Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-26T12:08:05.808Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of an energy-dense diet on the clinical course of acute shigellosis in undernourished children

Published online by Cambridge University Press:  09 March 2007

Ramendra N. Mazumder ,
Hassan Ashraf ,
Syed S. Hoque ,
Iqbal Kabir ,
Naseha Majid ,
Mohammad A. Wahed ,
George J. Fuchs  and
Dilip Mahalanabis
Hassan Ashraf
Affiliation:
International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B) GPO Box 128, Dhaka 1000, Bangladesh
Syed S. Hoque
Affiliation:
International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B) GPO Box 128, Dhaka 1000, Bangladesh
Iqbal Kabir
Affiliation:
International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B) GPO Box 128, Dhaka 1000, Bangladesh
Naseha Majid
Affiliation:
International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B) GPO Box 128, Dhaka 1000, Bangladesh
Mohammad A. Wahed
Affiliation:
International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B) GPO Box 128, Dhaka 1000, Bangladesh
George J. Fuchs
Affiliation:
International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B) GPO Box 128, Dhaka 1000, Bangladesh
Dilip Mahalanabis
Affiliation:
International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B) GPO Box 128, Dhaka 1000, Bangladesh
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

To date there have been few reports on the impact of dietary intervention on the clinical course of acute shigellosis. Current management of acute shigellosis is primarily focused on antibiotic therapy with less emphasis on nutritional management. In a randomised clinical trial, we examined the role of an energy-dense diet on the clinical outcome in malnourished children with acute dysentery due to shigellosis. Seventy-five children aged 12–48 months with acute dysentery randomly received either a milk–cereal formula with an energy density of 4960 kJ/l (test group) or a milk–cereal formula with energy of 2480 kJ/l (control group) for 10 d in hospital. In both milk–cereal formulas, protein provided 11 % energy. In addition, the standard hospital diet was offered to all children and all children received an appropriate antibiotic for 5 d. The mean food intakes (g/kg per d) in the test and control groups were: 112 (SE 2·28) AND 116 (se 3·48) (P=0·16) on day 1; 118 (se 2·72) and 107 (se 3·13) (P=0·04) on day 5; 120 (se 2·25) and 100 (se 3·83) (P=0·04) on day 10. The mean energy intakes (kJ/kg per d) in the test and control groups respectively were: 622 (se 13·2) and 315 (se 11·3) (P<0·05) on day 1; 655 (se 15·1) and 311 (se 7·98) (P<0·05) on day 5; 672 (se 14·7) and 294 (se 11·1) (P<0·05) on day 10. The food and energy intakes were mostly from the milk–cereal diet. There was no difference between two groups in resolution of fever, dysenteric (bloody and or mucoid) stools, stool frequency and tenesmus. However, vomiting was more frequently observed among the test-group children during the first 5 d of intervention (67 % v. 41 %, P=0·04). There was an increase in the mean weight-for-age (%) in the test group compared with the control group after the 10 d of dietary intervention (6·2 (se 0·6) v. 2·7 (se 0·4), P<0·01). In addition, resolution of rectal prolapse was better (26 % v. 8 %, P=0·04) in the test group v. control group after 5 d, and 13 % v. 6 %, (P=0·08) after 10 d of dietary intervention. Supplementation with a high-energy diet does not have any adverse effect on clinical course of acute shigellosis and reduces the incidence of rectal prolapse in malnourished children.

Keywords

ShigellosisMalnutritionRectal prolapseChildrenEnergy-dense diet
Type
Research Article
Information
British Journal of Nutrition , Volume 84 , Issue 5 , November 2000 , pp. 775 - 779
Copyright
Copyright © The Nutrition Society 2000

References

Bennish, ML (1991) Potentially lethal complications of shigellosis. Review of Infectious Disease 13 (Suppl. 4), pp. S319–S324.CrossRefGoogle ScholarPubMed
Bennish, ML, Harris, JR, Wojtyniak, BJ and Struelens, M (1990) Death in shigellosis: incidence and risk factors in hospitalised patients. Journal of Infectious Disease 161, pp. 500–506.CrossRefGoogle Scholar
Black, RE, Brown, KH and Becker, S (1984) Effects of diarrhoea associated with specific enteropathogens on the growth of children in rural Bangladesh. Paediatrics 73, pp. 799–805.CrossRefGoogle ScholarPubMed
Black, RE, Merson, MH, Rahman, ASMM, Yunus, M, Alim, ARMA, Huq, MI, Yolken, RH and Curlin, GT (1980) A two-year study of bacterial, viral, and parasitic agents associated with diarrhoea in rural Bangladesh. Journal of Infectious Disease 142, pp. 660–664.CrossRefGoogle ScholarPubMed
Briend, A, Dykewicz, C, Graven, K, Mazumder, RN, Wojtyniak, B and Bennish, M (1986) Usefulness of nutritional indices and classification in predicting death of malnourished children. British Medical Journal 293, pp. 373–375.CrossRefGoogle ScholarPubMed
Hamil, PVV (1977) NCHS Growth Curve for Children birth–18 years, United States, DHEW publication no. (PHS) 78-165, Vital and Health Statistics, series 11, no.165. Hyattsville, MD: National Center for Health Statistics.Google Scholar
Henry, FJ, Alam, N, Aziz, KMS and Rahaman, MM (1987) Dysentery not watery diarrhoea is associated with stunting in Bangladeshi children. Human Nutrition: Clinical Nutrition 41C, pp. 243–249.Google Scholar
International Centre for Diarrhoeal Disease Research, Bangladesh (1994) Annual Report. Dhaka: ICDDR, B.Google Scholar
Kabir, I, Malek, MA, Mazumder, RN and Mahalanabis, D (1993) Rapid catch-up growth of children fed a high protein-diet during convalescence from shigellosis. American Journal of Clinical Nutrition 57, pp. 441–445.CrossRefGoogle ScholarPubMed
Katz, SL (1986) The burden of disease resulting from diarrhoea. In New Vaccine Development: Establishing Priorities. Diseases of Importance in Developing Countries, pp. 165. [Katz, SL,editors]. Washington, DC: National Academy Press.Google Scholar
Mackle, EJ and Parks, TG (1986) The pathogenesis and pathophysiology of rectal prolapse and solitary rectal prolapse syndrome. Clinical Gastroenterology 15, pp. 985–1002.Google Scholar
Martorell, R, Yarbrough, C, Lechtig, A, Habicht, JP and Klein, RE (1975) Diarrhoeal diseases and growth retardation in pre-school Guatemalan children. American Journal of Physiological Anthropology 43, pp. 341–346.CrossRefGoogle ScholarPubMed
Molla, AM, Molla, A, Sarker, SA, Rahaman, MM (1983) Food intake during and after recovery from diarrhoea in children. In Diarrhoea and Malnutrition: Interactions, Mechanisms and Interventions. pp. 155–160. [Chen, LC and Scrimshaw, NS, editors]. New York, NY: Plenum Press.Google Scholar
Rowland, MGM, Cole, TJ and Whitehead, RG (1977) A quantitative study into the role of infection in determining nutritional status in Gambian village children. British Journal of Nutrition 37, pp. 441–450.CrossRefGoogle ScholarPubMed
Scrimshaw, NS (1977) Effect of infection on nutrient requirements. American Journal of Clinical Nutrition 30, pp. 1536–1544.CrossRefGoogle ScholarPubMed
Struelens, MJ, Patte, D, Kabir, I, Salam, MA, Nath, SK and Butler, T (1985) Shigella septicaemia: prevalence, presentation, risk factors and outcome. Journal of Infectious Disease 152, pp. 784–790.CrossRefGoogle ScholarPubMed
Tomkins, A (1981) Nutritional status and severity of diarrhoea among pre-school children in rural Nigeria. Lancet 1, pp. 860–862.CrossRefGoogle ScholarPubMed
Victoria, CG, Huntly, SRA, Fuchs, SC and Barrows, FC (1993) International difference in clinical patterns of diarrhoeal deaths: a comparison of children from Brazil, Senegal, Bangladesh, and India. Journal of Diarrhoeal Disease Research 11, pp. 25–29.Google Scholar
World Health Organization (1994) Programme for the Control of Diarrhoeal Diseases. The Management of Bloody Diarrhoea in Young Children. WHO/CDD/94.49. Geneva: WHO.Google Scholar