Nutritional Management of Acute Diarrhea in Infants and Children (1985) / Chapter Skim
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1. Nutritional Consequences of Acute Diarrhea
1. Nutritional Consequences of Acute Diarrhea
Pages 1-10
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In a malnourished child, even a brief episode of diarrhea can seriously affect nutritional status and require prompt attention to prevent further nutritional deterioration and its consequences. Furthermore, the high frequency of diarrhea allows less time for recovery and catch-up growth between episodes.
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The potential for the accelerated deterioration of nutritional status demands that lost fluids and nutrients be rapidly replaced. DECREASE IN DIETARY INTAKE Hospital-based investigations of dietary intake by children with diarrhea have consistently shown a reduction in food intake, and hence caloric intake, during their illness.
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In contrast, a recent study of Bangladeshi infants, who were still receiving most of their dietary energy from breast milk, did not find significant decreases in energy intake during diarrhea.6 Many explanations for the observed reductions in energy intake are possible, including food withholding (as dictated by parental beliefs or recommendations by health-care personnel) , substitution of nutrient-poor Dehydration solutions for other dietary components, reduction in the nutrient density of the diet, vomiting, and anorexia.
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Mucosal renewal probably requires stimulation by the diet and pancreatic secretions. During chronic starvation and after acute withdrawal of food, mucosal cell turnover and production of brush-border hydrolytic enzymes decrease.
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__ · Transient malabsorption of carbohydrates has been observed often, especially in episodes of viral origin.24~42 This malabsorption is presumably caused by secondary disaccharidase deficiencies, impairment in monosaccharide transport, alterations in intestinal motility, and loss of intestinal surface area. It remains unknown whether intestinal infections alter pancreatic function, either directly or by reducing the endocrine stimulation of pancreatic secretion by damaged intestinal mucosa.
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This points to a nutritional advantage of continued feeding. In the few comparative studies that have been completed, increasingly high dietary intakes were associated with absorption of increasingly high amounts of ingested nutrients.7~12~26 Nutrient-balance studies, which measure the amounts of specific nutrients ingested and excreted in feces, do not distinguish between the excretion of exogenous (dietary)
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Although there is no consensus on the extra nutrient requirements for tissue accretion during catch-up growth, estimates of 5-8 kcal and approximately 0.4 g of protein per gram of desired gain of lean body mass appear reasonable. The daily caloric requirement for growth is approximately 2% of the recommended energy intake for a 2-year-old child.49 If diet is not limiting, catch-up growth after diarrhea might be as much as 7 times as great as average daily
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Colonic bacterial fermentation of unabsorbed carbohydrate that reaches the large intestine produces short-chain organic acids, increases the number of small molecules, and thus contributes to systemic acidosis and augments diarrhea.47 Dietary intake that exceeds intestinal absorptive capacity can result in a greater risk of dehydration, electrolyte imbalance, and systemic acidosis.
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Early studies of food intake during diarrhea found increased fecal losses in children who ate more. However, these studies used milk-based diets.12 Human milk appears to be well tolerated.8 Recent studies with lactose-free diets have found no increase in severity of diarrhea among children who consumed these diets, compared with children who received only oral glucose-electrolyte solutions.7~44
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