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Persistent diarrhoea: efficacy of a rice-based diet and role of nutritional status in recovery and nutrient absorption

Published online by Cambridge University Press:  09 March 2007

S. K. Roy
Affiliation:
International Centre for Diarrhoea1 Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
S. M. Akramuzzaman
Affiliation:
International Centre for Diarrhoea1 Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
R. Haider
Affiliation:
International Centre for Diarrhoea1 Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
M. Khatun
Affiliation:
International Centre for Diarrhoea1 Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
M. S. Akbar
Affiliation:
Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
R. Eeckels
Affiliation:
International Centre for Diarrhoea1 Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
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Abstract

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A diet based on rice powder, soya-bean oil, glucose, egg-white and salts was given to twenty-six patients of different nutritional status aged 4–18 months with persistent diarrheoa and twenty-five age-matched controls without diarrhoea. Clinical response was monitored during 1 week of dietary treatment and absorption of macronutrients was estimated during a 72 h balance study. Twenty-one patients (81 %) recovered from diarrhoea within 7 d. There were significant relationships between nutritional indices, recovery, and absorption of total energy, fat and N. The absorption of fat, protein and carbohydrate in the better nourished controls without diarrhoea was significantly higher than in patients with persistent diarrhoea with better nutrition or malnutrition. The duration of diarrhoea was significantly longer in lighter patients (weight-for-age < 65% NCHS (1976) standard), in wasted patients (weight/height < 80% of NCHS) and those with mid upper arm circumference (MUAC) less than 110 mm. There were negative relationships between the period of recovery and the coefficient of absorption of fat (P < 0·001), total energy intake (P < 0·01) and MUAC (P < 0·05). Weight-for-age and MUAC showed most effective discriminative power for absorption of nutrients. However, the coefficients of absorption for carbohydrate were not different for any pair of nutritional groups. Absorption of all nutrients was also correlated negatively with severity of persistent diarrhoea on admission. The results of the present study indicate that a rice-based diet is highly effective in the management of persistent diarrhoea, while malnutrition aggravates nutrient malabsorption, increases duration and severity of diarrhoea and less severely malnourished patients do not absorb nutrients as well as healthy controls. Malnutrition and the initial severity of diarrhoea are significant determinants of clinical prognosis and nutrient absorption in persistent diarrhoea.

Type
Persistent Diarrhoea and Rice-Based Diet
Copyright
Copyright © The Nutrition Society 1994

References

REFERENCES

Bhandari, N., Bhan, M. K., Sazawal, S., Clemens, J. D., Bhat Nagar, S. & Khossoo, V. (1989). Association of antecedent malnutrition with persistent diarrhoe case control study. British Medical Journal 298, 12841287Google Scholar
Bhave, S. A., Pandit, A. N. & Agarkhedker, S. R. (1983). Protracted diarrhoea and its management. Indian Journal of Pediatrics 20, 173178.Google Scholar
Briend, A., Dykewicz, C., Graven, K., Mazumder, R. N., Wojtyniak, B. & Bennish, M. (1986). Usefulness of nutritional indices and classifications in predicting death of malnourished children. British Medical Journal 293, 373375.Google Scholar
Cash, R. A., Toha, K. M. M., Nalin, D. R., Huq, Z. & Phillips, R. A. (1969). Acetate in the correction of acidosis secondary to diarrhoea. Lancet ii, 302304.Google Scholar
Chandra, R. K., Pawa, R. R. & Ghai, O. P. (1968). Sugar intolerance in malnourished infant and children. British Medical Journal 4, 611613.Google Scholar
Chen, L. C., Chowdhury, A. K. M. A. & Huffman, S. L. (1980). Anthropometric assessment of energy protein malnutrition and subsequent risk of mortality among pre-school aged children. American Journal of Clinical Nutrition 33, 18361845.Google Scholar
Gracey, M. & Stone, D. E. (1972). Small intestinal microflora in Australian aboriginal children with chronic diarrhoea. Australian and New Zealand Journal of Medicine 3, 315318.Google Scholar
Henry, R. J. (1964). Clinical Chemistry Principles and Techniques. New York: Harper and Row.Google Scholar
Jackson, D., Walker-Smith, J. A. & Philip, A. D. (1983). Macromolecular absorption by histologically normal and abnormal small intestinal mucosa in childhood: an in vitro study using organ culture. Journal of puediatric Gustroenterology and Nutrition 23, 235247.Google Scholar
Jain, M. K., Bhui, P. S., Mehta, N. J., Taskar, S. P., Sane, S. Y. & Mehta, A. P. (1986). Pancreatic function in malnourished children. In Diarrhoea and Malnutrition in Childhood, pp. 142146. [ Walker-Smith, J. A. and McNeish, A. S., editors]. London: Butterworths.Google Scholar
Larcher, V. F., Shepard, R., Francis, D. E. M. & Harries, J. T. (1977). Protracted diarrhoea in infancy: analysis of 82 cases with particular reference to diagnosis and management. Archives of Disease in Childhood 52, 597605.Google Scholar
Mata, L. J., Kronmal, R. A., Urrutia, J. J. & Gracia, B. (1977). Effect of infection on food intake and the nutritional status. Perspectives as viewed from the village. American Journal of Clinical Nutrition 30, 12151277.Google Scholar
Molla, A., Molla, A. M., Rahim, A., Sarker, S. A., Mozaffar, Z. & Rahman, M. (1982). Intake and absorption of nutrients in children of cholera and rota virus infection during acute diarrhoea and after recovery. Nutrition Research 2, 233242.Google Scholar
NCHS (1976). Growth Charts. Health Resources Administrution Publication. HRA 76–1120,25,3. Rockville Pike, Md.: United States Public Health Service.Google Scholar
Palmer, D. L., Koster, F. T., Alam, A. K. M. J. & Islam, M. R. (1976). Nutritional status: A determinant of the severity of diarrhoea in patients with cholera. Journal of Infectious Diseases 134, 814.Google Scholar
Roy, S. K., Akramuzzaman, S. M. & Akbar, M. S. (1991). Persistent diarrhoea: Total gut transit time and its relationship with nutrient absorption and clinical response. Journal of Pediatric Gastroenterology and Nutrition 13, 409414.Google Scholar
Roy, S. K.. Alam, A. N., Majid, N., Khan, A. M. I, Hamadani, J. & Shome, G. P. (1989). Persistent diarrhoea: A preliminary report on clinical features and dietary therapy in Bangladeshi children. Journal of Tropical Pediatrics 35, 5559.Google Scholar
Roy, S. K., Behrens, R. H., Haider, R., Akramuzzaman, S. M., Mahalanabis, D., Wahed, M. A. & Tomkins, A. M. (1992). Impact of zinc supplementation on intestinal permeability in children with acute and persistent diarrhoea. Journal of Paediatric Gastroenterology and Nutrition 15, 289296.Google Scholar
Roy, S. K., Chowdhury, A. K. M. A. & Rahaman, M. M. (1983). Excess mortality among children discharged from hospital after treatment for diarrhoea in rural Bangladesh. British Medical Journal 287, 10971099.Google Scholar
Roy, S. K., Haider, R., Akbar, M. S., Alam, A. N., Khatun, M. & Eeckels, R. (1990). Persistent Diarrhea: Clinical efficacy and nutrient absorption with a rice based diet. Archives of Disease in Childhood 65, 294297.Google Scholar
Scrimshaw, N. S., Tayler, C. E. & Gordon, G. E. (1968). Interaction of Nutrition and Infection. World Health Organization Monograph Series no. 57. Geneva: WHO.Google Scholar
Tomkins, A. (1981). Nutritional status and severity of diarrhoea among preschool children in rural Nigeria. Lancet i, 860864.Google Scholar
Van de Kamer, J. H. I, TenBokkel Huinik, H. & Weyers, H. A. (1949). Rapid method of determination of fat in faeces. Journal of Biological Chemistry 117, 347355.Google Scholar
Waterlow, J. C. (1972). Classification and definition of protein-calorie malnutrition. British Medical Journal 3, 566569.Google Scholar
Whittington, P. E. & Gibson, R. (1977). Soy-Protein intolerance, four patients with concomitant cow's milk intolerance. Pediatrics 59, 730732.Google Scholar