Randomized clinical trial Effect of honey on gastric emptying of infants with protein energy malnutrition Sanaa Youssef Shaaban, Mamdouh Abdulmaksoud Abdulrhman, May Fouad Nassar and Rasha Adel Fathy Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt ABSTRACT Background Patients with protein-energy malnutrition (PEM) have delayed gastric emptying time (GET) which may affect nutritional rehabilitation. This study was designed to examine the effect of honey on GET during nutri- tional rehabilitation of PEM patients. Patients and methods Thirty patients were enrolled and randomly assigned to one of two equal groups. One group received conventional nutritional rehabilitation therapy and the other received honey in addition. They were compared with 20 age- and sex-matched controls. History taking, clinical examination and laboratory tests were performed for enrolled cases and GET was assessed using abdominal ultrasonography. These parameters were performed before and 2 weeks after nutritional rehabilitation. Results The GET was significantly delayed in the PEM groups compared with the controls. Further significant delay occurred in the honey supplemented group after nutritional rehabilitation, while the un-supplemented group showed significant shortening of GET. The improvement of anthropometric measurements and laboratory parameters was equally noticed in the two PEM groups upon nutritional rehabilitation but their rate of change was distinctly higher, although non-significant, in the group supplemented with honey. Conclusion Honey supplementation increased GET in PEM patients with positive effect on the improvement in the anthropometric measurements and serum albumin which makes us wonder that this delay in GET might be primarily a compensatory phenomenon and it was augmented by the use of honey. Larger scale studies with longer term follow up are recommended to further clear this point and assess any changes in the absorptive indices in honey supplemented PEM patients. Keywords Gastric emptying, honey, nutritional rehabilitation, protein energy malnutrition. Eur J Clin Invest 2010; 40 (5): 383–387 Introduction Protein energy malnutrition (PEM) remains as one of the most important health problems in developing countries [1]. Shaaban et al. [2] previously reported that the gastric emptying time (GET) is delayed in patients with PEM especially the marasmic kwashiorkor and the marasmic patients and recommended that this point must be considered during nutritional rehabilitation of those patients. Honey is a substance which is made up of the nectar and sweet deposits from plants gathered, modified and stored in the honeycomb by honey bees. It is composed primarily of the sugars glucose and fructose; its third greatest component is water. Honey also contains numerous other types of sugars, as well as acids, proteins and minerals [3,4]. Honey is a natural substance with a lot of benefits for nutrition and health [5]. Among honey benefits are its anti-inflammatory [6], anti-oxidant [7–9] and anti-microbial effects [10–14] and knowing the pathogenesis of PEM such patients are expected to benefit from honey. Therefore, we planned to test the effects of honey on PEM patients from dif- ferent aspects starting by the gastrointestinal tract. Honey was reported by Naguib et al.[15] to increase residual gastric volume if taken by patients 2 h before surgery; however, the patients did not suffer any consequence especially rise in gastric pH, did not regurgitate or aspirate and thus were not more prone to acid pneumonitis syndrome. Additionally Sha- aban et al. [2] did not report any harm occurring to their PEM patients from the prolonged GET. This study was thus designed to evaluate the effect of addi- tion of honey on the GET during the nutritional rehabilitation of PEM patients. European Journal of Clinical Investigation Vol 40 383 DOI: 10.1111/j.1365-2362.2010.02280.x ORIGINAL ARTICLE