Effect of continued oral feeding on clinical and nutritional outcomes of acute diarrhea in children

Brown, Kenneth H.; Gastañaduy, Arturo S.; Saavedra, José M.; Lembcke, Jorge; Rivas, Diana; Robertson, Alastair D.; Yolken, Robert H.; Sack, R. Bradley

doi:10.1016/s0022-3476(88)80055-6

Cited by 149 publications

(83 citation statements)

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“…Tanto los niños que recibieron fórmula completa (110 kcal/kg/día) como aquellos a quienes se les administró fórmula a media dilución por dos días, seguida de fórmula completa, a partir del inicio del manejo dietético, mostraron mayor absorción y retención de nitrógeno, reflejada en mayor ganancia de peso, circunferencia braquial y pliegues cutáneos, que los niños que fueron sometidos inicialmente a periodos variables de ayuno. 25 Los resultados del presente estudio pueden apoyar las intervenciones de manejo dietético del niño con diarrea aguda. Las decisiones de la madre sobre el manejo en el hogar de su hijo enfermo van formando parte de las prácticas culturales de la comunidad, y están influidas por diferentes aspectos, incluyendo el consejo * Evaluado por las madres mediante una apreciación cualitativa, que fue de 0 = "Sin apetito" a +++= "Muy buen apetito" ‡ El número de niños varía en cada tiempo de evaluación porque no siempre se encontró presente la madre para dar su apreciación sobre el apetito de su hijo de sus mayores (sobre todo de sus madres y sus suegras), su propia experiencia en el manejo de episodios similares anteriores y el consejo médico.…”

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“…[17][18][19] En diversos estudios se ha demostrado que, entre las ventajas de la alimentación sostenida durante la diarrea, están la recuperación más rápida de la fisiología alterada, incluyendo la absorción intestinal; 20,21 asimismo, los episodios diarreicos se hacen más cortos [22][23][24] y hay mayor ganancia de peso de los niños durante y después del episodio diarreico. 25 Con base en estas evidencias, la recomendación actual de la Organización Mundial de la Salud es que se mantenga la alimentación durante el episodio diarreico, dando preferencia a los alimentos a los que el niño esté habituado. 26 La mayoría de estos estudios están enfocados ya sea al uso de fórmulas lácteas hidrolizadas o elementales, o bien, los alimentos específicos, pero en ningún caso en el contexto de una dieta que se propone a las madres para que la preparen en el hogar.…”

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Alimentación sostenida durante diarrea aguda en niños menores de cinco años

1998

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ARTÍCULO ORIGINAL Alimentación durante diarrea agudaMartínez-Salgado H, Diez-Urdanivia S, Meneses-Díaz LM. Sustained feeding during acute diarrhea in children younger than five years of age. Salud Publica Mex 1998;40:141-149. AbstractObjective. To identify locally available and culturally acceptable foods for children with acute diarrhea, and test their acceptance and effect on the child's weight. Material and methods. 142 mothers of children younger than five years of age living in rural communities were interviewed to indentify culturally accepted diets by means of group sorting. These were displayed in a multidimensional scale. A descriptive study was performed of the clinical course of 54 children, ages 4 to 50 months who received the designed diets during the first 48 hours of diarrhea. Results. The designed diets considered age of the child, and stage of the disease. Children spent 47.6 ± 22.2 h in the hospital during which they consumed 44.8 ± 28.6 kcal/kg/day (additional to breast milk) and they gained 70.6 ± 179.7 g. A direct relationship was observed between increasing age and larger caloric intake, and between this and greater weight gain. Conclusion. Children showed good acceptance of diets. Caloric intake was enough to prevent weight loss.

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Alimentación sostenida durante diarrea aguda en niños menores de cinco años

1998

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“…Data were excluded from the analyses if infections, diarrhea [defined as three or more liquid stools/24 h with or without accompanying blood or mucus ( 6 ) ] , or steatorrhea (defined as fecal fat in excess of 15% of fat intake) occurred during energy balance studies. A total of 18 children completed two energy balance studies, the first in early recovery and the second in late recovery.…”

Section: Methodsmentioning

confidence: 99%

A New Model for Predicting Energy Requirements of Children during Catch-Up Growth Developed Using Doubly Labeled Water

1989

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ABSTRACT. Energy partitioned to maintenance plus activity, tissue synthesis, and storage was measured in 41 children in early recovery [W/L (wtllength) < 5th percentile] from severe protein-energy malnutrition and in late recovery (WIL = 25th percentile) to determine energy requirements during catch-up growth. Metabolizable energy intake was measured by bomb calorimetry and metabolic collections. Energy expended (i f SD) for maintenance and activity estimated by the doubly labeled water method was 97 2 1 2 kcallkg F F M (fat-free mass) in early recovery and 9 8 f 12 kcallkg F F M in late recovery (p > 0.5). Energy stored was 5-6 kcal/g of wt gain. Tissue synthesis increased energy expenditure by I 2 0.7 kcallg gain in both early and late recovery. From these data a mathematical model was developed to predict energy requirements for children during catch-up growth a s a function of initial body composition and rate and composition of wt gain. 50recommended, however, that new evaluations based on energy expenditure be made when methods and data become available (1). This need is particularly acute for malnourished children who enter into a period of rapid growth during treatment.Recently, the doubly labeled water method for measuring longterm daily energy expenditure was validated in preterm infants (2) and postsurgical infants (3). This method does not interfere with normal clinical treatment and thus provides the necessary component for new evaluations of energy requirements during recovery from malnutrition.During recovery from malnutrition, the required intake of matabolizable energy is partitioned between energy expenditure for maintenance and activity (m + a), energy expenditure for new tissue synthesis, and energy stored in new tissues. Because energy expenditure for m + a is partially dependent on fat-free mass (4) and because energy stored is dependent on the composition of the new tissue, concurrent measures of body composition would further facilitate the reevaluation of energy requirements. We therefore applied the doubly labeled water method to develop a model for predicting metabolizable energy requirements of children with growth failure secondary to proteinenergy malnutrition. METHODSSubjects. Children studied (Table I) were from periurban areas of Lima, Peru, and were being treated for PEM in an in-patient metabolic ward. They were classified as being either in early recovery (W/L <5th NCHS percentile (5)) or in late recovery W/L = 25th NCHS percentile). Written consent was given by each child's parent or guardian. The protocol was approved by the University of Chicago Clinical Investigation Committee and the Ethical Review Committee of the Instituto de Investigaci6n Nutritional in Lima, Peru, where the studies were done.Criteria for admission to the study were height-age of 3 to 18 mo, wt deficit of at least 2.5 Z scores below the National Center for Health Statistics reference median for length (5), no detectable organic disease or edema, serum albumin >2.5 g/dL, and wt gain for 3 consecutive d...

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“…Investigators have also shown that during an acute enteric illness, early nutritional intervention of nourished infants is well tolerated. A rapid return to adequate nutritional intake results in reduced weight loss but does not alter the duration or severity of the diarrheal illness (4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Early refeeding also may prevent fatal hypoglycemia, a recently recognized complication of acute diarrheal illness in infants (14).…”

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confidence: 99%

“…We established a model of protein-energy malnutrition in suckling infant rabbits and used it to demonstrate that nutrient deprivation reduces small intestinal mass, impairs mucosal growth, delays maturation and enhances ileal glucose-stimulated Na+ transport (1 [6][7][8][9][10][11][12][13][14][15][16][17][18]. Subsequent research demonstrated that the intestinal injury suffered by the malnourished infant infected with an enteric pathogen is more severe and more prolonged compared to that sustained by infected dietary controls (17).…”

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Refeeding Enhances Intestinal Repair during an Acute Enteritis in Infant Rabbits Subjected to Protein-Energy Malnutrition

Butzner

Gall

1991

Pediatr Res

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ABSTRACT. We examined the effects of refeeding during an acute bacterial enteritis on small intestinal repair in infant rabbits subjected to protein-energy malnutrition and in noninfected and infected dietary controls. Malnutrition was induced by litter expansion at 7 d of age. Randomly selected litters from both dietary groups were infected on d 17 with Yersinia enterocolotica. Inflammation and intestinal damage were observed in the jejunum and ileum at the "acute stage" of infection in 23-d-old animals from both dietary groups, as evidenced by an inflammatory infiltrate, blunted villi, and reduced disaccharidase activities. In addition, ileal glucose-stimulated Na+ absorption was depressed. On d 24, a 7-d period of ad libitum refeeding of breast milk and rabbit feed was initiated in randomly selected litters of infected-malnourished animals and all dietary controls. Mucosal repair was nearly complete at 31 d of age in infected dietary controls and in the infectedmalnourished animals that were refed, as demonstrated by the recovery of segmental mucosal mass and ileal glucosestimulated Na+ transport in association with the resolution of inflammation and diarrhea. Only mucosal disaccharidase activities remain depressed. In contrast, in 31-d-old infected-malnourished animals subjected to ongoing nutrient deprivation, severe intestinal damage persisted as evidenced by increased mortality, ongoing intestinal inflammation, mucosal hypoplasia, depressed disaccharidase activities, and reduced glucose-stimulated Na+ transport. We conclude that a refeeding regimen introduced during an acute bacterial enteritis is well tolerated and promotes recovery of intestinal mass, structure, and function in malnourished infant rabbits and dietary controls.

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Effect of continued oral feeding on clinical and nutritional outcomes of acute diarrhea in children

Cited by 149 publications

References 21 publications

Alimentación sostenida durante diarrea aguda en niños menores de cinco años

Alimentación sostenida durante diarrea aguda en niños menores de cinco años

A New Model for Predicting Energy Requirements of Children during Catch-Up Growth Developed Using Doubly Labeled Water

Refeeding Enhances Intestinal Repair during an Acute Enteritis in Infant Rabbits Subjected to Protein-Energy Malnutrition

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