An unexplained illness in children aged 15 years and younger in Muzaffarpur, Bihar, which claims many lives in May-June, has been solved. Scientists from the U.S. and India have found that consumption of litchi fruit and skipping evening meal can result in very low blood glucose level (less than 70 mg/dL) and acute encephalopathy that provokes seizures and coma, and causes death in many cases. This is particularly so in the case of young children as they have limited hepatic glycogen reserves. Hypoglycin A and methylenecyclopropylglycine (MCPG), which are naturally present in litchi fruit, make the condition worse. The toxins block enzymes involved in normal glucose metabolism and this results in an inability to synthesis glucose leading to acutely low level of blood sugar. The build-up of other metabolic by-products could also have an adverse effect (encephalopathy) on the child. These two cause death in many children. The study shows the modifying effect of skipping the evening meal on the impact of these toxins. In 2013, scientists from Delhi’s National Centre for Disease Control, India (NCDC) and the U.S. Centres for Disease Control and Prevention (CDC) started an investigation. The first focus of the team was to evaluate if the mysterious condition was due to an infectious cause or not. Following the study, the Indian government issued a public health recommendation to minimize the consumption of lychee fruit among children in the affected regions, and to ensure they eat dinner during the outbreak period. The cases of illness reportedly fell to less than 50 in the past year. The researchers said they believe their study may help shed light on similar outbreaks in lychee-growing regions in Bangladesh and Vietnam, although thorough investigations in those areas are yet to be done.