rehabilitation. Since the gut epithelial barrier can be supported by short chain fatty acids, derived from microbiota fermentation by particular fermentable carbohydrates, we postulated that an energy-dense nutritional feed comprising of legume-based fermentable carbohydrates, incorporated with lactose-free versions of standard World Health Organization (WHO) F75/F100 nutritional feeds will enhance epithelial barrier function in malnourished children, reduce and promote resolution of diarrhoea and improve overall outcome. Methods: We will investigate in an open-label trial in 160 Ugandan children with SAM, defined by mid-upper arm circumference <11.5cm and/or presence of kwashiorkor. Children will be randomised to a lactose-free, chickpea-enriched feed containing 2 kcal/ml, provided in quantities to match usual energy provision (experimental) or WHO standard treatment F75 (0.75 kcal/ml) and F100 (1 kcal/ml) feeds on a 1:1 basis, conducted at Mbale Regional Referral Hospital nutritional rehabilitation unit. The primary outcomes are change in MUAC at day 90 and survival to day 90. Secondary outcomes include: i) moderate to good weight gain (>5 g/kg/day), ii) de novo development of diarrhoea (>3 loose stools/day), iii) time to diarrhoea resolution (if >3 loose stools/day), and iv) time to oedema resolution (if kwashiorkor) and change in intestinal biomarkers (faecal calprotectin). Discussion: We hypothesize that, if introduced early in the management of malnutrition, such lactose-free, fermentable carbohydrate-based feeds, could safely and cheaply improve global outco
AU  - Walsh,K
AU  - Calder,N
AU  - Olupot-Olupot,P
AU  - Ssenyondo,T
AU  - Okiror,W
AU  - Okalebo,CB
AU  - Muhindo,R
AU  - Mpoya,A
AU  - Holmes,E
AU  - Marchesi,J
AU  - Delamare,de la Villenaise de Chenevarin G
AU  - Frost,G
AU  - Maitland,K
DO  - 10.12688/wellcomeopenres.14706.1
PY  - 2018///
SN  - 2398-502X
TI  - Modifying Intestinal Integrity and MicroBiome in Severe Malnutrition with Legume-Based Feeds (MIMBLE 2.0): protocol for a phase II refined feed and intervention trial
T2  - Wellcome Open Research
UR  - http://dx.doi.org/10.12688/wellcomeopenres.14706.1
UR  - http://hdl.handle.net/10044/1/62365
VL  - 3
ER  -
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